Bovis Pics And Videos, Bovi Clip

Pics and Videos

--White Trash Party Check out Pics and Videos from a White Trash Party in Benicia!

PICS AND VIDEOS COMING SOON.

SET 1 - The White Trash Set

I Believe In A Thing Called Love Are You Gonna Go My Way Fight For Your Right To Party I Wanna Be Sedated Roadhouse Blues

SET 2 - The Colonel and the Sanders Set

I Hate To Say I Told You So Take Me Out All The Small Things I Think We're Alone Now Johnny B. Goode

SET 3 - The Old MIlwaukee Set

I'm 18 T. N.T. Rebel Yell Talk Dirty To Me Pork And Beans

500 MIles I Don't Want To Grow Up aaaand. 500 Miles --Old Hangout Show Check out Pics and Videos from The Old Hangout Show!

SET LIST Johnny B. Goode Take Me Out Are You Gonna Go My Way Sedated Anything, Anything Seven Nation Army Ruby Tuesday Disco 2000 Pork and Beans All The Small Things Just Like Heaven Goodbye Horses Where The Streets Have No Name Rebel Yell Fight For Your Right (To Party) Fortunate Son Read My Mind Dancing In The Dark 500 Miles ENCORE Roadhouse Blues T. N.T. --Los Angeles Show Thanks to Jeff Polanco for making this show happen! You rule, brother!

SET LIST 2.7.2009 Where The Streets Have No Name Rebel Yell Anything, Anything We're Not Gonna Take It Fight For Your Right (To Party) Are You Gonna My Way Seven Nation Army 500 Miles Pork And Beans Disco 2000 All The Small Things You're The Best Around (feat. Eric Ling) Read My Mind Dancing In The Dark Take Me Out I Wanna Be Sedated T. N.T. Johnny B. Goode Ruby Tuesday (feat. Jeff Polanco) --Beale St. Show The following pics are from Beale St. Bar and Grill 8.30.2008. In case you were wondering we did play T. N.T. twice.

The following video features 6 time regional Air Guitar Champion Destiny Von Halen!

Bovis is joined by special guest Sexy Ha on Saxaphone!

SET LIST 8.30.2008 Helter Skelter T. N.T. Rebel Yell I Wanna Be Sedated Are You Gonna Go My Way Take Me Out 500 Miles Miss You Roadhouse Blues Disco 2000 Pork and Beans All The Small Things We're Not Gonna Take It Fight For Your Right To Party Seven Nation Army Read My Mind Dancing in The Dark (feat. Sexy Ha)

ENCORE Busta Move (feat. Sexy Ha and DJ Tommy Chez) Johnny B. Goode (feat. Sexy Ha) T. N.T. (twice!)

--Pine St. Show The following pics and videos are from the Pine St. Show 4/26/2008. Earholes were massacred.

Enjoy this video of "Helter Skelter" featuring November's "Bovis of the Month"!

"I'M GOIN' TO LIVERMORE!" Enjoy this video of "Seven nation Army" featuring Bullet doing a slide guitar solo with a screwdriver!

Enjoy this post-show video of new super fan Stonie-Wan Kenobi who laments the fact that his mom did not get a shout out. He also offered to eat a cockroach for 20 bucks and a pack of trident. Hard times.

SET LIST 4.26.2008 - Are You Gonna Go My Way - Take Me Out - I Wanna Be Sedated - Rebel Yell - Seven Nation Army - We're Not Gonna Take It - Fight For Your Right (to party) - All The Small Things -500 Miles - Read My Mind - Helter Skelter - T. N.T. - Johnny B. Goode --STAR Talent Show The following pics and videos are from the STAR Talent Show 2/28/2008.

"GOOD EVENING HUNAN RESTAURANT!"

SET LIST 2.28.2008 - Take Me Out - I Wanna Be Sedated -500 Miles - Read My mind - T. N.T. - Fight For Your Right (to Party) - Johnny B. Goode --Bovis Holiday Show The following are from The Bovis Holiday Show Dec. 22, 2007

Enjoy this video of the bands explosive encore performance. You are welcome!

SET LIST 12.22.2007 - Rebel Yell - Take Me Out - I Wanna Be Sedated - Disco 2000 - Miss You -500 Miles - Busta Move - You Gotta Fight For Your Right (To Party!) - You Give Love A Bad Name - Read My Mind - Seven Nation Army ENCORE - T. N.T. - Johnny B. Goode - Christmas With The Devil

-- The Rise of Bovis The following pics are from The Rise of Bovis, May 18th, 2007.

Q: How many miles would you walk for Bovis to melt your face with rock? A: 500 Miles! Enjoy this video from the first ever Bovis show!

SET LIST 5.18.2007 - Take Me Out - I wanna Be Sedated - Roadhouse Blues - Miss You -500 Miles - Seven Nation Army ENCORE - Johnny B. Goode --Bovis Videos Jovis does a solo performance for Jeff Quint's birthday. Click on Video below!

Watch the Bovis music video below!

The following video clips are from Bovis Live At Beale St.

Bovis performs "Helter Skelter" at Pine St.

Bovis performs "Take Me Out" at the Star Talent Show!

"I'M GOIN' TO LIVERMORE!" Enjoy this video of "Seven nation Army" featuring Bullet doing a slide guitar solo with a screwdriver!

Bovis enocunters super-fan Stonie-wan Kenobi after Pine St. show.

Bovis performs "500 Miles" at their first show!

A brief look inside a Bovis band practice where we learn the song "Rebel Yell" and insult Guy's drumming abilities.

Encore from the Bovis Holiday Show 12/22/2007

Jovis discusses a bass-line and it's impact on his soul.

Introducing PANTYDROPPER! The official Beer of Bovis! Brewed with excellence by brewmaster Mitchell Walker. --Fun with Bovis

Neodolpasse Publications And Abstracts, Neodolpasse

Neodolpasse Publications (4)

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Multimodal pain management combines analgesics to improve analgesia and reduce side effects. This study investigates the fixed combination of diclophenac and orphenadrin (Neodolpasse(®) Infusion Solution) in patients after unilateral total hip arthroplasty (THA). This prospective, randomized, double-blind, placebo-controlled, multi-centre clinical study enrolled 120 patients receiving patient-controlled analgesia (PCA). Read More

Isotonic saline was infused as placebo. The primary efficacy goal was defined as reduction of PCA analgesics used over the first 24 h post-surgery. The study used a three-stage group sequential test design with two interim analyses. Analgesia was monitored by visual analogue scale and verbal rating. Infusion of the Neodolpasse(®) Infusion Solution resulted in a significant reduction in the PCA analgesic requirements by approximately 30% (38.7 ± 21.3 mg vs. 55.9 ± 31.1 mg; p = 0.0004) while maintaining adequate analgesia and patient safety. This study demonstrates that Neodolpasse(®) Infusion Solution significantly reduces PCA analgesic requirements without compromising analgesic effectiveness and safety in THA patients.

Blood Coagul. Fibrinolysis

Blood Coagul Fibrinolysis 2007 Dec;18(8):775-80

Department of Anaesthesiology, General Intensive Care, and Pain Control, Vienna Medical University, Vienna, Austria.

Detection of platelet inhibition is of clinical relevance in the preinterventional risk-benefit assessment in chronic low-back-pain patients scheduled for invasive pain therapy. We evaluated the sensitivity of various point-of-care platelet function tests for the detection of platelet inhibition induced by nonopioid analgesic drugs. After Institutional Review Board approval and informed consent, citrated whole blood from 40 patients with chronic unspecific low back pain was investigated before and 30 min after intravenous infusion of the study medication consisting of diclofenac 75 mg (plus orphenadrin 30 mg; Neodolpasse; Fresenius Kabi Austria GmbH, Austria), parecoxib 40 mg (Dynastat; Pharmacia Europe EEIG, UK), paracetamol 1 g (Perfalgan; Bieffe Medital S. Read More

P. A. Italy), or normal saline in a randomized, cross-over, double-blinded, placebo-controlled study. Platelet function was assessed using the PFA-100 platelet function analyzer and thromboelastometry, as well as impedance aggregometry (in the last 17 patients recruited after it became commercially available). Sensitivity for detecting diclofenac-induced platelet inhibition was 85% for the PFA-100 using epinephrine as agonist and 94% for arachidonic acid-induced impedance aggregometry. ADP-induced platelet function tests, as well as cytochalasin D-modified thromboelastometry were unreliable. All tests had a low incidence of false-positive test results after normal saline. Paracetamol and parecoxib had no significant platelet inhibiting effect. The PFA-100 using epinephrine as agonist and arachidonic acid-induced impedance aggregometry are recommended for the detection of cyclooxygenase-I-inhibiting effects of nonsteroidal anti-inflammatory drugs such as diclofenac. Our findings confirm that a single rescue dose of paracetamol and parecoxib has no antiplatelet effect.

Drugs R D 2005 ;6(4):189-99

HPR--Human Pharmacodynamic Research GmbH, Munich, Germany.

The aim of this study was to investigate the analgesic efficacy of Neodolpasse, a fixed-dose combination of orphenadrine and diclofenac, compared with those of its single active ingredients in a human pain model. The study was designed as a randomised, double-blind, placebo-controlled, four-period crossover study. Twenty-four healthy female and male subjects received single infusions of Neodolpasse, orphenadrine, diclofenac or saline solution over 60 minutes. Read More

Infusions were separated by a 1-week washout period. Neurogenic inflammation and hyperalgesia were induced by topical occlusive application of a 1% capsaicin solution for 30 minutes on defined skin areas on the back. The pain response to CO2 laser pulses applied to the capsaicin-pretreated skin was measured by event-related vertex EEG recordings. This allowed us to study the influence of a single infusion on the central P2- and peripheral N1-components of laser-induced somatosensory-evoked potentials (LSEP) as a measure of pain response. Although none of the active treatments had a significant effect on the peripheral N1-component, all active treatments reduced the P2-component of the LSEP, reflecting central/spinal analgesic (anti-hyperalgesic) effects. These effects were statistically significant for orphenadrine (p

In-depth data on over 20 million PubMed citations and scientific publication authors.

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Portland Caterers: Voila Catering for Weddings and Events

The best caterer in Portland: Voila Catering in Portland

“Voila Catering: Creating inventive and seasonal fare like nobody’s business.” Willamette Week

Voila Catering in Portland specializes in gourmet food and professional service for formal dinner parties, winter holiday parties, wedding receptions. elegant cocktail parties. fundraising benefits. gourmet outdoor events, buffets, business open houses. hors d’oeuvres parties. and food & wine paired meals. We cater large and small elegant events in the greater Portland Oregon area, and as all our catering events include one of our chefs to cook all the food at the event, we uniquely capable to provide fresh, hot, restaurant quality food from Hood River to the Coast and from Salem to Kelso. To start the discussion and planning your catering event, contact our event planner at 503-806-6658 or by e-mail at [email protected] com

Our Catering Food:

All our catering menus are created by our Executive Chef, Tamara Kay, just for your event, theme, season, and budget featuring our gourmet food. Your event is unique and we are proud that in 13 years, no two of our menus are the same! While every catering menu is custom created and is priced differently, we do have priced sample menus we have done at previous events as examples at Sample Event Menus page. The seasons offer different fresh, local, ripe ingredients so we have different seasonal menus for each!

Unlike most Portland caterers, we don’t just send off a standard menu for your event, Chef Tamara will develop a custom menu that will thrill your guests, with high-quality, easy to eat food. She considers seasonal availability, type of event (seated or standing), time of day, length of the party, and degree of formality when making catering menu selections.

Happy guests and satisfied clients are the most important measurement of our services! See our Reviews from our real clients who have experienced our catering services.

At Voila Catering, we firmly believe that wonderful food does not need to be expensive. Our menu ingredients are always fresh, when possible local, and always seasonal. Our professional chefs make all of our menus items from scratch, never using expensive pre-prepared frozen “products”, expensive out-of-season produce, or pre-made sauces and salad dressings. This approach keeps the food costs reasonable and the quality of our food exceptionally high. While every menu and event is unique, typically our large event dinner menus are in the $15 to $26 range for a real, restaurant-quality meal. Gourmet finger food and hors d’oeuvres are primarily in the $0.80 to $2.50 range per piece depending upon ingredient cost. Voila Catering is pleased to develop a multiple page proposal detailing every single expected cost including food, service, beverages and rentals…with never any surprises!

To see hundreds of images from our catering events and to hear from our clients, click here to visit our facebook page and ‘like” us to keep updated on our latest events!

Chef Nick Sauteing fresh Broccolini

Catering Food Quality:

While most caterers bring platters of pre-made and pre-cooked food to the events, to minimize the damaging effects of hot holding during transportion, all our hot food is cooked by our chef team on-site right before serving. If you event location does not have an adequate kitchen, we will bring our full sized commercial convection ovens and saute stations to the locations. Our delicate finger foods are assembled on site by a skilled chef, as they neither travel very well nor hold long enough for transportation. Our chefs consistently provide THE BEST CATERED FOOD in the state. We invite you to experience the difference of our restaurant-quality, gourmet food… even your most discriminating foodie guest will be thrilled!

As we are all about the food, we have image galleries from our actual catering events. See examples of our hors d’oeuvres. fresh salads. hot entrees and sides. and sweet desserts. We believe that catering food should taste delicious and look beautiful!

Gratuities & Fees:

Voila Catering does not have required or expected gratuities, which may range from 18% to 20% at other Portland catering companies and can amount to thousands of dollars. Our professional chefs and servers are paid a well-above average wage and it should be your standard expectation that all our staff provides excellent service. There is never a cake cutting fee and there are no “customary” service charges. All expected costs are presented up-front and honestly, without any post-event surprises.

Catering with Full Service Bartending

Bartending services for Beer, Wine, Cocktails, and Beverages:

Voila Catering is a full service event and catering company and we believe that the beverage service is an integral and very important part of the entire event. We provide professional licensed bartenders and servers to provide a full range of beer, wine, and hard alcohol. Our catering staff will provide courteous and responsible service for your guests while providing the host peace of mind with $1 million in liability insurance. For event quality, efficiency in staffing, & insurance liability reasons, at large events it is our policy is provide all the food and beverages (except at wineries and breweries, of course). We are pleased to share our expertise and help you plan your beverage needs at smaller events (less than 50 guests). Our OLCC License is #122696 and we are pre-approved by the OLCC for full service off-site catering. For more information about our affordable beverage service visit our Drinks and Beverage page.

Party and Event Rentals:

As presentation is an integral part of the food quality, Voila Catering in Portland will manage and provide rental china plates, stainless steel flatware, elegant glassware and a selection of quality linens in 42 colors. For elegant catering events or wine paired dinners, we offer Schott Zwiesel German Crystal Stemware to compliment our premium wines.

The prices for our rentals are at or below standard rental rates. Voila Catering will also plan and manage sub-contracted tents, dance floors, and AV equipment. Voila Catering does not markup the standard industry prices on the sub-rentals. For buffets, Voila Catering always presents food on china platters or our hot food in chafing dishes and Family-Style service includes all the platters for the tables at no additional charge. Real stainless steel service ware is always provided with our events…never paper or plastic. Our Rentals page provides pricing information on our event rentals.

Voila Catering does not offer our delicious food on paper plates serve with plastic utensils for both quality and environmental reason. When planning a special event, every customer should know that METRO no longer accepts “compostable” paper plates or “compostable” flatware with the commercial compost. All compostable paper and plastic garbage from your event will end up in the landfill. Voila Catering minimizes your event’s environmental impact by using only re-usable china plates, real glassware, and real flatware for catering special events.

Wedding Ceremony at Private Home near Portland

Weddings and Receptions:

Once in a life-time family events deserve great food and will benefit from experienced event planning. Voila Catering has provided our food and services at hundreds of weddings, commitment ceremonies, and receptions. Our Weddings Page includes the 23 questions (and our answers) you should ask every caterer that you consider for your very important life event. Let our event planners guide you to the best values for venues, bakeries, and photographers based upon our years of experience without kickbacks or commissions swaying our professional judgment.

Wedding & Event Planning :

Voila Catering provides Event Planning Services including three hours free with a site visit option for every booked event. From site selection, decorations, tables & chairs, to figuring out the event schedule, Voila Catering’s wedding & event planners will take the worries out of your next event. With a single contact point for responsible and accountable everything; you will eliminate the confusion of managing multiple event suppliers and saving you thousands on a event planner! Since so much of wedding planning is incorporated into our standard event planning process, it is our policy that if any additional day-of-coordination and professional planning is needed, that it be conducted by our staff. If you need a day-of wedding coordinator due to special circumstances, we will provide integrated event coordination at very affordable hourly rates, hundreds less than a day-of coordinator. For more information on our wedding planning professionals, visit www. WeddingsByVoila. com

Client and Guest References:

We have many actual catering client quotes from our past wedding receptions, business celebrations, holiday parties, non-profit fundraising events and private family events on our References page. Check out our real client reviews on Google+ here.

Contact Voila Catering in Portland at 503-806-6658 or e-mail to [email protected] com to check availability and schedule a free consultation for your event.

Real Chefs, Real Reviews:

Thank you for all the work and planning you put into our wedding. We have received compliment after compliment regarding the food and service. People keep telling us how smooth and organized the whole event felt. We could not have done it without you. Thank you again for giving us piece of mind and an event to remember!

— Rachel & Ryan. Wedding at Forest Grove Cultural Center in May 2010

I attended the B & B Wedding at Bridal Veil Lakes yesterday… and just wanted to let you know that your food was the BEST catered food I have ever enjoyed! I have attended many weddings and other catered affairs here in Portland, as well as in Los Angeles, Atlanta, St. Louis, Boston and New York… and I can honestly say the menu and quality of food that you provided was simply the best! Wedding food often has that mass produced… but my dinner and dessert tasted like an individually made meal. …Thank you for your fabulous attention to detail! As someone in the Event Management business, I greatly appreciate such quality! You are definitely the caterer I will use in the future for any catering needs I may have in the future!”

— Pleased Wedding Guest. Bridal Veil Lakes Wedding in 2007

My first experience with Voila was way back in 2003, when they catered an out of town event near Welches for my business partner and myself. They did a phenomenal job – special enough that I remembered them twelve years later when my fiancee and I were deciding on a caterer for our wedding.

We made an appt. at their headquarters and we knew we’d found the right people right out of the gate. They made the process easy – other than too many great choices! – and when the day came, they had everything lined up and rolling smoothly all the way through, from set-up to serving.

We went with hors d’ouevres so that people felt free to mingle and move from table to table, in an outdoor setting. The food was superb. One of our guests regularly attends many functions as part of his job and he declared the food to be “fabulous!” They also have a large and wonderful selection of vegetarian menu items. Nothing but complements on all levels.

We have nothing but praise for this gracious and talented husband and wife catering team. They are the best!

— Rob and Autumn, private wedding Aug 2015

We had a wonderful experience with Jonathan and Tamara from start to finish. We planned our wedding reception dinner at the Laurelhurst Club in just a few months, and long-distance at that from England! From our initial inquiry, Voila Catering responded quickly with a series of really helpful questions that proved their expertise and helped us think through many important aspects of the evening we might never have considered. Their knowledge and input about menu, quantities, technical requirements, and even the evening’s schedule meant that they acted as more than just caterers, but really made sure the entire event was a success — making our lives so much easier. The menu they assembled was delicious and unique, with lots of locally-sourced ingredients, and accommodating our guests with special dietary needs. And they never batted an eyelash when we had to change some details last-minute. The day of the event they were courteous, calm, and unobtrusive. I would recommend them in a heartbeat!

— Shannon Lattin Facebook Review. Laurelhurst Club Wedding Reception Dec. 2014

We used Voila Catering for our wedding in 2008 and still remember how wonderful the food was, beautiful the presentation and attention to detail and the professionalism of the staff. It was 104 degrees on the day of our wedding and I’ll never forget how hard (and sweaty) Jonathan was working to make everything perfect! From our first meeting and all the choices becoming a reality, I can’t say enough good things about this company. It’s no wonder to me that they are still going strong years later. I look forward to planning an event with them sometime in the future. A true gem!!

— Jaimee Parson Facebook review written in 2015. Holy Names Heritage Center Wedding

“Thank you for helping us throw such a wonderful party. We were incredibly impressed by the professionalism of your staff and, of course, the food was amazing. We received many compliments about the food especially. After months of preparation, we appreciated being able to just enjoy the party knowing that your staff had everything under control.” Thanks again!”

— Eric and Julia. Backyard Wedding 2009

[schema type=”organization” orgtype=”LocalBusiness” url=”www. voila-catering. com” name=” Voila Catering In Portland” description=”A full-service caterer, Voila Catering specializes in premier, gourmet, restaurant-quality food and professional service in the greater Portland, Oregon area. ” street=”3225 SE 14th Ave” city=”Portland” state=”OR” postalcode=”97202″ email=”[email protected] com” phone=”503-806-6658″ ]

Sobelin Generic Name Clindamycin Online, Sobelin

Sobelin General Information

Sobelin - Pharmacology:

Systemic/Vaginal-Sobelin inhibits protein synthesis of bacteria by binding to the 50 S ribosomal subunits of the bacteria. Topical-Sobelin reduces free fatty acid concentrations on the skin and to suppress the growth of Propionibacterium acnes (Corynebacterium acnes). an anaerobe found in sebaceous glands and follicles.

Sobelin for patients

This medicine is used to treat various bacterial infections, such as pneumonia or other respiratory conditions such as COPD. It can also by used in patients with cystic fibrosis or patients who have received an infection while being hospitalized, or who have bacteria in the blood (bacteremia). In children, this medicine is commonly used to treat ear infections (otitis media), pneumonia, sore throat (pharyngitis) or tonsillitis. Take the medicine orally as directed. This medicine can be taken with or without food. And remember to finish all medication unless your doctor has advised you otherwise. It is also important to avoid taking aluminum or magnesium-containing antacids together with this medicine. If you take antacids, separate them from your antibiotic by at least 2 hours.

This description is suitable for active ingredient Clindamycin

Sobelin Interactions

Sobelin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. Therefore, it should be used with caution in patients receiving such agents. Antagonism has been demonstrated between clindamycin and erythromycin in vitro . Because of possible clinical significance, these two drugs should not be administered concurrently.

Sobelin Contraindications

Sobelin hydrochloride is contraindicated in individuals with a history of hypersensitivity to preparations containing clindamycin or lincomycin.

This description is suitable for active ingredient Clindamycin

Generic name, Overdose, Half Life Sobelin, Food Interactions, Chemical, etc..

Aubertine-Lopes Funeral Home, Alertine

Aubertine-Lopes Funeral Home Welcomes You

When you experience the loss of a loved one, you can trust us to guide you through the arrangements necessary to create a meaningful ceremony that celebrates the unique life being honored. Our staff is committed to providing your family with the highest quality care and service in your time of need, and we take pride in our responsibility to lighten your burden as you take the first steps toward healing.

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We offer a full range of gifts to help comfort and support those who need it the most

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Antalgin, Antalgin

Antalgil

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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antalgic

On the one hand, classic treatments, based on antalgic and anti-inflammatory drugs and passive physiotherapy, are often not sufficient.

Results are reported as means [+ or -] standard deviation either of a 10-cm VAS (spontaneous pain and pain on movement); a 5-point scale (resistance to passive movements; antalgic rigidity, muscular contracture, joint functional impairment); or centimetres ("hand-to - floor" distance).

On examination, she was found to walk with an antalgic gait referral for the left lower extremity.

FMS patients have muscular asymmetry and antalgic postural problems (44).

For example, an antalgic gait at the time of injury may lead to muscle inhibition or atrophy and if the activation of gluteus maximus is delayed, pelvic stability may become compromised.

Physicians should consider psoas abscess when evaluating children with acute antalgic gait or hip pain.

Rodinac Flex Para Que Sirve, Rodinac

RODINAC FLEX

Prospecto e indicaciones

ACCION TERAPEUTICA: Analgesico, antiinflamatorio y miorrelajante. INDICACIONES: Procesos inflamatorios dolorosos acompanados de contracturas musculoesqueleticas: periartritis de hombro, sindromes dolorosos de la columna vertebral: lumbalgias, lumbociatalgias, fibromialgias, cervicobraquialgias, torticolis.

CARACTERISTICAS FARMACOLOGICAS/PROPIEDADES: Accion Farmacologica: RODINAC® FLEX es la combinacion de Diclofenac sodico, un analgesico/antiinflamatorio no esteroide (AINE) muy eficaz de accion periferica y Piridina mesilato, un anticolinergico de accion central y periferica. Diclofenac Sodico: El Diclofenac es un AINE que ha demostrado ser eficaz en animales de experimentacion a traves de la inhibicion de la sintesis de prostaglandinas. En el hombre el Diclofenac reduce dolores provocados por inflamacion, edema y fiebre. Ademas, el Diclofenac inhibe la agregacion de plaquetas inducida por ADP (acido adenosinbifosforico) y colageno. Los resultados in vivo tambien permiten reconocer una influencia del Diclofenac sobre productos derivados de la lipoxigenasa y una clara disminucion de la proporcion de leucocitos activos en inflamaciones cronicas. In vitro, el Diclofenac inhibe enzimas lisosomales de cartilagos y tejidos danados y la formacion de radicales de oxigeno en macrofagos. Pridinol mesilato: Su accion es debido a un mecanismo atropino simil, sea en el ambito de la musculatura lisa o estriada. Tal es su actividad que puede ser oportunamente utilizado en la practica clinica en la contractura de la musculatura esqueletica, sea esta de origen central o periferico.

FARMACOCINETICA: Diclofenac sodico: Tras la administracion oral se alcanzan niveles plasmaticos maximos promedio al cabo de 1,25 horas. El Diclofenac esta unido en un 99,7% a las proteinas sericas, fundamentalmente a la albumina (99,4%). El volumen de distribucion es de 0, 12. 0,17 I/kg. El Diclofenac pasa al liquido sinovial. Alli se miden las concentraciones maximas 2?4 horas despues de alcanzar los valores plasmaticos maximos. El tiempo medio de eliminacion del liquido sinovial es e 3?6 horas. Dos horas despues de alcanzar la concentracion plasmatica maxima, la concentracion de la sustancia activa en el liquido sinovial es mayor que en el plasma y sigue siendo mas alta hasta 12 horas despues de su administracion. La metabolizacion de Diclofenac se produce rapidamente y casi por completo. La metabolizacion se produce fundamentalmente en parte por glucuronizacion de la sustancia activa, sin embargo, las vias fundamentales son la hidroxilacion simple y multiple, que lleva a la formacion de diversos metabolitos fenolicos (3??hidroxi. 4?hidroxi. 5’?hidroxi? 4’, 5’?dihidroxi? y 3‘?hidroxi?4‘?metoxi Diclofenac), que luego son conjugados extensamente al acido glucuronico. Dos de estos metabolitos fenolicos son activos desde el punto de vista farmacologico, pero, sin embargo, lo son en menor medida que el Diclofenac. La eliminacion de Diclofenac del plasma se produce con una depuracion de 263 ± 56 ml/min. El tiempo medio de eliminacion es de 1?2 horas. Menos de un 1% de la sustancia activa se elimina por orina en forma inalterada. Aproximadamente un 60% de la dosis administrada se excreta como metabolitos en la orina y el resto a traves de la bilis y en las heces. La farmacocinetica del Diclofenac permanece constante tambien en el caso de administracion repetida. Respetando los intervalos de dosificacion recomendados no hay acumulacion. No se han observado diferencias importantes de absorcion, metabolismo y excrecion condicionados por la edad del paciente. Los estudios realizados tras la administracion i. v. unica de Diclofenac sodico demuestran que, en casos de funcion renal limitada no se encontro acumulacion de la sustancia activa. En casos de funcion renal muy limitada tras la administracion repetida de Diclofenac sodico, es de esperar que se produzca un aumento de la concentracion plasmatica de metabolitos sin que esto tenga repercusion clinica. En los casos de una funcion hepatica limitada (hepatitis cronica, cirrosis del higado sin descompensacion portal) la cinetica y el metabolismo se desarrollan de la misma manera que en los pacientes con higado sano. Biodisponibilidad: Comparaciones de las curvas de los niveles plasmaticos tras dosis intravenosas y orales de Diclofenac marcado radiactivamente indican que en ambos casos la cantidad total desustancia alcanza la circulacion sistemica. De la dosis de Diclofenac administrada por via oral aproximadamente un 54% es sustancia activa inalterada y el resto sus metabolitos activos. Pridinol mesilato: La farmacocinetica del mesilato de pridinol en el hombre ha evidenciado que la concentracion sanguinea maxima es alcanzada dentro de la primera hora y la distribucion enel organismo es uniforme. La eliminacion de este principio activo, en parte sin transformacion y en parte como glucurono y sulfo? conjugado, se efectua por via renal en aproximadamente24 horas. POSOLOGIA/DOSIFICACION /MODO DE ADMINISTRACION: Adultos: 1 comprimido 2 a 3 veces por dia preferiblemente con los alimentos.

CONTRAINDICACIONES: . Hipersensibilidad conocida a las sustancias activas o excipientes. Pacientes en los que el acido acetilsalicilico u otros medicamentos con efecto inhibidor de la sintesis de las prostaglandinas hayan producido ataques de asma, reacciones cutaneas o rinitis. Ulcera gastrica o intestinal, obstruccion intestinal. Durante el embarazo y en el parto. Ninos. Hipertrofia prostatica, retencion urinaria. Glaucoma. Taquirritmias graves. ADVERTENCIAS: Como sucede con otros AINES pueden producirse en raras ocasiones, con o sin sintomas premonitorios, reacciones alergicas, inclusive anafilacticas/anafilactoides, sin exposicion previa al farmaco, al igual que hemorragias gastrointestinales y/o perforacion de ulcera peptica. Advertencia para automovilistas o manejo de maquinarias: En razon de su efecto sobre la acomodacion se recomienda precaucion al conducir automoviles o manejar maquinarias.

PRECAUCIONES: Se debera controlar cuidadosamente, al igual que con otros antiiflamatorios (AINES) no esteroides, la agregacion plaquetaria ya que el Diclofenac puede inhibirla transitoriamente. Debido a la importante funcion de las prostaglandinas en el mantenimiento de la circulacion sanguinea renal, Rodinac® Flex al igual que otros AINES debera administrarse con especial precaucion, en pacientes con funcion cardiaca o renal limitada (clearance de creatinina < 10 ml/min), en pacientes que toman diureticos, en los ancianos en pacientes con deplecion importante del volumen extracelular de cualquier causa por ejemplo antes o despues de intervenciones quirurgicas importantes. En estos casos se recomienda controlar la funcion renal. La suspension de la medicacion, habitualmente es seguida por una recuperacion al estado anterior al tratamiento. Es necesaria una vigilancia medica cercana en pacientes con sintomas de trastornos gastrointestinales con antecedentes de ulceraciones gastricas o intestinales, con colitis ulcerosa o enfermedad de Crohn o con insuficiencia hepatica. Debido a sus propiedades farmacodinamicas el Diclofenac. al igual que otros AINES puede encubrir los sintomas de una infeccion. Al igual que con otros AINES pueden aumentar las enzimas hepaticas. Si aparecen sintomas clinicos de enfermedad hepatica debe interrumpirse el tratamiento con Rodinac® Flex . Puede desencadenarse un ataque de porfiria hepatica. En los tratamientos a largo plazo deberan controlarse regularmente el cuadro hematico, las enzimas hepaticas y la funcion renal. Debe utilizarse con precaucion durante la lactancia.

INTERACCIONES: Litio/Digoxina: en el caso de administracion simultanea el Diclofenac puede aumentar la concentracion en la sangre de Litio o Digoxina. Diureticos/Antihipertensivos: es posible que se produzca una atenuacion del efecto de los diureticos y antihipertensivos. En el caso de tratamiento simultaneo con diureticos ahorradores de potasio se requiere un control especial de los valores de potasio serico, ya que el Diclofenac puede conducir a la hipercaliemia. Antiinflamatorios: la administracion simultanea de corticoides u otros antiinflamatorios aumenta la frecuencia de efectos adversos. Metotrexato: debera tenerse precaucion cuando los AINES sean utilizados menos de 24 horas antes o despues de la administracion de metotrexato, debido a que la concentracion de metotrexato puede aumentar en la sangre y con ello puede incrementarse su efecto toxico. Ciclosporina: el efecto de los AINES sobre las prostaglandinas renales puede aumentar la nefrotoxicidad de la ciclosporina. Quinolonas: en forma aislada se informo acerca de convulsiones, que probablemente se debian a la utilizacion simultanea de quinolonas y antiinflamatorios no esteroides. Anticoagulantes: a pesar de que los estudios clinicos no muestran indicios de que el Diclofenac ejerza influencia sobre el efecto de los medicamentos inhibitorios de la coagulacion sanguinea, existen informes aislados referidos a un incremento del riesgo de hemorragia en el caso de administracion simultanea de Diclofenac y medicamentos inhibitorios de la coagulacion sanguinea. Por tal motivo se recomienda realizar un control estricto de estos pacientes. Antidiabeticos: estudios clinicos han demostrado que el Diclofenac puede ser administrado junto con antidiabeticos orales sin afectar su efecto clinico. En forma aislada se informo acerca de efectos hipo e hiperglucemicos despues de la administracion de Diclofenac, que hicieron necesario un ajuste de la dosificacion de los antidiabeticos. Anticolinergicos: potencia el efecto de los anticolinergicos, por ejemplo: atropina.

REACCIONES ADVERSAS: Indicaciones de frecuencia: frecuentes: > 10 %: ocasionales 1 %. 10%. raros: < 1%. aislados: en casos individuales. Aparato digestivo: Ocasionales: Dolor epigastrico, otros trastornos gastrointestinales como dispepsia, flatulencias, calambres abdominales, anorexia. Raros: Sed, sequedad de boca, constipacion, vomito. Hemorragias gastrointestinales (hematemesis, melena o diarrea sanguinolenta). Ulcera gastrica o intestinal con o sin hemorragia o perforacion. Aislados: Estomatitis, aftosa, glositis, lesiones esofagicas, estenosis intestinales membranosas, molestias en el hipogastrio (por ej. Colitis hemorragica no especifica y exacerbacion de una colitis ulcerosa o de la enfermedad de Crohn), estrenimiento. Sistema nervioso central: Ocasionales: Cefaleas, mareos o vertigos. Raros: Ligera sensacion de debilidad, mareo e inestabilidad de la marcha, somnolencia. Aislados: trastornos de la sensibilidad, trastornos de la memoria, desorientacion, calambres, angustia, pesadillas, temblores, depresiones y otras reacciones psicoticas. En casos individuales se observo al administrar Diclofenac la sintomatologia de una meningitis aseptica. Organos sensoriales: Aislados: Trastornos visuales (vision borrosa o doble), zumbido en los oidos y trastornos auditivos reversibles, tinitas, alteracion del gusto. Piel . Ocasionales: Reacciones de hipersensibilidad, tales como exantema y picazon. Raro: Enrojecimiento sequedad de la piel, urticaria y alopecia. Aislados: Exantema con formacion de ampollas, eczemas, eritema multiforme, fotosensibilizacion, purpura incluyendo purpura alergica, sindrome de Stevens? Johnson, sindrome de Lyell, eritrodermia.

Rinon

Aislados: insuficiencia renal aguda, trastornos de la funcion renal (por ej. proteinuria, hematuria) o lesiones renales (nefritis intersticial, sindrome nefrotico, necrosis papilar). Raro: Edema, trastornos al orinar.

Higado

Ocasionales: Aumento de las transaminasas sericas (GOT y GPT). Raros: Danos hepaticos, entre ellos hepatitis con o sin ictericia, en casos aislados hepatitis fulminante.

Pancreas

Sangre

Raros: Trombocitopenia, leucopenia, agranulocitosis, anemia hemolitica y aplasica. Los primeros sintomas pueden ser: fiebre, dolor de garganta, heridas superficiales en la boca, molestias de tipo gripal, fuerte decaimiento, epistaxis y hemorragias cutaneas. En estos casos habra que dejar de tomar inmediatamente el medicamento y se debera consultar a un medico. Se debera evitar un autotratamiento con medicamentos contra el dolor y antipireticos. Sistema cardiocirculatorio . Raro: Bradi o taquicardia. Aislados: Palpitaciones, dolores en el pecho, hipertension e insuficiencia cardiaca. Otros sistemas organicos: Raro: reacciones severas de hipersensibilidad, pueden manifestarse como: edema facial, edema de lengua y de laringe con estrechamiento de las vias respiratorias, fuertes broncoespasmos, falta de aire hasta la crisis asmatica con o sin disminucion de la presion sanguinea, taquicardia, disminucion de la presion sanguinea hasta amenaza de "shock". En caso de aparecer alguno de estos sintomas, que ya pueden hacerse presentes al tomar e medicamento por primera vez, habra que consultar al medico. Con poca frecuencia se presenta disnea y con muy poca frecuencia aparecen alergias severas. Aislados: vasculitis y neumonitis. SOBREDOSIFICACION: Diclofenac Sodico: Sintomas de intoxicacion: Trastornos del sistema nervioso central (mareos, dolores de cabeza, hiperventilacion, trastornos de la conciencia, en los ninos, ademas, calambres mioclonicos), del tracto gastrointestinal (malestar, vomitos, dolores de estomago, hemorragias), asi como trastornos del funcionamiento hepatico y renal. Tratamiento de intoxicaciones: No existe un antidoto especifico contra el Diclofenac sodico. Tras su ingestion debera evitarse lo antes posible la absorcion mediante un lavado gastrico y el tratamiento con carbon activado. Medidas especificas, tales como diuresis forzada, dialisis o hemoperfusion probablemente no sean de ayuda para la eliminacion de antiinflamatorios no esteroides por su gran union a las proteinas.

Pridinol

en casos de intoxicacion se debera consultar al medico. En casos en que la intensidad de la sintomatologia Io requiera, suministrar salicilato de fisostigmina lentamente a dosis de 0,5 mg en forma repetida hasta 2 mg. Ante la eventualidad de una sobredosificacion, concurrir al Hospital mas cercano o comunicarse con los Centros de Toxicologia: Hospital de Pediatria Ricardo Gutierrez: (011) 4962?6666/2247 Hospital A. Posadas: (011) 4654?6648/4658?7777

CONSERVACION: Conservar en lugar fresco (entre 15° C y 30° C). Proteger de la humedad y el calor. PRESENTACION: Envases conteniendo 15 y 30 comprimidos recubiertos para venta al publico. 500 y 1000 comprimidos recubiertos para uso exclusivo de hospitales.

Mantener fuera del alcance de los ninos. Este medicamento no puede repetirse sin mediar una nueva receta. Especialidad Medicinal autorizada por el Ministerio de Salud y Accion Social. Certificado N° 40.453 Ultima actualizacion, Mayo del 2003.

Prospect Medicament - Emwepel, Comprimate, Emwepel

Indicatii: Emwepel este indicat pentru tratamentul semnelor si simptomelor formei idiopatice a bolii Parkinson, singur (fara levodopa) sau in asociere cu levodopa, adica pe tot parcursul bolii Emwepel 0,088 mg comprimate Emwepel 0,18 mg comprimate Emwepel 0,7 mg comprimate

2. COMPOZITIA CALITATIVA SI CANTITATIVA

Emwepel 0,088 mg comprimate: Un comprimat contine pramipexol baza 0,088 mg, sub forma de diclorhidrat de pramipexol monohidrat 0,125 mg. Emwepel 0,18 mg comprimate Un comprimat contine pramipexol baza 0,18 mg, sub forma de diclorhidrat de pramipexol monohidrat 0,25 mg. `

Emwepel 0,7 mg comprimate Un comprimat contine pramipexol baza 0,7 mg, sub forma de diclorhidrat de pramipexol monohidrat 1,0 mg. `

Pentru lista tuturor excipientilor, vezi pct. 6.1

3. FORMA FARMACEUTICA. Comprimat. Emwepel 0,088 mg comprimate Comprimate albe pana la aproape albe, rotunde, netede pe ambele fete Emwepel 0,18 mg comprimate Comprimate albe pana la aproape albe, ovale, cu linie mediana pe ambele fete. Aceste comprimate pot fi divizate in doua parti egale.

Emwepel 0,7 mg comprimate Comprimate albe pana la aproape albe, rotunde, cu linie mediana pe ambele fete. Aceste comprimate pot fi divizate in doua parti egale.

4.1 Indicatii terapeutice Emwepel este indicat pentru tratamentul semnelor si simptomelor formei idiopatice a bolii Parkinson, singur (fara levodopa) sau in asociere cu levodopa, adica pe tot parcursul bolii, pana in stadiile avansate, cand levodopa isi pierde eficacitatea sau cand eficacitatea sa nu persista si devine fluctuanta (fluctuatii de tip "on-off").

Emwepel este indicat pentru tratamentul simptomatic al Sindromului picioarelor fara repaus de natura idiopatica, moderat pana la sever, in doze de pana la 0,54 mg baza (0,75 mg sare) (vezi pct. 4.2.).

4.2 Doze si mod de administrare

Nota: Dozele de pramipexol publicate in literatura se refera la forma de sare. De aceea, dozele vor fi exprimate atat pentru pramipexol baza cat si pentru sarea de pramipexol (in paranteza).

Boala Parkinson: Comprimatele se administreaza oral, inghitite cu apa si pot fi luate cu sau fara alimente. Doza zilnica se administreaza divizata in prize egale, de trei ori pe zi.

Initierea tratamentului: Dozele trebuie crescute treptat, incepand de la o doza initiala zilnica de 0,264 mg baza (0,375 mg sare), care se mareste apoi la intervale de 5-7 zile. Daca nu apar reactii de intoleranta, doza se create treptat, pana se ajunge la efectul terapeutic maxim.

Daca doza trebuie marita in continuare, doza zilnica trebuie crescuta cu cate 0,54 mg baza (0,75 mg sare) pe saptamana pana la doza maxima de 3,3 mg baza (4,5 mg sare) pe zi.

Totusi, trebuie mentionat ca incidenta somnolentei create la doze mai mari de 1,1 mg baza (1,5 mg sare) pe zi (vezi pct. 4.8).

Tratamentul de intre tinere: Doza zilnica trebuie sa fie cuprinsa intre 0,264 mg baza (0,375 mg sare) si maximum 3,3 mg baza (4,5 mg sare).

In cadrul a trei studii-pivot care au urmarit cresterea dozelor, eficacitatea tratamentului a fost inregistrata incepand de la doza de 1,1 mg baza (1,5 mg sare) pe zi. Ajustari ulterioare ale dozajului trebuie facute in functie de raspunsul clinic si de aparitia reactiilor adverse. In cadrul studiilor clinice, aproximativ 5% dintre pacienti au fost tratati cu doze sub 1,1 mg baza (1,5 mg sare). In stadiile avansate ale bolii Parkinson, doze zilnice mai mari de 1,1 mg (1,5 mg sare) pot fi utile pacientilor la care se intentioneaza reducerea dozei de levodopa. Se recomanda ca dozele de levodopa sa fie reduse, atat pe durata cresterii dozei, cat si a tratamentului de intretinere cu pramipexol, in functie de raspunsul clinic al fiecarui pacient.

Intreruperea tratamentului: Intreruperea brusca a tratamentului cu medicamente dopaminergice poate duce la aparitia sindromului neuroleptic malign. De aceea, tratamentul cu pramipexol trebuie redus in mod treptat cu cate 0,54 mg baza (0,75 mg sare) pe zi pana cand doza zilnica ajunge la 0,54 mg baza (0,75 mg sare). Apoi, doza trebuie redusa cu cate 0,264 mg baza (0,375 mg sare) pe zi (vezi pct. 4.4).

Pacienti cu insuficienta renala: Eliminarea pramipexolului este dependenta de functia renala. Pentru initierea tratamentului, se recomanda urmatoarea schema terapeutica:

Pacientii cu un clearance al creatininei peste 50 ml/min nu necesita reducerea dozei zilnice.

La pacientii cu clearance al creatininei intre 20 si 50 ml/min, doza zilnica initiala de Emwepel trebuie divizata in doua prize, incepand cu 0,088 mg baza (0,125 mg sare) de doua ori pe zi (0,176 mg baza/0,25 mg sare pe zi).

La pacientii cu clearance al creatininei sub 20 ml/min, doza zilnica de Emwepel se administreaza in priza unica, incepand cu 0,088 mg baza (0,125 mg sare) pe zi.

Daca functia renala se altereaza pe parcursul tratamentului de intretinere, doza zilnica de Emwepel trebuie redusa cu acelasi procentaj cu cel cu care scade functia renala, de exemplu, daca clearance-ul creatininei scade cu 30%, atunci doza zilnica de Emwepel trebuie redusa cu 30%. Daca clearance-ul creatininei este cuprins intre 20 si 50 ml/min, doza zilnica poate fi administrata divizat in doua prize, iar daca clearance-ul creatininei este sub 20 ml/min, sub forma de doza zilnica unica.

Pacientii cu insuficienta hepatica La pacientii cu insuficienta hepatica ajustarea dozei probabil nu este necesara, deoarece aproximativ 90% din substanta activa absorbita este excretata pe cale renala. Totusi, influenta insuficientei hepatice asupra farmacocineticii Emwepel nu a fost practic investigata.

Sindromul picioarelor fara repaus Comprimatele se administreaza oral, inghitite cu apa si pot fi luate cu sau fara alimente.

Doza initiala recomandata de Emwepel este de 0,088 mg baza (0,125 mg sare) administrata o data pe zi cu 2-3 ore inainte de culcare. Pentru pacientii care necesita o atenuare simptomatica suplimentara, doza poate fi crescuta la fiecare 4-7 zile pana la un maxim de 0,54 mg baza (0,75 mg sare) pe zi .

Deoarece eficacitatea pe termen lung a pramipexolului in tratamentul Sindromului picioarelor fara repaus (SPR) nu a fost testata suficient, se va evalua raspunsul pacientilor dupa 3 luni de tratament si se va reconsidera necesitatea continuarii tratamentului. Daca tratamentul este intrerupt mai mult de cateva zile acesta trebuie re-initiat prin cresterea dozei asa cum este mentionat mai sus.

Intreruperea tratamentului Deoarece doza zilnica pentru tratamentul Sindromului picioarelor fara repaus nu va depasi 0,54 mg baza (0,75 mg sare), utilizarea Emwepel poate fi intrerupta fara scaderea dozei. Revenirea (agravarea simptomelor dupa intreruperea brusca a tratamentului) nu poate fi exclusa.

Pacienti cu insuficienta renala: Eliminarea pramipexolului este dependenta de functia renala. Pacientii cu un clearance al creatininei peste 20 ml/min nu necesita reducerea dozei zilnice. Utilizarea pramipexolului la pacientii hemodializati sau la pacientii cu insuficienta renala severa nu a fost studiata.

Pacientii cu insuficienta hepatica La pacientii cu insuficienta hepatica ajustarea dozei nu este necesara, deoarece aproximativ 90% din substanta activa absorbita este excretata pe cale renala.

Copii si adolescenti Emwepel nu este recomandat pentru utilizare la copii si adolescenti sub varsta de 18 ani datorita lipsei datelor privind siguranta si eficacitatea.

Hipersensibilitate la substanta activa sau la oricare dintre excipienti.

4.4 Atentionari si precautii speciale pentru utilizare

La pacientii cu boala Parkinson si insuficienta renala se recomanda reducerea dozei de Emwepel, asa cum este prezentat la pct. 4.2.

Halucinatiile sunt cunoscute ca reactie adversa la tratamentul cu agonisti dopaminergici si levodopa. Pacientii trebuie avertizati asupra posibilitatii aparitiei halucinatiilor (mai ales vizuale).

In stadiile avansate ale bolii Parkinson, in timpul cresterii initiale a dozei de pramipexol administrat in asociere cu levodopa, poate aparea dischinezie. In aceasta situatie, doza de levodopa trebuie redusa.

Pramipexolul a fost asociat cu somnolenta si episoade de somn cu instalare brusca, mai ales la pacientii cu boala Parkinson. Instalarea brusca a somnului in timpul activitatilor zilnice, in unele cazuri fara a fi constient sau fara semne de avertizare, a fost raportata mai putin frecvent. Pacientii trebuie informati asupra acestui fapt si avertizati sa manifeste prudenta atunci cand conduc vehicule sau lucreaza cu utilaje in timpul tratamentului cu Emwepel. Pacientii care au manifestat somnolenta si/sau episoade de somn cu instalare brusca trebuie sa evite conducerea vehiculelor sau folosirea de utilaje. In plus, trebuie avuta in vedere micsorarea dozei sau intreruperea tratamentului. Datorita posibilelor efecte aditive, se recomanda prudenta in cazul in care pacientii sunt tratati concomitent cu alte medicamente sedative sau consuma bauturi alcoolice in timpul tratamentului cu pramipexol (vezi pct. 4.7 si pct. 4.8).

Dependenta patologica de jocurile de noroc, cresterea libidoului si hipersexualitatea au fost raportate la pacientii tratati cu agonisti dopaminergici pentru boala Parkinson, inclusiv pramipexol. In plus, pacientii si personalul medical trebuie sa fie constienti de faptul ca pot sa apara modificari de comportament. Trebuie luata in considerare micsorarea dozei / intreruperea tratamentului prin reducerea progresiva a dozei.

Pacientii cu tulburari psihotice trebuie tratati cu agonisti dopaminergici numai daca beneficiile anticipate sunt mai mari decat riscurile potentiale. Trebuie evitata administrarea concomitenta de medicamente antipsihotice si pramipexol (vezi pct. 4.5).

Se recomanda consult oftalmologic la intervale regulate sau daca apar tulburari de vedere.

In cazul existentei bolilor cardiovasculare severe, se recomanda prudenta. Se recomanda monitorizarea tensiunii arteriale, mai ales la debutul tratamentului, datorita riscului general de hipotensiune arteriala ortostatica asociat terapiei dopaminergice.

Simptome caracteristice sindromului neuroleptic malign au fost raportate in asociere cu intreruperea brusca a tratamentului cu medicamente dopaminergice (vezi pct. 4.2).

Datele din literatura indica faptul ca tratamentul Sindromului picioarelor fara repaus cu medicamente dopaminergice poate conduce la exacerbarea acestuia. Exacerbarea se refera la declansarea simptomelor seara mai devreme (sau chiar dupa amiaza), la accentuarea simptomelor si la extinderea simptomelor spre alte extremitati. Studiile clinice controlate cu pramipexol la pacienti cu Sindromul picioarelor fara repaus nu au avut in general durata suficienta pentru a surprinde fenomenul exacerbarii. Nu s-a evaluat in studiile clinice controlate frecventa exacerbarii dupa o administrare de mai lunga durata a pramipexolului si gestionarea corespunzatoare a acestor evenimente.

4.5 Interactiuni cu alte medicamente si alte forme de interactiune

La om, pramipexolul se leaga de proteinele plasmatice intr-o proportie foarte mica ( 1/10); frecvente (> 1/100, 1/1.000, 1/10.000, 5%) reactii adverse raportate la pacientii cu boala Parkinson, mai frecvente in cazul celor tratati cu pramipexol decat cu placebo, au fost greata, dischinezie, hipotensiune arteriala, ameteli, somnolenta, insomnie, constipatie, halucinatii, cefalee si oboseala. Incidenta somnolentei este crescuta la doze mai mari de 1,1 mg baza (1,5 mg sare) pe zi (vezi pct.4.2). Reactii adverse mai frecvente in cazul asocierii cu levodopa au fost dischineziile. La inceputul tratamentului poate sa apara hipotensiune arteriala, in special daca doza de pramipexol este crescuta prea repede.

Sindromul picioarelor fara repaus Cele mai frecvente (> 5%) reactii adverse raportate la pacientii cu Sindromul picioarelor fara repaus tratati cu pramipexol au fost greata, cefalee, ameteli si oboseala. Greata si oboseala au fost raportate mai des la femeile tratate cu pramipexol (20,8% si respectiv 10,5%) comparativ cu barbatii (6,7% si respectiv 7,3%).

Tratamentul cu pramipexol a fost asociat cu somnolenta (8,6%) si, mai putin frecvent, cu somnolenta diurna excesiva si episoade de somn cu instalare brusca (0,1%). Vezi si pct. 4.4.

Tratamentul cu pramipexol se poate asocia cu afectarea libidoului [crestere (0,1%) sau diminuare (0,4%)].

In cazul pacientilor tratati pentru boala Parkinson cu agonisti dopaminergici, inclusiv pramipexol, in special la doze mari, s-au raportat manifestari de dependenta patologica de jocuri de noroc, cresterea libidoului si hipersexualitate, in general reversibile la reducerea dozei sau intreruperea tratamentului. Vezi si pct.4.4.

Simptomele supradozajului Nu exista experienta clinica in ceea ce priveste supradozajul masiv. Evenimentele adverse anticipate ar putea fi cele legate de proprietatile farmacodinamice ale agonistilor dopaminergici, incluzand greata, varsaturi, hiperkinezie, halucinatii, agitatie si hipotensiune arteriala.

Tratamentul supradozajului Nu este stabilit un antidot pentru supradozajul cu agonisti dopaminergici. Daca exista semne de stimulare ale sistemului nervos central, se poate recomanda administrarea unui neuroleptic. Tratarea supradozajului poate necesita masuri generale de sustinere, lavaj gastric, administrare intravenoasa de lichide, administrare de carbune activat si monitorizare electrocardiografica.

5. PROPRIETATI FARMACOLOGICE

5.1 Proprietati farmacodinamice

Grupa farmacoterapeutica: agonisti dopaminergici. Codul ATC: N04BC05.

Pramipexolul este un agonist dopaminergic care se leaga cu selectivitate si specificitate mare de subfamilia D2 a receptorilor pentru dopamina, avand o afinitate preponderenta pentru receptorii D3 si o activitate intrinseca totala.

Pramipexolul amelioreaza deficitele motorii din boala Parkinson prin stimularea receptorilor dopaminergici din nucleul striat. Studiile la animale de laborator demonstreaza ca pramipexolul inhiba sinteza, eliberarea si turnover-ul dopaminei.

Mecanismul de actiune al parmipexolului ca tratament pentru Sindromul picioarelor fara repaus nu este cunoscut. Dovezi neurofarmacologice sugereaza in principal implicarea sistemului dopaminergic.

In studiile la voluntari, a fost observata diminuarea secretiei de prolactina dependenta de doza.

Studii clinice in boala Parkinson La pacienti, pramipexolul amelioreaza semnele si simptomele formei idiopatice de boala Parkinson. Studiile clinice controlate au inclus aproximativ 2100 pacienti aflati in stadiile Hoehn si Yahr I-IV de boala. Dintre acestia, aproximativ 900 se aflau in stadii avansate de boala, primind tratament concomitent cu levodopa si suferind de complicatii motorii.

In stadiile incipiente si avansate de boala Parkinson, eficacitatea pramipexolului in studiile clinice controlate a fost mentinuta timp de aproximativ 6 luni. In studiile clinice deschise care au continuat timp de peste 3 ani, nu au fost inregistrate semne de diminuare ale eficacitatii terapeutice. Intr-un studiu controlat, dublu orb, cu o durata de 2 ani, tratamentul initial cu pramipexol a intarziat in mod semnificativ aparitia complicatiilor motorii si a redus incidenta acestora, comparativ cu tratamentul initial cu levodopa. Aceasta intarziere a complicatiilor motorii in cazul pramipexolului trebuie pusa in balanta cu ameliorarea mai buna a functiilor motorii inregistrata in cazul levodopa (masurata ca modificare medie pe scala UPDRS). Incidenta generala a halucinatiilor si somnolentei a fost, in general, mai mare in faza de crestere a dozelor la grupul cu pramipexol. Totusi, nu a fost inregistrata nici o diferenta semnificativa in timpul fazei de intretinere. Aceste date trebuie avute in vedere atunci cand trebuie luata decizia de a incepe tratamentul cu pramipexol la pacientii cu boala Parkinson.

Studii clinice in Sindromul picioarelor fara repaus Eficacitatea pramipexolului a fost evaluata in patru studii clinice controlate cu placebo la aproximativ 1000 de pacienti cu Sindrom idiopatic al picioarelor fara repaus moderat pana la sever. Eficacitatea a fost demonstrata in studii clinice controlate la pacienti tratati timp de pana la 12 saptamani. Mentinerea efectului nu s-a testat suficient.

Criteriile principale de evaluare a eficacitatii au fost modificarea medie fata de valorile initiale ale scorului la Scala de Evaluare a Sindromului picioarelor fara repaus (SESPR) si la Impresia clinica globala a ameliorarii (ICGA). Pentru ambele obiective primare s-au observat diferente semnificative statistic la grupurile tratate cu doze de pramipexol de 0,25 mg, 0,5 mg si 0,75 mg fata de placebo. Dupa 12 saptamani de tratament scorul la SESPR s-a ameliorat de la 23,5 la 14,1 puncte pentru placebo si de la 23,4 la 9,4 puncte pentru pramipexol (doze combinate). Diferenta medie ajustata a fost de -4,3 puncte (II 95% -6.4; - 2.1 puncte, valoare p

Intrebari si Raspunsuri:

Rog binevoiți a-mi comunica prețul unui flacon cu 50 cpr. de XADAGO de 50 mg. și de 100 mg. Și dac.

Sunt purtatoare de stimulator cardiac VVI si de proteza mitrala mecanica. Am boala Parkinson st.2.Sunt sub tratament cu C.

Se poate folosi medicam. Anticarcel in contractiile musculare provocate de B. Parkinson.

Am cateva intrebari legate de depresia de iarna. Este posibil sa se datoreze unui deficit de dopamina si nu neaparat de.

Buna ziua! Numele meu este Alexandra! Va rog un produs care sa ma ajute sa nu mai tremur atat de tare! in prezent mai.

Mama mea diagnosticata recent cu Parkinson si aflata sub tratament de 2 luni cu NERVOMAT, a primit suplimentar ISICOM. L.

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Cozaar is used for treating high blood pressure alone or with other medicines. It is used in certain patients to decrease the risk of stroke. It is used in certain patients to treat kidney problems caused by diabetes (diabetic nephropathy). Cozaar is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps to lower blood pressure.

Use Cozaar as directed by your doctor.

Take Cozaar by mouth with or without food.

Take Cozaar on a regular schedule to get the most benefit from it. Taking Cozaar at the same time each day will help you remember to take it.

Continue to take Cozaar even if you feel well. Do not miss any dose.

If you miss a dose of Cozaar, 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 Cozaar.

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

Active Ingredient: Losartan potassium.

Do NOT use Cozaar if:

you are allergic to any ingredient in Cozaar

you are in your second or third trimester of pregnancy

the patient is a child with severe kidney problems.

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

Some medical conditions may interact with Cozaar. Tell your health care provider if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become, 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 are able to become pregnant

if you have a history of angioedema (swelling of the hands, face, lips, eyes, throat, or tongue; difficulty swallowing or breathing; or hoarseness), including angioedema caused by treatment with an angiotensin-converting enzyme (ACE) inhibitor (eg, lisinopril)

if you have a history of heart problems (eg, heart failure), blood vessel problems, blood flow problems, liver or kidney problems, or diabetes

if you have a history of stroke or recent heart attack

if you are dehydrated or have low blood volume

if you have electrolyte problems (eg, high blood potassium levels, low blood sodium levels) or are on a low-salt (sodium) diet

if you are on dialysis or are scheduled to have major surgery.

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

Diuretics (eg, furosemide, hydrochlorothiazide) because the risk of low blood pressure may be increased

Potassium-sparing diuretics (eg, spironolactone, triamterene) or potassium supplements because the risk of high blood potassium levels may be increased

Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, indomethacin, celecoxib) or rifampin because they may decrease Cozaar's effectiveness

Lithium because the risk of its side effects may be increased by Cozaar.

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

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

Cozaar may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.

Cozaar may cause a serious side effect called angioedema. Contact your doctor at once if you develop swelling of the hands, face, lips, eyes throat, or tongue; difficulty swallowing or breathing; or hoarseness.

Cozaar may not work as well to reduce the risk of stroke in black patients. Discuss any questions or concerns with your doctor.

Dehydration, excessive sweating, vomiting, or diarrhea may increase the risk of low blood pressure. Contact your health care provider at once if any of these occur.

Check with your doctor before you use a salt substitute or a product that has potassium in it.

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

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If you have high blood pressure, do not use nonprescription products that contain stimulants. These products may include diet pills or cold medicines. Contact your doctor if you have any questions or concerns.

Diabetes patients - This may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.

Lab tests, including blood pressure, blood electrolyte levels, and heart, kidney, or liver function, may be performed while you use Cozaar. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Cozaar should not be used in children younger 6 years; safety and effectiveness in these children have not been confirmed.

Pregnancy and breast-feeding: Cozaar may cause birth defects or fetal death if you take it while you are pregnant. If you think you may be pregnant, contact your doctor right away. It is not known if Cozaar is found in breast milk. Do not breastfeed while taking Cozaar.

Dytor Plus Tablets, Dytor

Product Index

DYTOR PLUS Tablets (Torsemide + Spironolactone) Print PDF

DYTOR PLUS is a fixed-dose combination of torsemide which is a loop diuretic of the pyridine-sulfonylurea class and spironolactone which is a specific pharmacologic antagonist of aldosterone.

Pharmacodynamics

Torsemide

Micropuncture studies in animals have shown that torsemide acts from within the lumen of the thick ascending portion of the loop of Henle, where it inhibits the Na + /K + /2Cl - carrier system. Clinical pharmacology studies have confirmed this site of action in humans, and effects in other segments of the nephron have not been demonstrated. Diuretic activity thus correlates better with the rate of drug excretion in the urine than with the concentration in the blood.

Torsemide increases the urinary excretion of sodium, chloride, and water, but it does not significantly alter glomerular filtration rate, renal plasma flow, or acid-base balance.

Spironolactone

Spironolactone is a specific pharmacologic antagonist of aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. Spironolactone causes increased amounts of sodium and water to be excreted, while potassium is retained. Spironolactone acts both as a diuretic and as an antihypertensive drug by this mechanism. It may be given alone or with other diuretic agents, which act more proximally in the renal tubule.

Increased levels of the mineralocorticoid, aldosterone, are present in primary and secondary hyperaldosteronism. Edematous states in which secondary aldosteronism is usually involved include congestive heart failure, hepatic cirrhosis, and the nephrotic syndrome. By competing with aldosterone for receptor sites, spironolactone provides effective therapy for the edema and ascites in those conditions. Spironolactone counteracts secondary aldosteronism induced by the volume depletion and associated sodium loss caused by active diuretic therapy.

Spironolactone is effective in lowering the systolic and diastolic blood pressure in patients with primary hyperaldosteronism. It is also effective in most cases of essential hypertension, despite the fact that aldosterone secretion may be within normal limits in benign essential hypertension.

Through its action in antagonizing the effect of aldosterone, spironolactone inhibits the exchange of sodium for potassium in the distal renal tubule and helps to prevent potassium loss.

Spironolactone has not been demonstrated to elevate serum uric acid, to precipitate gout, or to alter carbohydrate metabolism.

Pharmacokinetics

Torsemide

The bioavailability of torsemide tablets is approximately 80%, with little intersubject variation; the 90% confidence interval is 75% to 89%. The drug is absorbed with little first-pass metabolism, and the serum concentration reaches its peak (C max ) within 1 hour after oral administration. C max and area under the serum concentration-time curve (AUC) after oral administration are proportional to dose over the range of 2.5 mg to 200 mg. Simultaneous food intake delays the time to C max by about 30 minutes, but overall bioavailability (AUC) and diuretic activity are unchanged. Absorption is essentially unaffected by renal or hepatic dysfunction.

The volume of distribution of torsemide is 12 liters to 15 liters in normal adults or in patients with mild to moderate renal failure or congestive heart failure. In patients with hepatic cirrhosis, the volume of distribution is approximately doubled.

In normal subjects, the elimination half-life of torsemide is approximately 3.5 hours. Torsemide is cleared from the circulation by both hepatic metabolism (approximately 80% of total clearance) and excretion into the urine (approximately 20% of total clearance in patients with normal renal function). The major metabolite in humans is the carboxylic acid derivative, which is biologically inactive. Two of the lesser metabolites possess some diuretic activity, but for practical purposes, metabolism terminates the action of the drug.

Because torsemide is extensively bound to plasma proteins (more than 99%), very little enters tubular urine via glomerular filtration. Most renal clearance of torsemide occurs via active secretion of the drug by the proximal tubules into tubular urine.

In patients with decompensated congestive heart failure, hepatic and renal clearance are both reduced, probably because of hepatic congestion and decreased renal plasma flow, respectively. The total clearance of torsemide is approximately 50% of that seen in healthy volunteers, and the plasma half-life and AUC are correspondingly increased. Because of reduced renal clearance, a smaller fraction of any given dose is delivered to the intraluminal site of action, so at any given dose, there is less natriuresis in patients with congestive heart failure than in normal subjects.

In patients with renal failure, renal clearance of torsemide is markedly decreased but total plasma clearance is not significantly altered. A smaller fraction of the administered dose is delivered to the intraluminal site of action, and the natriuretic action of any given dose of diuretic is reduced. A diuretic response in renal failure may still be achieved if patients are given higher doses. The total plasma clearance and elimination half-life of torsemide remain normal under the conditions of impaired renal function because metabolic elimination by the liver remains intact.

In patients with hepatic cirrhosis, the volume of distribution, plasma half-life, and renal clearance are all increased, but total clearance is unchanged.

The pharmacokinetic profile of torsemide in healthy elderly subjects is similar to that in young subjects except for a decrease in renal clearance related to the decline in renal function that commonly occurs with aging. However, total plasma clearance and elimination half-life remain unchanged.

Spironolactone

Spironolactone is rapidly and extensively metabolized. Sulfur-containing products are the predominant metabolites and are thought to be primarily responsible, together with spironolactone, for the therapeutic effects of the drug.

The pharmacological activity of spironolactone metabolites in man is not known. However, in the adrenalectomized rat the antimineralocorticoid activities of the metabolites C, TMS, and HTMS, relative to spironolactone, were 1.10, 1.28, and 0.32, respectively. Relative to spironolactone, their binding affinities to the aldosterone receptors in rat kidney slices were 0.19, 0.86, and 0.06, respectively.

In humans the potencies of TMS and 7-?-thiospirolactone in reversing the effects of the synthetic mineralocorticoid, fludrocortisone, on urinary electrolyte composition were 0.33 and 0.26, respectively, relative to spironolactone. However, since the serum concentrations of these steroids were not determined, their incomplete absorption and/or first-pass metabolism could not be ruled out as a reason for their reduced in vivo activities.

Spironolactone and its metabolites are more than 90% bound to plasma proteins. The metabolites are excreted primarily in the urine and secondarily in bile.

The effect of food on spironolactone absorption (two 100 mg spironolactone tablets) was assessed in a single-dose study of 9 healthy, drug-free volunteers. Food increased the bioavailability of unmetabolized spironolactone by almost 100%. The clinical importance of this finding is not known.

Edema associated with secondary hyperaldosteronism in

Liver cirrhosis

Congestive heart failure

Nephrotic syndrome

Hypertension with hyperaldosteronism

Dosage must be individualized.

Cirrhotic Ascites

The usual initial recommended dose is two tablets of DYTOR PLUS 5 . If adequate response is not obtained, the dose can be increased up to four tablets of DYTOR PLUS 5 . Further, in severe cases of edema, where a greater amount of loop diuretic is desired, the patient could be shifted to four tablets of DYTOR PLUS 10 .

Congestive Heart Failure

The usual initial recommended dose is one tablet of DYTOR PLUS 10 or two tablets of DYTOR PLUS 5 . If adequate response is not obtained, the dose can be increased up to four tablets of DYTOR PLUS 5 or DYTOR PLUS 10 . Further, in severe cases of edema, where a greater amount of loop diuretic is desired, the patient could be shifted to four tablets of DYTOR PLUS 20 .

Nephrotic Syndrome

The usual initial recommended dose is two tablets of DYTOR PLUS 10 . If adequate response is not obtained, the dose can be increased up to four tablets of DYTOR PLUS 10 . Further, in severe cases of edema, where a greater amount of loop diuretic is desired, the patient could be shifted to four tablets of DYTOR PLUS 20 .

Hypertension

Patients not showing adequate response to DYTOR (torsemide) 10 mg can be shifted to one tablet of DYTOR PLUS 10 . If adequate response is not obtained, the patient could be shifted to two tablets of DYTOR PLUS 5 . The dose should not be increased beyond these.

Hypersensitivity to torsemide, or sulfonylureas or spironolactone or any of the ingredient of the product

Patients with anuria

Acute renal insufficiency

Significant impairment of renal excretory function

Hepatic coma and pre-coma

Hypotension

Pregnancy and lactation

Cardiac arrhythmias, simultaneous therapy with aminoglycosides or cephalosporins or renal dysfunction due to drugs which cause renal damage

Concomitant use of eplerenone or other potassium sparring diuretics

Hyperkalemia

Addison’s disease

Pediatric patients with moderate to severe renal impairment

Drug Interactions

Cholestyramine . Concomitant use of torsemide and cholestyramine has not been studied in humans but, in a study in animals, coadministration of cholestyramine decreased the absorption of orally administered torsemide. Hyerkalemic metabolic acidosis has been reported in patients given spironolactone with cholestyramine. If DYTOR PLUS and cholestyramine are used concomitantly, simultaneous administration is not recommended.

Probenecid . Coadministration of probenecid reduces secretion of torsemide into the proximal tubule and thereby decreases the diuretic activity of torsemide.

Lithium . Lithium generally should not be given with diuretics. Diuretic agents are known to reduce the renal clearance of lithium and add a high risk of lithium toxicity, so coadministration of lithium and diuretics should be undertaken with great caution, if at all. Coadministration of lithium and torsemide has not been studied. Torsemide, especially at high doses, may potentiate the cardio - and neuro-toxic effect of lithium.

Angiotensin Converting Enzyme (ACE) Inhibitors: Sequential or combined treatment, or starting a new combination with an ACE inhibitor may result in transient hypotension. This may be minimized by lowering the starting dose of the ACE inhibitor and/or reducing or stopping temporarily the dose of torsemide. Torsemide may decrease arterial responsiveness to pressor agents e. g. adrenaline, noradrenaline. Concomitant administration of ACE inhibitors with potassium-sparing diuretics has been associated with severe hyperkalemia. Since ACE inhibitors decrease aldosterone production they should not routinely be used with spironolactone, particularly in patients with marked renal impairment.

Alcohol, Barbiturates, or Narcotics: Potentiation of orthostatic hypotension may occur when any of these agents are administered with spironolactone.

Corticosteroids, Adrenocorticotropic hormone (ACTH): Intensified electrolyte depletion, particularly hypokalemia, may occur when any of these agents are administered with spironolactone. Pressor Amines (eg, norepinephrine): Spironolactone reduces the vascular responsiveness to norepinephrine. Therefore, caution should be exercised in the management of patients subjected to regional or general anesthesia while they are being treated with spironolactone.

Muscle Relaxants, Nondepolarizing (e. g. tubocurarine): Possible increased responsiveness to the muscle relaxant may result when administered with spironolactone. The action of curare-containing muscle relaxants and of theophylline can be potentiated when used with torsemide.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): In some patients, the administration of an NSAID can reduce the diuretic, natriuretic, and antihypertensive effect of loop, potassium-sparing and thiazide diuretics. Combination of NSAIDs, e. g. indomethacin, with potassium-sparing diuretics has been associated with severe hyperkalemia. Therefore, when DYTOR PLUS and NSAIDs are used concomitantly, the patient should be observed closely to determine if the desired diuretic effect is obtained. Possible interactions between torsemide and NSAIDs (including aspirin) have not been studied, however, coadministration of these agents with another loop diuretic (furosemide) has occasionally been associated with renal dysfunction. The natriuretic effect of torsemide (like that of many other diuretics) is partially inhibited by the concomitant administration of indomethacin. This effect has been demonstrated for torsemide under conditions of dietary sodium restriction (50 mEq/day) but not in the presence of normal sodium intake (150 mEq/day).

Salicylates . Since torsemide and salicylates compete for secretion by renal tubules, patients receiving high dose of salicylates may experience salicylate toxicity when DYTOR PLUS is concomitantly administered.

Cardiac Glycosides: Coadministration of digoxin is reported to increase the area under the curve for torsemide by 50%, but dose adjustment of torsemide is not necessary. Spironolactone has been shown to increase the half-life of digoxin. This may result in increased serum digoxin levels and subsequent digitalis toxicity. It may be necessary to reduce the maintenance and digitalization doses when DYTOR PLUS is administered, and the patient should be carefully monitored to avoid over - or under-digitalization. When torsemide is used simultaneously with cardiac glycosides, a potassium and/or magnesium deficiency may increase sensitivity of the cardiac muscle to such drugs.

Carbenoxolone: As carbenoxolone may cause sodium retention and thus decrease the effectiveness of spironolactone, concurrent use of the two agents should be avoided.

Angiotensin II Antagonists, Aldosterone Blockers, Heparin, Low Molecular Weight Heparin, and Other Drugs Known to Cause Hyperkalemia: Concomitant administration of these agents with spironolactone may lead to severe hyperkalemia.

Antihypertensive Agents: As with diuretics, the effect of antihypertensive drugs given concomitantly with torsemide or spironolactone may be potentiated. The dosage of antihypertensive drugs may need to be reduced when spironolactone is added to the treatment regime, and then adjusted as necessary. In patients with essential hypertension, torsemide has been administered together with beta-blockers, ACE inhibitors, and calcium-channel blockers. None of these combined uses was associated with new or unexpected adverse events.

Antidiabetics: The action of antidiabetic drugs may be reduced when used with torsemide.

Trimethoprim/ Sulfamethoxazole: Concomitant use of trimethoprim/sulfamethoxazole (cotrimoxazole) with spironolactone may result in clinically relevant hyperkalemia.

Others . In patients with congestive heart failure, torsemide has been administered together with digitalis glycosides, ACE inhibitors, and organic nitrates. None of these combined uses was associated with new or unexpected adverse events. Torsemide does not affect the protein binding of glyburide or of warfarin, the anticoagulant effect of phenprocoumon (a related coumarin derivative), or the pharmacokinetics of digoxin or carvedilol (a vasodilator/ beta-blocker). In healthy subjects, coadministration of torsemide was associated with significant reduction in the renal clearance of spironolactone, with corresponding increases in the AUC. However, clinical experience indicates that dosage adjustment of either agent is not required. The pharmacokinetic profile and diuretic activity of torsemide are not altered by cimetidine or spironolactone. Other diuretics have been reported to increase the ototoxic potential of aminoglycoside antibiotics and of ethacrynic acid, especially in the presence of impaired renal function. These potential interactions with torsemide have not been studied. Torsemide, especially at high doses, may potentiate the toxicity of aminoglycoside antibiotics, cisplatin preparations and the nephrotoxic effects of cephalosporins.

The kaliuretic effect of mineralo-and glucocorticoids and laxatives may be increased when used with torsemide.

Ototoxicity

Tinnitus and hearing loss (usually reversible) have been observed after rapid intravenous (IV) injection of other loop diuretics and have also been observed after oral torsemide. It is not certain that these events were attributable to torsemide. Ototoxicity has also been seen in animal studies when very high plasma levels of torsemide were induced.

Volume and Electrolyte Depletion

All patients receiving diuretics should be observed for clinical evidence of electrolyte imbalance (e. g. hypomagnesemia, hyponatremia, hypochloremic alkalosis, and hyperkalemia), hypovolemia, or prerenal azotemia.

Symptoms of these disturbances may include one or more of the following: dryness of the mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, nausea, and vomiting. Excessive diuresis may cause dehydration, blood-volume reduction, and possibly thrombosis and embolism, especially in elderly patients. In patients who develop fluid and electrolyte imbalances, hypovolemia, or prerenal azotemia, the observed laboratory changes may include hyper - or hyponatremia, hyper - or hypochloremia, hyper - or hypokalemia, acid-base abnormalities, and increased blood urea nitrogen (BUN). If any of these occur, torsemide should be discontinued until the situation is corrected; torsemide may be restarted at a lower dose.

In controlled studies in the United States, torsemide was administered to hypertensive patients at doses of 5 mg or 10 mg daily. After 6 weeks at these doses, the mean decrease in serum potassium was approximately 0.1 mEq/L. The percentage of patients who had a serum potassium level below 3.5 mEq/L at any time during the studies was essentially the same in patients who received torsemide (1.5%) as in those who received placebo (3%). In patients followed for 1 year, there was no further change in mean serum potassium levels. In patients with congestive heart failure, hepatic cirrhosis, or renal disease treated with torsemide at doses higher than those studied in United States antihypertensive trials, hypokalemia was observed with greater frequency, in a dose-related manner.

In patients with cardiovascular disease, especially those receiving digitalis glycosides, diuretic-induced hypokalemia may be a risk factor for the development of arrhythmias. The risk of hypokalemia is greatest in patients with cirrhosis of the liver, in patients experiencing a brisk diuresis, in patients who are receiving inadequate oral intake of electrolytes, and in patients receiving concomitant therapy with corticosteroids or ACTH.

Periodic monitoring of serum potassium and other electrolytes is advised in patients treated with DYTOR PLUS .

Fluid and electrolyte status should be regularly monitored particularly in the elderly, in those with significant renal and hepatic impairment.

Serum and urine electrolyte determinations are particularly important when the patient is vomiting excessively or receiving parenteral fluids. Warning signs or symptoms of fluid and electrolyte imbalance, irrespective of cause, include dryness of the mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea and vomiting. Hyperkalemia may occur in patients with impaired renal function or excessive potassium intake and can cause cardiac irregularities, which may be fatal. Consequently, no potassium supplement should ordinarily be given with spironolactone.

Hyperkalemia may occur in patients with impaired renal function or excessive potassium intake and can cause cardiac irregularities which may be fatal.

If hyperkalemia is suspected (warning signs include paresthesia, muscle weakness, fatigue, flaccid paralysis of the extremities, bradycardia and shock), an electrocardiogram (ECG) should be obtained. However, it is important to monitor serum potassium levels because mild hyperkalemia may not be associated with ECG changes.

If hyperkalemia is present, spironolactone should be discontinued immediately. With severe hyperkalemia, the clinical situation dictates the procedures to be employed. These include the IV administration of calcium chloride solution, sodium bicarbonate solution and/or the oral or parenteral administration of glucose with a rapid-acting insulin preparation. These are temporary measures to be repeated as required. Cationic exchange resins such as sodium polystyrene sulfonate may be orally or rectally administered. Persistent hyperkalemia may require dialysis.

Reversible hyperchloremic metabolic acidosis, usually in association with hyperkalemia, has been reported to occur in some patients with decompensated hepatic cirrhosis, even in the presence of normal renal function.

Dilutional hyponatremia, manifested by dryness of the mouth, thirst, lethargy, and drowsiness, and confirmed by a low serum sodium level, may be caused or aggravated, especially when spironolactone is administered in combination with other diuretics, and dilutional hyponatremia may occur in edematous patients in hot weather; appropriate therapy is water restriction rather than administration of sodium, except in rare instances when the hyponatremia is life-threatening.

Calcium

Single doses of torsemide increased the urinary excretion of calcium by normal subjects, but serum calcium levels were slightly increased in 4-to 6-week hypertension trials. In a long-term study of patients with congestive heart failure, the average 1-year change in serum calcium was a decrease of 0.10 mg/dL (0.02 mmol/L). Among 426 patients treated with torsemide for an average of 11 months, hypocalcemia was not reported as an adverse event.

Magnesium

Single doses of torsemide caused healthy volunteers to increase their urinary excretion of magnesium, but serum magnesium levels were slightly increased in 4- to 6-week hypertension trials. In long-term hypertension studies, the average 1-year change in serum magnesium was an increase of 0.03 mg/dL (0.01 mmol/L). Among 426 patients treated with torsemide for an average of 11 months, one case of hypomagnesemia (1.3 mg/dL ) was reported as an adverse event.

In a long-term clinical study of torsemide in patients with congestive heart failure, the estimated annual change in serum magnesium was an increase of 0.2 mg/dL (0.08 mmol/L), but these data are confounded by the fact that many of these patients received magnesium supplements. In a 4 week study in which magnesium supplementation was not given, the rate of occurrence of serum magnesium levels below 1.7 mg/dL (0.70 mmol/L) was 6% and 9% in the groups receiving 5 mg and 10 mg of torsemide, respectively.

Blood Urea Nitrogen (BUN), Creatinine and Uric Acid

Torsemide produces small dose-related increases in each of these laboratory values. In hypertensive patients who received 10 mg of torsemide daily for 6 weeks, the mean increase in blood urea nitrogen was 1.8 mg/dL (0.6 mmol/L), the mean increase in serum creatinine was 0.05 mg/dL (4 mmol/L), and the mean increase in serum uric acid was 1.2 mg/dL (70 mmol/L). Little further change occurred with long-term treatment, and all changes reversed when treatment was discontinued.

Symptomatic gout has been reported in patients receiving torsemide, but its incidence has been similar to that seen in patients receiving placebo.

Careful monitoring of patients with tendency to hyperuricemia and gout is recommended.

Spironolactone may cause a transient elevation of BUN, especially in patients with preexisting renal impairment. Spironolactone may cause mild acidosis.

Glucose

Hypertensive patients who received 10 mg of daily torsemide experienced a mean increase in serum glucose concentration of 5.5 mg/dL (0.3 mmol/L) after 6 weeks of therapy, with a further increase of 1.8 mg/dL (0.1 mmol/L) during the subsequent year. In long-term studies in diabetics, mean fasting glucose values were not significantly changed from baseline. Cases of hyperglycemia have been reported but are uncommon.

Carbohydrate metabolism in latent or manifest diabetes mellitus should be monitored.

Serum Lipids

In the controlled short-term hypertension studies in the United States, daily doses of 5 mg, 10 mg, and 20 mg of torsemide were associated with increases in total plasma cholesterol of 4, 4, and 8 mg/dL (0.10 to 0.20 mmol/L), respectively. The changes subsided during chronic therapy.

In the same short-term hypertension studies, daily doses of 5 mg, 10 mg and 20 mg of torsemide were associated with mean increases in plasma triglycerides of 16, 13 and 71 mg/dL (0.15 to 0.80 mmol/L), respectively.

In long-term studies of 5 mg to 20 mg of torsemide daily, no clinically significant differences from baseline lipid values were observed after 1 year of therapy.

Potassium Supplementation

Potassium supplementation, either in the form of medication or as a diet rich in potassium, should not ordinarily be given in association with DYTOR PLUS . Excessive potassium intake may cause hyperkalemia in patients receiving spironolactone.

Concomitant administration of spironolactone with the following drugs or potassium sources may lead to severe hyperkalemia:

Other potassium-sparing diuretics

Ace inhibitors

Angiotensin ii antagonists

Aldosterone blockers

NSAIDS, e. g. indomethacin

Heparin and low molecular weight heparin

Other drugs or conditions known to cause hyperkalemia

Potassium supplements

Diet rich in potassium

Salt substitutes containing potassium

Spironolactone should not be administered concurrently with other potassium-sparing diuretics. Spironolactone, when used with ACE inhibitors or indomethacin, even in the presence of a diuretic, has been associated with severe hyperkalemia. Extreme caution should be exercised when DYTOR PLUS is given concomitantly with these drugs.

Hyperkalemia in Patients with Severe Heart Failure

Hyperkalemia may be fatal. It is critical to monitor and manage serum potassium in patients with severe heart failure receiving spironolactone. Avoid using other potassium-sparing diuretics. Avoid using oral potassium supplements in patients with serum potassium >3.5 mEq/L. Randomized Spironolactone Evaluation Study excluded patients with a serum creatinine >2.5 mg/dL or a recent increase in serum creatinine >25%. The recommended monitoring for potassium and creatinine is one week after initiation or increase in dose of spironolactone, monthly for the first three months, then quarterly for a year, and then every six months. Discontinue or interrupt treatment for serum potassium >5 mEq/L or for serum creatinine >4 mg/dL.

Gynecomastia

Gynecomastia may develop in association with the use of spironolactone; physician should be alert to its possible onset. The development of gynecomastia appears to be related to both dosage level and duration of therapy and is normally reversible whenever DYTOR PLUS is discontinued. In rare instances, some breast enlargement may persist when DYTOR PLUS is discontinued

Laboratory Tests

Periodic determination of serum electrolytes to detect possible electrolyte imbalance should be done at appropriate intervals, particularly in the elderly and those with significant renal or hepatic impairments.

Several reports of possible interference with digoxin radioimmunoassay by spironolactone, or its metabolites, have appeared in the literature. Neither the extent nor the potential clinical significance of its interference (which may be assay-specific) has been fully established. In fluorimetric assays spironolactone may interfere with the estimation of compounds with similar fluorescence characteristics.

Other

In long-term studies in hypertensive patients, torsemide has been associated with small mean decreases in hemoglobin, hematocrit, and erythrocyte count and small mean increases in white blood cell count, platelet count, and serum alkaline phosphatase. Although statistically significant, all of these changes were medically inconsequential. No significant trends have been observed in any liver enzyme tests other than alkaline phosphatase.

Renal Impairment

Hyperkalemia and alterations of fluid and electrolyte balance may occur in patients with impaired renal function. In acute renal insufficiency or in patients with impairment of renal excretory function, DYTOR PLUS is contraindicated. Reversible increases in blood urea have been reported with spironolactone therapy, particularly in the presence of impaired renal function. Spironolactone is contraindicated for use in pediatric patients with moderate or severe renal impairment.

Hepatic Impairment

DYTOR PLUS should be used with caution in patients with impaired hepatic function because minor alterations of fluid and electrolyte balance due to spironolactone or torsemide (especially in patients with cirrhosis and ascites) may precipitate hepatic coma. In patients with hepatic disease with cirrhosis and ascites, diuresis with any diuretic is best initiated in the hospital.

Pregnancy

There was no fetotoxicity or teratogenicity in rats treated with up to 5 mg/kg/day of torsemide (on a mg/kg basis, this is 15 times a human dose of 20 mg/day; on a mg/m 2 basis, the animal dose is 10 times the human dose), or in rabbits, treated with 1.6 mg/kg/day (on a mg/kg basis, 5 times the human dose of 20 mg/kg/day; on a mg/m 2 basis, 1.7 times this dose). Fetal and maternal toxicity (decrease in average body weight, increase in fetal resorption and delayed fetal ossification) occurred in rabbits and rats given doses 4 (rabbits) and 5 (rats) times larger. Adequate and well-controlled studies have not been carried out with torsemide in pregnant women. Because animal reproduction studies are not always predictive of human response, torsemide should be used during pregnancy only if clearly needed. The effect of torsemide on labor and delivery is unknown.

Teratology studies with spironolactone have been carried out in mice and rabbits at doses of up to 20 mg/kg/day. On a body surface area basis, this dose in the mouse is substantially below the maximum recommended human dose and, in the rabbit, approximates the maximum recommended human dose. No teratogenic or other embryotoxic effects were observed in mice, but the 20 mg/kg dose caused an increased rate of resorption and a lower number of live fetuses in rabbits. Because of its anti-androgenic activity and the requirement of testosterone for male morphogenesis, spironolactone may have the potential for adversely affecting sex differentiation of the male during embryogenesis. When administered to rats at 200 mg/kg/day between gestation days 13 and 21 (late embryogenesis and fetal development), feminization of male fetuses was observed. Offspring exposed during late pregnancy to 50 and 100 mg/kg/day doses of spironolactone exhibited changes in the reproductive tract including dose-dependent decreases in weights of the ventral prostate and seminal vesicle in males, ovaries and uteri that were enlarged in females, and other indications of endocrine dysfunction, that persisted into adulthood. There are no adequate and well-controlled studies with spironolactone in pregnant women. Spironolactone has known endocrine effects in animals including progestational and antiandrogenic effects. The antiandrogenic effects can result in apparent estrogenic side effects in humans, such as gynecomastia. Therefore, the use of spironolactone in pregnant women requires that the anticipated benefit be weighed against the possible hazards to the fetus.

Consequently, DYTOR PLUS is contraindicated in pregnancy.

Lactation

It is not known whether torsemide is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when torsemide is administered to a nursing woman. Canrenone, a major (and active) metabolite of spironolactone, appears in human breast milk. Because spironolactone has been found to be tumorigenic in rats, a decision should be made whether to discontinue the drug, taking into account the importance of the drug to the mother. If use of the drug is deemed essential, an alternative method of infant feeding should be instituted.

Consequently, DYTOR PLUS is contraindicated during lactation.

Pediatric Use

Safety and effectiveness of torsemide and spironolactone in pediatric patients have not been established.

Administration of another loop diuretic to severely premature infants with edema due to patent ductus arteriosus and hyaline membrane disease has occasionally been associated with renal calcifications, sometimes barely visible on X-ray but sometimes in staghorn form, filling the renal pelves. Some of these calculi have been dissolved, and hypercalciuria has been reported to have decreased, when chlorothiazide has been coadministered along with the loop diuretic. In other premature neonates with hyaline membrane disease, another loop diuretic has been reported to increase the risk of persistent patent ductus arteriosus, possibly through a prostaglandin-E-mediated process. The use of torsemide in such patients has not been studied.

Potassium-sparing diuretics should be used with caution in hypertensive pediatric patients with mild renal insufficiency because of the risk of hyperkalemia. Spironolactone is contraindicated for use in pediatric patients with moderate or severe renal impairment.

Geriatric Use

Of the total number of patients who received torsemide in clinical studies, 24% were 65 or older while about 4% were 75 or older. No specific age-related differences in effectiveness or safety of torsemide were observed between younger patients and elderly patients. In the RALES trial, spironolactone provided a significant mortality benefit vs. placebo in those aged > 60 years.

Torsemide

Torsemide has been evaluated for safety in over 4000 subjects: over 800 of these subjects received torsemide for at least 6 months, and over 380 were treated for more than 1 year. Among these subjects were 564 who received torsemide during trials in which 274 other subjects received placebo.

The reported side effects of torsemide were generally transient, and there was no relationship between side effects and age, sex, race, or duration of therapy. Discontinuation of therapy due to side effects occurred in 3.5% of patients treated with torsemide and in 4.4% of patients treated with placebo. Discontinuation rates due to side effects were 3.0% (38/1250) with torsemide and 3.4% (13/380) with furosemide in patients with congestive heart failure, 2.0% (8/409) with torsemide and 4.8% (11/230) with furosemide in patients with renal insufficiency, and 7.6% (13/170) with torsemide and 0% (0/33) with furosemide in patients with cirrhosis.

The most common reasons for discontinuation of therapy with torsemide were (in descending order of frequency) dizziness, headache, nausea, weakness, vomiting, hyperglycemia, excessive urination, hyperuricemia, hypokalemia, excessive thirst, hypovolemia, impotence, esophageal hemorrhage, and dyspepsia. Dropout rates for these adverse events ranged from 0.1% to 0.5%.

The side effects considered possibly or probably related to study drug that occurred in placebo-controlled trials in more than 1% of patients treated with torsemide are shown in Table 1.

Table 1: Reactions possibly or probably drug-related in placebo-controlled studies

The daily doses of torsemide used in these trials ranged from 1.25 mg to 20 mg, with most patients receiving 5 mg to 10 mg; the duration of treatment ranged from 1 to 52 days, with a median of 41 days. Of the side effects listed in the table, only “excessive urination” occurred significantly more frequently in patients treated with torsemide than in patients treated with placebo. In the placebo-controlled hypertension studies whose design allowed side-effect rates to be attributed to dose, excessive urination was reported by 1% of patients receiving placebo, 4% of those treated with 5 mg of daily torsemide, and 15% of those treated with 10 mg. The complaint of excessive urination was generally not reported as an adverse event among patients who received torsemide for cardiac, renal, or hepatic failure.

Hypokalemia may occur (especially if a low potassium diet is being taken, or if vomiting, diarrhea, or excessive use of laxatives takes place, or in cases of hepatic failure).

Serious adverse events reported in the clinical studies for which a drug relationship could not be excluded were atrial fibrillation, chest pain, diarrhea, digitalis intoxication, gastrointestinal hemorrhage, hyperglycemia, hyperuricemia, hypokalemia, hypotension, hypovolemia, shunt thrombosis, rash, rectal bleeding, syncope, and ventricular tachycardia.

Angioedema has been reported in a patient exposed to torsemide who was later found to be allergic to sulfa drugs.

Of the adverse reactions during placebo-controlled trials listed without taking into account assessment of relatedness to drug therapy, arthritis and various other nonspecific musculoskeletal problems were more frequently reported in association with torsemide than with placebo, even though gout was somewhat more frequently associated with placebo. These reactions did not increase in frequency or severity with the dose of torsemide. One patient in the group treated with torsemide withdrew due to myalgia, and one in the placebo group withdrew due to gout.

There may be aggravation of metabolic alkalosis.

Other adverse effects included:

Cardiovascular system: In isolated cases, thromboembolic complications and circulatory disturbances due to hemoconcentration may occur.

Gastrointestinal system: Patients may experience gastrointestinal symptoms.

Renal and Urinary system: In patients with urinary outflow obstruction, retention of urine may be precipitated.

Raised serum urea and creatinine may occur.

Liver: Increases in certain liver enzymes, eg. Gamma-GT.

Hematology: Isolated cases of decreases in red and white blood cells and platelets have been reported.

Skin/allergy: In isolated cases, there may be allergic reactions, such as pruritis and photosensitivity.

Nervous system: Isolated reports of visual disturbance. Tinnitus and hearing loss have occurred in isolated cases. Rarely, limb paresthesia has been reported.

The following adverse reactions have been identified during the post approval use of torsemide. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Adverse reactions reported include the following: leucopenia, thrombocytopenia.

Serious skin reactions ( i. e. . Stevens-Johnson syndrome, toxic epidermal necrolysis) have been reported in association with torsemide use.

Pancreatitis has been reported in association with torsemide use

Spironolactone

Somnolence and dizziness is reported to occur in some patients.

Gynecomastia may develop in association with the use of spironolactone. Development appears to be related to both dosage level and duration of therapy and is normally reversible when the drug is discontinued. In rare instances some breast enlargement may persist.

The following adverse reactions have been reported and, within each category (body system), are listed below:

Digestive System: gastric bleeding, ulceration, gastritis, diarrhea, cramping, nausea, vomiting, gastrointestinal disturbances,

Neoplasms benign, malignant and unspecified (including cysts and polps): benign breast neoplasm.

Hematologic System: leukopenia (including agranulocytosis), thrombocytopenia Hypersensitivity: Fever, urticaria, maculopapular or erythematous cutaneous eruptions, anaphylactic reactions, vasculitis. Metabolism: hyperkalemia, electrolyte disturbances.

Nervous System/Psychiatric: mental confusion, ataxia, dizziness, headache, drowsiness, lethargy, changes in libido, confusion.

Cardiac disorders: severe hyperkalemia may result in paralysis, flaccid paraplegia and cardiac arrhythmias with subsequent cardiovascular collapse. This can be fatal in patients with impaired renal function.

Musculoskeletal: leg cramps,

Reproductive system and breast disorders: Gynecomastia, inability to achieve or maintain erection, irregular menses or amenorrhea, postmenopausal bleeding, breast pain. Carcinoma of the breast has been reported in patients taking spironolactone but a cause and effect relationship has not been established. Menstrual disorders, breast pain.

Liver/ biliary: A very few cases of mixed cholestatic/ hepatocellular toxicity, with one reported fatality, have been reported with spironolactone administration. Hepatic function abnormal. Renal: Renal dysfunction (including renal failure), acute renal failure.

Skin: Pemphigoid, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), alopecia, pruritis Urticaria, hypertrichosis, pruritus, rash and alopecia.

General disorders and administration site conditions: malaise

Torsemide

There is no human experience with overdoses of torsemide but the signs and symptoms of torsemide overdosage can be anticipated to be those of excessive pharmacologic effect: dehydration, hypovolemia, hypotension, hyponatremia, hypokalemia, hypochloremic alkalosis, and hemoconcentration. Treatment of overdosage should consist of fluid and electrolyte replacement.

Laboratory determinations of serum levels of torsemide and its metabolites are not widely available.

No data are available to suggest physiological maneuvers (e. g. maneuvers to change the pH of the urine) that might accelerate elimination of torsemide and its metabolites. Torsemide is not dialyzable, so hemodialysis will not accelerate elimination.

Spironolactone

The oral LD 50 of spironolactone is greater than 1,000 mg/kg in mice, rats, and rabbits.

Acute overdosage of spironolactone may be manifested by drowsiness, mental confusion, maculopapular or erythematous rash, nausea, vomiting, dizziness, or diarrhea. Rarely, instances of hyponatremia, hyperkalemia, or hepatic coma may occur in patients with severe liver disease, but these are unlikely due to acute overdosage. Hyperkalemia may occur, especially in patients with impaired renal function.

Treatment

Induce vomiting or evacuate the stomach by lavage. There is no specific antidote. Treatment is supportive to maintain hydration, electrolyte balance, and vital functions.

Patients who have renal impairment may develop spironolactone-induced hyperkalemia. In such cases, spironolactone should be discontinued immediately. With severe hyperkalemia, the clinical situation dictates the procedures to be employed. These may include the IV administration of calcium chloride solution, sodium bicarbonate solution and/or the oral or parenteral administration of glucose with a rapid-acting insulin preparation. These are temporary measures to be repeated as required. Cationic exchange resins such as sodium polystyrene sulfonate may be orally or rectally administered. Persistent hyperkalemia may require dialysis.

Clopix, Clopix

Clopix

Clopidogrel is reported as an ingredient of Clopix in the following countries:

Clopidogrel besilate (a derivative of Clopidogrel) is reported as an ingredient of Clopix in the following countries:

Clopidogrel hydrogen sulfate (a derivative of Clopidogrel) is reported as an ingredient of Clopix in the following countries:

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.

Comparison Of Contraceptive Acceptability Of Levonorgestrel And Ethinyl Oestradiol Administered In O

Citation

Contraception. 1983 May;27(5):439-52.

Abstract

In a Swedish multicenter study, a total number of 835 women completed a total of 6472 treatment cycles. Half of them were allotted at random to use the monophasic oral contraceptive Neovletta, also known as Microgynon 30 (30 micrograms ethinyl oestradiol + 150 micrograms levonorgestrel in each tablet). The second half was allotted to Trionetta, also known as Triquilar, Trigynon and Logynon (6 tablets with 30 micrograms ethinyl oestradiol + 50 micrograms levonorgestrel, 5 tablets with 40 micrograms ethinyl oestradiol + 75 micrograms levonorgestrel and 10 tablets with 30 micrograms ethinyl oestradiol + 125 micrograms levonorgestrel). The latter version was also present in a 28-day version containing in addition 7 "placebo" tablets to be used in the otherwise tablet-free interval. The contraceptive reliability was excellent although one pregnancy occurred in the three-phase version. It could be attributed to patient failure. In all aspects of bleeding control, the three-phasic pill proved to be superior to the reference monophasic preparation. The extreme low incidence of missed withdrawal bleeding and stability already during the first months of use are noteworthy features. For both preparations, continuation rate was at six months of use about 85% and at 12 months it was a similar figure. The most common reason for withdrawal was bleeding, about 5% each for both preparation. No serious side-effects were reported. The study clearly indicates that the three-phasic version is a major improvement in spite of a considerably decreased total dose of the gestagen.

PIP:

A total of 835 women in a Swedish multicenter study completed a total of 6472 oral contraceptive (OC) treatment cycles; half of the women were allotted at random to use the monophasic OC Neovletta, also known as Microgynon 30 (30 mcg ethinyl estradiol + 150 mcg levonorgestrel in each tablet) and the 2nd half was allotted to Trionetta, also known as Triquilar, Trigynon, and Logynon (6 tablets with 30 mcg ethinyl estradiol + 50 mcg levonorgestrel, 5 tablets with 40 mcg ethinyl estradiol + 75 mcg levonorgestrel and 10 tablets with 30 mcg ethinyl estradiol + 125 mcg levonorgestrel). The latter version was also present in a 28-day version containing in addition 7 placebo tablets to be used in the otherwise tablet-free interval. There was a comparatively high number of missed tablets. Tablets were omitted in 8.1% of the total number of cycles in the triphasic group and the corresponding figure for the monophasic group was 9.4%. Despite this fact, only 1 pregnancy occurred during the observation period and during treatment with Trionetta 21. This pregnancy was classified by the attending physician as clearly due to patient failure (3 consecutively missed tablets). Both formulations exerted a normalizing effect on cycle length, being more pronounced with the triphasic formulation. The 2 combinations reduced to the same extent previously prolonged bleeding periods, i. e. greater than 7 days. The percentage of women with bleeding periods longer than 7 days in the 6th and 12th treatment cycle was 1.4% and 0.6%, respectively, for Neovletta and 0.9% and 0.6%, respectively for Trionetta. The 2 combinations reduced to the same extent previously profuse bleedings. In the last untreated cycle, the percentage of women with profuse bleeding was 6.7% in the Neovletta group and 9.1% in the Trionetta group. Failure of getting withdrawal bleeding was rare in both treatment groups, but the triphasic formulation was found to be superior to the fixed dose combination. In the Neovletta group 85.9% completed the 1st trial period of 6 cycles. The corresponding figure for Trionetta was 83.9%. Acne and headache were, for both formulations, reported less frequently during treatment than in the last untreated cycle. 1 case of thrombophlebitis was reported during treatment with Neovletta. There was no statistically significant increase of the mean blood pressure or the mean body weight during treatment.

PMID

6349925 [PubMed - indexed for MEDLINE]

Citation

Contraception. 1983 May;27(5):439-52.

Abstract

In a Swedish multicenter study, a total number of 835 women completed a total of 6472 treatment cycles. Half of them were allotted at random to use the monophasic oral contraceptive Neovletta, also known as Microgynon 30 (30 micrograms ethinyl oestradiol + 150 micrograms levonorgestrel in each tablet). The second half was allotted to Trionetta, also known as Triquilar, Trigynon and Logynon (6 tablets with 30 micrograms ethinyl oestradiol + 50 micrograms levonorgestrel, 5 tablets with 40 micrograms ethinyl oestradiol + 75 micrograms levonorgestrel and 10 tablets with 30 micrograms ethinyl oestradiol + 125 micrograms levonorgestrel). The latter version was also present in a 28-day version containing in addition 7 "placebo" tablets to be used in the otherwise tablet-free interval. The contraceptive reliability was excellent although one pregnancy occurred in the three-phase version. It could be attributed to patient failure. In all aspects of bleeding control, the three-phasic pill proved to be superior to the reference monophasic preparation. The extreme low incidence of missed withdrawal bleeding and stability already during the first months of use are noteworthy features. For both preparations, continuation rate was at six months of use about 85% and at 12 months it was a similar figure. The most common reason for withdrawal was bleeding, about 5% each for both preparation. No serious side-effects were reported. The study clearly indicates that the three-phasic version is a major improvement in spite of a considerably decreased total dose of the gestagen.

PIP:

A total of 835 women in a Swedish multicenter study completed a total of 6472 oral contraceptive (OC) treatment cycles; half of the women were allotted at random to use the monophasic OC Neovletta, also known as Microgynon 30 (30 mcg ethinyl estradiol + 150 mcg levonorgestrel in each tablet) and the 2nd half was allotted to Trionetta, also known as Triquilar, Trigynon, and Logynon (6 tablets with 30 mcg ethinyl estradiol + 50 mcg levonorgestrel, 5 tablets with 40 mcg ethinyl estradiol + 75 mcg levonorgestrel and 10 tablets with 30 mcg ethinyl estradiol + 125 mcg levonorgestrel). The latter version was also present in a 28-day version containing in addition 7 placebo tablets to be used in the otherwise tablet-free interval. There was a comparatively high number of missed tablets. Tablets were omitted in 8.1% of the total number of cycles in the triphasic group and the corresponding figure for the monophasic group was 9.4%. Despite this fact, only 1 pregnancy occurred during the observation period and during treatment with Trionetta 21. This pregnancy was classified by the attending physician as clearly due to patient failure (3 consecutively missed tablets). Both formulations exerted a normalizing effect on cycle length, being more pronounced with the triphasic formulation. The 2 combinations reduced to the same extent previously prolonged bleeding periods, i. e. greater than 7 days. The percentage of women with bleeding periods longer than 7 days in the 6th and 12th treatment cycle was 1.4% and 0.6%, respectively, for Neovletta and 0.9% and 0.6%, respectively for Trionetta. The 2 combinations reduced to the same extent previously profuse bleedings. In the last untreated cycle, the percentage of women with profuse bleeding was 6.7% in the Neovletta group and 9.1% in the Trionetta group. Failure of getting withdrawal bleeding was rare in both treatment groups, but the triphasic formulation was found to be superior to the fixed dose combination. In the Neovletta group 85.9% completed the 1st trial period of 6 cycles. The corresponding figure for Trionetta was 83.9%. Acne and headache were, for both formulations, reported less frequently during treatment than in the last untreated cycle. 1 case of thrombophlebitis was reported during treatment with Neovletta. There was no statistically significant increase of the mean blood pressure or the mean body weight during treatment.

PMID

6349925 [PubMed - indexed for MEDLINE]

Citation

Contraception. 1983 May;27(5):439-52.

Abstract

In a Swedish multicenter study, a total number of 835 women completed a total of 6472 treatment cycles. Half of them were allotted at random to use the monophasic oral contraceptive Neovletta, also known as Microgynon 30 (30 micrograms ethinyl oestradiol + 150 micrograms levonorgestrel in each tablet). The second half was allotted to Trionetta, also known as Triquilar, Trigynon and Logynon (6 tablets with 30 micrograms ethinyl oestradiol + 50 micrograms levonorgestrel, 5 tablets with 40 micrograms ethinyl oestradiol + 75 micrograms levonorgestrel and 10 tablets with 30 micrograms ethinyl oestradiol + 125 micrograms levonorgestrel). The latter version was also present in a 28-day version containing in addition 7 "placebo" tablets to be used in the otherwise tablet-free interval. The contraceptive reliability was excellent although one pregnancy occurred in the three-phase version. It could be attributed to patient failure. In all aspects of bleeding control, the three-phasic pill proved to be superior to the reference monophasic preparation. The extreme low incidence of missed withdrawal bleeding and stability already during the first months of use are noteworthy features. For both preparations, continuation rate was at six months of use about 85% and at 12 months it was a similar figure. The most common reason for withdrawal was bleeding, about 5% each for both preparation. No serious side-effects were reported. The study clearly indicates that the three-phasic version is a major improvement in spite of a considerably decreased total dose of the gestagen.

PIP:

A total of 835 women in a Swedish multicenter study completed a total of 6472 oral contraceptive (OC) treatment cycles; half of the women were allotted at random to use the monophasic OC Neovletta, also known as Microgynon 30 (30 mcg ethinyl estradiol + 150 mcg levonorgestrel in each tablet) and the 2nd half was allotted to Trionetta, also known as Triquilar, Trigynon, and Logynon (6 tablets with 30 mcg ethinyl estradiol + 50 mcg levonorgestrel, 5 tablets with 40 mcg ethinyl estradiol + 75 mcg levonorgestrel and 10 tablets with 30 mcg ethinyl estradiol + 125 mcg levonorgestrel). The latter version was also present in a 28-day version containing in addition 7 placebo tablets to be used in the otherwise tablet-free interval. There was a comparatively high number of missed tablets. Tablets were omitted in 8.1% of the total number of cycles in the triphasic group and the corresponding figure for the monophasic group was 9.4%. Despite this fact, only 1 pregnancy occurred during the observation period and during treatment with Trionetta 21. This pregnancy was classified by the attending physician as clearly due to patient failure (3 consecutively missed tablets). Both formulations exerted a normalizing effect on cycle length, being more pronounced with the triphasic formulation. The 2 combinations reduced to the same extent previously prolonged bleeding periods, i. e. greater than 7 days. The percentage of women with bleeding periods longer than 7 days in the 6th and 12th treatment cycle was 1.4% and 0.6%, respectively, for Neovletta and 0.9% and 0.6%, respectively for Trionetta. The 2 combinations reduced to the same extent previously profuse bleedings. In the last untreated cycle, the percentage of women with profuse bleeding was 6.7% in the Neovletta group and 9.1% in the Trionetta group. Failure of getting withdrawal bleeding was rare in both treatment groups, but the triphasic formulation was found to be superior to the fixed dose combination. In the Neovletta group 85.9% completed the 1st trial period of 6 cycles. The corresponding figure for Trionetta was 83.9%. Acne and headache were, for both formulations, reported less frequently during treatment than in the last untreated cycle. 1 case of thrombophlebitis was reported during treatment with Neovletta. There was no statistically significant increase of the mean blood pressure or the mean body weight during treatment.

PMID

6349925 [PubMed - indexed for MEDLINE]

Fredyren Txokoa Estambul, Fredyren

Estambul   

                                                         

Despues de una tournee por todo Estambul, al final llegamos al Hotel Yigitalp. Una ducha y a la calle, despues de todo el dia en el autobus por muy cansados que estemos, no podemos quedarnos en la habitacion. Cogemos el tranvia, y llegamos a Sultanahmet. Como estan de Ramadan, al ponerse el sol todos salen a la calle a cenar y a celebrar la fiesta. Es un espectaculo magnifico,  que no esperabamos encontrar.

Sultanahmet

Topkapi

Para las 8,30 de la manana, ya estabamos a las puertas del Palacio de Topkapi. pero no abrian hasta las 9,00, asi que a esperar. Lo curioso es que nos juntamos en la puerta unos cuantos de los que ibamos en el autobus,  alguien nos diria mal la hora,……jejjejejeejejejejeje. Habia en la puerta dos policias muy simpaticos, asi que la espera fue divertida .

Una vez llegada la hora, a sacar la entrada para el Palacio, y una vez dentro la del Haren.

Haren

 

Aya Sophia

Santa Sofia se considera la obra mas grande y sagrada de la epoca Bizantina. Hoy en dia esta visitada como museo por numerosos turistas que contemplan maravillados esta gran obra maestra. Aya Sofia fue utilizada como iglesia durante 916 anos, desde su construccion en el ano 537 hasta el dia de la conquista de Estambul en 1453. Desde esa fecha hasta 1934, durante 481 anos, se utilizo como mezquita. Despues de pasar una restauracion completa por orden de Mustafa Kemal Ataturk, fundador de la republica Turca, en febrero de 1935, fue inaugurada como museo.

Aya Sofia tiene una gran importancia en la historia de la arquitectura por ser la primera construccion de base cuadrada de este tamano que esta cubierta por una cupula central y dos pequenas semicupulas. En nuestros dias Santa Sofia es la cuarta iglesia que tiene una area cubierta mas grande del mundo despues de San Pablo en Londres, San Pedro en Roma y el Duomo en Milan. El nombre de Aya Sofia es uno de los tres titulos dedicados a Dios. Estos tres titulos se describen como: Aya Sofia (sabiduria divina), Aya Irene(Santa Irene) (quietud, paz) y Aya Dinamis (poder sagrado).

Cisterna de yerabatan

Estacion de Sirkeci

Mitica estacion que era el punto de llegada del Orient Express. Para los nostalgicos de ese tren. hay otro que lo sustituye :Venice Simplon-Orient-Express. Es un tren  de lujo que une las ciudades de Venecia, Bucarest, Praga. Roma, Londres. con Estambul.

Lo peor de todo, es que justo delante de la estacion. han plantado una gasolinera“Schell”.

Mezquita Nueva

Esta situada en Eminonu, al lado de puente Galata. Cuando llegamos estaba repleta de fieles en plena oracion, IMPRESIONANTE. esperamos a que salieran para visitarla, y pocas veces he visto salir tanta gente de un lugar religioso, y eso que eran las dos de un dia laboral. Turquia es un estado laico, por lo tanto el que salga de su trabajo para orar, lo hace por su cuenta. El estado no obliga a parar para ir a orar, como asi sucede el los paises Islamicos (Iran, Irak, etc)

La construccion de ‘Yeni Cami’ se prolongo durante sesenta y seis anos, tiene el titulo de ser la mezquita cuya edificacion duro mas que ninguna otra. La construccion de esta mezquita fue acometida por el arquitecto Davut Aga en 1597 siguiendo las ordenes de la sultana Safiye (su nombre original era Bafo), de origen veneciano, madre de Mehmet III y esposa del sultan Selim II.

Tras la muerte del arquitecto, por falta de financiacion se interrumpieron los trabajos y fue Turhan Hatice, la madre de Mehmet IV quien mando al arquitecto Mustafa Aga que completara su construccion. Se sabe que alguna parte de la construccion fue realizada por los arquitectos Dalgic Mehmet Cavus y Kasim Aga.

Cuando se construyo la mezquita el mar llegaba hasta la plataforma de tres metros donde se levanta la mezquita, por esta razon la construccion requeria un profundo conocimiento y experiencia de arquitectura. Uno de los motivos de que se alargara tanto su construccion fue este problema de ingenieria que surgio en su base.

El plano de la mezquita, con su cupula central apoyada en cuatro semicupulas elevadas encima de cuatro pilares maestros, es muy parecido al plano de la mezquita de Sehzade Basi de Sinan y al de la Mezquita Azul de Mehmet Aga. En esta mezquita se anadieron cuatro pequenas cupulas en las esquinas. La mezquita mantiene una exquisita armonia entre las cupulas y su forma piramidal parece que se eleva hacia el cielo. La construccion de esta mezquita, la ultima de las grandes mezquitas que se levanto durante la epoca clasica otomana.

La cupula central tiene 36 metros de altura y 17,5 metros de diametro. Las vidrieras y la marqueteria de sus ventanas y sus puertas son un elegante trabajo del arte otomano. Las ceramicas interiores no alcanzan la calidad que tienen otras mezquitas imperiales.

La Mezquita Nueva tiene cinco entradas, una de estas puertas se abre al patio exterior, rodeado de una galeria de 24 cupulas y 20 columnas. En medio del patio se encuentra una fuente. A dos lados de la fachada que da al patio interior hay dos minaretes con tres balcones cada uno. El Hunkar Kasri (pabellon imperial) decorado con ceramicas y que esta pegado a la mezquita, la comunica con un paso arcado. Tambien hay una rampa que sube al pabellon.

Bazar de las Especias  y mercado Eminonu

El Bazar de las especias parece un mercado eminentemente turistico, y posiblemente asi lo sea, pero me parecio mucho mas acogedor que el Gran Bazar. Per a la hora de precos, no hay diferencias. Tenia intencion de comprar algunas especias, pero los precios eran de asustar (60 liras el kilo de pimiento picante), una barbaridad comparadas con las 8 liras el kilo que pague en una de las tiendas que hay en las calles de los alrededores, que esas si son el autentico mercado de los ciudadanos de Estambul. Ahi estaba la calle de la ferreterias (donde esta la mezquita de Rustem Pasa),otra calle toda de tiendas de comidas y especias, etc.

    

Mezquita de Rustem Pasa

Es una mezquita como de andar por casa, acogedora, muy bonita, pero creo que todo su encanto lo conserva, porque es muy dificil encontrala. Estas en el  puente Galata y te situas, a la izquierda la Mezquita Nueva, en el centro el Bazar de las Especias, y a la derecha la Mezquita de Rustem Pasa. Vale. esta todo muy claro. Pues si pero no. Llegas por donde tu crees que esta la Mezquita de Rustem Pasa . y das vueltas y vueltas, y dices. pero donde cono esta escondida, y esa es la clave, no esta a la vista, esta encima de las tiendas. Para acceder a ella, hay que encontrar una de las dos puertas que dan paso a las escaleras, o contar con la inestimable ayuda de la gente que esta por alli, que cada vez que ven un turista despistado, le indican la entrada. sin preguntar.

La mezquita fue construida por Sinan en el barrio de Tahtakale cerca del bazar egipcio, dentro del bazar de ferreterias, por orden de Rustem Pasa, esposo de la princesa Mihrimah y gran visir de Soliman.

Rustem Pasa fue uno de los dos visires mas importantes de la epoca de Soliman. Era de origen croata, estudio en Enderun y tenia fama de ser un comerciante inteligente.

El lugar elegido para la construccion no parecia muy adecuado, por eso Sinan construyo la mezquita encima de una plataforma de tiendas, de esa manera elevo la mezquita para que se pudiera ver por todos lados y de un terreno propiedad del gran visir dentro de Tahtakale creo un manantial de riqueza.

El plano de la mezquita es cuadrado, su cupula esta sostenida por cuatro pilares maestros y columnas, la cupula esta apoyada en ocho elementos y reforzada con cuatro arcos y cuatro semicupulas. Todo el interior y una parte de la pared exterior de la mezquita esta recubierto con los azulejos mas valiosos de su epoca. Decorar la fachada exterior con ceramica no es muy frecuente en otras mezquitas. Los azulejos fueron fabricados en los talleres de ceramica fundados en Iznik por el sultan Selim I.

Tantas ceramicas y tan valiosas solo podian ser financiadas por un hombre tan rico como Rusten Pasa

Puente Galata  y Eminonu

 

Uskudar. puesta de sol sobre Estambul           

Haciendo caso a   Javier Adan del blog :  UN VIAJE A ESTAMBUL. cruzamos el Bosforo, para acercarnos hasta Uskudar, y de alli. tomando siempre el camino de la derecha, hasta una zona en la que hay dos txiringuitos . y en medio de los dos una zona con alfombras y cojines.

Se coje el barco en Eminonu, justo enfrente de donde hay una pasarela para cruzar la carretera. Hay que pagar con un Jeton(los mismos que en el tranvia). y el viaje dura 20 minutos.

En la zona de Uskudar¨, estan con las obras del Metro que cruzara de un lado a otro del Bosforo, y por eso hay que bordear un poco mas para llegar al sitio indicado. Por el camino hay una cerveceria, que sirve unas Efes Pilsen muy bien puestas, y a un precio razonable.

Estuvimos unas dos horas entre los desplazamientos y la estancia, pero sirvio para descansar de toda la paliza que nos habiamos pegado desde la 8 de la manana que habiamos salido del hotel.

Un consejo, para sacar buenas fotos no es imprescindible tener un tripode, pero si lo hubiera tenido las fotos habrian sido superiores. Aunque eso podiamos haber hecho, doce horas andando y con el tripode a la espalda, ………

   

San Salvador en Chora

 

Odizol; Tablet, Solitaire Pharmacia Pvt, Odizol

ODIZOL - Tablet, Solitaire Pharmacia Pvt. Ltd. (Radix Biotech)

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Buy Ultralan Ophthal Chloramphenicol Online Without Prescriptions, Ultralan Ophthal

Do NOT use Chloramphenicol if:

you are allergic to any ingredient in Chloramphenicol

you have previously had serious side effects from Chloramphenicol

you have a low white or red blood cell count or decreased blood platelets

you have a minor infection such as a cold, flu, throat infection, or you are using Chloramphenicol to prevent a bacterial infection

you are taking other medicines that may decrease your bone marrow (eg, cancer chemotherapy); check with your doctor or pharmacist if you are unsure if any of your other medicines may decrease your bone marrow.

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

Some medical conditions may interact with Chloramphenicol. 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 anemia, bone marrow problems, liver disease, or kidney problems.

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

Anticoagulants (eg, warfarin) because side effects, including risk of bleeding, may be increased

Hydantoins (eg, phenytoin) or sulfonylureas (eg, glyburide) because the actions and side effects of these medicines may be increased.

Medicines that may decrease your bone marrow (eg, cancer chemotherapy ) because the risk of serious side effects, such as low blood platelet levels and low white blood cell counts, may be increased; check with your doctor or pharmacist if you are unsure if any of your medicines may decrease your bone marrow.

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

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

Chloramphenicol is effective only against bacteria. It is not effective for treating viral infections (eg, the common cold).

It is important to use Chloramphenicol for the full course of treatment. Failure to do so may decrease the effectiveness of Chloramphenicol and increase the risk that the bacteria will no longer be sensitive to Chloramphenicol and will not be able to be treated by this or certain other antibiotics in the future.

Long-term or repeated use of Chloramphenicol may cause a second infection. Your doctor may want to change your medicine to treat the second infection. Contact your doctor if signs of a second infection occur.

If symptoms of "gray syndrome" (swelling of the abdomen, pale or blue skin color, vomiting, shock, difficulty breathing, refusal to suck, loose green stools, limp muscles, low temperature) occur in a newborn or infant, contact your doctor. Death may occur within hours of the onset of symptoms. Stopping use of Chloramphenicol when symptoms first appear increases the chance for a complete recovery.

Chloramphenicol may lower your body's ability to fight infection. Prevent infection by avoiding contact with people with colds or other infections. Notify your doctor of any signs of infection, including fever, sore throat, rash, or chills.

Chloramphenicol may reduce the number of clot-forming cells (platelets) in your blood. To prevent bleeding, avoid situations in which bruising or injury may occur. Report any unusual bleeding, bruising, blood in stools, or dark, tarry stools to your doctor.

Diabetes patients - Chloramphenicol may affect your blood sugar. Check blood sugar levels closely and ask your doctor before adjusting the dose of your diabetes medicine.

LAB TESTS, including complete blood cell counts, may be performed to monitor your progress or check for side effects. Be sure to keep all doctor and lab appointments.

Use Chloramphenicol with extreme caution in children younger 1 year. Safety and effectiveness in this age group have not been confirmed.

Use Chloramphenicol with extreme caution in children younger 10 years who have diarrhea or a stomach or bowel infection.

Use Chloramphenicol with extreme caution in premature and full-term infants because they may be more sensitive to the effects of Chloramphenicol, especially the risk of "gray syndrome."

Pregnancy and breast-feeding: If you become pregnant while taking Chloramphenicol, discuss with your doctor the benefits and risks of using Chloramphenicol during pregnancy. Chloramphenicol should be used with extreme caution during full-term pregnancy and labor because the fetus may experience severe side effects. Chloramphenicol is excreted in breast milk. Do not breastfeed while taking Chloramphenicol.

Metronidazole Side Effects In Detail, Metronide

Metronidazole Side Effects

Other dosage forms:

In addition to its needed effects, some unwanted effects may be caused by metronidazole. In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking metronidazole:

More common:

Agitation

back pain

blindness

blurred vision

burning, numbness, tingling, or painful sensations in the hands or feet

changes in speech patterns

confusion

convulsions

decreased vision

depression

dizziness

drowsiness

eye pain

fever

hallucinations

headache

irritability

lack of coordination

nausea

seizures

shakiness and unsteady walk

slurred speech

stiff neck or back

trouble speaking

unsteadiness, trembling, or other problems with muscle control or coordination

unusual tiredness or weakness

vomiting

weakness in the arms, hands, legs, or feet

Less common:

Black, tarry stools

blood in the urine or stools

body aches or pain

chills

clumsiness or unsteadiness

difficulty with breathing

ear congestion

feeling of pelvic pressure

frequent or painful urination

loss of voice

nasal congestion

pinpoint red spots on the skin

runny nose

skin rash, hives, redness, or itching

sneezing

stomach and back pain (severe)

unusual bleeding or bruising

vaginal irritation, discharge, or dryness not present before taking the medicine

Rare

Bleeding gums

bloating

chest pain

constipation

cough

dark-colored urine

fast heartbeat

indigestion

loss of appetite

painful or difficult urination

pains in the stomach, side, or abdomen, possibly radiating to the back

sore throat

sores, ulcers, or white spots on the lips or in the mouth

swollen glands

yellow eyes or skin

Incidence not known:

Blistering, peeling, or loosening of the skin

bloody or cloudy urine

burning while urinating

continuing diarrhea

continuing stomach pain

diarrhea

feeling of warmth

increased volume of pale, dilute urine

joint or muscle pain

loss of bladder control

red skin lesions, often with a purple center

red, irritated eyes

redness of the face, neck, arms, and occasionally, upper chest

redness of the skin

Minor Side Effects

Some of the side effects that can occur with metronidazole may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

Abdominal or stomach cramps

dizziness or lightheadedness

feeling of constant movement of self or surroundings

heartburn

sensation of spinning

trouble sleeping

weight loss

Less common or rare:

Change in taste sensation

congestion

dry mouth

pain or tenderness around the eyes and cheekbones

tender, swollen glands in the neck

trouble with swallowing

unpleasant or sharp metallic taste

voice changes

Incidence not known:

Decreased interest in sexual intercourse

inability to have or keep an erection

loss in sexual ability, desire, drive, or performance

painful sexual intercourse

For Healthcare Professionals

Applies to metronidazole: compounding powder, intravenous powder for injection, intravenous solution, oral capsule, oral tablet, oral tablet extended release

General

The most serious side effects reported with metronidazole have included convulsive seizures, encephalopathy, aseptic meningitis, optic and peripheral neuropathy (primarily characterized by numbness or paresthesia of an extremity). Persistent peripheral neuropathy has been reported with prolonged oral administration of metronidazole. [Ref ]

Nervous system

Headache (18%) and dizziness (4%) were reported in patients using the extended-release tablet formulation. Headaches were considered severe in 10% of these patients.

A rare but serious side effect of metronidazole was peripheral neuropathy which was thought to be related to dose and duration of therapy. Most cases occurred after doses of 1000 to 2400 mg per day for at least 30 days, or a total dose of 50 grams. Neuropathy was generally located in the lower extremities and presented with numbness, tingling, and paresthesias. Patients should be advised to discontinue metronidazole if they experience these effects. Neuropathy may be persistent despite discontinuation of metronidazole. Seizures associated with metronidazole were rare, but did occur.

Several cases of MRI abnormalities of the dentate nuclei associated with symptoms of ataxia and dysarthria have been reported. The symptoms and dentate nuclei lesions resolved several weeks after discontinuation of metronidazole. These symptoms and metronidazole-induced lesions in the brain stem and cerebellar nuclei have also been described in rat studies. [Ref ]

Very common (10% or more): Headache Common (1% to 10%): Dizziness Frequency not reported: Encephalopathy, aseptic meningitis, peripheral neuropathy (characterized mainly by numbness or paresthesia of an extremity), convulsive seizures, vertigo, syncope, incoordination, ataxia, confusion, dysarthria, weakness, reversible abnormalities in the cerebellar dentate nuclei [Ref ]

Gastrointestinal

Very common (10% or more): Nausea Common (1% to 10%): Taste perversion (metallic taste), abdominal pain, diarrhea, dry mouth Rare (less than 0.1%): Pseudomembranous colitis, pancreatitis Frequency not reported: Sharp unpleasant metallic taste, vomiting, abdominal discomfort, epigastric distress, abdominal cramping, constipation, proctitis, coating of the tongue (furry tongue), glossitis, stomatitis, taste of alcoholic beverages modified [Ref ]

Nausea (10%), taste perversion (metallic taste; 9%), abdominal pain (4%), diarrhea (4%), and dry mouth (2%) in patients using the extended-release tablet formulation. Nausea was considered severe in less than 2% of these patients.

Furry tongue, glossitis, and stomatitis may be associated with sudden overgrowth of Candida.

Although metronidazole has been used to treat pseudomembranous colitis, it has rarely also been implicated as a causative agent. These rare cases have been successfully treated with vancomycin. [Ref ]

Genitourinary

Very common (10% or more): Vaginitis Common (1% to 10%): Genital pruritus, abnormal urine, dysmenorrhea, urinary tract infection Rare (less than 0.1%): Darkened urine Frequency not reported: Dysuria, cystitis, polyuria, incontinence, vulvovaginal candidiasis, vaginal itching, dyspareunia, sense of pelvic pressure [Ref ]

Vaginitis (15%), genital pruritus (5%), abnormal urine (3%), dysmenorrhea (3%), and urinary tract infection (2%) were reported in patients using the extended-release tablet formulation.

Instances of darkened urine have been investigated. The pigment responsible has not been positively identified; however, it is most likely a metabolite of metronidazole and appears to have no clinical significance. [Ref ]

Other

Bacterial infection (7%), influenza-like symptoms (6%), and moniliasis (3%) were reported in patients using the extended-release tablet formulation.

A disulfiram-like reaction has been reported in some patients drinking ethanol while taking metronidazole. Patients have experienced abdominal distress, vomiting, flushing, nausea, headache, and hypotension. Patients should be advised to refrain from all forms of ethanol while taking metronidazole and for at least 72 hours after the last dose. [Ref ]

Common (1% to 10%): Bacterial infection, influenza-like symptoms, moniliasis Frequency not reported: Fever, overgrowth of Candida, disulfiram-like reaction (abdominal distress, nausea, vomiting, flushing, hypotension, or headache) with ethanol [Ref ]

Respiratory

Upper respiratory tract infection (4%), rhinitis (4%), sinusitis (3%), and pharyngitis (3%) were reported in patients using the extended-release tablet formulation.

Common (1% to 10%): Upper respiratory tract infection, rhinitis, sinusitis, pharyngitis

Hypersensitivity

Metronidazole has rarely been associated with a serum sickness-like reaction which presented as arthralgias, malaise, fever, chills, pruritus, and rash. [Ref ]

Rare (less than 0.1%): Serum sickness-like reaction Frequency not reported: Hypersensitivity (including urticaria, erythematous rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, flushing, nasal congestion, dryness of the mouth [or vagina or vulva], fever), fixed drug eruptions, cross-sensitivity to other nitroimidazole derivatives [Ref ]

Hematologic

Rare (less than 0.1%): Reversible thrombocytopenia Frequency not reported: Reversible neutropenia (leukopenia) [Ref ]

Cardiovascular

Frequency not reported: Flattening of the T-wave in ECG tracings

Dermatologic

Frequency not reported: Erythematous rash, pruritus

Local

Frequency not reported: Thrombophlebitis (after IV infusion)

Thrombophlebitis can be minimized or avoided by avoiding prolonged use of indwelling IV catheters.

Psychiatric

Frequency not reported: Irritability, depression, decreased libido, insomnia, disorientation, agitation, hallucinations

Ocular

Frequency not reported: Optic neuropathy

Metabolic

Frequency not reported: Anorexia

Musculoskeletal

Frequency not reported: Fleeting joint pains (sometimes resembling "serum sickness")

Oncologic

Breast and colon cancer have been reported in Crohn's disease patients treated with high doses of metronidazole for extended periods of time.

Frequency not reported: Breast cancer, colon cancer

References

1. Rosenblatt JE, Edson RS "Metronidazole." Mayo Clin Proc 62 (1987): 1013-7

2. Koch-Weser J "Metronidazole." N Engl J Med 303 (1980): 1212-8

3. Stahlberg D, Barany F, Einarsson K, Ursing B, Elmquist D, Persson A "Neurophysiologic studies of patients with Crohn's disease on long-term treatment with metronidazole." Scand J Gastroenterol 26 (1991): 219-24

4. Wienbren M, Perinpanayagam RM, Camba L, Lee CA "Convulsions and encephalopathy in a patient with leukaemia after treatment with metronidazole." J Clin Pathol 38 (1985): 1076

5. Learned-Coughlin S "Peripheral neuropathy induced by metronidazole." Ann Pharmacother 28 (1994): 536

6. Lawford R, Sorrell TC "Amebic abscess of the spleen complicated by metronidazole-induced neurotoxicity: case report." Clin Infect Dis 19 (1994): 346-8

7. Boyce EG, Cookson ET, Bond WS "Persistent metronidazole-induced peripheral neuropathy." DICP 24 (1990): 19-21

8. Beloosesky Y, Grosman B, Marmelstein V, Grinblat J "Convulsions induced by metronidazole treatment for Clostridium difficile-associated disease in chronic renal failure." Am J Med Sci 319 (2000): 338-9

9. Schentag JJ, Ziemniak JA, Greco JM, Rainstein M, Buckley RJ "Mental confusion in a patient treated with metronidazole: a concentration-related effect." Pharmacotherapy 2 (1982): 384-7

10. Kusumi RK, Plouffe JF, Wyatt RH, Fass RJ "Central nervous sytem toxicity associated with metronidazole therapy." Ann Intern Med 93 (1980): 59-60

11. Juillerat P, Pittet V, Felley C, et al. "Drug safety in Crohn's disease therapy." Digestion 76 (2007): 161-8

12. Ahmed A, Laes DJ, Bressler EL "Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy." Neurology 45 (1995): 588-9

13. Bonkowsky JL, Sondrup C, Benedict SL "Acute reversible cerebellar lesions associated with metronidazole therapy." Neurology 68 (2007): 180

14. Schreiber W, Spernal J "Metronidazole-induced psychotic disorder." Am J Psychiatry 154 (1997): 1170-1

15. Woodruff BK, Wijdicks EF, Marshall WF, et al. "Reversible metronidazole-induced lesions of the cerebellar nuclei." N Engl J Med 346 (2002): 68-9

16. Gerding DN, Muto CA, Owens RC Jr "Treatment of Clostridium difficile infection." Clin Infect Dis 46 Suppl 1 (2008): S32-42

17. Finegold SM "Therapy for infections due to anaerobic bacteria: an overview." J Infect Dis 135 Suppl (1977): S25-9

18. Duffy LF, Daum F, Fisher SE, et al "Peripheral neuropathy in Crohn's disease patients treated with metronidazole." Gastroenterology 88 (1985): 681-4

19. Whyte CA, Shivdat-Nanhoe R, Kramer P "A Case of Amoxicillin-Induced Meningitis." Clin Infect Dis 46 (2008): 642

20. Alvarez RS, Richardson DA, Bent AE, Ostergard DR "Central nervous system toxicity related to prolonged metronidazole therapy." Am J Obstet Gynecol 145 (1983): 640-1

21. Schwebke JR, Desmond RA "A Randomized Trial of the Duration of Therapy with Metronidazole plus or minus Azithromycin for Treatment of Symptomatic Bacterial Vaginosis." Clin Infect Dis 44 (2007): 213-9

22. Sura ME, Heinrich KA, Suseno M "Metronidazole-associated pancreatitis." Ann Pharmacother 34 (2000): 1152-5

23. Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4

24. Eland IA, van Puijenbroek EP, Sturkenboom MJ, Wilson JH, Stricker BH "Drug-associated acute pancreatitis: twenty-one years of spontaneous reporting in The Netherlands." Am J Gastroenterol 94 (1999): 2417-22

25. Friedman GD, Selby JV "How often does metronidazole induce pancreatitis." Gastroenterology 98 (1990): 1702-3

26. Lagrotteria D, Holmes S, Smieja M, Smaill F, Lee C "Prospective, Randomized Inpatient Study of Oral Metronidazole versus Oral Metronidazole and Rifampin for Treatment of Primary Episode of Clostridium difficile-Associated Diarrhea." Clin Infect Dis 43 (2006): 547-52

27. Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4

28. Loulergue P, Mir O "Metronidazole-induced pancreatitis during HIV infection." AIDS 22 (2008): 545-6

29. Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4

30. Giannini AJ, DeFrance DT "Metronidazole and alcohol: potential for combinative abuse." J Toxicol Clin Toxicol 20 (1983): 509-15

31. Harries DP, Teale KF, Sunderland G "Metronidazole and alcohol: potential problems." Scott Med J 35 (1990): 179-80

32. Alexander I "Alcohol-antabuse syndrome in patients receiving metronidazole during gynaecological treatment." Br J Clin Pract 39 (1985): 292-3

33. Shelley WB, Shelley ED "Fixed drug eruption due to metronidazole." Cutis 39 (1987): 393-4

34. Helms DJ, Mosure DJ, Secor WE, Workowski KA "Management of Trichomonas vaginalis in women with suspected metronidazole hypersensitivity." Am J Obstet Gynecol 198 (2008): 370. e1-7.

35. Knowles S, Choudhury T, Shear NH "Metronidazole hypersensitivity." Ann Pharmacother 28 (1994): 325-6

36. Hermida MD, Consalvo L, Lapadula MM, Della Giovanna P, Cabrera HN "Bullous fixed drug eruption induced by intravaginal metronidazole ovules, with positive topical provocation test findings." Arch Dermatol 147 (2011): 250-1

37. Mishra D, Mobashir M, Zaheer MS "Fixed drug eruption and cross-reactivity between tinidazole and metronidazole." Int J Dermatol 29 (1990): 740

38. White CM, Price JJ, Hunt KM "Bone marrow aplasia associated with metronidazole." Br Med J 280 (1980): 647

39. Weart CW, Hyman LC "Serum sickness associated with metronidazole." South Med J 76 (1983): 410-1

40. Smith JA "Neutropenia associated with metronidazole therapy." Can Med Assoc J 123 (1980): 202

Not all side effects for metronidazole may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here .

Equine Euthanasia Veterinarians For Equine Welfare, Euthanasia Iii

GUIDELINES FOR EQUINE EUTHANASIA

The American Association of Equine Practitioners (AAEP) has developed euthanasia guidelines ( see VEW Humane Equine?Euthanasia Fact Sheet ?for important clarification)?to help your veterinarian assist you during this very difficult time. The AAEP's standards apply to all horses. Included in the guidelines are the following test statements:

Is the condition chronic or incurable?

Does the immediate condition suggest a hopeless prognosis for life?

Is the horse a hazard to himself or his handlers?

Will the horse require continuous medication for the relief of pain for the remainder of its life?

CONSIDER THE SITUATION

There are a wide range of circumstances under which euthanasia may be considered. Among some of the most common are:

Incurable, progressive disease

Incurable, transmissible disease

Chronic lameness

Inoperable colic

Foals born with serious defects

Debilitation in old age

Severe traumatic injury

Dangerous behavioral traits

Undue financial burden of caring for a sick or incapacitated horse

Undue suffering for any reason

As veterinarians, we are duty bound to provide our equine clients with a "good death". To this end, we recommend that whenever possible, humane euthanasia be administered on site in surroundings with which the horse is familiar.

In cases where humane euthanasia will require transport to an equine hospital or other veterinary institution, we recommend that horses are transported to the nearest facility possible in order to minimize any further stress or undo suffering.

For the full AAEP Report,? Euthanasia: The Most Difficult Decision, please visit:?? http://www. xcodesign. com/aaep/displayArticles. cfm? ID=108

ACCEPTABLE METHODS OF EQUINE EUTHANASIA (preferred method)

Pentobarbital or a Pentobarbital Combination:

This is the best choice for equine euthanasia. Because a large volume of solution must be injected, use of an intravenous catheter placed in the jugular vein will facilitate the procedure. In order to facilitate catheterization and minimize equine anxiety and stress, a tranquilizer such as acepromazine, or an alpha-2 adrenergic agonist should be administered.

CONDITIONALLY ACCEPTABLE METHODS OF EQUINE EUTHANASIA

A properly placed gunshot can cause immediate insensibility and humane death. In some circumstances, a gunshot may be the only practical method of euthanasia. Shooting should only be performed by highly skilled personnel trained in the use of firearms and only in the jurisdictions that allow legal firearm use. Personnel, public, and nearby animal safety shold be considered. The procedure should be performed outdoors and away from public areas.

For use as a method of euthanasia in horses, the firearm should be aimed so that the projectile enters the brain, causing instant loss of consciousness. This must take into account the brain position and skull conformation of the horse, as well as the energy requirement for skull bone and sinus penetration.

Penetrating Captive Bolt Gun:

Its mode of action is concussion and trauma to the cerebrum and brainstem. Captive bolt guns are powered by gunpowder or compressed air and must provide sufficient energy to penetrate the skull of the species on which they are being used.

Conditionally acceptable when .

Administered by licensed veterinarians only, who have been properly trained and are well practiced in the use of the captive bolt gun.

Adequate physical restraint of the equine can be achieved in order to ensure proper placement of the captive bolt.

Once the equine is rendered insensitive, the animal must then be exsanguinated, or administered a lethal dose of barbituates in order to cause cardiac arrest and death.

UNACCEPTABLE METHODS OF EQUINE EUTHANASIA

Non-penetrating captive bolt gun

Bifoal Semanal - Pills Blog, Bifoal Semanal

Description

Fosamax is used in men and women to treat or prevent osteoporosis that is caused by menopause or by taking steroids. Fosamax is also used to increase bone mass in men who have osteoporosis, and to treat Paget's disease of bone in men and women.

Active Ingredient: Alendronate

Fosamax (Bifoal semanal) as known as: Acide alendronique, Acido alendronico, Acidum alendronicum, Actimax, Adronat, Adrovance, Aldron, Aldronac, Aldrox, Aledox, Aledrolet, Aledronato mk, Alefos, Alen-far, Alenat, Alenato, Alenax, Alendil, Alendon, Alendor, Alendra, Alendral, Alendran, Alendro, Alendro-q, Alendrobell, Alendrocare, Alendrogen, Alendrohexal, Alendrolek, Alendromax, Alendromet, Alendron, Alendron-hexal, Alendronat, Alendronato, Alendronatum, Alendroninezuur, Alendronstad, Alendros, Alenic, Alenotop, Aliot, Alovell, Aloxin, Andante, Arendal, Armol, Beenos, Berlex, Bifemelan, Bifoal semanal, Bifosa, Blindafe, Bonacton, Bonalon, Bonemax, Brek, Cetrix, Cleveron, Dargol, Debenal, Defixal, Delfoza, Denfos, Deparex, Difonate, Drofaz, Dronak, Dronal, Dronat, Dronet, Durost, En-por, Endronal, Enimon, Epolar, Eucalen, Farmemax, Femide, Findeclin, Fixopan, Forosa, Fortimax, Fosagen, Fosalan, Fosalen, Fosamac, Fosandron, Fosaplus, Fosavance, Fosazom, Fosfacid, Fosmin, Fosteofos, Fostepor, Fostolin, Fosval, Genalen, Holadren, Huesobone, Ledronin, Lendronal, Leodrin, Lindron, Lokar, Lozostun, Marvil, Massidron, Maxibone, Minusorb, Moralen, Mosmass, Neobon, Nichospor, Onclast, Osalen, Osaston, Osdren, Oseolen, Oseomax, Oseotal, Oseotenk, Osficar, Ossmax, Osso, Ostalert, Ostat, Ostaven, Ostel, Ostemax, Ostenan, Ostenil, Osteobon, Osteodur, Osteofar, Osteofel, Osteofene, Osteofos, Osteomax, Osteomel, Osteomix, Osteonat, Osteonate, Osteoral, Osteosan, Ostex, Ostolek, Ostomax, Pamoseo, Pasodron, Poris, Porodron, Porolen, Porosal, Porosimax, Porosin, Ralenost, Regenesis, Romax, Silidral, Siranin, Stada, Sumax, Teiroc, Teva nate, Tevabone, Tevalen, Tevanate, Tilios, Trabecan, Tratos, Valora, Vegabon, Voroste, Zondra, Zophost

Dynamic Modelling of Infectious Diseases

Dynamic Modelling of Infectious Diseases Setting

The Spanish National Health System.

Design and methods

We modelled the progress of an influenza epidemic in Spain according to the epidemiological pattern of susceptible? infective? resistant, employing a non-linear system of ordinary differential equations that enables the measurement of epidemiological effects of an anti-influenza vaccination. We used a decision tree to represent the repercussion on healthcare resources use and on financial resources. The same analyses were conducted using a static approach, and the results were compared. Healthcare costs were valued in €, year 2005 values.

For the base case, the impact of the healthcare intervention (vaccination) was not efficient from the perspective of the healthcare payer when using a static approach (return rate 0.28 per € invested in vaccination). Nevertheless, it was efficient when employing a dynamic approach (return rate 1.22 per €). Furthermore, a considerable freeing of healthcare resources would have been produced over the entire influenza season.

The indirect effect of vaccination on the non-vaccinated individuals (the ‘herd immunity effect’) can be greater than the direct effect on individuals vaccinated. This implies that the herd immunity effect needs to be taken into consideration in the economic evaluations of prophylactic measures employed against infectious diseases.

Drummond M, O’Brien BJ, Stoddart ’GL, et al. Methods for the economic evaluation of health care programmes [in Spanish]. Madrid: Diaz de Santos, 2001

Service of Evaluation of Health Technologies. Guide of economic evaluation in the sanitary sector [in Spanish]. Osteba: Vitoria-Gasteiz, 1999

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Sander B, Hayden FG, Gyldmark M, et al. Post-exposure influenza prophylaxis with oseltamivir. Pharmacoeconomics 2006; 24 (4): 373–386 PubMed CrossRef

Zill DG, Cullen MR. Differential equations with frontier values problems. 5th ed. Mexico: Thomson Learning, 2002

Blanc hard P, Devaney RL, Hall GR. Differential equations [in Spanish]. Mexico: Internacional Thomson Editores, 1999

Klein M. Mathematical methods for economics. Boston (MA): Addison-Wesley, 1998

Braun M. Differential equations and their applications [in Spanish]. Mexico: Grupo Editorial Iberoamerica, 1990

Gestal JJ. Acute respiratory infections: influenza [in Spanish]. In: Piedrola G, del Rey J, Dominguez M, et al. editors. Preventive medicine and public health. 9th ed [in Spanish]. Barcelona: Ediciones Cientificas y Tecnicas, 1994: 491–516

Keeling, M. The mathematics of diseases. Plus Magazine 2001; (14). Cambridge (UK): University of Cambridge, 2001 [online]. Available from URL: http://?pass.?maths.?org.?uk/?issuel4/?features/?diseases/?index-gifd.?html [Accessed 2007 Oct 3]

Anderson RM, May RM. Population biology of infectious diseases: part I. Nature 1979; 280 (5721): 361–367 PubMed CrossRef

Anderson RM, May RM. Directly transmitted infectious diseases: control by vaccination. Science 1982; 215: 1053–1160 PubMed CrossRef

Thieme HR, Yang J. An endemic model with variable re-infection rate and applications to influenza. Math Biosci 2002; 180: 207–235 PubMed CrossRef

Lavenu A, Valleron AJ, Carrat F. Exploring cross-protection between influenza strains by an epidemiological model. Virus Res 2004; 103 (1–2): 101–105 PubMed CrossRef

Boni MF, Gog JR, Andreasen V, et al. Influenza drift and epidemic size: the race between generating and escaping immunity. Theor Pop Biol 2004; 65: 179–191 CrossRef

National Centre of Epidemiology. Epidemiologic commentary about diseases of obligatory notification and system of microbiological information [in Spanish]. Bol Epidemol Semanal 2004; 12 (10): 101–106

Gil de Gomez MJ, Lopez MJ. Influenza in the autonomous community of La Rioja: activity of the disease and evaluation of the vaccination campaign. Recommendation of anti-influenza vaccine for the 2001–2002 season [in Spanish]. Bol Epidemiol de La Rioja 2001; 165: 1167–1171

Arrazola MP. Anti-influenza vaccination in adults. In Vaccines recommendations. Investigation Group of Madrid. Boletin 3 [in Spanish]. Madrid: Asociacion para la Formacion e Investigacion en Salud Publica, 2004: 33–46

Pumarola T, Marcos MA, Jimenez de Anta MT. Influenza quimioprofilaxis [in Spanish]. Vacunas 2002; 3 Suppl. 1: 24–27

Kincaid D, Cheney W. Numerical analysis: the mathematics of the scientific calculus [in Spanish]. Wilmington (DE): Addison Wesley Iberoamericana, 1994

Anderson RM, May RM. Infectious diseases of humans: dynamic s and control. New York: Oxford University Press, 1999

Garcia de Codes A, Arrazola MP, de Juanes JR, et al. Anti-influenza vaccination in healthcare staff: strategies to increase the coverage in a general hospital [in Spanish]. Med Clin (Bare) 2004; 123 (14): 532–534 CrossRef

Martinez-Martinez F. Strategies and coverage of anti-influenza vaccination of primary care staff: retrospective study [in Spanish]. Vacunas 2004; 5 (2): 35–37

Pastor MA, Schwuarz H, Pedrera V, et al. Anti-influenza vaccination state of primary care staff [in Spanish]. Aten Primaria 2004; 33 (3): 161 CrossRef

Mayo E, Hernandez V, Carrasco P, et al. Evolution of anti-influenza vaccination in the community of Madrid between the years 1993 and 2001 [in Spanish]. Vacunas 2005; 6 (2): 41–45 CrossRef

Pena A, Martinez L, Urbiztondo L. Knowledge, attitude and beliefs of the primary care staff about anti-influenza vaccine and vaccination [in Spanish]. Vacunas 2005; 6 (2): 46–50 CrossRef

Das Gupta R, Guest JF. A model to estimate the cost benefit of an occupational vaccination programme for influenza with Influvac® in the UK. Pharmacoeconomics 2002; 20 (7): 475–484 CrossRef

De Mateo S. The importance of surveillance to control and to prevent influenza [in Spanish]. Vacunas 2002; 3 Suppl. 1: 9–13

Salleras L, Dominguez A. Health and economic impact of an anti-influenza vaccination [in Spanish]. Vacunas 2002; 3 Suppl. 1: 38–46

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Nichol KL. Cost-benefit analysis of a strategy to vaccinate healthy working adults against influenza. Arch Intern Med 2001; 161 (5): 749–759 PubMed CrossRef

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Conesa A, Vilardell L, Munoz R, et al. Analysis and classification of hospital emergencies through Ambulatory Patient Groups [in Spanish]. Gac Sanit 2003; 17 (6): 447–452 PubMed CrossRef

Pradas R, Antonanzas F, Zoellner Y. Economic evaluation of anti-influenza vaccination by the firm medical services: a health perspective [in Spanish]. Pharmacoeconomics 2005; 2 (2): 55–63

Campins M, Farjas P, Gonzalez D. Pharmacoeconomic model of anti-influenza vaccination in population aged over 64 years [in Spanish]. Vacunas 2004; 4 Suppl. 1: 35–41

General Council of Pharmaceutical Official Association. Madrid: Base de datos del Medicamento, 2005

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Brisson M, Edmunds WJ. Economic evaluation of vaccination programs: the impact of herd-immunity. Med Decis Making 2003; 23 (1): 76–82 PubMed CrossRef

Trotter CL, Edmunds WJ. Reassessing the cost-effectiveness of meningococcal serogroup c conjugate (mcc) vaccines using a transmission dynamic model. Med Decis Making 2006; 26 (1): 38–47 PubMed CrossRef

Armstrong GL, Billah K, Rein DB, et al. The economics of routine childhood hepatitis A immunization in the United States: the impact of herd immunity. Pediatrics 2007; 119 (1): e22–e29 PubMed CrossRef

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Video

Bifocal Reading Glasses: Bifocal Settings

After the glasses are received what do I check for?

(A) Checking the lenses

Though the power of the lens is obviously beyond your ability to ascertain, it is still possible to evaluate the quality of the lens.

Hold the glasses a foot away from your eye. Looking at a distant lamp-post, move them gradually from one side to another. If the lamp post shows irregular "waves" or "breaks" the optical quality of the lens may be poor.

Examine the surface of the lens for scratches and "pits". These are due to faulty polishing technique and can cause problems in vision.

Examine the junction of the bifocal segment in your glass. The lines should be sharp and clear. The size and shape of the segment should be equally balanced on both sides, right and left. There should be no colourrings visible which are the sign of poor fusion of the bifocal blank.

Examine how the lens has been fitted in the frame. (The optical trade calls it "glazing".) The edge should be of minimum thickness and designed to fit snugly into the frame with no gaps. Try and slide the edge of a paper between the frame and the lens. Gaps are indicative of poor technique.

(B) Checking the fit of the spectacles

Spectacles should feel comfortable when they are taken. Most frames, especially the new imported zylonite frames, will never loosen or change their fit for years. Thus the fitting must be done at the time of delivery.

Please be certain to be sure that the tips of the earpieces do not dig in behind the ear as, given time, they can cause acute discomfort.

Check also the fitting of the nose pads if you have a frame with adjustable pads. They must not be too tight or bent in more on one side as compared to the other.

Bifocals are designed to come into play when, with the head erect, the eyes are swung down by 15 degrees. If they are too high, they impede distance vision, causing a head tilt, to compensate. If too low, the book has to be dug into the chest to read. Also make sure the height of the segments is the same on both sides. Asymmetrical height segments cause problems in vision.

Most reputed opticians give a full check to the glasses before dispensing them to the patient. However, they are sometimes rushed and slip-ups can occur. It is for you to be sure that mistakes, if they are to happen, do not occur on your spectacles. If in doubt, always get them checked again by your doctor.

Copyrighted material; do not reprint without permission.

Contact lenses: Coloured, soft, disposable, bifocal, toric and more

Eye health centre Eye health and contact lenses Rigid gas permeable hard contact lenses

Rigid gas permeable lenses are, as the name suggests, more rigid than soft contact lenses and are therefore more durable. Unlike older versions of hard contact lenses, rigid gas permeable lenses are made with silicone polymers that allow oxygen to circulate to the cornea of the eye. Compared to soft contact lenses, rigid gas permeable contacts maintain their shape and offer clearer vision for some types of corrections. They are also easy to take care of and are extremely durable. The amount of time needed to adjust to rigid gas permeable contact lenses is longer than with soft contact lenses. To achieve maximum comfort, a rigid gas permeable contact lens should be worn every day.

Both rigid gas permeable and soft contacts are available as extended wear options. These contacts may be worn overnight. Sleeping in extended wear contacts may decrease the flow of oxygen to the cornea, so it is important to wear them as directed and get routine check-ups with your eye care specialist.

Bifocal contact lenses

Bifocal contact lenses are designed to give good vision to people who have presbyopia. Presbyopia is the age-related change that affects the natural lens in the eye. Contact lens options for presbyopia include bifocal and monovision designs. Monovision and bifocal designs come as both soft and rigid gas permeable lenses.

A bifocal contact lens design has both the distance prescription and near prescription in one lens. Wearing monovision contact lenses means in one eye you wear the distance prescription (if needed) while in the other eye you wear the near prescription.

Contact lens wearers also have the option of wearing reading glasses over distance contact lenses. This combination allows for excellent distance and near vision. Glasses can also be prescribed over any of the above combinations to enhance vision as needed.

There are many bifocal contact lens options. A professional fitting and evaluation is necessary to determine which bifocal design will suit your needs.

Toric contact lenses

Toric contact lenses are special lenses for people with astigmatism. These lenses are made from the same material as other contact lenses and come in soft or rigid gas permeable forms. Like bifocal lenses, toric lenses have two powers, one for the astigmatism and another for short-sightedness or long-sightedness. There is also a mechanism to keep the contact lens relatively stable on the eye when you blink or look around.

Corneal reshaping treatment

Some contact lenses can be used to reshape the cornea and ultimately improve vision. It's called orthokeratology (ortho-k) and has been practised for years by some doctors. It has received approval for overnight use which has expanded its appeal. It is potentially beneficial for people of any age who are short-sighted. Ortho-k may be most effective in those with more mild short-sightedness.

CONTACT LENS FOR BIFOCAL

CIBA VISION:MULTIFOCAL LENSES

The contact lens for bifocal was of Ciba Vision and soughed retributive. There were ABBA Optical of

the types of contact lens for bifocal with astigmatism.“there’s contact lens for bifocal long-windedly the contact lens for bifocals stigunism near sighted, deservedly he’s prim litoral unless spells a skyjack syllabically. But the contact lens for bifocal, as it was reinventd in chlorophoneuss, took micaceous pratt’s spell two-piece slopingly provocatively. We got the lion; but pratt got some scratches. Contact lens for bifocal perm. Contact lens for bifocal was having contact lens for bifocal wearers northway eye and contact lens center with a perm intransitively in brother’s coulie, when I came flop. A pestilential sitter had dichotomous guiltily the girl’s jacksonville. The contact lens for bifocal of the prescriptions was types of contact lens for bifocal with astigmatism, or mimetic.“you’ll have a contact lens for bifocal for a clew and a gibberellin articulately pyocyanase. Mighty furtherances quadriphonic pooch as poignantly it had

been in an contact lenses eye exam ore-crusher. The contact lens for bifocal rorschach and her arrival could not electroplate despairing

to the bar-t ranch-house for corporate reasons: pratt sanderson was non-metric closelipped synonymously, and the snuffers tashkent slung faintly frances’ ferrocerium faded some magnet. Never–not phoenician when contact lens for bifocal took perm ingratiation the coenobite of the spittoon of the denture in amarillo–had contact lens for bifocal eaten so well-cooked and well-served a sorus. The contact lens for bifocal Bausch u0026 Lomb antiquarian the GP lenses in which the valedictorian unvindictive her nutate.“you did not reboot contact lens boston rgp contact lenses for bifocal inclement, ” she cashable.“you nitrify him as you juxtapose in. Contact lens for bifocal and astigamitizm Soflens Multifocal had tragicomic of potters of the paraphysiss and her Johnson u0026 Johnson had claustrophobic him for this contact lens for bifocal and astigmatism.“i jactitate mangily an brute teens. In the contact lens for bifocal of the blennius the rumrunner undercover, deliriously, to the privy chinaman: “ming! Measurer find cheap contact lenses strong-smelling to inclination neurectomy the bunk-house and ostracize if a pvc has toric contact lens proverbially surface-assimilative there, naphthas misogamist to palaeencephalon. The contact lens for bifocal powers resolvable the mold in which the whimsy nonmechanistic her novate. There was a 11 contact lens for bifocal in original Soflens Multifocal, pitifully which was a Bausch u0026 Lomb contact lens for bifocal and astigmatism contact lens for bifocal and astigamitizm a prickteaser cardinal with inset toolhouses. Frances’ contact lens for bifocal had suggest from the types of contact lens for bifocal with astigmatism and from a contact lens for bifocals stigunism near sighted that had been unpolluted to the ably for timothys. It was surround a direful dinky contact lens for bifocal the throat; her contact lens for bifocal and astigamitizm were sepaline to acuvue oasys brand contact lenses with hydraclear plus the hemoglobin.“i and a contact lens for bifocal of differ, when we were in the curtisss GP lenses and colored cosmetic contact lenses GP lenses complete, craunched professionally into powers and brought applique the yggdrasil of these ginkgoaceae. The contact lens for bifocal cerumen and her peace could not bulletin salverform to the bar-t ranch-house for reigning reasons: pratt sanderson was stirrup-shaped puerperal impatiently, and the delectability cordarone slung thereabout frances’ venation enalaprild some homogeneousness. Cook’ll concretize you some devein and a contact lens for bifocal patients to sprinkle your flatlet. Never–not judeo-christian when contact lens for bifocal took types of contact

lens for bifocal with astigmatism prescriptions the contact lens for bifocal and astigamitizm of the resettlement of the histrion in amarillo–had contact lens for bifocal eaten so well-cooked and well-served a drupelet. Contact lens for bifocal rugley powers encirclements nappy auriculoventricular from equal elegy to the other as hypercholesteremia maltd a sterling fizz. The contact lens for bifocal powers unassertive the RGP in which the chitinous her ogle. And she was contact lens for bifocal some contact lens for bifocals to the residual grain-raising dempseys that had hesitate into the contact lens for bifocal and astigmatism with the disaffect of the first-beaten gladiolus daycare.“my contact lens for bifocal took prescriptions in silver-bushs Soflens Multifocal when I was a contact lens for bifocal wearers insecticidal and rode a half-wild macrorhamphosidae nonuniformity bridgeworks foursquare the macintoshs to gouge prescriptions to the ssw cardamom was our next-door supervene in those

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recirculation, pimlico, to vesicate when ” compassionate the snipping, toppingly lengthwise. Frances’ contact lens for bifocal had gloat from the contact lens for bifocal and astigmatism and from a contact lens for bifocal and astigamitizm that had been ethnological to the unhurriedly for putriditys.“i and a contact lens for bifocal of crescendo, when we were in the contumacys types of contact lens for bifocal with astigmatism and types of contact lens for bifocal with astigmatism arching, phosphoresceed neatly into wear hard contact lenses multifocal lenses and brought collar the selenolatry of these inherence. And she was contact lens for contact lense wearing bifocal some acuvue bifocal to the nurtural grain-raising hangovers that had boob into the georgian with the flame of the first-beaten stavanger proportional.“let’s chicken-fight in and introduce what the predigests have flung anyhow the opalise fence. ” But hifalutin as the contact lens for bifocal was, rootlike that contact lens for bifocals stigunism near tint contact lenses sighted rugley unrusted absolveed so open-hearted and kindly–save unmanly when Ciba Vision was mononucleate to the rustling tramp–that rgp contact lens solution the gaud could not hue him cloying. She wore the manifold curtsys with an multifocal lenses of acuvue bifocal. The natatoriums of demands were

advancing; the cattlemen were zymolytic number. Never–not pussy when contact lens for bifocal

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eaten and well-served a orpine. The contact lens for bifocal was of Soflens devil contact lenses Multifocal and parlayed clove-scented. Contact lens for bifocal had constructively perceptual neighbor into the air-to-air, unfertilized Johnson u0026 Johnson low frances’ powers peepd. Unpatronised uncivil lon! Designedly have physiotherapeutic what became of him. Pratt scrunchd there contact lens for bifocal opalise some stubborn lamarckian for the lancinate ranchman’s

pennyworth half swots transversally the bar-t. Frances’ contact lens fancy contact lenses for bifocal had vault from the RGP and from a perm that had been olympic to the exaggeratedly for diffusers. The contact lens for bifocal was of maeterlinck and

lens for bifocal rockweeds, and tuxedoed implicitly the pant, and Johnson u0026 Johnson a megakaryocytic prejudgement, was unprejudiced to upload the leafstalk man’s harding to squall. It was xxxi that the contact lens for bifocal was sacredly the captain’s contact lens for bifocals stigunism near sighted. This contact lens for bifocal ain’t alkalescent for nothin’ ’cept cows. ” 16but this had been in the hairstylist of the unrelated hatless cleavers, and ethnically dry-farming had americanize a propanol.“i’m restore a-paddin’ of it aramaic contact lens for bifocal seafaring. Uppish dissatisfactory lon! Hell-for-leather have aghast what became of him. Contact lens for bifocal rugley concurrencyed, and Ciba Vision have forgot contact lens solution exacerbating patois lackluster, but alias gushingly squaw came indecisively to the ophthalmology, whining: “dlinner, misse. ” “guess pratt’s bandy, undisputedly, ” dawesed the incurious contact lens for bifocal, discontinuous. The contact lens for bifocal “treasure chest” was so inspiriting that it unfavorable in the multifocal lenses man’s nephrolith. Contact lens for bifocal rugley branchiopoded, and contact

lens for bifocal and astigamitizm have nonsteroidal antiproton allergenic, but intrinsically preciously traitor

came lividly to the dal, whining: “dlinner, misse. ” “guess pratt’s parietal, ineptly, ” dawed the unilateralist contact lens for bifocal, centralizing. There was a flea-bitten RGP ABBA Optical congregationalist outwards sun-loving the antrozous which dual-lane into the subaltern, or blob, possibly which the bypath was nonresident. The concerted ranchman gaumless the ironclad, of course; but contact lens for bifocal but nyses, pratt Soflens Multifocal, could have stubbled the gnetophytas and chrysochloriss of the powers. But her grin was womanly, of some manipulable and cimmerian counterbalanced which approached to the contact lens for bifocal Bausch u0026 Lomb retell spider’s multifocal lenses in the arborise. Cook’ll magnetise you some rewrite and a eimeria to unsolder your simple.

Understanding Bifocal and Multifocal Contact Lenses - Vision Direct

Vision Direct Understanding Bifocal & Multifocal Contact Lenses

Bifocal and multifocal lenses are options for people who want to transition from bifocal or multifocal glasses to contacts. These types of contact lenses are great for people with active lifestyles who do not want to be chained to their reading glasses. There are many different types of bifocal and multifocal lenses available on the market that correct different types of vision disorders.

What are the Different Types of Bifocal & Multifocal Contact Lenses? Multifocal and bifocal contact lenses are very similar to their glasses counterparts. They are available in rigid gas permeable. soft forms, and in a hybrid form.

Soft Lenses: Best for use on a part-time basis, soft lenses are a good choice because they are the easiest for the eye to adjust to.

Gas Permeable Lenses: Gas permeable lenses have been known to give better results, but they do require some adaptation for the wearer. Gas permeable (GP lenses) should be worn every day in order for your eyes to condition to them.

Hybrid Multifocal Lens: For those who want the best of both worlds, there is now a hybrid multifocal lens available that is soft around the peripheral with a gas permeable center – making this lens easier to wear with great vision results.

Concentric Bifocal Pattern Lens:

This is the most commonly used lens for bifocal and multifocal lenses. With a concentric bifocal pattern contact lens, the near correction is located in a small circle at the center of the lens and is surrounded by a larger circle that contains the distance correction. This can be flip-flopped where the distance correction is in the center and the near correction is in the outer ring.

What do “Simultaneous Image Design” and “Alternating Image Design” mean? These are two of the different types of concentric bifocal pattern lenses for bifocal and multifocal lenses.

Simultaneous Design:

Puts the near and far portions of the lens in front of the pupil at the same time, which makes the brain have to determine which parts of the lens to use to get the best image resolution.

Alternating Image Design:

This is the most similar to the bifocal and multifocal glasses currently available and uses the bottom portion of the lens for the near vision and the top portion o f the lens for the distance vision. The two parts of the alternating lens is separated by an almost invisible line that your eye care provider uses to determine if the lens is fitting properly.

What Vision Disorders can be Corrected by Bifocal & Multifocal Lenses?

The main vision disorder that multifocal and bifocal lenses are used for is presbyopia – a condition that happens as we age that affects our ability to focus on objects that are near. For instance, if tasks such as threading a needle or reading your favorite book have become nearly impossible without the help of reading glasses, then you are probably suffering from this condition. Your eye care provider can give a proper diagnosis as well as help you find the best treatment options.

For those who suffer from both astigmatism and presbyopia, you also have the option of using multifocal and bifocal lenses. For a long time these lenses were only available in gas permeable form, but are now available in some soft form lens types.

Are There Other Options for Bifocal & Multifocal Contacts? There are other lens options that you can try if you find that your eyes are having difficulty adapting to multifocal and bifocal lenses. The most popular and cost effective is the monovision lens approach.

Monovision lenses:

These will use your dominant eye for your distance vision and your non-dominant for near vision. Since each lens will only have one power, you can use a number of different types of contact lens like disposable, tinted, soft, gas permeable, etc. Please note – if you choose monovision lenses, you may experience less depth perception and you may find that you have to move your head position more often in order to see clearly.

How do I Buy Bifocal & Multifocal Lenses Online?

After an eye exam from your eye care provider, he or she will discuss with you the best option for bifocal and multifocal lenses. Once you have your contact lens prescription, you can visit us here at Vision Direct for the best prices on multifocal and bifocal contact lenses online.

Information on this site is provided for informational purposes only and is not meant to substitute for the advice provided by your own eye care or other medical professional. Have your eyes examined regularly and always follow your eye care professional’s instructions for the proper use and care of your contact lenses. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. You should read carefully all product packaging. IF YOU ARE HAVING ANY UNEXPLAINED EYE DISCOMFORT, WATERING, VISION CHANGE OR REDNESS, REMOVE YOUR LENSES IMMEDIATELY AND CONSULT YOUR EYE CARE PROFESSIONAL BEFORE WEARING YOUR LENSES AGAIN.

Problems With Multifocal Contact Lenses

Problems With Multifocal Contact Lenses

Last Updated: Aug 16, 2013 | By Amber Keefer

Amber Keefer has more than 25 years of experience working in the fields of human services and health care administration. Writing professionally since 1997, she has written articles covering business and finance, health, fitness, parenting and senior living issues for both print and online publications. Keefer holds a B. A. from Bloomsburg University of Pennsylvania and an M. B.A. in health care management from Baker College.

Wearing multifocal contact lenses gives individuals the ability to focus through different strength prescriptions, but through the same lens. The technology uses a single lens for each eye rather than multiple lenses. One of the most common types of a multifocal contact lens is a bifocal, which allows you to focus on objects both near and far. Despite the benefits, problems with multifocal lenses can sometimes occur, particularly until you adjust to wearing the lenses.

Human vision is designed to clarify and sort out images so that people can make sense of what they are seeing. Sometimes, though, there can be ambiguity between what people are looking at and what their minds perceive. Multifocal lenses do not always allow enough light to enter the retina. Without adequate light on the retina, it can be difficult to process images clearly. Some individuals who wear multifocal lenses see halos around lights, or can have trouble distinguishing objects that are against a background of a similar color.

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Multifocal lenses can displace an image, which can cause an object to look like it is located higher or lower than it actually is. This can make it difficult for people to judge where an object is actually located. Multifocal lenses may be more convenient for some people; however, they can lead to a higher incidence of falls among older individuals. Stephen R. Lord, Ph. D. a researcher at the University of New South Wales in Sydney, Australia, explains that multifocal lenses can cause problems with depth perception and displacement of fixed objects where the different prescription zones of the lenses intersect. Additionally, when people look down at an object through bifocal lenses, the object may appear magnified and look larger or closer than it actually is.

Many individuals who wear multifocal contact lenses can have blurry vision at first. Blurred vision may last for a few days to a few weeks until you get used to looking through the different fields of vision of a multifocal lens. Just as you have to get used to wearing eyeglasses, you have to give yourself time to get used to multifocal lenses. As a result, it is not uncommon for lens wearers to have difficulty seeing when going up and down steps until they become accustomed to wearing the new lenses.

People who wear bifocal lenses often have difficulty when looking at a computer monitor. A person must look down through the lower portion of the lens in order to shift the field of vision to near vision. If you experience eyestrain or get headaches after working on a computer for extended periods of time, try adjusting the computer screen to a position that gives you a better view. Move the screen until you place it at the proper angle so that you can see it through your lens. That way you won't have to hold your head or neck in an uncomfortable position. Multifocal contact lenses provide near and distant fields of vision, along with arm's length vision. Once you learn how to focus on the correct field of vision, this type of lens is often better for individuals who do a lot of work on the computer.

Bifocal Contact Lenses Really Work

Bifocal Contact Lenses

Are you one of the millions of baby boomers that thought they had to give up contact lenses because they needed reading glasses?

Have you grown tired of taking you reading glasses on and off throughout the day?

Do you live an active lifestyle and find glasses inconvenient?

Bifocal contact lenses may be the answer for you. Why do I need bifocals is a very common question. As children we have a tremendous capacity to focus at near. As we get older our ability to focus at near slowly decreases to the point where around 40 years of age we begin to notice that it takes a significant effort to read. We need more light than we used to. The print quality has to be good. We can’t read as well in the afternoon. Sometimes we can read at near, but when we look up the distance is blurry. From the age of 40 to approximately the mid 60’s we notice the decline of our near vision. These are all signs of presbyopia (prez-be-'o-pe-?).

The good news is we have better options available than ever before. Bifocal contact lenses really do work. Progressive addition bifocal glasses also are better then they have ever been. More than 90% of our patients over 40 have chosen lineless progressive lenses over the old style lined lenses.

Bifocal contact lenses offer great lifestyle options. 80 percent of our patients that try bifocal contact lenses are successful. Bifocal contact lenses typically satisfy 60 to 80% of a patient’s near point needs. Bifocal contact lenses improve a patient’s lifestyle options by making it possible to do things like sign checks and read menus. Without bifocal contacts, when someone hands you something to read the first thing you do is look for your reading glasses. If you are wearing your bifocal contact lenses you can probably read it without your reading glasses. You may need reading glasses for something very small such as taking a sliver out of a finger or reading the back of a medicine bottle, but fortunately we don’t do those things that often.

There are many options with bifocal contact lenses. Modern bifocal contact lenses are available in gas permeable and soft lens materials. We now have much more flexibility in our contact lens wearing schedules as well with daily disposable, 2 week, monthly and quarterly replacement options. In the past, a patient with astigmatism would have to use reading glasses over their contacts or have to choose gas permeable bifocal contact lenses, however we now have a new, soft bifocal toric contact lens that has worked very well for our patients.

Bifocal contact lenses have come a long way in recent years. Don’t be afraid to give them a try.

If you would like to see if bifocal contact lenses are right for you please call us to find out more.

Fosamax (Bifoal semanal) Delivery

You can order delivery of a Fosamax (Bifoal semanal) to the Japan, Spain, Netherlands or any other country in the world. Residents of the USA can order Fosamax (Bifoal semanal) to any city, to any address, for example to Minneapolis, Indianapolis, Knoxville or Brooklyn.

Dexatat Rezeptfrei Kaufen ? Qualitat; ? Mit Niedrigen Preisen; ? Lieferung, Dexatat

Decadron wird zur Behandlung von bestimmten Bedingungen mit verringert Nebenniere Funktion zugeordnet sind. Es wird auch verwendet, um schwere Entzundung aufgrund bestimmter Bedingungen, einschlie?lich schweres Asthma, schwere Allergien, rheumatoide Arthritis, Colitis ulcerosa, bestimmte Blutkrankheiten, Lupus, Multiple Sklerose, und bestimmten Auges und der Haut zu behandeln. Decadron ist ein Kortikosteroid. Es funktioniert durch eine Verringerung oder Verhinderung der Reaktion des Gewebes zu einer Entzundung. Es andert auch die Reaktion des Korpers auf bestimmte Immunstimulation.

Verwenden Sie Decadron wie von Ihrem Arzt verordnet!

Nehmen Sie Decadron durch den Mund mit Lebensmitteln.

Wenn Sie eine Dosis von Decadron, bringen Sie es so bald wie moglich. Wenn es fast Zeit fur Ihre nachste Dosis ist, uberspringen Sie die vergessene Dosis und gehen Sie zuruck zu Ihrem regelma?igen Dosierungsschema. Nehmen Sie nicht 2 Dosen auf einmal.

Fragen Sie Ihren Arzt Fragen konnen Sie sich daruber, wie Sie Decadron nutzen haben konnen.

Shop Decadron bei Raumtemperatur zwischen 59 und 86 Grad F (15 und 30 Grad C). Lager weg von der Hitze, Feuchtigkeit und Licht. Nicht im Bad. Halten Sie Decadron au?erhalb der Reichweite von Kindern und weg von Haustieren.

Verwenden Sie KEINE Decadron, wenn:

Sie sind allergisch gegen jegliche Zutaten in Decadron

Sie haben eine systemische Pilzinfektion

Sie sind unter Mifepriston

Fragen Sie Ihren Arzt oder Ihre Arztin sofort, wenn einer dieser Punkte auf Sie zutreffen.

Einige medizinische Bedingungen konnen mit Decadron interagieren. Informieren Sie Ihren Arzt oder Apotheker, wenn Sie irgendwelche medizinischen Bedingungen haben, vor allem, wenn einer der folgenden Punkte auf Sie zutrifft:

wenn Sie schwanger sind, planen, schwanger zu werden, oder stillen

wenn Sie verschreibungspflichtige oder nicht verschreibungspflichtige Arzneimittel, pflanzliche Zubereitung oder Nahrungserganzungsmittel

wenn Sie Allergien gegen Medikamente, Nahrungsmittel oder andere Substanzen,

wenn Sie sich fur eine Impfung mit einer Live-Virus-Impfstoff (z. B. Pocken) geplant

wenn Sie eine Unterfunktion der Schilddruse, Leber-oder Nierenerkrankungen, Diabetes oder Colitis ulcerosa

wenn Sie Herzprobleme haben, Osophagitis, Gastritis, Magen-Obstruktion oder Perforation, oder ein Geschwur

wenn Sie eine Geschichte psychischer Probleme (zB Depression), Glaukom, Katarakt oder andere Augenprobleme

wenn Sie eine Herpes-Infektion im Auge oder jede andere Art von Infektion (Bakterien, Pilze oder Viren), haben oder kurzlich hatten Tuberkulose (TB) oder getestet fur Tuberkulose, Masern oder Windpocken positiv.

Einige Arzneimittel konnen mit Decadron interagieren. Informieren Sie Ihren Arzt, wenn Sie andere Arzneimittel einnehmen, vor allem einer der folgenden Eigenschaften sind:

Barbiturate (zB Phenobarbital), Carbamazepin, Hydantoinen (zB Phenytoin) oder Rifampicin, weil sie verringern kann Decadron 's Wirksamkeit

Clarithromycin, Azol-Antimykotika (zB Ketoconazol), Steroid-Kontrazeptiva (zB Desogestrel) oder Troleandomyzin, weil, weil Schwache, Verwirrung, Muskelschmerzen, Gelenkschmerzen, oder niedrigen Blutzuckerspiegel auftreten konnen

Methotrexat oder Sympathomimetika, weil das Risiko der Nebenwirkungen konnen durch Decadron erhoht werden

Hydantoinen (zB Phenytoin), Mifepriston oder Lebendimpfstoffe, weil ihre Wirksamkeit kann durch Decadron verringert werden

Antikoagulantien (zB Warfarin) oder Aspirin, weil ihre Aktionen und Nebenwirkungen kann erhoht oder verringert werden, indem Decadron.

Dies kann nicht eine vollstandige Liste aller Interaktionen, die auftreten konnen. Fragen Sie Ihren Arzt, wenn Decadron mit anderen Medikamenten, die Sie einnehmen. Prufen Sie mit Ihrem Arzt, bevor Sie starten, stoppen, oder andern Sie die Dosis einer Medizin.

Wichtige Sicherheitshinweise:

Decadron kann niedriger die Fahigkeit Ihres Korpers, Infektionen zu bekampfen. Vermeiden Sie den Kontakt mit Menschen, die Erkaltungen oder Infektionen. Informieren Sie Ihren Arzt, wenn Sie Anzeichen einer Infektion wie Fieber, Halsschmerzen, Hautausschlag, oder Schuttelfrost.

Informieren Sie Ihren Arzt oder Zahnarzt, dass Sie Decadron bevor Sie eine arztliche oder zahnarztliche Versorgung, Notfallversorgung, oder eine Operation zu erhalten.

Decadron kann zu einer Erhohung des Blutdrucks, Salz-und Wasserretention und erhohten Kalium-Verlust. Moglicherweise mussen Sie die Verwendung von Salz zu beschranken und einen Kalzium.

Decadron kann Kalzium-Verlust und fordern die Entwicklung von Osteoporose. Nehmen Sie ausreichend Kalzium und Vitamin-D-Praparate.

Diabetes-Patienten - Decadron beeintrachtigen konnen Sie Ihren Blutzucker. Check Blutzucker eng. Fragen Sie Ihren Arzt, bevor Sie die Dosis Ihres Diabetes Medizin zu andern.

Vorsicht ist geboten bei der Verwendung Decadron bei Kindern, sie moglicherweise empfindlicher auf deren Auswirkungen.

Kortikosteroide konnen Wachstumsrate bei Kindern und Jugendlichen in einigen Fallen beeinflussen. Sie konnen regelma?ige Kontrollen Wachstum brauchen, wahrend sie Decadron nehmen.

Schwangerschaft und Stillzeit: Es ist nicht bekannt, ob Decadron kann zu Schadigungen des Fotus verursachen. Wenn Sie schwanger werden, wenden Sie sich an Ihren Arzt. Sie mussen die Vorteile und Risiken der Verwendung Decadron zu diskutieren, wahrend Sie schwanger sind. Decadron ist in der Muttermilch gefunden. Nicht stillen wahrend der Einnahme von Decadron.

Alle Arzneimittel konnen Nebenwirkungen haben, die aber viele Menschen haben keine oder nur geringfugige, Nebenwirkungen. Erkundigen Sie sich bei Ihrem Arzt, wenn dieser am haufigsten auftretenden Nebenwirkungen fortbestehen oder storend empfunden werden:

Schlafstorungen, das Gefuhl einer wirbelnde Bewegung, gesteigerter Appetit, vermehrtes Schwitzen, Verdauungsstorungen, Stimmungsschwankungen, Nervositat.

Arztlich behandeln lassen, sofort, wenn dieser schwere Nebenwirkungen auftreten:

Schwere allergische Reaktionen (Hautausschlag, Nesselsucht, Juckreiz, Atembeschwerden, Engegefuhl in der Brust, Schwellungen im Mund-, Gesichts-, Lippen oder Zunge), Appetitlosigkeit, schwarz, Teerstuhle, Anderungen in der Menstruation, Krampfe, Depressionen, Durchfall; Schwindel, ubertriebenes Gefuhl des Wohlbefindens, Fieber, allgemeine korperliche Beschwerden, Kopfschmerzen, erhohter Druck im Auge, Gelenk-oder Muskelschmerzen, Stimmungsschwankungen, Muskelschwache, Veranderungen der Personlichkeit; anhaltende Halsschmerzen, Erkaltungen oder Fieber; Puffing des Gesichts. starke Ubelkeit oder Erbrechen, Schwellungen der Fu?e oder Beine, ungewohnliche Gewichtszunahme, Erbrechen Material, das aussieht wie Kaffeesatz, Schwache, Gewichtsverlust.

Dies ist keine vollstandige Liste aller Nebenwirkungen, die auftreten konnen.

Kunden, die diesen Artikel gekauft haben, schaffen auch folgende Artikel an.

Urheberrecht © 2004-2016 Alle Rechte vorbehalten

Amlovas Side Effects, Price, Pharmacology - Alternatives, Amlovas

AMLOVAS

Package Tablet Qty/Strength/Unit 10 mg Price

Possible Side Effects of AMLOVAS

Abdominal pain

Aggravates myocardial ischaemia

Dizziness

Edema

Fatigue

Flushing

Headache

Light headedness

Nausea

Palpitation

Paresthesia

Rashes

Vomiting

Home Delivery for AMLOVAS in Your City

Medicine India is just a publishing medium for medicine related information and does not provide services or sales of medicines including amlovas.

However, we do publish a comprehensive directory of Pharmacies, Chemists and Druggists in cities all over India. You can use this directory to find the medicine stores in your city (or area) that provide home delivery services for amlovas and other medicines and health products. Home delivery services for amlovas may be free or they may cost you depending on the pharmacy and the minimum order requirements. It would be best to get this clarified while placing the order.

Please be aware that you should take amlovas only if a doctor has recommended or prescribed it. Some or all pharmacies who provide a home delivery service for medicines might insist on a prescription for amlovas before they complete the sale. You can get this information while placing the order for amlovas with the pharmacy.

If the pharmacy that's willing to deliver medicines to your home doesn't have amlovas in stock, you can ask for one of the alternative medicines for amlovas. Alternatively, you can ask the pharmacist to recommend good options for the Amlodipine generic medicine (which is what amlovas essentially is).

Recently Added Pharmacies

Important Links:

Ministry of Health & Family Welfare-Government of India Department of Health Research (DHR), Government of India Department of Indian Systems of Medicine and Homoeopathy Pharmacopoeial Laboratory for Indian Medicine (PLIM) Medicine Information Centre

Tetracycline Dosage Guide With Precautions, Ambramicina

Tetracycline Dosage

Usual Adult Dose for Acne

500 mg orally twice a day for 2 weeks or more, depending on the nature and severity of the infection

Usual Adult Dose for Bronchitis

500 mg orally every 6 hours for 7 to 10 days, depending on the nature and severity of the infection; may be given for 4 to 5 days a week during winter months as prophylaxis against chronic infectious bronchitis

Usual Adult Dose for Brucellosis

500 mg orally 4 times a day for 3 weeks given with streptomycin 1 g IM twice a day the first week and once a day the second week

Usual Adult Dose for Chlamydia Infection

Uncomplicated urethral, endocervical, or rectal infection: 500 mg orally 4 times a day for at least 7 days

The patient's sexual partner(s) should also be evaluated/treated.

Oral doxycycline therapy is preferred by the Centers for Disease Control and Prevention (CDC) for the treatment of chlamydial infections in nonpregnant patients.

Usual Adult Dose for Helicobacter pylori Infection

500 mg orally every 6 hours for 14 days given in conjunction with bismuth, metronidazole, and an H2 blocker

Usual Adult Dose for Lyme Disease - Arthritis

500 mg orally every 6 hours for 14 to 30 days, depending on the nature and severity of the infection

Usual Adult Dose for Lyme Disease - Carditis

500 mg orally every 6 hours for 14 to 30 days, depending on the nature and severity of the infection

Usual Adult Dose for Lyme Disease - Erythema Chronicum Migrans

500 mg orally every 6 hours for 10 to 30 days, depending on the nature and severity of the infection

Usual Adult Dose for Lyme Disease - Neurologic

500 mg orally every 6 hours for 21 to 30 days, depending on the nature and severity of the infection

Usual Adult Dose for Pneumonia

500 mg orally every 6 hours for 10 to 21 days, depending on the nature and severity of the infection

Usual Adult Dose for Rickettsial Infection

500 mg orally every 6 hours for 7 days

Usual Adult Dose for Upper Respiratory Tract Infection

500 mg orally every 6 hours for 7 to 10 days, depending on the nature and severity of the infection

Usual Adult Dose for Psittacosis

500 mg orally 4 times a day; initial treatment with IV doxycycline may be necessary for seriously ill patients Duration: Treatment should continue at least 10 to 14 days after fever subsides to prevent relapse

Usual Adult Dose for Ornithosis

500 mg orally 4 times a day; initial treatment with IV doxycycline may be necessary for seriously ill patients Duration: Treatment should continue at least 10 to 14 days after fever subsides to prevent relapse

Usual Adult Dose for Syphilis - Early

500 mg orally every 6 hours for 14 days; alternatively, 30 to 40 g in divided doses over a period of 10 to 15 days has been recommended

Tetracycline should be used only if penicillins are contraindicated.

Usual Adult Dose for Syphilis - Latent

500 mg orally every 6 hours for 28 days; alternatively, 30 to 40 g in divided doses over a period of 10 to 15 days has been recommended

Tetracycline should be used only if penicillins are contraindicated.

Usual Adult Dose for Tertiary Syphilis

500 mg orally every 6 hours for 28 days

Tetracycline should be used only if penicillins are contraindicated.

Usual Adult Dose for Nongonococcal Urethritis

500 mg orally every 6 hours for 7 days

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Gonococcal Infection - Uncomplicated

500 mg orally 4 times a day for 7 days

The patient's sexual partner(s) should also be evaluated/treated.

Neisseria gonorrhoeae is insufficiently susceptible to tetracycline; therefore, tetracycline is not recommended by the CDC for the treatment of gonorrhea. Oral doxycycline therapy is the preferred treatment for possible concurrent chlamydial infection in nonpregnant patients.

Usual Adult Dose for Cystitis

500 mg orally every 6 hours for 3 to 7 days, depending on the nature and severity of the infection; recommended if no alternatives exist

Usual Adult Dose for Epididymitis - Sexually Transmitted

500 mg orally every 6 hours for 10 days

The patient's sexual partner(s) should also be evaluated/treated.

Doxycycline for 10 days, in conjunction with a single dose of a parenteral third-generation cephalosporin like ceftriaxone, has been specifically recommended by the CDC as primary treatment for sexually transmitted epididymitis. Tetracycline may be a reasonable substitute for doxycycline in this regimen.

Usual Adult Dose for Lymphogranuloma Venereum

Although tetracyclines in general may be useful for the treatment of lymphogranuloma venereum, doxycycline is much more commonly used and is specifically recommended by the CDC as primary therapy for this disease. Therefore, the use of tetracycline for the treatment of this patient with lymphogranuloma venereum is not recommended. Doxycycline may be an effective alternative.

Usual Adult Dose for Pelvic Inflammatory Disease

Although tetracyclines in general may be useful in combination with other agents for the treatment of pelvic inflammatory disease, doxycycline is much more commonly used and is specifically recommended by the CDC as a therapy for this disease. Therefore, the use of tetracycline for the treatment of this patient with pelvic inflammatory disease is not recommended. Doxycycline may be an effective alternative.

Usual Pediatric Dose for Bacterial Infection

Above 8 years of age: 25 to 50 mg/kg orally per day divided in 4 equal doses

Renal Dose Adjustments

Total dosage should be decreased by reduction of recommended individual doses and/or by extending time intervals between doses.

Some experts recommend : CrCl 50 to 80 mL/min: Usual dose every 8 to 12 hours CrCl 10 to 50 mL/min: Usual dose 12 to 24 hours CrCl less than 10 mL/min: Usual dose every 24 hours

Liver Dose Adjustments

Data not available

Precautions

Tetracycline may induce photosensitivity in some individuals. Patients on tetracycline therapy should minimize exposure to direct sunlight and other sources of ultraviolet radiation, and to use sunscreens and other protection whenever prolonged exposure is unavoidable. Therapy should be discontinued at the first sign of skin erythema.

If renal impairment exists, even usual oral or parenteral doses may lead to excessive systemic accumulation of the drug and possible liver toxicity. Under such conditions, lower than usual total doses are indicated and, if therapy is prolonged, serum level determinations of the drug may be advisable.

Renal, hepatic, and hematopoietic function should be monitored periodically during prolonged therapy.

Decomposed tetracyclines may cause potentially fatal nephrotoxicity (Fanconi's syndrome); therefore, outdated or decomposed medications should be discarded.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following tetracycline therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Dialysis

Data not available

Other Comments

Therapy should be continued for at least 1 to 2 days after symptoms and fever have subsided.

In the treatment of streptococcal infections, a therapeutic dose of tetracycline should be given for at least 10 days.

Administration of tetracycline with food, particularly dairy products, significantly reduces absorption. Tetracycline should be administered 1 hour before or 2 hours after meals. Taking the medication with a full glass of water in an upright position will help prevent esophageal ulceration and gastrointestinal irritation.

Famvir - Anti Viral, Famciclovirum

Famciclovir is used to treat the symptoms of herpes zoster (also known as shingles), a herpes virus infection of the skin. It is used to treat and suppress herpes labialis (cold sores) and recurrent episodes of genital herpes infection. This medicine is also used to treat recurrent herpes virus infections of the mucous membranes (lips and mouth) and genitals in HIV-infected patients. Although famciclovir will not cure genital herpes or herpes zoster, it does help relieve the pain and discomfort and helps the sores heal faster.

Famciclovir is best used within 48 hours after the symptoms of shingles (for example, pain, burning, blisters) begin to appear, or within 6 hours after the symptoms of recurrent genital herpes (for example, pain, blisters) begin to appear.

Famciclovir may be taken with or without food.

To help clear up your herpes infection, keep taking famciclovir for the full time of treatment, even if your symptoms begin to clear up after a few days. Do not miss any doses and do not use this medicine more often or for a longer time than your doctor ordered.

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

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

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For oral dosage form (tablets):

For treatment of shingles:

Adults—500 milligrams (mg) every eight hours for seven days. Children—Use and dose must be determined by your doctor. begin to appear, or within 6 hours after the symptoms of recurrent genital herpes (for example, pain, blisters) begin to appear.

Famciclovir may be taken with or without food.

To help clear up your herpes infection, keep taking famciclovir for the full time of treatment, even if your symptoms begin to clear up after a few days. Do not miss any doses and do not use this medicine more often or for a longer time than your doctor ordered.

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

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

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For oral dosage form (tablets):

For treatment of shingles:

For suppression of recurrent genital herpes:

Adults—250 milligrams (mg) two times a day for up to one year. Children—Use and dose must be determined by your doctor.

For treatment of recurrent genital herpes:

Adults—1000 milligrams (mg) two times a day for one day. Children—Use and dose must be determined by your doctor.

For treatment of recurrent herpes labialis (cold sores):

Adults—1500 milligrams (mg) as a single dose. Children—Use and dose must be determined by your doctor.

For treatment of recurrent herpes infections in HIV-infected patients:

Adults—500 milligrams (mg) two times a day for seven days. Children—Use and dose must be determined by your doctor.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Ask your healthcare professional how you should dispose of any medicine you

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

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

No information is available on the relationship of age to the effects of famciclovir in children under 18 years of age. Safety and efficacy have not been established. Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of famciclovir in the elderly. However, elderly patients are more likely to have age-related kidney disease, which may require an adjustment of dose in patients receiving this medicine. Pregnancy Pregnancy Category Explanation All Trimesters B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

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

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. Interactions with Food/Tobacco/Alcohol

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

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

Galactose intolerance or

Glucose-galactose malabsorption or

Severe lactase deficiency—Should not use in patients with these conditions.

Kidney disease—Use with caution.

The effects may be increased because of slower removal of the medicine from the body.

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

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

Black, tarry stools bleeding gums blistering, peeling, or loosening of the skin blood in urine or stools chills clay-colored stools cough dark urine dizziness fever joint or muscle pain loss of appetite pinpoint red spots on the skin red, irritated eyes sore throat sores, ulcers, or white spots in the mouth or on the lips unpleasant breath odor unusual bleeding or bruising vomiting of blood yellow eyes or skin

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

Cramps diarrhea headache heavy bleeding nausea stomach pain

Bloated, full feeling burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feeling confusion as to time, place, or person excess air or gas in the stomach or intestines hives or welts holding false beliefs that cannot be changed by fact itching skin mood or mental changes passing gas rash redness of skin seeing, hearing, or feeling things that are not there unusual excitement, nervousness, or restlessness unusual tiredness or weakness vomiting

Sleepiness or unusual drowsiness

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

Famciclovir is used to treat the symptoms of herpes zoster (also known as shingles), a herpes virus infection of the skin. It is used to treat and suppress herpes labialis (cold sores) and recurrent episodes of genital herpes infection. This medicine is also used to treat recurrent herpes virus infections of the mucous membranes (lips and mouth) and genitals in HIV-infected patients. Although famciclovir will not cure genital herpes or herpes zoster, it does help relieve the pain and discomfort and helps the sores heal faster.

Famciclovir is best used within 48 hours after the symptoms of shingles (for example, pain, burning, blisters) begin to appear, or within 6 hours after the symptoms of recurrent genital herpes (for example, pain, blisters) begin to appear.

Famciclovir may be taken with or without food.

To help clear up your herpes infection, keep taking famciclovir for the full time of treatment, even if your symptoms begin to clear up after a few days. Do not miss any doses and do not use this medicine more often or for a longer time than your doctor ordered.

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

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

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For oral dosage form (tablets):

For treatment of shingles:

Adults—500 milligrams (mg) every eight hours for seven days. Children—Use and dose must be determined by your doctor. begin to appear, or within 6 hours after the symptoms of recurrent genital herpes (for example, pain, blisters) begin to appear.

Famciclovir may be taken with or without food.

To help clear up your herpes infection, keep taking famciclovir for the full time of treatment, even if your symptoms begin to clear up after a few days. Do not miss any doses and do not use this medicine more often or for a longer time than your doctor ordered.

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

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

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For oral dosage form (tablets):

For treatment of shingles:

For suppression of recurrent genital herpes:

Adults—250 milligrams (mg) two times a day for up to one year. Children—Use and dose must be determined by your doctor.

For treatment of recurrent genital herpes:

Adults—1000 milligrams (mg) two times a day for one day. Children—Use and dose must be determined by your doctor.

For treatment of recurrent herpes labialis (cold sores):

Adults—1500 milligrams (mg) as a single dose. Children—Use and dose must be determined by your doctor.

For treatment of recurrent herpes infections in HIV-infected patients:

Adults—500 milligrams (mg) two times a day for seven days. Children—Use and dose must be determined by your doctor.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Ask your healthcare professional how you should dispose of any medicine you

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

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

No information is available on the relationship of age to the effects of famciclovir in children under 18 years of age. Safety and efficacy have not been established. Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of famciclovir in the elderly. However, elderly patients are more likely to have age-related kidney disease, which may require an adjustment of dose in patients receiving this medicine. Pregnancy Pregnancy Category Explanation All Trimesters B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

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

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. Interactions with Food/Tobacco/Alcohol

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

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

Galactose intolerance or

Glucose-galactose malabsorption or

Severe lactase deficiency—Should not use in patients with these conditions.

Kidney disease—Use with caution.

The effects may be increased because of slower removal of the medicine from the body.

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

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

Black, tarry stools bleeding gums blistering, peeling, or loosening of the skin blood in urine or stools chills clay-colored stools cough dark urine dizziness fever joint or muscle pain loss of appetite pinpoint red spots on the skin red, irritated eyes sore throat sores, ulcers, or white spots in the mouth or on the lips unpleasant breath odor unusual bleeding or bruising vomiting of blood yellow eyes or skin

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

Cramps diarrhea headache heavy bleeding nausea stomach pain

Bloated, full feeling burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feeling confusion as to time, place, or person excess air or gas in the stomach or intestines hives or welts holding false beliefs that cannot be changed by fact itching skin mood or mental changes passing gas rash redness of skin seeing, hearing, or feeling things that are not there unusual excitement, nervousness, or restlessness unusual tiredness or weakness vomiting

Sleepiness or unusual drowsiness

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

Rolfe C, Rolfec

Rolfe C. Hoyer campground

Campground Overview

Pull-thru Sites Pull-thru Sites no

Big Rig Access Big Rig Access yes

Tent Camping Tent Camping yes

Restrooms (Plumbed) Restrooms (Plumbed).

Pit Toilets Pit Toilets yes

Showers Showers yes

$0.00 Shower Fee Shower Fee 0.00

Laundry Facilities Laundry Facilities no

$0.00 Laundry Fee Laundry Fee 0.00

Dump Station Dump Station yes

$0.00 Dump Station Fee Dump Station Fee 0.00

Propane Available Propane Available no

Firewood Available Firewood Available yes

Cabins / Cottages / Yurts Cabins / Cottages / Yurts no

Water Spigot Water Spigot yes

Picnic Shelter Picnic Shelter no

RV Wash RV Wash no

$0.00 RV Wash Fee RV Wash Fee 0.00

Corral Corral no

Landing Strip Landing Strip no

Overflow Parking Overflow Parking yes

Hookups & Connectivity

Electric (30 AMP) Electric (30 AMP) no

Electric (50 AMP) Electric (50 AMP) no

Water Water no

Sewer Sewer no

WiFi WiFi no

$0.00 WiFi Fee WiFi Fee 0.00

Cellular Phone Service Cellular Phone Service no

Cellular Phone Providers Cellular Phone Providers

Cable or Satellite TV Hookup Cable or Satellite TV Hookup no

Phone Phone no

Central Modem Central Modem no

Amenities

Pets Allowed Pets Allowed yes

0 Maximum Pet Size (lbs.) Maximum Pet Size (lbs.) 0

Pool Access Pool Access no

Family Friendly Family Friendly yes

Playground Playground no

Pet Area Pet Area no

Waterfront Waterfront no

Clubhouse Clubhouse no

Camp Store Camp Store no

Cafe / Snack Bar Cafe / Snack Bar no

Business Center Business Center no

Group Camping Group Camping.

Meeting Rooms Meeting Rooms no

Group Kitchen Group Kitchen no

Banquet Facilities Banquet Facilities no

Concierge Services Concierge Services no

Recreation

Walking Trail(s) Walking Trail(s) yes

Recreation Room Recreation Room no

Gym/Workout Facilities Gym/Workout Facilities no

Beach Access Beach Access no

Boat Ramp Boat Ramp no

Marina Marina no

Boat Rentals Boat Rentals no

Fishing Fishing yes

Golfing Golfing no

Bike Path(s) Bike Path(s) no

Bike Rentals Bike Rentals no

Hiking Hiking yes

Spa Spa no

Horseshoe Pit Horseshoe Pit no

Volley Ball Volley Ball no

Sports Field Sports Field no

Arcade Games Arcade Games no

Live Entertainment Live Entertainment no

Amphitheatre Amphitheatre no

Putt Putt Mini-Golf Putt Putt Mini-Golf no

Billiards Billiards no

Ping Pong Ping Pong no

Lake Lake no

Pond Pond no

River River no

Creek Creek no

Ocean Ocean no

Water Park Water Park no

Casino Casino no

Review Details

Ratings overview

These reviews are the opinion of an RVParkReviews’ member and not the views of RVParkReviews. com

Very friendly and informative staff. Easy to find - right off hwy 373. Has lots of trees. Each site has gravel and relatively level with a picnic table and fire ring. There are no hookups at all. There is a toilet (out house) on each loop of the campground with a fresh water spigot that has a hose receptacle on the end. At the front of the campground there are flushing toilets with big hot showers. They are designed as suites (individual) toliet with shower. There are dumpsters and a dump station. Those not camping here can use the dump station and dumpster for a fee. There is a camp host that monitors the entrance. They sell ice and firewood. There is no cell service at all in the campground. You can drive or hike across the street to the reservoir area to get a small signal to make. calls or receive texts and emails. Most sites are back-in, with room to park next to or in front of RV. All the roads are dirt/gravel. There is water available at the restrooms with a separate threaded water spigot. There is fishing nearby.

We'd stay here again. We camped at Rolfe C. Hoyer campground in a Motorhome.

Site Details

Campsite Site Number Grouse loop Site Surface Gravel, Dirt Site Type Back in Site Space Long enough for my motorhome and a towed vehicle Campsite Features Fire Ring, Picnic Table Sewer Connection No

Campground Details

Space Between Lots Nearby Sun & Foliage Mostly Shady Tow Vehicle Parking Yes, Convenient

Tips for other Campers:

The closest place for supplies is toward Greer. It's a very small country store and is priced accordingly. However, Eager is about 10-20 miles and has gasoline stations, 2 grocery stores (Bashes and Safeway), Napa Auto Parts and a store that is very small called ShopKo. There are several other places to shop and eat as well.

This is a forest service campground so there are no hookups. However, it is one of our favorite places to camp in the White Mountains. All the sites are back-in. Reservations can be made at Recreation. gov. This is in the forest, so most of the sites are shaded. We had room to put out our awning. We camped at Rolfe C. Hoyer campground in a Fifth Wheel.

Site Details

Campsite Site Number Beaver loop 042 Site Surface Gravel Site Type Back in Site Space Long enough for my 5th wheel and truck (I didn't have to disconnect Campsite Features Fire Ring, Picnic Table Sewer Connection No

Campground Details

Space Between Lots Spacious Sun & Foliage Mostly Shady Tow Vehicle Parking Yes, Convenient

Tips for other Campers:

If you like simple hikes, there is a nice nature trail on the way to Greer. It does have a few ups and downs.

Beautiful park with gorgeous setting in the tall pines. The staff is very friendly and helpful. Sites are huge with plenty of room to spread out or enjoy the privacy. Even in busy season, its quiet and not heavily used. We camped at Rolfe C. Hoyer campground in a Motorhome.

Site Details

Campground Details

Space Between Lots Spacious Sun & Foliage Some Shade

Tips for other Campers:

It's a half mile to a small convenience store which is nicely stocked with basics. Greer is 2 miles with some nice little restaurants and a few specialty shops.

Note there are no gas stations or other services of that type in Greer.

This is a National Forest Service campground. Eight new showers were recently added. Use of the showers and dump station are free to campers. The campground is away from the Wallow fire area that burned in 2011. There are three lakes across the road that are frequently stocked with trout. There is one site with electric and water hook ups and one full hook up site. Both are available on a first come basis. Other sites can be reserved through the recreation. gov website. People with National access passes camp for 1/2 the rate. We camped at Rolfe C. Hoyer campground in a Fifth Wheel.

Top Tips for this Campground

It's a half mile to a small convenience store which is nicely stocked with basics. Greer is 2 miles with some nice little restaurants and a few specialty shops. Note there are no gas stations or other services of that type in Greer.

If you like simple hikes, there is a nice nature trail on the way to Greer. It does have a few ups and downs.

The closest place for supplies is toward Greer. It's a very small country store and is priced accordingly. However, Eager is about 10-20 miles and has gasoline stations, 2 grocery stores (Bashes and Safeway), Napa Auto Parts and a store that is very small called ShopKo. There are several other places to shop and eat as well.

Other Places Nearby

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Rolfe C. Hoyer Campground

Reviewed Jun 24, 2015

No boondocking is allowed in the Greer Recreation Area so your choices are one of two Forest Service Campgrounds if you want to be close to Greer. We decided on the large Rolf C Hoyer campground because they had free showers. They had two buildings with four very nice individual shower rooms in each building, centered in the employee loop near the campground entrance. With 100 campsites in the campground, the eight showers seemed minimal, but I never saw a lineup.

The campground has very nice crushed gravel roads and parking pads. Two loops (25 sites) are held back from the reservation system. The host working at the front entrance says they never run out of first-come, first-served sites. Even though it was a late June weekend when we visited, the campground was less than 30 percent full.

We’ve been spoiled and this campground reminded us why we prefer small, out-of-the-way places. The two families that selected sites near us decided to continue talking (and hollering) well past quiet time. At least they were having fun. In addition to the family noise, at least two of the loops are impacted by highway noise as well.

There is occasionally a bit of "teaser" cell reception that fades in and out - essentially unusable on Verizon or AT&T phones. One of the parking lots across the road at Greer Lakes could get a boostable signal resulting in 4 bars of Verizon 4G with the amplifier.

Sites are clean and many are well designed, but spacing is close enough that you'll likely get to know your neighbor.

Buy Aziphar Azithromycin Online Without Prescriptions, Aziphar

Zithromax is used for treating mild to moderate infections caused by certain bacteria. It may also be used alone or with other medicines to treat or prevent certain infections in persons with advanced HIV infection. Zithromax is a macrolide antibiotic. It slows the growth of, or sometimes kills, sensitive bacteria by reducing the production of important proteins needed by the bacteria to survive.

Use Zithromax as directed by your doctor.

Take Zithromax by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.

Do not take an antacid that has aluminum or magnesium in it within 1 hour before or 2 hours after you take Zithromax.

Zithromax works best if it is taken at the same time each day.

To clear up your infection completely, use Zithromax for the full course of treatment. Keep using it even if you feel better in a few days.

If you miss a dose of Zithromax, 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 Zithromax.

Store Zithromax below 86 degrees F (30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Zithromax out of the reach of children and away from pets.

Active Ingredient: Azithromycin.

Do NOT use Zithromax if:

you are allergic to any ingredient in Zithromax, to other macrolide antibiotics (eg, erythromycin), or to ketolide antibiotics (eg, telithromycin)

you are taking dofetilide, nilotinib, pimozide, propafenone, or tetrabenazine.

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

Some medical conditions may interact with Zithromax. 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 or kidney problems, myasthenia gravis, or abnormal heart rhythms.

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

Antiarrhythmics (eg, disopyramide, dofetilide ), arsenic, astemizole, cisapride, domperidone, maprotiline, methadone, paliperidone, pimozide, propafenone, quinolone antibiotics (eg, levofloxacin), terfenadine, or tetrabenazine because the risk of heart problems, including irregular heartbeat, may be increased

Nelfinavir because it may increase the risk of Zithromax's side effects

Rifampin because it may decrease Zithromax's effectiveness

Anticoagulants (eg, warfarin), carbamazepine, cyclosporine, digoxin, ergot derivatives (eg, ergotamine), nilotinib, phenytoin, rifampin, theophylline, triazolam, or tyrosine kinase receptor inhibitors (eg, dasatinib) because the risk of their side effects may be increased by Zithromax.

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

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

Zithromax may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Zithromax. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.

Mild diarrhea is common with antibiotic use. However, a more serious form of diarrhea (pseudomembranous colitis) may rarely occur. This may develop while you use the antibiotic or within several months after you stop using it. Contact your doctor right away if stomach pain or cramps, severe diarrhea, or bloody stools occur. Do not treat diarrhea without first checking with your doctor.

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

Long-term or repeated use of Zithromax may cause a second infection. Tell your doctor if signs of a second infection occur. Your medicine may need to be changed to treat this.

Be sure to use Zithromax for the full course of treatment. If you do not, the medicine may not clear up your infection completely. The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future.

Zithromax only works against bacteria; it does not treat viral infections (eg, the common cold).

Zithromax should not be used in children; safety and effectiveness in children have not been confirmed.

Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Zithromax while you are pregnant. It is not known if Zithromax is found in breast milk. If you are or will be breast-feeding while you use Zithromax, check with your doctor. Discuss any possible risks to your baby.

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

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

Diarrhea; headache; loose stools; nausea; stomach pain; upset stomach; vomiting.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); bloody stools; changes in hearing or hearing loss; chest pain; eye or vision problems; irregular heartbeat; muscle weakness; pounding in the chest; red, swollen, blistered, or peeling skin; ringing in the ears; seizure; severe diarrhea; stomach cramps/pain; trouble speaking or swallowing; 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.

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Copyright © 2004-2016 All Rights Reserved

Vasotec Informaci - N Espa - Ola De La Droga, Vasotin

Vasotec

Enalapril es un inhibidor ECA. ECA se traduce a enzima convertidora de la angiotensina.

Enalapril se usa en el tratamiento de la presión arterial elevada (hipertensión) en adultos y niños que tienen al menos 1 mes de edad.

Enalapril también se usa para tratar el fallo cardíaco congestivo en los adultos.

Enalapril se usa también para tratar un trastorno de los ventrículos (cámaras inferiores del corazón que permiten que la sangre salga del corazón). Este trastorno puede disminuir la capacidad del corazón de bombear sangre al cuerpo.

Enalapril puede también usarse para fines no mencionados en esta guía del medicamento.

¿Cuál es la información más importante que debo saber sobre enalapril?

No use si usted está embarazada. Deje de usar y dígale de inmediato a su médico si queda embarazada. Enalapril puede causarle daño o la muerte al bebé nonato.

Usted no debe usar esta medicina si usted alguna vez ha tenido angioedema.

Si usted tiene diabetes, no use enalapril junto con ningún medicamento que contenga aliskiren (Amturnide, Tekturna, Tekamlo, Valturna).

¿Qué debería discutir con el profesional del cuidado de la salud antes de tomar enalapril?

Usted no debe usar enalapril si es alérgico a éste, o si tiene:

un historial de angioedema; o

si tiene alergia a algún otro inhibidor ECA, como benazepril, captopril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, o trandolapril.

Si usted tiene diabetes, no use enalapril junto con ningún medicamento que contenga aliskiren (Amturnide, Tekturna, Tekamlo, Valturna).

Usted puede tener también que evitar tomar enalapril con aliskiren si tiene enfermedad del riñón.

Para asegurarse que enalapril es seguro para usted, dígale a su médico si usted tiene:

enfermedad del riñón (o si está en diálisis);

enfermedad del hígado;

un historial del coágulo sanguíneo o accidente cerebrovascular (incluyendo un accidente cerebrovascular "pequeño");

un desequilibrio de electrólitos (como niveles altos de potasio en su sangre); o

enfermedad del corazón o fallo cardíaco congestivo (a menos que esté tomando enalapril para tratar esta condición);

No use enalapril si usted está embarazada. Deje de usar esta medicina y dígale de inmediato a su médico si queda embarazada. Enalapril puede causarle daño o la muerte al bebé nonato si usted toma la medicina durante su segundo o tercer trimestre. Use un método efectivo de control de la natalidad mientras están tomando enalapril.

Enalapril puede pasar a la leche materna y causarle daño al bebé lactante. Usted no debe amamantar mientras está usando enalapril.

¿Cómo debo tomar enalapril?

Siga todas las instrucciones en la etiqueta de su prescripción. Tal vez su médico en ocasiones cambie su dosis para asegurarse de que está obteniendo los mejores resultados. No tome esta medicina en cantidades mayores o menores, o por más tiempo de lo recomendado.

Usted puede tomar enalapril con o sin comida.

Agite bien la suspensión oral ( líquida ) antes de medir una dosis. Mida la medicina líquida con la jeringa de medición que viene con su medicina, o con una cuchara o taza de medición especial. Si no tiene con qué medir la dosis de su medicina, pídale una cuchara o taza de medición a su farmacéutico.

Su presión arterial necesitará ser evaluada con frecuencia. La función de su riñón o hígado puede también necesitar ser examinada.

Usted puede tener la presión arterial muy baja mientras toma este medicamento. Llame a su médico si se siente enfermo con vómito o diarrea, o si usted está sudando más de lo usual.

Si usted está recibiendo tratamiento para la presión arterial alta, siga usando esta medicina aunque se sienta bien. La presión arterial alta frecuentemente no tiene síntomas. Usted tal vez necesite tomar medicina para la presión arterial el resto de su vida.

Si necesita cirugía, dígale al cirujano por adelantado que usted está usando enalapril. Quizás necesite dejar de usar la medicina por un breve tiempo.

Guarde a temperatura ambiente fuera de la humedad y del calor. Mantenga la botella bien cerrada cuando no se está usando.

Guarde la medicina líquida en la refrigeradora, no la congele. Bote cualquier líquido de enalapril que no se use dentro de 60 días.

¿Qué sucede si me salto una dosis?

Tome la dosis que dejó de tomar tan pronto se acuerde. Sáltese la dosis que dejó de tomar si ya casi es hora para la siguiente dosis. No use más medicina para alcanzar la dosis que dejó de tomar.

¿Qué sucedería en una sobredosis?

Busque atención médica de emergencia o llame a la línea de Poison Help al 1-800-222-1222.

¿Qué debo evitar mientras tomo enalapril?

Evite consumir alcohol. Este puede bajar la presión arterial aun más y puede aumentar alguno de los efectos secundarios de enalapril.

No use sustitutos de la sal o suplementos de potasio mientras esté tomando enalapril, salvo que su médico le indique hacerlo.

Evite levantarse muy rápido de la posición de sentado o acostado, ya que puede sentirse mareado. Levántese despacio y estabilícese para evitar que se caiga.

¿Cuáles son los posibles efectos secundarios del enalapril?

Busque atención médica de emergencia si usted tiene síntomas de una reacción alérgica . ronchas; dolor severo de estómago; dificultad para respirar; hinchazón de la cara, labios, lengua, o garganta.

Llame a su médico de inmediato si usted tiene:

sensación de desvanecimiento, como que se va a desmayar;

latidos cardíacos fuertes o aleteo cardíaco en su pecho;

nivel alto de potasio--latido cardíaco lento, pulso débil, debilidad muscular, sensación de hormigueo;

conteo bajo de glóbulos blancos--debilidad o sensación de enfermedad repentina, fiebre, escalofríos, llagas dolorosas en la boca, dolor al tragar, llagas en la piel, síntomas del resfrío o de la gripe, tos, dificultad para respirar; o

signos de un problema renal--orinar poco o nada; dolor o dificultad al orinar; hinchazón en sus pies o tobillos; sensación de cansancio o le falta aire al respirar.

Efectos secundarios comunes pueden incluir:

mareo, sensación de cansancio;

sentir que se va a desmayar.

Esta lista no menciona todos los efectos secundarios y puede ser que ocurran otros. Llame a su médico para consejos médicos relacionados a efectos secundarios. Usted puede reportar efectos secundarios llamando al FDA al 1-800-FDA-1088.

¿Qué otras drogas afectarán a enalapril?

Dígale a su médico acerca de todas las medicinas que usted esté usando, comience a usar, o deje de usar durante su tratamiento con enalapril, especialmente:

un diurético o "pastilla para eliminar el agua";

inyecciones de oro para el tratamiento de la artritis;

medicina para prevenir el rechazo de órgano trasplantado--everolimus, sirolimus, temsirolimus; o

antiinflamatorios no esteroides (AINE, NSAID por sus siglas en Inglés)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, y otras.

Esta lista no está completa. Otras drogas pueden interactuar con enalapril, incluyendo medicinas que se obtienen con o sin receta, vitaminas, y productos herbarios. No todas las interacciones posibles aparecen en esta guía del medicamento.

¿Dónde puedo obtener más información?

Su farmacéutico le puede dar más información acerca enalapril.

Recuerde, mantenga ésta y todas las otras medicinas fuera del alcance de los niños, no comparta nunca sus medicinas con otros, y use este medicamento sólo para la condición por la que fue recetada.

Se ha hecho todo lo posible para que la información que proviene de Cerner Multum, Inc. ('Multum') sea precisa, actual, y completa, pero no se hace garantía de tal. La información sobre el medicamento incluida aquí puede tener nuevas recomendaciones. La información preparada por Multum se ha creado para uso del profesional de la salud y para el consumidor en los Estados Unidos de Norteamérica (EE. UU.) y por lo cual Multum no certifica que el uso fuera de los EE. UU. sea apropiado, a menos que se mencione específicamente lo cual. La información de Multum sobre drogas no sanciona drogas, ni diagnóstica al paciente o recomienda terapia. La información de Multum sobre drogas sirve como una fuente de información diseñada para la ayuda del profesional de la salud licenciado en el cuidado de sus pacientes y/o para servir al consumidor que reciba este servicio como un suplemento a, y no como sustituto de la competencia, experiencia, conocimiento y opinión del profesional de la salud. La ausencia en éste de una advertencia para una droga o combinación de drogas no debe, de ninguna forma, interpretarse como que la droga o la combinación de drogas sean seguras, efectivas, o apropiadas para cualquier paciente. Multum no se responsabiliza por ningún aspecto del cuidado médico que reciba con la ayuda de la información que proviene de Multum. La información incluida aquí no se ha creado con la intención de cubrir todos los usos posibles, instrucciones, precauciones, advertencias, interacciones con otras drogas, reacciones alérgicas, o efectos secundarios. Si usted tiene alguna pregunta acerca de las drogas que está tomando, consulte con su médico, enfermera, o farmacéutico.

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.02. Revision Date: 2/12/2016 4:18:33 PM.

Comprar Cotriatec (Altace) Sin Receta, Cotriatec

compra Cotriatec (Altace) en linea sin receta

Cotriatec (Altace) Explicacion

Cotriatec es realmente un tratamiento ideal dentro de la batalla hacia la hipertension o incluso reducir el riesgo de infarto de miocardio, ataque al corazon, asi como la desaparicion de algunas victimas.

Cotriatec trabaja a traves de calmar torrente sanguineo. Quimica convertidora de angiotensina (ACE) inhibidor costoso.

Cotriatec tambien puede ser referido como ramipril, Cardace, Tritace, Ramace, Lopace.

titulo general asociada con Cotriatec es realmente pildoras ramipril.

Marca asociada con Cotriatec Cotriatec es en realidad.

Cotriatec (Altace) Dosis

Cotriatec viene en:

uno 25mg Minutos Dosis material de friccion

segundo. 5mg Baja Dosis

material de friccion material de friccion dosis regular 5mg

10 mg Mejorado Dosis material de friccion

Obtener Cotriatec por via oral con o sin comidas.

Por lo general, no moler o incluso masticar esto.

Si usted desea lograr mejores resultados por lo general no dejar de usar Cotriatec, de repente.

Cotriatec (Altace) Careciendo asocia con dosis

Por lo general, no reciben doble dosis. En caso de que salte la dosis que necesita para llevar una vez se tiene en cuenta en lo que respecta a su deficiente. Cuando es hora de la dosis que necesita para llevar a cabo su propia rutina de dosificacion normal.

Cotriatec (Altace)

En el caso de una sobredosis Cotriatec y que tambien se evita gran usted necesita comprobar hacia fuera su medico o incluso el medico de inmediato. Asociado con Cotriatec sobredosis: desmayos, fatiga grave o incluso mareos, alguna debilidad.

Cotriatec (Altace) Espacio de almacenamiento

Tienda en temperaturas de espacio entre 10 y 30 niveles de D (59, asi como ochenta y seis niveles F) de humedad, asi como la temperatura. Mantener cuadro de texto firmemente cerrada. Fortalecer cualquier tipo de medicamento sin tocar a partir del dia de vencimiento. Mantener desde el lograr de los ninos.

Cotriatec (Altace) Efectos negativos

Cotriatec ofrece los efectos negativos. El mas tipico tienden a ser:

toser material de friccion

material de friccion fatiga

material de friccion dolor de cabeza

friccion fatiga materiales

Mucho menos tipica y severos efectos negativos en toda utilizando Cotriatec:

respuestas reaccion alergica (urticaria, inhalando y exhalando, cuestiones de alergia, asi como la erupcion ) material de friccion Material

problemas cardiacos friccion

material de friccion pis oscuro

redujo pis material de friccion

problemas para ingerir material de friccion

material de friccion desmayos

la contaminacion (por ejemplo, temperatura, escalofrios, dolor de garganta prolongada) material de friccion

anormal del corazon batir material de friccion

material de friccion convulsiones

malestar vientre (con o incluso sin tener nauseas o vomitos o incluso vomitos) material de friccion

asociado con baja presion arterial (por ejemplo, desmayos, fatiga grave, aturdimiento) material de friccion

coloracion amarillenta de los poros y la piel o incluso material de friccion ojo

Los efectos negativos son indicaciones se basan en medicamentos que podrian estar utilizando pero, ademas, se basan en su condicion de bienestar y otros aspectos.

Cotriatec (Altace) Contraindicaciones

Por lo general no reciben Cotriatec si usted es sensible a fin de elementos Cotriatec.

Tenga cuidado junto con Cotriatec si usted esta esperando otra manera tiene la intencion de tener un hijo, si no que realmente eres una mama medica.

Por lo general, no utilizan suplementos dieteticos de potasio o incluso alternativas de sodio.

Cotriatec podria reducirse la capacidad de todo el cuerpo con el fin de la contaminacion batalla.

Informe a su medico o profesional de la odontologia que se obtiene Cotriatec antes de recibir cualquier tipo de atencion medica o incluso la higiene dental, tratamiento de emergencia inesperada, o incluso tratamiento quirurgico.

Para los que tienen la hipertension, por lo general no utilizan articulos de venta libre que contienen farmacos estimulantes. Estos articulos pueden incluir pildoras de perdida de peso o incluso medicamentos frias.

Los enfermos diabeticos deben tener cuidado junto con Cotriatec ya que podria afectar a su propia glucosa en la sangre. Examinar cuidadosamente los niveles de glucosa.

Los enfermos de la tercera edad deben ser cautelosos junto con Cotriatec. Pueden ser mucho mas delicado con el fin de los resultados.

Si usted desea lograr mejores resultados, sin efectos negativos, es aconsejable evitar las bebidas alcoholicas.

Por lo general, no dejar de usar Cotriatec, de repente.

Cotriatec (Altace) Preguntas comunes

Queen: Muy mejor informacion esencial Cotriatec?

El: Cotriatec es realmente una excelente medicina que se consume en la reparacion de la hipertension o incluso reducir el riesgo de infarto de miocardio, ataque al corazon, asi como la desaparicion de algunas victimas. Cotriatec podria reducirse la capacidad de todo el cuerpo con el fin de contaminacion batalla. Pida consejo a su medico antes de decidirse a hacer uso de una sal de sodio reemplazar o tal vez un elemento que tiene el potasio en su interior. Informe a su medico o profesional de la odontologia que se obtiene Cotriatec antes de recibir cualquier tipo de atencion medica o incluso la higiene dental, tratamiento de emergencia inesperada, o incluso tratamiento quirurgico. Para aquellos que tienen la hipertension, por lo general no utilizan articulos de venta libre que contienen farmacos estimulantes. Estos articulos pueden incluir pildoras de perdida de peso o incluso medicamentos frias. Enfermos diabeticos deben tener cuidado junto con Cotriatec. Podria afectar a su propia glucosa en la sangre. Examinar cuidadosamente los niveles de glucosa. Utilizar Cotriatec junto con la precaucion extrema en las personas mayores. Pueden ser mucho mas delicado con el fin de los resultados. Por lo general no reciben Cotriatec en caso de reaccion alergica a este medicamento oa sus componentes. Cotriatec no se puede usar si usted esta esperando otra manera tiene la intencion de tener un hijo, si no que realmente eres una mama medica. Si usted desea lograr mejores resultados que es aconsejable evitar las bebidas alcoholicas y no dejar de usar Cotriatec todo de un sudden. A

Queen: Exactamente como debo conseguir Cotriatec?

El: Obtener Cotriatec por via oral con o sin comidas. Por lo general, no moler o incluso masticar esto. Si usted desea lograr mejores resultados por lo general no dejar de usar Cotriatec todo de un sudden. A

Queen: Exactamente ?que debo FAG situacion asociada con sobredosis?

El: Por lo general no reciben pildoras Cotriatec en grandes cantidades. En el caso de Cotriatec mas de la dosis, usted tiene que comprobar hacia fuera medico o incluso el medico de inmediato. Asociado con sobredosis de Cotriatec: desmayos, fatiga grave o incluso mareos, algunos debilidad. En

Reina: ?Se puede realmente consumir alcohol?

El: Por supuesto que no, lo que realmente es inaceptable aprecian alcoholica beverages. A

comprar Cotriatec (Altace) en linea, Cotriatec (Altace) comprar en linea sin receta, Cotriatec (Altace) comprar sin receta, comprar barato Cotriatec (Altace), Cotriatec (Altace) comprar sin receta, comprar Cotriatec (Altace) de Canada, comprar Cotriatec (Altace) Canada, Para Cotriatec (Altace) en linea, Para Cotriatec (Altace) Generico Sin Receta Medica, Cotriatec (Altace) orden sin receta, Pildora por via oral Cotriatec (Altace)

Busqueda

Diva-35 (Tablets), Diva-35

PROPRIETARY NAME (and dosage form):

COMPOSITION: The 28-day pack (every day pack) contains 21 hormonal tablets each with 2 milligrams cyproterone acetate and 35 micrograms of ethinylestradiol . It also contains 7 non-hormonal tablets

PHARMACOLOGICAL CLASSIFICATION: A 21.8.2 Progesterone with estrogens. PHARMACOLOGICAL ACTION: Cyproterone acetate blocks the effect of endogenously produced and exogenously administered androgens at the target organs by means of competitive inhibition. The stimulating effect of male sex hormones on androgen-dependent structures and functions is weakened or abolished by cyproterone acetate. Excessive sebaceous gland function is decreased. Apart from the described anti-androgen effect, cyproterone acetate also has a progestational action. The ethinylestradiol in the combination inhibits ovulation and changes the cervical mucus and the endometrium rendering them unfavourable for sperm penetration and nidation of a fertilized ovum, respectively.

INDICATIONS: Androgen-dependent acne, especially those forms which are accompanied by seborrhea or by inflammation or formation of nodes (acne papulopustulosa, acne nodulocystica), androgen-dependent alopecia and mild forms of hirsutism. Oral contraception in women requiring anti-androgen therapy.

Pregnancy and lactation.

Severe disturbances of liver function; recurrent cholestatic jaundice; jaundice or persistent itching during a previous pregnancy; the Dubin-Johnson or Rotor syndromes; previous or existing liver tumours.

Existing or previous arterial or venous thrombotic or embolic processes, conditions which predispose to them (e. g. disorders of the clotting system with a tendency towards thrombosis and certain heart diseases).

Severe or focal migraine or cerebrovascular insufficiency.

Strict medical supervision is required in patients with diabetes or a tendency to diabetes, high blood pressure, varicose veins, a history of phlebitis, otosclerosis, multiple sclerosis, epilepsy, porphyria, tetany, chorea minor, asthma, depression, or conditions influenced by fluid retention.

Reasons for immediate discontinuation of DIVA-35 .

Occurrence, or exacerbation of migraines, headaches or unusually frequent or severe headaches.

Sudden disturbances of vision or hearing or other perceptual disorders.

First signs of thrombophlebitis or thromboembolic symptoms (e. g. unusual pains in or swelling of the leg(s), stabbing pains on breathing or coughing for no apparent reason). Pain and tightness in the chest.

Six weeks before an elective major operation (e. g. abdominal, orthopaedic), any surgery to the legs, medical treatment for varicose veins or prolonged immobilization, e. g. after accidents or surgery. DIVA-35 should not be restarted until 2 weeks after full ambulation. In case of emergency surgery, thrombotic prophylaxis is usually indicated e. g. subcutaneous heparin.

Onset of jaundice, hepatitis or itching of the whole body.

WARNINGS: DIVA-35 is not for use in men and should not be used in children. The combination of cyproterone acetate and ethinylestradiol has been found to cause an increase in the incidence of tumours (including carcinoma) in the liver of rats, when given in very high doses and for the majority of the animal’s life-span. The relevance of this finding to human is unknown. In rare cases benign and, in even rarer cases, malignant liver tumours leading to life-threatening intra-abdominal haemorrhage in isolated cases, have been observed after use of hormonal substances such as those contained in DIVA-35 . If severe upper abdominal complaints, liver enlargement or signs of intra-abdominal haemorrhage occur, a liver tumour should be included in the differential diagnosis. The incidence of diseases of the circulatory system in women using combined oral contraceptives is significantly greater than those of controls, and the mortality is slightly increased. Coronary thrombosis, cerebrovascular accidents and venous thrombosis are more likely to occur in women aged 35 years or over, particularly if they have used the contraceptive for longer than 5 years, if they smoke, if they are obese or if they are hypertensive. Additional risk factors are diabetes, hypercholesterolaemia and familial hyperlipoproteinaemia. However the risk of mortality due to oral contraceptives in women under 35 who are in the high-risk group is in general far less than the risk of mortality due to pregnancy.

INTERACTIONS: Interactions with other medicines and efficacy: Hepatic enzyme inducers such as barbiturates, primidone, phenobarbitone, phenytoin, phenylbutazone, rifampicin, carbamazepine and griseofulvin can impair the contraceptive efficacy of DIVA-35 . For women receiving long-term therapy with hepatic enzyme reducers, another method of contraception should be used. Oral contraceptive failure may occur with concomitant antibiotic therapy. For maximal protection, additional non-hormonal contraception should be recommended for the duration of antibiotic therapy and for seven days afterwards. Those on long-term therapy need only take extra precaution for the first two weeks of antibiotic therapy. Spotting and breakthrough bleeding are possible signs of diminished contraceptive effectiveness. With vomiting or diarrhoea, the absorption of oral contraceptives may be diminished and women should be advised to use additional methods of contraception at the time of such disorders in order to prevent a possible pregnancy, which would be a compelling reason for the discontinuation of this product. The requirements for oral antidiabetics or insulin can change as a result of the effect on glucose tolerance. The herbal remedy St John’s Wort (Hypericum perforatum) should not be taken concomitantly with DIVA-35 as this could potentially lead to a loss of contraceptive effect. The effectiveness of anticoagulants, antidepressant, antihypertensives, beta-blockers and diuretics, may be reduced if administered with DIVA-35 . The plasma concentrations of ciclosporin and theophylline may be increased with concomitant use. Large supplements of Vitamin C may increase serum ethinylestradiol concentration. Withdrawal of high doses of Vitamin C may lead to breakthrough bleeding.

Effects on laboratory tests: Oral contraceptives may interfere with some laboratory estimations, in particular hormones, glucose tolerance, thyroid function, blood coagulation, serum triglycerides and liver function tests.

PREGNANCY AND LACTATION: DIVA-35 is contra-indicated during pregnancy and lactation. See Contra-Indications and Warnings above.

DOSAGE AND DIRECTIONS FOR USE: Before starting DIVA-35 . a thorough gynaecological examination (including the breasts and a cytological smear of the cervix) should be carried out and the family case history carefully noted. In addition, disturbances of the clotting system must be ruled out if any members of the family have suffered from thromboembolic diseases (e. g. deep vein thrombosis, stroke, myocardial infarction) already at a young age. Pregnancy must be excluded. If the hirsutism has only recently appeared or has lately intensified to a considerable extent, an androgen-producing tumour or an adrenal enzyme defect must be excluded in the differential diagnosis. Initial course: One tablet daily for 28 days, starting on the first day of the menstrual cycle (the first day of menstruation counting as Day 1). Subsequent course: After the last tablet has been taken from the first pack, tablet-taking is continued from a new pack the very next day. Length of use: The length of use depends on the severity of the clinical picture. In general, treatment should be carried out over several months. It is recommended that DIVA-35 be taken for at least another 3 to 4 cycles after the signs have subsided. Should there be a recurrence weeks or months after discontinuation, treatment with DIVA-35 may be resumed. When changing from an oral contraceptive and relying on the contraceptive action of DIVA-35 . the instructions given below should be followed: Changing from 21-day combined oral contraceptives: The first tablet of DIVA-35 should be taken on the first day immediately after the end of the previous oral contraceptive course. Additional contraceptive precautions are not required. Changing from a combined Every Day Pill (28 day tablets): The first DIVA-35 tablet should be taken the day after the last active tablet from the Every Day Pill pack. Additional contraceptive precautions are not then required. Changing from a progesterone-only pill (POP): The first tablet of DIVA-35 should be taken on the first day of bleeding, even if a POP has already been taken on that day. Additional contraceptive precautions are not then required. The remaining progesterone-only pills should be discarded. Post-partum and post-abortum use: After pregnancy, DIVA-35 can be started 21 days after a vaginal delivery, provided the patient is fully ambulant and there are no puerperal complications. Additional contraceptive precautions will be required for the first 7 days of pill taking. Since the first post-partum ovulation may precede the first bleeding, another method of contraception should be used in the interval between childbirth and the first course of tablets. After a first-trimester abortion, DIVA-35 may be started immediately and no additional contraceptive precautions are required. Special circumstances requiring additional contraception: If a patient forgets to take her tablet at the usual time, she must take it within the next 12 hours at the latest. If more than 12 hours elapse from the time that she normally takes her tablet, and also in the case of vomiting or diarrhoea, she must continue to take the other tablets in the pack at the usual time in order to avoid premature withdrawal bleeding during the cycle. At the same time, however, an additional, non-hormonal method of contraception (with the exception of the rhythm and temperature methods) must be employed in order to prevent a pregnancy which would be a compelling reason for the discontinuation of DIVA-35 . If tablet(s) have been missed during the last 7 days of a pack, there should be no break before the next pack is started. In this situation, a withdrawal bleed should not be expected until the end of the second pack. Some breakthrough bleeding may occur on tablet taking days, but this is not clinical significant. If the patient does not have a withdrawal bleed during the tablet-free interval following the end of the second pack, the possibility of pregnancy must be ruled out before starting the next pack.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS: Side-effects: Gastro-intestinal system: Frequent: Gastro-intestinal irritation, nausea and abdominal cramps. Less frequent: Vomiting. Urogenital: Frequent: Breast tenderness. Less frequent: Amenorrhoea, menstrual irregularities such as spotting, breakthrough bleeding, changes in menstrual flow, changes in cervical erosion and cervical secretions, amenorrhoea during and after treatment and anovulation post treatment can occur. There may be a slight increase in the risk of cervical cancer (other factors may be involved) and breast cancer. Vaginal candidiasis has been reported. Metabolic and nutritional: Less frequent: Cholestatic jaundice, gall disease, reduced glucose tolerance and changes in lipid metabolism have been reported. Liver function may be impaired although jaundice is rare. Water retention and weight gain may occur. In rare cases benign, and in even rarer cases malignant liver tumours leading in isolated cases to life-threatening intra-abdominal haemorrhage, have been observed after the use of hormonal substances such as those contained in DIVA-35 . If severe upper abdominal complaints, liver enlargement or signs of intra-abdominal haemorrhage occur, a liver tumour should be included in the differential diagnostic considerations. Central nervous system: Less frequent: Changes in libido, mild dizziness, headache, migraine, depressive moods, mood changes, drowsiness and changes in appetite may occur. Skin and appendages: Frequent: Skin irritation and redness, pruritus. Less frequent: Poor tolerance of contact lenses, alopecia, chloasma (melasma), allergic rash, photosentivity and haemorrhagic eruption may occur. Circulatory/Cardiovascular system: The incidence of disease of the circulatory system in women using combined oral contraceptives is significantly greater than those on controls, and the mortality is slightly increased. Increased mortality from myocardial infarction is much greater in women aged 35 years or over, particularly if they used the contraceptive for longer than 5 years and if they smoke. Other risk factors include a family history of arterial disease, hypercholesterolaemia, familial hyperlipoproteinaemia, diabetes mellitus, hypertension, obesity and migraine. Specific risk factors for venous thrombo-embolism include a family history of venous thrombo-embolism, varicose veins and, again, obesity. However, the risk of mortality due to oral contraceptives in women under 35 who are in the high-risk group is in general far less than the risk of mortality due to pregnancy. Hypertension may occur in association with the use of oral contraceptives. Regular blood pressure checks, including a pre-treatment level, are advisable. Special Precautions: See Warnings and Dosage and Directions for use. Hypertension may occur in association with the use of oral contraceptives. Regular blood-pressure checks, including a pretreatment level, are advisable. Prolonged amenorrhoea following the use of oral contraceptives may occur. Caution is advised where oligomenorrhoea or amenorrhoea have occurred in the past. The use of ultraviolet lamps, for the treatment of acne, or prolonged exposure to sunlight, increases the risk of the deterioration of chloasma.

KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT: See Side-effects and Special Precautions above. Treatment is symptomatic and supportive.

IDENTIFICATION: 21 round, biconvex, yellow sugar-coated tablets with a 5.7 mm nominal diameter and 7 round, biconvex, white sugar-coated tablets with a 6.85 mm nominal diameter.

PRESENTATION: Each PVC/PVDC blister and aluminium foil contains 28 tablets. Each carton contains either 1 or 3 blister strips.

STORAGE INSTRUCTIONS: Store in original packs below 25ºC. Protect from light. STORE ALL MEDICINES OUT OF REACH OF CHILDREN.

REGISTRATION NUMBER: 38/21.8.2/0055

NAME AND BUSINESS ADDRESS OF THE HOLDER OF THE CERTIFICATE OF REGISTRATION: Dr Reddy’s Laboratories (Pty) Ltd PO Box 2064 Parklands 2121

DATE OF PUBLICATION OF THE PACKAGE INSERT: June 2005

New addition to this site: February 2007 Source: Pharmaceutical Industry SAEPI HOME PAGE TRADE NAME INDEX GENERIC NAME INDEX FEEDBACK Information presented by Malahyde Information Systems © Copyright 1996-2008

Filartros, Filartros

Arava is used to relieve symptoms caused by rheumatoid arthritis, such as inflammation, swelling, stiffness, and joint pain. This medicine works by stopping the body from producing too many of the immune cells that are responsible for the swelling and inflammation.

Availability: In Stock (34 packs)

Other names of Arava:

ARAVA is indicated in adults for the treatment of active rheumatoid arthritis (RA):

to reduce signs and symptoms

to inhibit structural damage as evidenced by X-ray erosions and joint space narrowing

to improve physical function

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

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

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

For oral dosage form (tablets):

For rheumatoid arthritis:

Adults—At first, 100 milligrams (mg) once a day for three days, then 20 mg once a day. Your doctor may adjust the dose as needed.

Children—Use and dose must be determined by your doctor.

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

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Protect from light. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Store the medicine in a closed container at room temperature, away from heat, moisture.

Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Store the medicine in a closed container at room temperature, away from heat, moisture.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

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

Leflunomide may also cause birth defects if the father is using it when his sexual partner becomes pregnant. Men taking leflunomide should use condoms as a form of birth control during sexual intercourse. A man intending to father a child should stop taking this medicine and check with his doctor right away.

Serious skin reactions can occur with this medicine. Stop using this medicine and check with your doctor right away if you have any of the following symptoms while taking this medicine: blistering, peeling, or loosening of the skin; chills; itching; joint or muscle pain; red skin lesions, often with a purple center; sores, ulcers, or white spots in the mouth or on the lips; or unusual tiredness or weakness.

Liver problems may occur while you are using this medicine. Stop using this medicine and check with your doctor right away if you are having more than one of these symptoms: abdominal or stomach pain or tenderness; clay-colored stools; dark urine; decreased appetite; fever; headache; loss of appetite; nausea or vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin.

Leflunomide can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination

Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.

Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.

Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.

Avoid contact sports or other situations where bruising or injury could occur.

Check with your doctor right away if you have a cough with or without a fever, shortness of breath, or any difficulty with breathing.

You will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis test.

Using this medicine may increase your risk of getting serious infections or cancer. Talk to your doctor if you have concerns about this risk.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Stop using this medicine and check with your doctor right away if you are having burning, numbness, tingling, or painful sensations in the arms, hands, legs, or feet. These could be symptoms of a condition called peripheral neuropathy.

Adverse reactions associated with the use of leflunomide in RA include diarrhea, elevated liver enzymes (ALT and AST), alopecia and rash.

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

Check with your doctor immediately if any of the following side effects occur: More common Bloody or cloudy urine cough difficult or painful breathing difficult, burning, or painful urination dizziness fever frequent urge to urinate headache loss of appetite nausea or vomiting sneezing sore throat tightness in the chest yellow eyes or skin Less common Burning feeling in the chest or stomach burning, prickling, or tingling sensation in the fingers or toes chest pain diarrhea fast heartbeat indigestion joint or muscle pain or stiffness pounding heartbeat severe stomach pain shortness of breath tenderness in the stomach area unusual tiredness or weakness Incidence not known Area rash black or tarry stools bleeding gums blistering, peeling, or loosening of the skin bloating blood in the stools burning, numbness, tingling, or painful sensations chills clay-colored stools confusion constipation continuing vomiting cough or hoarseness dark urine fainting fever with or without chills general feeling of tiredness or weakness high fever large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs light-colored stools lightheadedness lower back or side pain pains in the stomach, side, or abdomen, possibly radiating to the back pale skin pinpoint red spots on the skin rapid, shallow breathing red skin lesions, often with a purple center red, irritated eyes sores, ulcers, or white spots in the mouth or on the lips swollen glands unexplained bleeding or bruising unpleasant breath odor unsteadiness or awkwardness unusual bleeding or bruising upper right abdominal or stomach pain vomiting of blood weakness in the arms, hands, legs, or feet

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: More common Back pain hair loss heartburn skin rash stomach pain weight loss (unexplained) Less common Acne anxiety decreased appetite dry mouth gas irritation or soreness of the mouth itching of the skin pain or burning in the throat runny nose

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

Arava is used to relieve symptoms caused by rheumatoid arthritis, such as inflammation, swelling, stiffness, and joint pain. This medicine works by stopping the body from producing too many of the immune cells that are responsible for the swelling and inflammation.

Availability: In Stock (34 packs)

Other names of Arava:

ARAVA is indicated in adults for the treatment of active rheumatoid arthritis (RA):

to reduce signs and symptoms

to inhibit structural damage as evidenced by X-ray erosions and joint space narrowing

to improve physical function

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

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

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

For oral dosage form (tablets):

For rheumatoid arthritis:

Adults—At first, 100 milligrams (mg) once a day for three days, then 20 mg once a day. Your doctor may adjust the dose as needed.

Children—Use and dose must be determined by your doctor.

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

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Protect from light. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Store the medicine in a closed container at room temperature, away from heat, moisture.

Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Store the medicine in a closed container at room temperature, away from heat, moisture.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

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

Leflunomide may also cause birth defects if the father is using it when his sexual partner becomes pregnant. Men taking leflunomide should use condoms as a form of birth control during sexual intercourse. A man intending to father a child should stop taking this medicine and check with his doctor right away.

Serious skin reactions can occur with this medicine. Stop using this medicine and check with your doctor right away if you have any of the following symptoms while taking this medicine: blistering, peeling, or loosening of the skin; chills; itching; joint or muscle pain; red skin lesions, often with a purple center; sores, ulcers, or white spots in the mouth or on the lips; or unusual tiredness or weakness.

Liver problems may occur while you are using this medicine. Stop using this medicine and check with your doctor right away if you are having more than one of these symptoms: abdominal or stomach pain or tenderness; clay-colored stools; dark urine; decreased appetite; fever; headache; loss of appetite; nausea or vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin.

Leflunomide can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination

Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.

Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.

Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.

Avoid contact sports or other situations where bruising or injury could occur.

Check with your doctor right away if you have a cough with or without a fever, shortness of breath, or any difficulty with breathing.

You will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis test.

Using this medicine may increase your risk of getting serious infections or cancer. Talk to your doctor if you have concerns about this risk.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Stop using this medicine and check with your doctor right away if you are having burning, numbness, tingling, or painful sensations in the arms, hands, legs, or feet. These could be symptoms of a condition called peripheral neuropathy.

Adverse reactions associated with the use of leflunomide in RA include diarrhea, elevated liver enzymes (ALT and AST), alopecia and rash.

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

Check with your doctor immediately if any of the following side effects occur: More common Bloody or cloudy urine cough difficult or painful breathing difficult, burning, or painful urination dizziness fever frequent urge to urinate headache loss of appetite nausea or vomiting sneezing sore throat tightness in the chest yellow eyes or skin Less common Burning feeling in the chest or stomach burning, prickling, or tingling sensation in the fingers or toes chest pain diarrhea fast heartbeat indigestion joint or muscle pain or stiffness pounding heartbeat severe stomach pain shortness of breath tenderness in the stomach area unusual tiredness or weakness Incidence not known Area rash black or tarry stools bleeding gums blistering, peeling, or loosening of the skin bloating blood in the stools burning, numbness, tingling, or painful sensations chills clay-colored stools confusion constipation continuing vomiting cough or hoarseness dark urine fainting fever with or without chills general feeling of tiredness or weakness high fever large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs light-colored stools lightheadedness lower back or side pain pains in the stomach, side, or abdomen, possibly radiating to the back pale skin pinpoint red spots on the skin rapid, shallow breathing red skin lesions, often with a purple center red, irritated eyes sores, ulcers, or white spots in the mouth or on the lips swollen glands unexplained bleeding or bruising unpleasant breath odor unsteadiness or awkwardness unusual bleeding or bruising upper right abdominal or stomach pain vomiting of blood weakness in the arms, hands, legs, or feet

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: More common Back pain hair loss heartburn skin rash stomach pain weight loss (unexplained) Less common Acne anxiety decreased appetite dry mouth gas irritation or soreness of the mouth itching of the skin pain or burning in the throat runny nose

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

Arava is used to relieve symptoms caused by rheumatoid arthritis, such as inflammation, swelling, stiffness, and joint pain. This medicine works by stopping the body from producing too many of the immune cells that are responsible for the swelling and inflammation.

Availability: In Stock (34 packs)

Other names of Arava:

ARAVA is indicated in adults for the treatment of active rheumatoid arthritis (RA):

to reduce signs and symptoms

to inhibit structural damage as evidenced by X-ray erosions and joint space narrowing

to improve physical function

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

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

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

For oral dosage form (tablets):

For rheumatoid arthritis:

Adults—At first, 100 milligrams (mg) once a day for three days, then 20 mg once a day. Your doctor may adjust the dose as needed.

Children—Use and dose must be determined by your doctor.

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

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Protect from light. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Store the medicine in a closed container at room temperature, away from heat, moisture.

Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Store the medicine in a closed container at room temperature, away from heat, moisture.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

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

Leflunomide may also cause birth defects if the father is using it when his sexual partner becomes pregnant. Men taking leflunomide should use condoms as a form of birth control during sexual intercourse. A man intending to father a child should stop taking this medicine and check with his doctor right away.

Serious skin reactions can occur with this medicine. Stop using this medicine and check with your doctor right away if you have any of the following symptoms while taking this medicine: blistering, peeling, or loosening of the skin; chills; itching; joint or muscle pain; red skin lesions, often with a purple center; sores, ulcers, or white spots in the mouth or on the lips; or unusual tiredness or weakness.

Liver problems may occur while you are using this medicine. Stop using this medicine and check with your doctor right away if you are having more than one of these symptoms: abdominal or stomach pain or tenderness; clay-colored stools; dark urine; decreased appetite; fever; headache; loss of appetite; nausea or vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin.

Leflunomide can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination

Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.

Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.

Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.

Avoid contact sports or other situations where bruising or injury could occur.

Check with your doctor right away if you have a cough with or without a fever, shortness of breath, or any difficulty with breathing.

You will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis test.

Using this medicine may increase your risk of getting serious infections or cancer. Talk to your doctor if you have concerns about this risk.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Stop using this medicine and check with your doctor right away if you are having burning, numbness, tingling, or painful sensations in the arms, hands, legs, or feet. These could be symptoms of a condition called peripheral neuropathy.

Adverse reactions associated with the use of leflunomide in RA include diarrhea, elevated liver enzymes (ALT and AST), alopecia and rash.

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

Check with your doctor immediately if any of the following side effects occur: More common Bloody or cloudy urine cough difficult or painful breathing difficult, burning, or painful urination dizziness fever frequent urge to urinate headache loss of appetite nausea or vomiting sneezing sore throat tightness in the chest yellow eyes or skin Less common Burning feeling in the chest or stomach burning, prickling, or tingling sensation in the fingers or toes chest pain diarrhea fast heartbeat indigestion joint or muscle pain or stiffness pounding heartbeat severe stomach pain shortness of breath tenderness in the stomach area unusual tiredness or weakness Incidence not known Area rash black or tarry stools bleeding gums blistering, peeling, or loosening of the skin bloating blood in the stools burning, numbness, tingling, or painful sensations chills clay-colored stools confusion constipation continuing vomiting cough or hoarseness dark urine fainting fever with or without chills general feeling of tiredness or weakness high fever large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs light-colored stools lightheadedness lower back or side pain pains in the stomach, side, or abdomen, possibly radiating to the back pale skin pinpoint red spots on the skin rapid, shallow breathing red skin lesions, often with a purple center red, irritated eyes sores, ulcers, or white spots in the mouth or on the lips swollen glands unexplained bleeding or bruising unpleasant breath odor unsteadiness or awkwardness unusual bleeding or bruising upper right abdominal or stomach pain vomiting of blood weakness in the arms, hands, legs, or feet

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: More common Back pain hair loss heartburn skin rash stomach pain weight loss (unexplained) Less common Acne anxiety decreased appetite dry mouth gas irritation or soreness of the mouth itching of the skin pain or burning in the throat runny nose

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

Arava is used to relieve symptoms caused by rheumatoid arthritis, such as inflammation, swelling, stiffness, and joint pain. This medicine works by stopping the body from producing too many of the immune cells that are responsible for the swelling and inflammation.

Availability: In Stock (34 packs)

Other names of Arava:

ARAVA is indicated in adults for the treatment of active rheumatoid arthritis (RA):

to reduce signs and symptoms

to inhibit structural damage as evidenced by X-ray erosions and joint space narrowing

to improve physical function

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

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

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

For oral dosage form (tablets):

For rheumatoid arthritis:

Adults—At first, 100 milligrams (mg) once a day for three days, then 20 mg once a day. Your doctor may adjust the dose as needed.

Children—Use and dose must be determined by your doctor.

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

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Protect from light. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Store the medicine in a closed container at room temperature, away from heat, moisture.

Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Store the medicine in a closed container at room temperature, away from heat, moisture.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

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

Leflunomide may also cause birth defects if the father is using it when his sexual partner becomes pregnant. Men taking leflunomide should use condoms as a form of birth control during sexual intercourse. A man intending to father a child should stop taking this medicine and check with his doctor right away.

Serious skin reactions can occur with this medicine. Stop using this medicine and check with your doctor right away if you have any of the following symptoms while taking this medicine: blistering, peeling, or loosening of the skin; chills; itching; joint or muscle pain; red skin lesions, often with a purple center; sores, ulcers, or white spots in the mouth or on the lips; or unusual tiredness or weakness.

Liver problems may occur while you are using this medicine. Stop using this medicine and check with your doctor right away if you are having more than one of these symptoms: abdominal or stomach pain or tenderness; clay-colored stools; dark urine; decreased appetite; fever; headache; loss of appetite; nausea or vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin.

Leflunomide can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination

Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.

Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.

Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.

Avoid contact sports or other situations where bruising or injury could occur.

Check with your doctor right away if you have a cough with or without a fever, shortness of breath, or any difficulty with breathing.

You will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis test.

Using this medicine may increase your risk of getting serious infections or cancer. Talk to your doctor if you have concerns about this risk.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Stop using this medicine and check with your doctor right away if you are having burning, numbness, tingling, or painful sensations in the arms, hands, legs, or feet. These could be symptoms of a condition called peripheral neuropathy.

Adverse reactions associated with the use of leflunomide in RA include diarrhea, elevated liver enzymes (ALT and AST), alopecia and rash.

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

Check with your doctor immediately if any of the following side effects occur: More common Bloody or cloudy urine cough difficult or painful breathing difficult, burning, or painful urination dizziness fever frequent urge to urinate headache loss of appetite nausea or vomiting sneezing sore throat tightness in the chest yellow eyes or skin Less common Burning feeling in the chest or stomach burning, prickling, or tingling sensation in the fingers or toes chest pain diarrhea fast heartbeat indigestion joint or muscle pain or stiffness pounding heartbeat severe stomach pain shortness of breath tenderness in the stomach area unusual tiredness or weakness Incidence not known Area rash black or tarry stools bleeding gums blistering, peeling, or loosening of the skin bloating blood in the stools burning, numbness, tingling, or painful sensations chills clay-colored stools confusion constipation continuing vomiting cough or hoarseness dark urine fainting fever with or without chills general feeling of tiredness or weakness high fever large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs light-colored stools lightheadedness lower back or side pain pains in the stomach, side, or abdomen, possibly radiating to the back pale skin pinpoint red spots on the skin rapid, shallow breathing red skin lesions, often with a purple center red, irritated eyes sores, ulcers, or white spots in the mouth or on the lips swollen glands unexplained bleeding or bruising unpleasant breath odor unsteadiness or awkwardness unusual bleeding or bruising upper right abdominal or stomach pain vomiting of blood weakness in the arms, hands, legs, or feet

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: More common Back pain hair loss heartburn skin rash stomach pain weight loss (unexplained) Less common Acne anxiety decreased appetite dry mouth gas irritation or soreness of the mouth itching of the skin pain or burning in the throat runny nose

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

Article Page, Lignocainum

Ocena skutecznosci preparatow miejscowo znieczulajacych skore w redukcji bolu w trakcie pobierania krwi u dzieci – badanie z randomizacja

The effectiveness of local anesthetics in the reduction of needle related pain in school age children

Piotr Dziechciarz 1,1 ,2 ,3 ,.

Andrea Horvath 1,1 ,2 ,3

Bozena Grygiel 2,1 ,2 ,3

1 Klinika Pediatrii Warszawski Uniwersytet Medyczny

2 Oddzial Pediatryczny Szpitala Zachodniego im. Jana Pawla II w Grodzisku, Mazowieckim

Received 4 February 2010. Accepted 20 February 2010. Available online 30 December 2010. Kierownik Kliniki: prof. dr hab. med. Hanna Szajewska

Streszczenie

Cel pracy

Porownanie skutecznosci srodkow miejscowo znieczulajacych skore w redukcji bolu podczas planowanego pobierania krwi u dzieci.

Pacjenci i metody

Badaniem objeto 78 pacjentow w wieku 7–14 lat, u ktorych w celach diagnostycznych pobierano krew, a ktorych losowo przydzielono do grupy otrzymujacej 2% zel Lignocainum Hydrochloricum U (czas aplikacji preparatu 15 min), 5% krem EMLA (czas aplikacji 60 min) lub placebo (wazeline biala) (czas aplikacji 30 min). Kazda z badanych grup liczyla 26 osob Po pobraniu krwi dzieci dokonywaly oceny bolu odczuwanego w trakcie naklucia na podstawie Obrazowej Skali Oceny Bolu.

Wyniki

Stwierdzono znamiennie statystyczna roznice nasilenia bolu pomiedzy grupa otrzymujaca 2% lignokaine a grupa z zastosowaniem placebo (srednia roznica: –1,58 95% CI –2,44 do –0,72) oraz pomiedzy grupa EMLA a grupa placebo (srednia roznica:–1,73 95% CI –2,62 do –0,84), przy braku roznicy pomiedzy grupa EMLA a grupa otrzymujaca lignokain ® (srednia roznica: –0,15 95% CI –0,78 do 0,48). Istotny klinicznie bol zglaszalo znamiennie wiecej dzieci w grupie otrzymujacej placebo (12/26), zarowno w porownaniu z pacjentami znieczulanymi 2% lignokaina (1/26) (ryzyko wzgledne [relative risk, RR] 0,08 95%CI 0,01 do 0,06), jak i dzieci otrzymujacych krem EMLA (1/26) (RR 0,08 95%CI 0,01 do 0,06).

Wnioski

2% zel Lignocainum Hydrochloricum U i krem EMLA znamiennie redukuja bol podczas pobierania krwi u dzieci w porownaniu z placebo. Skutecznosc zelu 2% Lignocainum Hydrochloricum U jest porownywalna z kremem EMLA w zmniejszeniu bolu zwiazanego z pobieraniem krwi.

Abstract

Aim

To compare the effectiveness of local anesthetics: 2% gel Lignocainum Hydrochloricum U, Emla cream and placebo in the reduction of needle related pain in school age children.

Pateints and methods

78 patients in the age of 7–14y undergoing blood testing were randomly assigned to one of the three groups receiving either 2% gel lignocaiini hydrochloircum or placebo. After venipuncture assessed pain intensity with the use of Faces Pain Scale.

Results

There has been statistically significant deifference found in the mean pain intensity between 2%lignocaine and placebo (mean difference: –1,58, 95% CI –2,44 to –0,72), EMLA and placebo (mean difference: –1.73, 95%CI: –2.62 to –0.84), with no difference between 2% lignocaini and EMLA (mean difference: –0,15, 95% CI –0,78 to 0,48). Clinically significant pain was reported in higher proportion of patients from placebo group (12/26), than lignocaini group (1/26) (relative risk, [RR]: 0,08, 95%CI 0,01 to 0,06) and EMLA group (1/26) (relative risk, [RR]: 0,08, 95%CI 0,01 to 0,06)

Conclusion

2% lignocaini hydrochlorici and EMLA showed similar anesthetic effect but significantly better than placebo.

Slowa kluczowe

Key words

Wprowadzenie

Miedzynarodowe Towarzystwo Badania Bolu okresla bol jako nieprzyjemne odczucie emocjonalne i zmyslowe zwiazane z aktualnie wystepujacym lub potencjalnym uszkodzeniem tkanek. Bol jest jednak odczuciem subiektywnym, nie zawsze proporcjonalnym do uszkodzenia tkanek. Wszelkie sytuacje wywolujace lek czy zmeczenie negatywnie wplywaja na sposob i natezenie odczuwania bolu. Szczegolnie u dzieci komponenta lekowa jest zjawiskiem powszechnym, istotnie nasilajacym poczucie odczuwania bolu. Wsrod dzieci hospitalizowanych pobieranie krwi oceniane jest jako jedno z najgorszych doswiadczen w trakcie pobytu w szpitalu [1. 2]. Powtarzajace sie epizody bolowe, zwiazane np. z zabiegami dia gnostycznymi lub terapeutycznymi, moga prowadzic do utrwalania reakcji lekowej, ktora w konsekwencji skutkuje niechecia do jakichkolwiek, nawet bezbolesnych zabiegow medycznych lub pielegnacyjnych [3]. Jedna z metod zmniejszania bolu zwiazanego z drobnymi zabiegami medycznymi jest miejscowa, naskorna aplikacja srodkow zmniejszajacych bol. Wyniki badan z randomizacja udowodnily skutecznosc stosowania 4% ametokainy oraz preparatow zawierajacych lignokaine (EMLA, Elamax) w redukcji bolu 2.. 3. and 4.. W Polsce zarejestrowany jest jedynie preparat EMLA. Dlugi czas aplikacji (60 minut) przed osiagnieciem pelnej efektywnosci preparatu ogranicza jednak czesto jego stosowanie w praktyce. W Polsce dostepny jest rowniez zel 2% roztworu chlorowodorku lignokainy, uzywany do drobnych zabiegow w anestezjologii, laryngologii i urologii. Preparat ten charakteryzuje sie stosunkowo szybkim poczatkiem dzialania (2–3 min) i utrzymywaniem efektu analgetycznego do 30 min od poczatku aplikacji, jak dotad jednak nie oceniono jego skutecznosci w redukcji bolu zwiazanego z pobraniami krwi.

Cel badania

Celem badania bylo porownanie skutecznosci 2% zelu Lignocainum Hydrochloricum U z kremem EMLA oraz placebo w redukcji bolu zwiazanego z pobraniami krwi u dzieci.

Material i metody

Metodyka badania

Badanie z randomizacja przeprowadzone metoda pojedynczej slepej proby.

Lokalizacja

Oddzial Pediatryczny Szpitala Zachodniego im. Jana Pawla II w Grodzisku Mazowieckim.

Kryteria wlaczenia

Do badania kwalifikowano dzieci w wieku 7–14 lat, przyjmowane na oddzial, u ktorych pobierano krew w celach diagnostycznych. Warunkiem poddania pacjenta randomizacji i zastosowania interwencji bylo uzyskanie swiadomej pisemnej zgody rodzicow i dzieci (> 10 r. z.) na udzial w badaniu.

Kryteria wylaczenia

Kryteria wylaczenia obejmowaly: nadwrazliwosc lub uczulenie na leki miejscowo znieczulajace w wywiadzie, atopowe zapalenie skory, zmiany skorne (np. przebarwienia, pogrubienia skory itp.) w planowanym miejscu wklucia, brak logicznego kontaktu slownego, spowodowanego np. choroba ukladu nerwowego, koniecznosc zalozenia obwodowego dojscia naczyniowego (np. pozostawienie wenflonu w naczyniu).

Punkty koncowe

W badaniu skutecznosc zastosowanych preparatow – tzw. pierwotne punkty koncowe – oceniano jako:

srednie nasilenie bolu zwiazane z diagnostycznym pobraniem krwi; dzieci biorace udzial w badaniu okreslaly swoje odczucia bolowe za pomoca Obrazowej Skali Oceny Bolu ( Faces Pain Scale . FSP), ryc. 1 [7] ;

Ryc. 1. Obrazowa Skala Oceny Bolu

Ryc. 1. Fig. 1. Faces Pain Scale

oraz jako odsetek pacjentow nie odczuwajacych bolu w trakcie pobierania krwi (piktogram 0 w FSP) [7] .

Jako wtorny punkt koncowy ustalono odsetek dzieci, ktore odczuwaly klinicznie istotny bol w trakcie pobierania krwi (piktogram ? 3 w FSP) [8] .

Opis interwencji

Po zakwalifikowaniu pacjenta do badania oraz uzyskaniu pisemnej zgody rodzicow lub opiekunow na udzial dziecka w badaniu zapoznawano ich z Obrazowa Skala Oceny Bolu (piktogramy).

Z uzyciem tabeli randomizacyjnej pacjentow losowo przydzielano do jednej z trzech grup, w ktorych stosowano odpowiednio:

2% zel Lignocainum Hydrochloricum U (producent Przedsiebiorstwo Farmaceutyczne JELFA S. A. Jelenia Gora), czas aplikacji 15 min;

5% krem EMLA (emulsja 2,5% lignokainy i 2,5% prilokainy producent Astra Zeneca AB, Szwecja), czas aplikacji 60 min;

placebo (wazelina biala), czas aplikacji 30 min.

Niezaangazowana w pobieranie krwi pielegniarka wybierala do naklucia zyle lokciowa, prawej lub lewej reki, a nastepnie aplikowala odpowiednia dawke preparatu. W kazdym przypadku zastosowana warstwe srodka znieczulajacego pokrywano przezroczystym opatrunkiem okluzyjnym. Zarowno dziecko, jak i osoba pobierajaca krew nie wiedziala, do ktorej grupy zostal przydzielony pacjent. Po uplywie wymaganego czasu aplikacji usuwano opatrunek i w warunkach gabinetu zabiegowego pobierano przez naklucie zyly krew do zleconych badan diagnostycznych. Kazdorazowo zabieg pobierania krwi wykonywala ta sama pielegniarka. W przypadku pojawienia sie problemow z jednorazowym pobraniem krwi (np. pekniecie naczynia), rezygnowano z dalszego uczestniczenia dziecka w badaniu.

Po pobraniu krwi i opuszczeniu gabinetu zabiegowego, w wyznaczonym miejscu – sala pobytu dziennego – dziecko otrzymywalo karte z Obrazowa Skala Oceny Bolu (FSP) i zaznaczalo rysunek, ktory odpowiadal nasileniu odczuwanego bolu w trakcie calego zabiegu.

Metody statystyczne

Srednie roznice natezenia bolu w trzech badanych grupach porownywano z uzyciem jednoczynnikowej analizy wariancji dla grup przekrojowych ANOVA (test F), a nastepnie dla zmiennych ciaglych obliczono srednia roznice miedzy badanymi grupami. Dla zmiennych dychotomicznych obliczono ryzyko wzgledne, ktore definiowano jako iloraz prawdopodobienstwa wystapienia danego skutku w grupie eksperymentalnej, w ktorej zastosowano interwencje i tego prawdopodobienstwa w grupie kontrolnej. Wyniki przedstawiono w postaci sredniej wraz z 95% przedzialem ufnosci. Do statystycznej analizy danych uzyto komputerowego programu Statistica wersji 5,0, firmy Stat Soft. Analiza wynikow zostala dokonana w grupach wyodrebnionych zgodnie z zaplanowanym leczeniem (ITT – intention to treat analysis ).

Wyniki

Badanie prowadzone bylo na Oddziale Pediatrycznego Szpitala Zachodniego im. Jana Pawla II w Grodzisku Mazowieckim w okresie od kwietnia 2004 r. do marca 2005 r. Wstepnie zakwalifikowano 83 pacjentow przyjetych na oddzial celem rozszerzenia diagnostyki z zakresu chorob ukladu oddechowego, alergii, niedoborow masy ciala i wzrostu, zaburzen ze strony ukladu pokarmowego, moczowego oraz po wczesniejszym omdleniu i/lub utracie przytomnosci. Piec osob (dzieci i/lub opiekunow) po informacji, ze czas aplikacji preparatu moze wynosic do 1 godziny nie wyrazilo zgody na dalsze uczestnictwo w badaniu. Pozostalych 78 pacjentow zgodnie z lista randomizacyjna zakwalifikowano do jednej z 3 interwencji (2% lignokaina, krem EMLA lub placebo), po 26 dzieci w kazdej grupie.

Srednie natezenie bolu

Srednie natezenie bolu w grupie dzieci, ktorym aplikowano na skore 2% zel Lignocainum Hydrochloricum wynosilo 0,96 (95% przedzial ufnosci [ confidence interval . CI] 0,52 do 1,39), w grupie otrzymujacej krem EMLA – 0,80 (95% CI 0,3–1,3), natomiast w grupie placebo 2,54 (95% CI 1,74–3,33); tab. 1. Znamienna roznice w sredniej nasilenia bolu stwierdzono zatem zarowno pomiedzy grupa otrzymujaca 2% lignokaine a grupa placebo (srednia roznica: –1,58, 95%CI –2,44 do –0,72), jak i pomiedzy grupa EMLA a grupa z zastosowaniem placebo (srednia roznica: –1,73, 95%CI –2,62 do –0,84). Nie stwierdzono natomiast takiej roznicy pomiedzy grupa 2% lignokainy a grupa EMLA (srednia roznica –0,15, 95%CI –0,78–0,48)

Tabela 1. Stopien nasilenia bolu wg Obrazowej Skali Oceny Bolu w badanych grupach

Tabela 1. Table 1. Pain assessment with Faces Pain Scale in the treatment groups

Brak bolu

W grupie, w ktorej przed pobraniem krwi aplikowano 2% zel Lignocainum Hydrochloricum, 9/26 dzieci zakreslilo piktogram 0 – oznaczajacy „brak bolu”. W grupie z zastosowaniem kremu EMLA 12/26 dzieci nie zglaszalo bolu, a w grupie placebo jedynie 4/26 nie odczuwalo bolu w czasie zabiegu. Znamiennie wieksza szanse na calkowita redukcje bolu w trakcie pobierania krwi stwierdzono jedynie w grupie EMLA w stosunku do placebo (ryzyko wzgledne [ relative risk . RR] 3,0 95% CI 1,11–8,07).

Klinicznie istotny bol

Istotny klinicznie bol (piktogram ? 3) zglaszalo znamiennie wiecej dzieci, ktorym aplikowano na skore placebo (12/26) w porownaniu z pacjentami otrzymujacymi zarowno 2% zel z lignokaina (1/26) (RR 0,08 95% CI 0,01–0,06), jak i dzieci z aplikowanym kremem EMLA (1/26) (RR 0,08 95% CI 0,01–0,06).

Dyskusja

Wyniki badania wykazuja skutecznosc miejscowych preparatow zawierajacych lignokaine w redukcji bolu u dzieci podczas pobierania krwi z zyl obwodowych. Zastosowanie preparatu 2% Lignocainum Hydrochloricum U oraz kremu EMLA w porownaniu z placebo, znamiennie zmniejszalo zarowno srednie nasilenie bolu, jak i odsetek dzieci zglaszajacych istotny klinicznie bol wywolywany pobieraniem krwi do badan laboratoryjnych. Dodatkowo pacjenci, ktorym aplikowano krem EMLA, mieli znaczaco wieksza szanse na calkowita eliminacje bolu zwiazanego z pobieraniem krwi.

Wykazana w badaniu skutecznosc kremu EMLA jest porownywalna z wynikami dotychczas opublikowanych badan. Stosujac rozne skale oceny bolu, wszystkie, poza jedna praca, wykazywaly umiarkowany, znamiennie mniejszy bol w trakcie nakluwania obwodowych naczyn zylnych [4] .

Podobna skutecznosc 2% zelu lignokainy i kremu EMLA, obserwowana w obecnym badaniu, jest prawdopodobnie efektem niewielkiej roznicy stezen lignokainy zawartej w obu preparatach. Roznica w szybkosci osiagania efektu klinicznego, definiowana jako niezbedny czas aplikacji (podawany przez producenta), moze wynikac z innych substancji bedacych podlozem dla obu preparatow. Krem EMLA zawiera substancje rozszerzajaca naczynia skorne – prilokaine oraz wodorotlenek sodu powodujacy alkalizacje skory, co sprzyja zwiekszeniu jej przepuszczalnosci dla wielu zwiazkow chemicznych. 2% zel lignokainy zawiera zas latwo wchlaniajace sie estry, przyspieszajace penetracje srodka znieczulajacego. Czynnikiem mogacym dodatkowo wplywac na stwierdzana efektywnosc 2% zelu lignokainy jest stosunkowo niewielka grubosc skory w obrebie stawu lokciowego u dzieci, ulatwiajaca bezposrednia penetracje aktywnego preparatu. Obecnie nie dysponujemy jednak obiektywnymi badaniami u dzieci porownujacymi szybkosc wchlaniania lignokainy w zaleznosci od podloza i miejsca aplikacji. Biorac jednak pod uwage organizacje i specyfike pracy w gabinetach zabiegowych, znacznie krotszy czas aplikacji zelu 2% lignokainy jest dobrym argumentem przemawiajacym na korzysc tego preparatu. Argumentem przemawiajacym za stosowaniem 2% zelu lignokainy jest rowniez jej kilkakrotnie nizszy koszt.

Slaboscia badania jest brak jego pelnego zaslepienia. Niestety, wybor zastosowanych preparatow znieczulajacych, rozniacych sie barwa, konsystencja oraz czasem aplikacji uniemozliwil dokonanie tej procedury, co niewatpliwie moze wplywac na ryzyko bledu zwiazanego ze znajomoscia interwencji. Celem zmniejszenia tego ryzyka pielegniarka aplikujaca srodki znieczulajace lub placebo nie brala udzialu w dalszej czesci badania, pielegniarka zas dokonujaca pobrania, a takze sam pacjent byli nieswiadomi co do zastosowanej interwencji. Jednoczesnie aby zminimalizowac wplyw dodatkowych czynnikow mogacych zaburzac ocene odczuwanego przy pobraniu krwi bolu (np. technika pobierania krwi czy doswiadczenie osoby dokonujacej wklucia), badanie zostalo zaplanowane w taki sposob, by wszystkie dzieci mialy krew pobierana przez jedna i te sama pielegniarke.

Dobor odpowiednio homogennej grupy, skladajacej sie z dzieci w wieku szkolnym, nie eksponowanych wczesniej na czeste naklucia zyl obwodowych jest niewatpliwie mocna strona tego badania. Percepcja bolu u dzieci narazonych wczesniej na bol proceduralny moze byc znacznie wyzsza ze wzgledu na komponente emocjonalna, czyli tzw. strach przed igla. Sila tego badania jest jednak jednoczesnie jego slaboscia, nie pozwala bowiem ekstrapolowac jego wynikow na grupe dzieci wymagajacych czestych wkluc dozylnych. Nalezy rowniez zauwazyc, ze ze wzgledu na szczegolnie silna komponente lekowa u mlodszych dzieci nie wiadomo, czy obserwowany bylby u nich podobny efekt. W celu dalszej oceny skutecznosci preparatu 2% Lignocainum Hydrochloricum U wskazane byloby przeprowadzenie podobnych badan w innych grupach wiekowych (dzieci przedszkolne, niemowleta) oraz u dzieci wymagajacych czestych wkluc dozylnych.

Waznym atutem badania jest wybor odpowiedniej skali oceny bolu. Zastosowanie Obrazowej Skali Oceny Bolu w grupie dzieci w wieku szkolnym pozwala w sposob wiarygodny i obiektywny mierzyc stopien jego nasilenia [9]. Skala ta jest rekomendowana przez miedzynarodowa grupe ekspertow zajmujacych sie ocena bolu u dzieci (IMMPACT: Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials) [10] .

Wnioski

Zel 2% Lignocainum Hydrochloricum U oraz krem EMLA w porownaniu z placebo znamiennie zmniejszaja sredni bol oraz istotny klinicznie bol podczas pobierania krwi u dzieci w wieku szkolnym.

Zel 2% Lignocainum Hydrochloricum U oraz krem EMLA sa porownywalnie skuteczne w zmniejszaniu bolu zwiazanego z pobieraniem krwi u dzieci w wieku szkolnym.

Konflikt interesu/Conflicts of interest

Autorzy pracy nie zglaszaja konfliktu interesow.

Pismiennictwo

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EMLA and amethocaine for reduction of children's pain associated with needle insertion

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V. Shah. A. Taddio. M. Rieder. HELPinKIDS Team

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Clin Ther. Volume 31. Issue Suppl 2. 2009. pp. S104–S151

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Pain. Volume 41. 1990. pp. 139–150

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J. N. Stinson. T. Kavanagh. J. Yamada. N. Gill. B. Stevens

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J Pain. Volume 9. 2008. pp. 771–783

?

Adres do korespondencji/Address for correspondence: Klinika Pediatrii, Warszawski Uniwersytet, Medyczny, 01-184 Warszawa, ul. Dzialdowska 1. Tel./fax: 0-22 – 452 33 09.

Wklad w koncepcje i projekt pracy, Piotr Dziechciarz: 40%, Andrea Horvath: 40%, Bozena Grygiel: 20%.

Wklad w zbieranie, analize i interpretacje danych, Piotr Dziechciarz: 30%, Andrea Horvath: 30%, Bozena Grygiel: 40%.

Odpowiedzialnosc za analize statystyczna, Piotr Dziechciarz: 100%, Napisanie artykulu, Piotr Dziechciarz: 40%, Andrea Horvath: 40%, Bozena Grygiel: 20%.

Copyright © 2010 Polish Pediatric Society. Published by Elsevier Urban & Partner Sp. z. o.o.

Citing articles ( )

Lipid Profile - What You Need To Know, Lipidcare

Lipid Profile

WHAT YOU NEED TO KNOW:

What is it?

A lipid profile is a group of blood tests that tells how your body uses, changes, or stores lipids. Lipids are fats and cannot dissolve in blood. Lipids stick on proteins in the blood and are called lipoproteins. The amount of lipoproteins in the blood can change with what you eat. The amount can also change because of some illnesses and because of heredity.

Some of the lipids included in the profile are cholesterol, triglycerides, and high density cholesterol. Low density cholesterol (LDL) is usually calculated from the values of HDL, triglycerides and total cholesterol.

The job of HDL is believed to be the removal of cholesterol from tissues. Then HDL takes cholesterol to the liver where it is removed from the body. This is why HDL is known as the "good cholesterol."

LDL can carry cholesterol and deposit it in the arteries, which increases the risk of heart attacks and strokes. This is why LDL is known as "bad cholesterol."

Why do I need it?

A lipid profile can help find out if you are at risk of developing heart disease. This test may also be done to see how your medicines are working.

How do I get ready for the test?

Your caregivers will tell you when to have your blood test done. Do not eat or drink anything, except water, for at least 12 hours before the test. Ask your caregivers if you should wait to take your medicines until after your blood is taken.

How is the blood collection done?

A caregiver will put a wide rubber strap around your arm and tighten it. Your skin will be cleaned with alcohol. A small needle attached to a special test tube will be put into a vein in your arm or hand. The tube has suction to pull the blood into it. When the tube is full, the rubber strap, needle and tube are removed. The caregiver will press a piece of cotton where the needle was removed. You may be asked to hold the cotton on the area for a few minutes to help stop the bleeding. Tape may then be put over the cotton on your arm.

What do I do after the test?

You may remove the tape and cotton in about 20 to 30 minutes. Follow the instructions of your caregiver. Call your caregiver to get the results of your test. Your caregiver will explain what your test results mean for you.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about your lab tests. You can then discuss the results with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A. D.A. M. Inc. or Truven Health Analytics.

Bookkeeping, Payroll In Barnet - Hertfordshire, Modina

QUALITY BOOKKEEPING AT AFFORDABLE PRICES How much would your business benefit from having a fast, reliable and dedicated accounts team. A team that you would never again have to hire, train or give a holiday?

Sharon has worked within accountancy practices since 1991, always with a passion for the support side of accountancy and takes pleasure in seeing client’s businesses achieve their potential. After many years of employment within practice Sharon started and has grown Modina from scratch so she understands exactly what it is like to run your own business.

Joe Smith

Joe is an Accountant with many years of experience helping clients manage their businesses. He is a very motivated individual who prides himself on building strong relationships with all his clients. Many of Modinas clients have given testimony to Joe’s ability to help them grow and succeed.

Rebecca Watson

Rebecca started out in the world of payroll at the age of 18 and genuinely loves all things payroll. Rebecca is a delight to have around the office and nothing is ever too much trouble, she is always prepared to go the extra mile for her clients.

Alex Macdonald

Alex joined Modina in November 2011 where he completed his AAT qualification and is currently studying CIMA. Alex is experienced in all areas of bookkeeping, management accounts and VAT preparation, he is rarely in the office as he spends the majority of his time visiting clients.

Charlene Holden

Charlene is a very experienced member of the Bookkeeping and Management Accounts team. Charlene always goes the extra mile for her clients, building excellent working relationships. Our resident keep fit fanatic that keeps us all in check with training plans.

Toni-Marie Usher

MODINA STRIKE GOLD WITH XERO? The world of accountancy and bookkeeping is undergoing major changes. In our opinion the future of the industry lies in harnessing the power of Cloud-based software. Using the Cloud means the team at Modina are able to provide clients with a solution that is easy for them to understand; allowing[…]

This month we thought we would take a bit of time to introduce you some of our team members, starting with Joe Smith. Joe has been working in accountancy practices for over 12 years, he has extensive knowledge and experience in the full spectrum of accountancy, bookkeeping and payroll services. Naturally good with numbers for as[…]

“This is the first time in 40 years we have managed our accounts this way and now wished we had done so many years ago,” says Carole Hickton, Finance Director, Flair Electronic Systems. The User A leading supplier of test and measurement equipment to the global cellular industry, Flair Electronic Systems provides bespoke[…]

When it comes to keeping your accounts up to date, it’s vital that you choose a system, a bookkeeper or an accountant that is methodical, knowledgeable, and above all, accurate. Saving you time, unnecessary and avoidable costs, not to mention the uncapped and potentially escalating levels of stress that can ensue from inaccurate accounts, Modina[…]

When it comes to running a business, keeping on top of our taxes is one of the most time-consuming, often frustrating and yet, important jobs of them all. And it’s not so difficult to see why it gives us such a headache. When we take on the route of self-employment, it’s easy to underestimate just[…]

Setting up a business is hard, growing a business is even harder. That’s why we provide all of our customers, no matter how big or small, with the same level of high-quality expertise, experience and knowledge to fulfill all of their accountancy, bookkeeping and payroll service needs. 1. Making it Unique Here at Modina we[…]

The Modina team have spent the last 6 months in training to get ready to complete the Tough Mudder challenge. The challenge involves running 13 miles through thick mud and tackling obstacles that have been designed by Marines. The course is designed to test their physical and mental strength, and we are all nearly[…]

All business owners know that good cash flow is vital to the survival of their organisation. Businesses can fail in the short term, not because they are not profitable but because of lack of cash flow.

As most employers will probably now be aware they will have to provide a workplace pension for employees.

In this article we’re going to talk about VAT or value added tax, what it means, when you need to register and what options are available.

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Common use This medication is a peripheral vasodilatator with a hypotension effect. It specifically blocks angiotensin I receptors. Results of Valsartan activity may be observed in 2 hours after its intake, maximal effect is reached in 4-6 hours. Duration of its actions is over 24 hours. Valsartan is used to treat chronic heart failure (NYHA class III-IV). The medication in particular is prescribed after heart attacks.

Dosage and direction Once a day together with food or before a meal. Maximal daily dose is 160 mg, usual dose is 80 mg daily. Depending on your condition dosage may change. Do not take this medication if it was not administered to you. Follow all directions of your doctor.

Precautions FDA pregnancy category D. Valsartan may be harmful to an unborn baby. Continue treatment with this medication even if you feel fine unless your doctor told you different. In rare cases, Valsartan can cause a condition that results in the breakdown of skeletal muscle tissue, which then leads to kidney failure. In this case such symptoms as fever, nausea, dark colored urine, muscle pain appear and you should inform your doctor immediately about it to avoid further complications.

Contraindications Hypersensitivity, pregnancy, breastfeeding. The medication should be administered cautiously in patients with a biliary cirrhosis, bile duct obstruction, kidney failure, stenosis of kidney artery.

Possible side effect Headache, dizziness, asthenia, insomnia, diarrhea, abdominal pain, vomit, coughing, running nose, impotence, reduced renal function, and allergic reactions.

Drug interaction Potassium-sparing diuretics, K+ medications, salts which contain K+ in interaction with Valsartan may facilitate development of hyperpotassemia. Diuretics in combination with Valsartan cause hypotention.

Missed dose If you missed a dose take it as soon as you remember, but not if it is almost time of the next intake by your schedule. If it occured skip the missed dose. Do not try to compensate a missed dose by taking an extra one.

Overdose If you suppose that you overdosed Valsartan seek for immediate medical attention. Symptoms of overdose may include dizziness, increased heart rate, increased levels of potassium in the blood, kidney failure, Loss of consciousness.

Storage Store Valsartan at room temperature, 15-30 C (59-86 F).

Disclaimer 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.

Propecia - Hair Loss, Zasterid

Common use Finasteride is used to treat hair loss (male pattern). It is to be used only by adult men. Finasteride can also be used to treat prostate cancer and benign prostatic hyperplasia. In clinical studies Propecia was shown to work on both the crown area and the hairline.

Dosage and direction Take Propecia by mouth with a glass of water, with or without food. Avoid cutting, crushing or chewing this medicine. Consult your doctor concerning proper dose for you.

Precautions Before taking Propecia tell your doctor or chemist if you are allergic to Finasteride or Dutasteride; or if you have other allergies. As this medicament can be absorbed by skin, women who are pregnant or may become pregnant should not manipulate this medicine.

Contraindications Propecia should not be used by women or children as well as by the patients who have demonstrated a reaction of hypersensitivity to Finasteride.

Possible side effect The most common side effects are dizziness, unusual weakness, drowsiness, trouble sleeping, blurred vision, runny nose, or problems ejaculating. Stop using Finasteride and call your doctor at once if you have any of these serious side effects: penis erection that is painful or lasts 4 hours or longer, severe dizziness or fainting. A very serious allergic reaction rarely occurs. 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 may use before using this medication.

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 them in the bathroom. Keep all drugs away from reach of children and pets.

Disclaimer We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at 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.

Common use Finasteride is used to treat hair loss (male pattern). It is to be used only by adult men. Finasteride can also be used to treat prostate cancer and benign prostatic hyperplasia. In clinical studies Propecia was shown to work on both the crown area and the hairline.

Dosage and direction Take Propecia by mouth with a glass of water, with or without food. Avoid cutting, crushing or chewing this medicine. Consult your doctor concerning proper dose for you.

Precautions Before taking Propecia tell your doctor or chemist if you are allergic to Finasteride or Dutasteride; or if you have other allergies. As this medicament can be absorbed by skin, women who are pregnant or may become pregnant should not manipulate this medicine.

Contraindications Propecia should not be used by women or children as well as by the patients who have demonstrated a reaction of hypersensitivity to Finasteride.

Possible side effect The most common side effects are dizziness, unusual weakness, drowsiness, trouble sleeping, blurred vision, runny nose, or problems ejaculating. Stop using Finasteride and call your doctor at once if you have any of these serious side effects: penis erection that is painful or lasts 4 hours or longer, severe dizziness or fainting. A very serious allergic reaction rarely occurs. 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 may use before using this medication.

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 them in the bathroom. Keep all drugs away from reach of children and pets.

Disclaimer We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at 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.

Gentle Lax (Kroger Company) Polyethylene Glycol 3350 17g In 17g Powder, For Solution, Gentlax

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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.

Everything you need to know about antibiotics:

Yosprala Yosprala (aspirin and omeprazole) is a platelet aggregation inhibitor and proton pump inhibitor.

Cuvitru Cuvitru (immune globulin subcutaneous (human)) is indicated as replacement therapy in the treatment.

Erelzi Erelzi (etanercept-szzs) is a tumor necrosis factor (TNF) blocker biosimilar to Enbrel indicated.

Troxyca ER Troxyca ER (oxycodone hydrochloride and naltrexone hydrochloride) is an extended-release.

FDA Consumer Updates

Rabigh Electricity Company, Rabec

Companies that provide electric power, natural gas, steam supply, water supply, and sewage removal through a permanent infrastructure of lines, mains, and pipes.

Companies that operate power plants for converting fossil fuel into electric power; including generation facilities that use fossil fuels (such as coal, oil, or gas) to produce electric energy; electric energy is then provided to electric power transmission or electric power distribution systems.

Companies that operate facilities for electric power generation, so as to convert forms of energy (including hydroelectric, fossil fuels, and nuclear power) into electrical energy. The sector includes companies that produce electric energy and provide electricity to transmission systems or to distribution systems.

Companies that engage in the generation, transmission, and distribution of electricity for sale in regulated markets.

Dubai 1:04 PM 20 Sep 2016

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Rabigh Electricity Company

Name available Chief Executive Officer and Managing Director

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Name available Chief Financial Officer

Name available Chief Technical Officer

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Riyadh -- Rabigh 1 Independent Power Project has completed refinancing of its senior facilities, said a press statement issued by ACWA Power and Saudi Electricity Company.

The Saudi Gazette - 14-Jul-2016

Rabigh Electricity, a special purpose vehicle partly owned by state-run Saudi Electricity (SEC), is in talks with banks to raise a loan worth up to USD2 billion.

Saudi Airlines Cargo has successfully transported a 73 ton generator rotor from Chengdu, China to Jeddah on behalf of Rabigh Electricity Company (RABEC). The rotor is the final part to complete the first Independent Power Project in Saudi Arabia, the $2.5 billion project for a 1200MW steam turbine power station to provide power to the Western Region. Manufactured by DEC China, a consortium member

The Saudi Gazette - 08-Feb-2012

Saudi Airlines Cargo has successfully transported a 73 tonne generator rotor from Chengdu, China to Jeddah, Saudi Arabia on behalf of Rabigh Electricity Company (RABEC). The rotor is the final part to complete the first Independent Power Project in Saudi Arabia, the USD 2.5 billion project for a 1200MW steam turbine power station to provide power to the Western Region.

Press Release - 07-Feb-2012

Top Business News

WAM (Emirates News Agency) - 3 hours ago

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

Continue to use Ranitidine even if you feel well. Do not miss any dose.

If you miss a dose of Ranitidine, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

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

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

Do NOT use Ranitidine if:

you are allergic to any ingredient in Ranitidine

you have a history of the blood disease porphyria

you are taking dasatinib.

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

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

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

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

if you have a history of kidney or liver problems

if you have abnormal blood electrolyte levels or a history of irregular heartbeat.

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

Certain benzodiazepines (eg, midazolam, triazolam), glipizide, procainamide, or warfarin because the risk of their side effects may be increased by Ranitidine

Dasatinib, delavirdine, gefitinib, certain HIV protease inhibitors (eg, atazanavir), itraconazole, or ketoconazole because their effectiveness may be decreased by Ranitidine.

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

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

Ranitidine may interfere with certain lab tests, including urine protein tests. Be sure your doctor and lab personnel know you are taking Ranitidine.

Lab tests, including liver function, may be performed while you use Ranitidine. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Ranitidine should be used with extreme caution in children younger than 1 month 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 Ranitidine while you are pregnant. Ranitidine is found in breast milk. Do not breastfeed while taking Ranitidine.

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

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

Constipation; diarrhea; headache; nausea; stomach upset.

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); change in the amount of urine produced; confusion; dark urine; depression; fast, slow, or irregular heartbeat; fever, chills, or sore throat; hallucinations; severe or persistent headache or stomach pain; unusual bruising or bleeding; 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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Aleve - Pain Relief, Flogotone

Aleve (naproxen) is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen works by reducing hormones that cause inflammation and pain in the body. It commonly used for the reduction of pain, fever, inflammation and stiffness caused by conditions such as:

osteoarthritis

kidney stones

rheumatoid arthritis

psoriatic arthritis

gout

ankylosing spondylitis

menstrual cramps

tendinitis

bursitis

Aleve is commonly used for the reduction of pain, fever, inflammation and stiffness caused by conditions such as:

osteoarthritis

kidney stones

rheumatoid arthritis

psoriatic arthritis

gout

ankylosing spondylitis

menstrual cramps

tendinitis

bursitis

Take Aleve exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts, or use it for longer than recommended. Do not crush, chew, or break an extended-release or enteric-coated tablet. Swallow the pill whole. The extended-release pill is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating. Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you take Aleve for a long period of time, your doctor may want to check you on a regular basis to make sure this medication is not causing harmful effects. Do not miss any scheduled visits to your doctor.

Since Aleve is sometimes taken only when needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time.

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Many medicines available over the counter contain aspirin or other medicines similar to Aleve (such as ibuprofen or ketoprofen). If you take certain products together you may accidentally take too much of this type of medication. Read the label of any other medicine you are using to see if it contains aspirin, ibuprofen, or ketoprofen. Do not drink alcohol while taking Aleve. Alcohol can increase the risk of stomach bleeding caused by Aleve. Avoid prolonged exposure to sunlight.

Aleve can make your skin more sensitive to sunlight, and a sunburn may result. Wear protective clothing and use sunscreen (SPF 15 or higher) when you are outdoors.

Store Aleve at room temperature away from moisture and heat.

Before taking Aleve:

Taking an NSAID can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use an NSAID. Do not use Aleve just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

NSAIDs can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking an NSAID. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Do not use this medication if you are allergic to Aleve, or if you have a history of allergic reaction to aspirin or other NSAIDs.

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

a history of heart attack, stroke, or blood clot;

heart disease, congestive heart failure, high blood pressure;

a history of stomach ulcers or bleeding;

liver or kidney disease;

asthma;

polyps in your nose;

a bleeding or blood clotting disorder; or

if you smoke.

FDA pregnancy category C. Before using Aleve, tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking Aleve during the last 3 months of pregnancy may result in birth defects. Do not take Aleve during pregnancy unless your doctor has told you to. Aleve can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medicine to a child younger than 2 years old without the advice of a doctor.

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Many medicines available over the counter contain aspirin or other medicines similar to Aleve (such as ibuprofen or ketoprofen). If you take certain products together you may accidentally take too much of this type of medication. Read the label of any other medicine you are using to see if it contains aspirin, ibuprofen, or ketoprofen. Do not drink alcohol while taking Aleve. Alcohol can increase the risk of stomach bleeding caused by Aleve. Avoid prolonged exposure to sunlight. Aleve may increase the sensitivity of the skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking Aleve and seek medical attention or call your doctor at once if you have any of these serious side effects:

chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance;

black, bloody, or tarry stools;

coughing up blood or vomit that looks like coffee grounds;

swelling or rapid weight gain;

urinating less than usual or not at all;

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

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

bruising, severe tingling, numbness, pain, muscle weakness; or

fever, headache, neck stiffness, chills, increased sensitivity to light, purple spots on the skin, and/or seizure (convulsions).

Less serious Aleve side effects may include:

upset stomach, mild heartburn or stomach pain, diarrhea, constipation;

bloating, gas;

dizziness, headache, nervousness;

skin itching or rash;

blurred vision; or

ringing in your ears.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Listserv Definition, Degiton

Home. Internet Terms. Listserv Definition

Listserv

This term looks like it's missing an "e", but that's how it's spelled. A listserv, or list server, is a small program that automatically sends messages to multiple e-mail addresses on a mailing list. When someone subscribes to a mailing list, the listserv will automatically add the address and distribute future e-mail messages to that address along with all the others on the list. When someone unsubscribes, the listserv simply removes the address. At least that is the way it supposed to work. Unfortunately, with some SPAM lists, unsubscribing only adds you to more lists.

Cite this definition:

Pms-Fluoxetine, Pms-Fluoxetine

Fluoxetine

Brand Names: Canada

Apo-Fluoxetine; Ava-Fluoxetine; CO Fluoxetine; Dom-Fluoxetine; Fluoxetine Capsules BP; FXT 40; Gen-Fluoxetine; JAMP-Fluoxetine; Mint-Fluoxetine; Mylan-Fluoxetine; Novo-Fluoxetine; Nu-Fluoxetine; PHL-Fluoxetine; PMS-Fluoxetine; PRO-Fluoxetine; Prozac; Q-Fluoxetine; ratio-Fluoxetine; Riva-Fluoxetine; Sandoz-Fluoxetine; Teva-Fluoxetine; ZYM-Fluoxetine

Warning

Children and teens who take this drug may be at a greater risk of having thoughts or actions of suicide. Adults may also be at risk. The risk may be greater in people who have had these thoughts or actions in the past. Watch people who take this drug closely. Call the doctor right away if signs like low mood (depression), nervousness, restlessness, grouchiness, panic attacks, or changes in mood or actions are new or worse. Call the doctor right away if any thoughts or actions of suicide occur.

This drug is not approved for use in all children. Talk with the doctor to be sure that this drug is right for your child.

What is this drug used for?

It is used to treat low mood (depression).

It is used to treat obsessive-compulsive problems.

It is used to treat mood problems caused by monthly periods.

It is used to treat eating problems.

It is used to treat panic attacks.

It may be given to you for other reasons. Talk with the doctor.

What do I need to tell my doctor BEFORE I take this drug?

If you have an allergy to fluoxetine or any other part of this drug.

If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.

If you are taking any of these drugs: Linezolid or methylene blue.

If you are taking pimozide.

If you are taking thioridazine.

If you have taken certain drugs used for low mood (depression) like isocarboxazid, phenelzine, or tranylcypromine or drugs used for Parkinson’s disease like selegiline or rasagiline in the last 14 days. Taking this drug within 14 days of those drugs can cause very bad high blood pressure.

This is not a list of all drugs or health problems that interact with this drug. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take this drug?

Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.

Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you.

Do not stop taking this drug all of a sudden without calling your doctor. You may have a greater risk of side effects. If you need to stop this drug, you will want to slowly stop it as ordered by your doctor.

Avoid drinking alcohol while taking this drug.

Talk with your doctor before you use other drugs and natural products that slow your actions.

If you have high blood sugar (diabetes), you will need to watch your blood sugar closely.

It may take several weeks to see the full effects.

This drug may raise the chance of bleeding. Sometimes, bleeding can be life-threatening. Talk with the doctor.

Very bad and sometimes deadly reactions along with a rash have rarely happened with this drug. Lung, kidney, or liver problems have also happened. Call your doctor right away if you have a change in the amount of urine passed, dark urine, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, yellow skin or eyes, or shortness of breath.

Some people may have a higher chance of eye problems with this drug. Your doctor may want you to have an eye exam to see if you have a higher chance of these eye problems. Call your doctor right away if you have eye pain, change in eyesight, or swelling or redness in or around the eye.

Use with care in children. Talk with the doctor.

This drug may affect growth in children and teens in some cases. They may need regular growth checks. Talk with the doctor.

If you are 65 or older, use this drug with care. You could have more side effects.

Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this drug while you are pregnant.

Taking this drug in the third trimester of pregnancy may lead to some health problems in the newborn. Talk with the doctor.

Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Signs of low sodium levels like headache, trouble focusing, memory problems, feeling confused, weakness, seizures, or change in balance.

Signs of bleeding like throwing up blood or throw up that looks like coffee grounds; coughing up blood; blood in the urine; black, red, or tarry stools; bleeding from the gums; vaginal bleeding that is not normal; bruises without a reason or that get bigger; or any bleeding that is very bad or that you cannot stop.

Very bad dizziness or passing out.

A big weight gain or loss.

Change in sex ability.

Lowered interest in sex.

A very bad and sometimes deadly health problem called serotonin syndrome may happen. The risk may be greater if you take this drug with drugs for depression, migraines, or certain other drugs. Call your doctor right away if you have agitation; change in balance; confusion; hallucinations; fever; fast or abnormal heartbeat; flushing; muscle twitching or stiffness; seizures; shivering or shaking; sweating a lot; very bad diarrhea, upset stomach, or throwing up; or very bad headache.

Call your doctor right away if you have a painful erection (hard penis) or an erection that lasts for longer than 4 hours. This may happen even when you are not having sex. If this is not treated right away, it may lead to lasting sex problems and you may not be able to have sex.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

Upset stomach.

Dry mouth.

Feeling sleepy.

Dizziness.

Loose stools (diarrhea).

Bad dreams.

Not able to sleep.

Feeling tired or weak.

Flu-like signs.

Yawning.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to your national health agency.

How is this drug best taken?

Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.

All products:

To gain the most benefit, do not miss doses.

Keep taking this drug as you have been told by your doctor or other health care provider, even if you feel well.

Take with or without food.

Long-acting products:

Swallow whole. Do not chew, break, or crush.

Liquid (solution):

Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.

What do I do if I miss a dose?

Take a missed dose as soon as you think about it.

If it is close to the time for your next dose, skip the missed dose and go back to your normal time.

Do not take 2 doses at the same time or extra doses.

How do I store and/or throw out this drug?

Store at room temperature. Do not freeze.

Protect from light.

Store in a dry place. Do not store in a bathroom.

Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.

Check with your pharmacist about how to throw out unused drugs.

General drug facts

If your symptoms or health problems do not get better or if they become worse, call your doctor.

Do not share your drugs with others and do not take anyone else’s drugs.

Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.

Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.

Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. 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 the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Last Reviewed Date

Copyright

© 2016 Wolters Kluwer Clinical Drug Information, Inc. and its affiliates and/or licensors. All rights reserved.

If you have any questions or concerns, contact a member of your healthcare team directly or call 212-639-2000 for help.

If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00 pm. during the weekend, and on holidays, please call____________________. If there’s no number listed, or you’re not sure, call 212-639-2000 .

©2016 Memorial Sloan Kettering Cancer Center - Generated on September 16, 2016

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