Rendapid, Rendapid

Rendapid

Rendapid - General Information

A derivative of lovastatin and potent competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase (hydroxymethylglutaryl COA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It may also interfere with steroid hormone production. Due to the induction of hepatic LDL receptors, it increases breakdown of LDL cholesterol. [PubChem]

Pharmacology of Rendapid

Rendapid, the methylated form of lovastatin, is an oral antilipemic agent which inhibits HMG-CoA reductase. simvastatin is used in the treatment of primary hypercholesterolemia and is effective in reducing total and LDL-cholesterol as well as plasma triglycerides and apolipoprotein B.

Rendapid for patients

Patients should be advised about substances they should not take concomitantly with simvastatin and be advised to report promptly unexplained muscle pain. tenderness, or weakness. Patients should also be advised to inform other physicians prescribing a new medication that they are taking ZOCOR.

Rendapid Interactions

Simvastatin is metabolized by CYP3A4 but has no CYP3A4 inhibitory activity; therefore it is not expected to affect the plasma concentrations of other drugs metabolized by CYP3A4. Potent inhibitors of CYP3A4 (below) increase the risk of myopathy by reducing the elimination of simvastatin.

HIV protease inhibitors

Large quantities of grapefruit juice (>1 quart daily)

Interactions with lipid-lowering drugs that can cause myopathy when given alone

The risk of myopathy is increased by gemfibrozil and to a lesser extent by other fibrates and niacin (nicotinic acid) (?1 g/day).

Other drug interactions

Danazol: The risk of myopathy/rhabdomyolysis is increased by concomitant administration of danazol particularly with higher doses of simvastatin

Amiodarone or Verapamil: The risk of myopathy/rhabdomyolysis is increased by concomitant administration of amiodarone or verapamil with higher doses of simvastatin

Propranolol: In healthy male volunteers there was a significant decrease in mean Cmax, but no change in AUC, for simvastatin total and active inhibitors with concomitant administration of single doses of ZOCOR and propranolol. The clinical relevance of this finding is unclear. The pharmacokinetics of the enantiomers of propranolol were not affected.

Digoxin: Concomitant administration of a single dose of digoxin in healthy male volunteers receiving simvastatin resulted in a slight elevation (less than 0.3 ng/mL) in digoxin concentrations in plasma (as measured by a radioimmunoassay) compared to concomitant administration of placebo and digoxin. Patients taking digoxin should be monitored appropriately when simvastatin is initiated.

Warfarin: In two clinical studies, one in normal volunteers and the other in hypercholesterolemic patients, simvastatin 20-40 mg/day modestly potentiated the effect of coumarin anticoagulants: the prothrombin time, reported as International Normalized Ratio (INR), increased from a baseline of 1.7 to 1.8 and from 2.6 to 3.4 in the volunteer and patient studies, respectively. With other reductase inhibitors, clinically evident bleeding and/or increased prothrombin time has been reported in a few patients taking coumarin anticoagulants concomitantly. In such patients, prothrombin time should be determined before starting simvastatin and frequently enough during early therapy to ensure that no significant alteration of prothrombin time occurs. Once a stable prothrombin time has been documented, prothrombin times can be monitored at the intervals usually recommended for patients on coumarin anticoagulants. If the dose of simvastatin is changed or discontinued, the same procedure should be repeated. Simvastatin therapy has not been associated with bleeding or with changes in prothrombin time in patients not taking anticoagulants.

Rendapid Contraindications

Hypersensitivity to any component of this medication.

Active liver disease or unexplained persistent elevations of serum transaminases

Pregnancy and lactation. Atherosclerosis is a chronic process and the discontinuation of lipid-lowering drugs during pregnancy should have little impact on the outcome of long-term therapy of primary hypercholesterolemia. Moreover, cholesterol and other products of the cholesterol biosynthesis pathway are essential components for fetal development, including synthesis of steroids and cell membranes. Because of the ability of inhibitors of HMG-CoA reductase such as ZOCOR to decrease the synthesis of cholesterol and possibly other products of the cholesterol biosynthesis pathway, ZOCOR is contraindicated during pregnancy and in nursing mothers. ZOCOR should be administered to women of childbearing age only when such patients are highly unlikely to conceive. If the patient becomes pregnant while taking this drug, ZOCOR should be discontinued immediately and the patient should be apprised of the potential hazard to the fetus.

Additional information about Rendapid

Rendapid Indication: For the treatment of hypercholesterolemia. Mechanism Of Action: The 6-membered lactone ring of simvastatin is hydrolyzed in vivo to generate mevinolinic acid, an active metabolite structurally similar to HMG-CoA (hydroxymethylglutaryl CoA). Once hydrolyzed, simvastatin competes with HMG-CoA for HMG-CoA reductase, a hepatic microsomal enzyme. Interference with the activity of this enzyme reduces the quantity of mevalonic acid, a precursor of cholesterol. Drug Interactions: Not Available Food Interactions: Avoid drastic changes in dietary habit. Avoid alcohol. Avoid taking with grapefruit juice. Generic Name: Simvastatin Synonyms: Not Available Drug Category: Anticholesteremic Agents; Antilipemic Agents; Hydroxymethylglutaryl-CoA Reductase Inhibitors Drug Type: Small Molecule; Approved Other Brand Names containing Simvastatin: Cholestat; Coledis; Colemin; Corolin; Denan; Labistatin; Lipex; Lodales; Medipo; Nivelipol; Pantok; Rendapid; Simovil; Simvastatin [Usan-Ban-Inn]; Simvastatina [Spanish]; Simvastatine [French]; Simvastatinum [Latin]; Sinvacor; Sivastin; Synvinolin; Vasotenal; Vytorin; Zocor; Zocord; Absorption: Absorption of simvastatin, estimated relative to an intravenous reference dose, in each of two animal species tested, averaged about 85% of an oral dose. In animal studies, after oral dosing, simvastatin achieved substantially higher concentrations in the liver than in non-target tissues. Toxicity (Overdose): Not Available Protein Binding: Both simvastatin and its b-hydroxyacid metabolite are highly bound (approximately 95%) to human plasma proteins. Biotransformation: Hepatic, simvastatin is a substrate for CYP3A4. Half Life: 3 hours Dosage Forms of Rendapid: Tablet Oral Chemical IUPAC Name: [(1S,3R,7S,8S,8aR)-8-[2-[(2R,4R)-4-hydroxy-6-oxooxan-2-yl]ethyl]-3,7-dimethyl-1,2,3,7,8,8a-hexahydronaphthalen-1-yl] 2,2-dimethylbutanoate Chemical Formula: C25H38O5 Simvastatin on Wikipedia: http://en. wikipedia. org/wiki/Simvastatin Organisms Affected: Humans and other mammals

Midol Pm Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Midol

Midol PM

GENERIC NAME(S): diphenhydramine-acetaminophen

Warnings

One ingredient in this product is acetaminophen. Taking too much acetaminophen may cause serious (possibly fatal) liver disease. Adults should not take more than 4000 milligrams (4 grams) of acetaminophen a day. People with liver problems and children should take less acetaminophen. Ask your doctor or pharmacist how much acetaminophen is safe to take.

Do not use with any other drug containing acetaminophen without asking your doctor or pharmacist first. Acetaminophen is in many nonprescription and prescription medications (such as pain/fever drugs or cough - and-cold products). Check the labels on all your medicines to see if they contain acetaminophen, and ask your pharmacist if you are unsure.

Get medical help right away if you take too much acetaminophen (overdose), even if you feel well. Overdose symptoms may include nausea. vomiting. loss of appetite, sweating. stomach /abdominal pain. extreme tiredness, yellowing eyes /skin. and dark urine.

Daily alcohol use, especially when combined with acetaminophen, may damage your liver. Avoid alcohol.

Uses

This combination product contains 2 medications, acetaminophen and an antihistamine. Acetaminophen helps to reduce fever and/or mild to moderate pain (such as headache. backache, aches/pains due to muscle strain. cold, or flu ). The antihistamine in this product may cause drowsiness, and therefore it can also be used as a nighttime sleep aid. Antihistamines can also be used to help relieve allergy or cold symptoms such as watery eyes. itchy eyes /nose/throat, runny nose. and sneezing .

Cough - and-cold products have not been shown to be safe or effective in children younger than 6 years. Therefore, do not use this product to treat cold symptoms in children younger than 6 years unless specifically directed by the doctor. Some products (such as long-acting tablets/capsules) are not recommended for use in children younger than 12 years. Ask your doctor or pharmacist for more details about using your product safely.

These products do not cure or shorten the length of the common cold and may cause serious side effects. To decrease the risk for serious side effects, carefully follow all dosage directions. Do not use this product to make a child sleepy. Do not give other cough - and-cold medication that might contain the same or similar ingredients (see also Drug Interactions section). Ask the doctor or pharmacist about other ways to relieve cough and cold symptoms (such as drinking enough fluids, using a humidifier or saline nose drops/spray).

How to use Midol PM

See also Warning section.

If you are taking an over-the-counter product, read all directions on the product package before taking this medication. If you have any questions, consult your pharmacist. If your doctor has prescribed this medication, take it as directed.

Take this medication by mouth with or without food or as directed by your doctor. If stomach upset occurs, you may take this medication with food or milk.

If you are using the liquid form, carefully measure your prescribed dose using a medication-measuring device or spoon. Do not use a household spoon because you may not get the correct dose.

If you are taking extended-release capsules, swallow them whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

The dosage is based on your medical condition and response to treatment. Pain medications work best if they are used as the first signs of pain occur. If you wait until the symptoms have worsened, the medication may not work as well.

Do not take this product for pain more than 10 days (adults) or 5 days (children) unless directed by a doctor. Do not take this product for fever more than 3 days unless directed by your doctor. If your condition persists or worsens, or if you think you may have a serious medical problem, seek immediate medical attention.

Side Effects

See also Warning section.

Dizziness. drowsiness, constipation. stomach upset, blurred vision. or dry mouth /nose/throat may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

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

Tell your doctor right away if any of these unlikely but serious side effects occur: mental/mood changes (such as confusion), trouble urinating.

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

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

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

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

Precautions

See also Warning section.

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

Before using this medication, tell your doctor or pharmacist your medical history, especially of: breathing problems (such as asthma, chronic obstructive pulmonary disease - COPD), glaucoma, heart disease, high blood pressure. liver disease, stomach/intestinal problems (such as blockage, constipation, ulcers), overactive thyroid gland (hyperthyroidism), urination problems (such as trouble urinating due to enlarged prostate. urinary retention).

This drug may make you dizzy or drowsy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Avoid alcoholic beverages.

Liquid products may contain alcohol, sugar, and/or aspartame. Caution is advised if you have diabetes, alcohol dependence, liver disease, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.

Caution is advised when using this drug in children because they are more sensitive to the effects of antihistamines. In young children, this drug may cause agitation and excitement instead of drowsiness.

Older adults may be more sensitive to the effects of this drug, especially dizziness, drowsiness, confusion, constipation, or trouble urinating. Dizziness, drowsiness, and confusion can increase the risk of falling.

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

This drug may pass into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Interactions

See also Warning section.

If you are taking this medication under your doctor's direction, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

Before using this product, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: antihistamines applied to the skin (such as diphenhydramine cream, ointment, spray), ketoconazole, MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine).

Tell your doctor or pharmacist if you are taking other products that cause drowsiness, including alcohol, other antihistamines, drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine).

Antihistamines are ingredients found in many nonprescription products and in some combination prescription medications. Check the labels on all your medicines (especially cough-and-cold products) because they may also contain an antihistamine. Ask your pharmacist about using those products safely.

This medication may interfere with certain medical/laboratory tests (such as urine 5-HIAA, allergy skin tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, agitation, confusion, flushing, hallucinations, yellowing eyes/skin, dark urine, seizures. In children, excitement may occur first, and may be followed by: loss of coordination, drowsiness, loss of consciousness, seizures.

Notes

If your doctor has prescribed this medication, do not share it with others.

Keep all regular medical and laboratory appointments.

Do not take this product for several days before allergy testing because test results can be affected.

Missed Dose

If you are taking this product on a regular schedule and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Storage

Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Do not freeze liquid forms of this product. Keep all medicines away from children and pets.

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

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

Images

Todol Products, Todol

Todol Products. founded in 1986, specializes in Polyurethane foam products. Urethane foam sealants are a very cost efficient way of filling and sealing voids. Our foams stop the passage of air, water, odors, and pests. Every construction industry has a need to inexpensively fill voids.

We offer a complete line of gun dispensed foams which allow precise control with no mess or waste. These guns make using foams a real tool. The systems should always be ready to go on the jobsite.

We also offer many different formulations for various purposes. Please review our products on this website to find the product to solve your needs. We welcome the opportunity to hear from you with your thoughts and comments.

For our printable brochure, click here .

For our product Quick Guides, click here .

Todol Products: System Overview

See this and other videos here .

Todol Products 25 Washington Avenue 508-651-3818 Natick, MA 01760 fax: 508-651-0729 © 2015 Todol Products. All Rights Reserved

Doxin Puppies For Sale, Doksin

Puppy Search

Doxin

Country of Origin

The Dachshund (pronounced dak-sund; also known as a ?Teckel?) originated in Germany in the sixteenth century. They were bred and trained to chase down prey, such as a badger (Dachshund means ?Badger Dog?) or fox, enter its burrow, kill it, and retrieve it. The Dachshund was recognized as a distinct breed in 1910 and has gradually increased in popularity to become a favored pet. Famous Dachshunds include Picasso?s dog Lump, who may have inspired some of his works, and Waldi, the first Olympic Mascot and symbol of the 1972 Summer Olympics in Munich, Germany.

Size

There are three different sizes of Dachshund. The standard Dachshund has a chest girth of at least 35 cm (13.75 in) and can weigh up to 26 lbs. The Miniature Dachshund has a chest girth of 30-35 cm (11.75-13.75 in) and can weigh up to 11 lbs. The Toy Dachshund (not formally recognized) has a chest girth smaller than 30 cm (11.75 in) and weighs 3.5 kg (8 lbs). All Dachshunds have an arched muzzle, almond shaped eyes, round ears, and straight tail. They are recognizable by their long, flat bodies and short legs. Writer H. L Mencken famously referred to them as ?a half-dog high and a dog-and-a-half long.?

Coat

The Dachshund coat may be smooth, long, or wire-haired. All have distinct appearance. Colors can be reddish-brown, black, tan, chocolate brown, deep chestnut in reddish-brown, and black and tan. The hairs on the wire-haired Dachshund should lie flat and be as hard as possible.

Character

Dachshunds are energetic, brave, intelligent and independent. They are quite happy, even clownish, and can behave mischievously on occasion. The Dachshund greatly enjoys interacting with humans and is quite friendly and outgoing at home. Dachshunds make fine companions and are not typically used as hunters.

Temperament

The Dachshund is somewhat reserved around strangers and may bark at them, but forms a strong bond with family. It can be too courageous around larger dogs. Dachshunds are bold and outgoing, enjoying attention and frequently seeking adventure. They get along well with known children but may behave aggressively towards unknown children. Wired-haired Dachshunds tend to be more lively and outgoing then smooth-hairs; miniature Dachshunds may also be more reserved.

Care

The smooth - and long-haired Dachshund should be brushed occasionally to remove dead hairs. Long-haired Dachshunds are prone to tangles, so they should be groomed more often. The coat of the wire-haired Dachshund should be plucked twice a year. Dachshunds live 12-15 years.

Training

Long-haired Dachshunds are slightly easier to train than smooth - or wire-haired Dachshunds, however all varieties need firm and consistent training because they have minds of their own. The Dachshund is also sensitive and should be corrected gently, lest it become cowed and afraid.

Activity

The Dachshund needs a small amount of exercise; medium length walks or a fair amount of play in the yard should be sufficient. Dachshunds may tire easily so exercise should be spaced out throughout the day. Dachshunds can live comfortably in an apartment, but it is best if they get an occasional view of the wild. Frequent jumping and running should not be allowed as it may cause back problems.

Puppies for Sale

Doxin Puppies for Sale - Shipped Worldwide!

Other Popular Dog Breeds

Flosteron, Flosteron

Flosteron

Storage conditions

List B. In the dark place at a temperature of no higher than 25 ° C

Shelf life

The registration

Of drugs

Combined korticosteroidnyi (containing hormones crust napochechnikov or their synthetic analogues) product with inflammatory, and protivorevmaticski protiwallergicakim action. Betamethasone phosphate dinatria is an easily soluble component, which bystro. vsasavetsa in tissue and provides quick effect. Renewed (long) of the betamethasone dipropionate, the. Over slow absorption (skin). Depending on the mode of application. intramuskulyarno (injection), intraartikulyarno (vnutrisustavno) periartikulyarno (in the space surrounding the joint), intradermalno (intracutaneously), is a general or localized effects.

Indications for use

Flosteron intended for the treatment of severe acute and chronic conditions that require the use of corticosteroid. Rheumatic diseases, rheumatoid arthritis (инфекционно-аллергич еская disease from the kollagenozov characterized by chronic progressive inflammation of joints), out-rheumatoid arthritis (sinovit / inflammation of the inner lining of joints / epikosschlit / inflammation limited portion of the humerus bone, the seat attachment of muscles and tendons / tendoshinovit / socetannoe inflammation of the tendon, and the inner lining of joints / myofasciitis / inflammation of the muscles / fibrosit / vospalitelnoe change fibres connective tissue / adult / pristupoobraznaya intense pain in the lumbar area / psoriaticeski arthritis / joint inflammation in psoriasis / traumatic arthritis / vospalitelnoe joint disease and stripped all surfaces articulated bones as a result of mechanical injury / etc.). Allergic disease, bronchial asthma, seasonal or chronic rinita (inflammation of nasal mucous membrane); Skin diseases - psoriaz, keloid (expansion of the connective tissue of skin), alopecia areata (partial hair loss), flaccid contact dermatitis (neiroallergicescoe inflammation of the skin characterized by everything and multiple skin vsapaniami, based on symmetric parts of the body due to the direct impact damaging factor / physical, chemical, etc.), the bite of insects, kollagenozy (known as disease characterized by diffuse loss of connective tissue and vessels), and other reactions of hypersensitivity. Ulcerative Colitis (vospachenie large bowel with the formation of ulcers).

Dosing and Administration

Dosage flosteron depends on the severity of each case, as well as the clinical picture.

Side-Effects

With long-term use drug-weight, neuroses, oedema, the deterioration of the diabetes, osteoporosis (eating disorders bone accompanied by the increase in its friability).

Contraindications

Tuberculosis, osteoporosis, various psychoses, peptica ulcers (ulcers stomach, colon or esophagus, as it has evolved as a result of the destructive actions of gastric juice in the mucous membrane), glaucoma (increased inner pressure), diabetes, throm (inflammation of the walls of veins with their zakuporka), bacterial, fungal or viral infections, kidney failure, Kushinga syndrome (obesity, with corresponding declines sexual function, more brittle bones as a result of the strengthened ?дренокортикотропног?? pituitary hormone). During the preparation contraindicated vaccination and immunization.

Form of

Ampoules to 1 ml in a package of 5 pieces.

All products of this group

What Can I Eat Celiac Disease Foundation, Glutim

What Can I Eat?

Cutting out gluten from your diet may seem like a difficult and limiting task. Fortunately, there are many healthy and delicious foods that are naturally gluten-free!

The most cost-effective and healthy way to follow the gluten-free diet is to seek out these naturally gluten-free food groups, which include:

Pure wheat grass and barley grass are gluten-free, but there is gluten in the seeds. If they are not harvested or processed correctly, there is risk of gluten contamination.

What About Grains?

There are many naturally gluten-free grains that you can enjoy in a variety of creative ways. Many of these grains can be found in your local grocery store, but some of the lesser-known grains may only be found in specialty or health food stores. It is not recommended to purchase grains from bulk bins because of the possibility for cross-contact with gluten.

The following grains and other starch-containing foods are naturally gluten-free:

There has been some research that some naturally gluten-free grains may contain gluten from cross-contact with gluten-containing grains through harvesting and processing. If you are concerned about the safety of a grain, purchase only versions that are tested for the presence of gluten and contain less than 20 ppm.

Gluten-Free Substitutes

Many items that usually contain gluten have gluten-free alternatives that are widely available in most grocery stores, and make living gluten-free much easier. Keep in mind, however, that minimally processed fresh foods are a crucial part of a healthy gluten-free diet. It is very important to base your diet around fruits, vegetables, meats, and other healthy food groups listed above.

Many commercially available products are labeled “gluten-free,” but there will be some that are not; this is why proper label reading is important. It is also important to remember that “wheat-free” does not necessarily mean “gluten-free.” Be wary, as many products may appear to be gluten-free, but are not.

As a rule, traditional wheat products such as pastas, breads, crackers, and other baked goods are not gluten-free. However, there are many gluten-free options available that use alternative flours and grains. Often, gluten-free bread can be found in the freezer section . Additionally, there are gluten-free flours and flour blends available in the grocery aisle, allowing you to bake your own bread.

Cereals

Many cereals contain gluten or wheat-based ingredients, but there are some that do not. Be on the lookout for the “gluten-free” label, but also realize that not all gluten-free cereals will advertise as such, so it is important to check the list of ingredients. Something to watch out for: cornflakes and puffed rice cereal may contain malt flavoring or extract, which contains gluten!

Oats

Oats are often harvested and processed with the same equipment that is used for wheat, and are therefore easily contaminated. Research indicates that pure, uncontaminated oats consumed in moderation (up to ? cup dry rolled oats daily) are tolerated by most people with celiac disease. Look for oats specifically labeled gluten-free in all products containing oats, including granolas and granola bars.

Soups and Sauces

Soups and sauces are one of the biggest sources of hidden gluten, as many companies use wheat as a thickener. It is always a good idea to read the label of any pre-prepared or canned soups and sauces, paying special attention to those that are cream-based .

Produce

Fresh and frozen fruits and vegetables are naturally gluten-free. However, it is important to read labels on any processed fruits and veggies, as well as dried fruit and pre-prepared smoothies. Additionally, packaged frozen potatoes are not always gluten-free, and labels should be read carefully when considering these products.

Beverages

Most beverages are gluten-free, including juices, sodas, and sports drinks. Alcoholic beverages, including wines and hard liquor/distilled liquors/hard ciders are also gluten-free. However , beers, ales, lagers, malt beverages and malt vinegars that are made from gluten-containing grains are not distilled and therefore are not gluten-free . There are several brands of gluten-free beers available in the United States and abroad.

Medicines, Vitamins and Supplements

Not all medicines and vitamins are gluten-free, so make sure to read the label before you buy.

How Do I Get Started?

The CDF 7 Day Gluten-Free Meal Plan can help you kick-start your gluten-free lifestyle. This nutritionally balanced Meal Plan provides three meals and two snacks each day with easy to make recipes and “Quick Fixes” for those on-the-go

The CDF Gluten-Free Allergy-Free Marketplace showcases products and services from companies that care about the gluten-free and allergy-free community. You can browse by dietary preferences, and view product pictures, ingredients, and nutrition facts to create your shopping list. You can also purchase specially designated products directly from Amazon.

What Can I Cook?

Find easy-to-fix recipes for every occasion at CDF’s Recipe Hub.

Ask-the-Dietitian

Janelle Smith, MS, RD, specializes in gastrointestinal symptom management through appropriate nutrition and food choices, helping you adapt to living on a gluten-free diet.

Bactroban Ointment (Mupirocin) Side Effects, Interactions, Warning, Dosage & Uses, Bactocin

DRUG DESCRIPTION

BACTROBAN (mupirocin calcium) nasal ointment. 2% contains the dihydrate crystalline calcium hemi - salt of the antibacterial drug, mupirocin. Chemically, it is (αE,2S,3R,4R,5S)-5-[(2S,3S,4S,5S)-2,3- epoxy-5-hydroxy-4-methylhexyl]tetrahydro-3,4-dihydroxy-β-methyl-2H-pyran-2-crotonic acid, ester with 9-hydroxynonanoic acid, calcium salt (2:1), dihydrate.

The molecular formula of mupirocin calcium is (C 26 H 43 O 9 ) 2 Ca•2H 2 O, and the molecular weight is 1075.3. The molecular weight of mupirocin free acid is 500.6. The structural formula of mupirocin calcium is:

BACTROBAN nasal ointment is a white to off white ointment that contains 2.15% w/w mupirocin calcium (equivalent to 2% mupirocin free acid) in a soft white ointment base. The inactive ingredients are paraffin and a mixture of glycerin esters (SOFTISAN® 649).

What are the possible side effects of mupirocin topical (Bactroban)?

Serious side effects are not expected to occur with mupirocin topical therapy. Stop using mupirocin topical and see your doctor if you experience unusual blistering, itching, redness, peeling, dryness, or irritation of the skin.

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

What are the precautions when taking mupirocin (Bactroban Ointment)?

Before using mupirocin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as polyethylene glycol found in some brands), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease (if you are using a brand of mupirocin that contains polyethylene glycol).

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

It is not known whether this drug passes into breast milk. Consult your doctor before.

Last reviewed on RxList: 9/2/2016 This monograph has been modified to include the generic and brand name in many instances.

Bionect - Fidia Farmaceutici S, Connettivina

Bionect

Composition: Hyaluronic acid sodium salt

Other Trademarks: CONNETTIVINA • BIOSKIN • EFFIDIA • HYALO4 SKIN • JALPLAST • JALOPLAST • RYM CICATRIZANTE

Indications: Stimulates the repair and regeneration of the skin, accelerating the healing of abrasions, excoriations, superficial wounds, scalds, mild burns, cracked nipples. • Also indicated in localised outbreaks of sore skin caused by physical agents such as the sun, cold, wind and nappy rash, and in irritated and dry skin caused by radiotherapy. • Can also be used as an aid in treatment for cutaneous ulcers of vascular origin, and slow-healing wounds such as bedsores.

Bionect 0.2% cream 15 g

Presentation: Tube, 15 g

Notes: Photo refers to Italian CONNETTIVINA packaging

Bionect 0.2% cream 30 g

Proloc, Proloc

pRoloc

A unifying bioinformatics framework for spatial proteomics

Bioconductor version: Release (3.3)

This package implements pattern recognition techniques on quantitiative mass spectrometry data to infer protein sub-cellular localisation.

Author: Laurent Gatto and Lisa M. Breckels with contributions from Thomas Burger and Samuel Wieczorek

Maintainer: Laurent Gatto <lg390 at cam.ac.uk>

Citation (from within R, enter citation("pRoloc") ):

Installation

To install this package, start R and enter:

Documentation

To view documentation for the version of this package installed in your system, start R and enter:

Informations

ProLoc est concu pour effectuer la gestion complete de vos locations pour tous les types de plateaux (salles, terrains de loisir, arenas, amphitheatres, piscines. ) Il s’integre facilement a votre environnement et ne demande que tres peu d’effort pour sa mise en place. La presentation graphique des informations constitue un avantage nettement superieur aux autres produits sur le marche.

ProLoc repose sur une base de donnees de type SQL-Serveur Langage de programmation. Delphi

Licence ProLoc de base

La licence ProLoc de base est specialement concue pour gerer les horaires de plateaux sportifs et culturels. Les grilles horaires sont dynamiques et peuvent etre creees par les utilisateurs en quantite illimitee. Vous trouverez pratique et facile d’ajouter et/ou de modifier des reservations directement a partir de ces grilles horaires.

ProLoc vous permet une personnalisation complete de la base de donnees en vous laissant libre choix d’ajouter vos propres champs afin de documenter les fiches selon vos besoins precis.

La version ProLoc de base permet de gerer et de produire facilement les :

contrats de reservations repetitives, occasionnelles et a confirmer

instructions de montage

conflits d’horaires

grilles tarifaires

suivis aupres des clients, des benevoles, des employes…

publipostage

rapports et statistiques divers

historiques detailles des reservations

Pro. Loc, Australia's leading manufacturer & supplier of loss prevention products. Get our FREE Industry Insights fact sheet.

Our electronic security display units showcase live electronic products both attractively & securely.

Our security cases are established as the industry leader throughout the world.

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Pro. Loc Australia is the leading manufacturer and supplier for retail security and loss prevention products including security cases, point of sale furniture and electronic security. Based out of Sydney, Pro. Loc provides quality and reliability on all its products and services. Over the last 21 years the Pro. Loc range of security cases has been established as a world leader in security case products. Pro. Loc security cases are currently being used to protect a vast range of products in retail stores, music shops, libraries, auto shops and chemists.

In 2005, Pro. Loc released its own range of display furniture, the “T-Wall®”, specially designed for the library market, and later utilised in retail and hardware stores. Pro. Loc then released its own range of electronic security in 2008. The Pro Series alarm system has been used to facilitate live secure displays of electronics, such as mobile phones, digital cameras, etc. Now, Pro. Loc is established as a major manufacturer and supplier of point of sale furniture and electronic security.

Get your FREE loss prevention, Industry Insights 2013 fact sheet today.

Electronic Security

Pro. Loc discussed specific loss prevention needs with several of its retail clients. The requirement for full merchandise functionality without compromising security was one of retailers’ major concerns. Electronic alarms which provide visual and audible responses to attempted theft are necessary.

Security Cases

Pro. Loc security cases provide effective and unobtrusive protection from theft and shop soiling. The cases are manufactured from high impact and UV impregnated polycarbonate material – the same material used in fabricating aircraft windows.

The security cases allow for merchandise to be displayed without the need for dummy products or empty packaging - facilitating quicker transactions and faster checkout times.

Cabinet lock alarms

All too often in the tough retail environment, cabinet alarms have a habit of not performing as they should. Either they fail to alarm when the cabinet is broken into, or they alarm for no reason and the staff lose confidence. Now, Pro. Loc brings to the market an exciting breakthrough in cabinet and merchandise display protection…

Point of sale furniture

Pro. Loc Australia manufactures Audio/Visual display systems for retail and library environments. Each of the point of sale furniture units is custom built and designed to suit your customer environment. All of the shelving systems are fabricated from the newly designed and registered “T-Wall” Extruded Aluminium System. The T-Wall point of sale furniture system offers more capacity and saves on valuable wall and floor space.

"I have always received great service from Pro. Loc Australia. From helpful telephone advice to the speedy delivery of security products which we use in our library, the service is faultless and I would definitely recommend Pro. Loc Australia to any company wanting to deal an efficient and trustworthy organisation."

- Lorraine Russo, Macquarie University Library

Buy Naboal - Diclofenac - Online Without Prescriptions, Naboal

Diclofenac (Naboal)

Diclofenac is used primarily for the treatment of inflammation and pain caused by conditions such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. It is also effective in treating soft tissue inflammations due to tendinitis and bursitis, and treating dysmenorrhea (menstrual cramps). Diclofenac is an NSAID. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms.

Use Diclofenac as directed by your doctor!

Take Diclofenac by mouth. It may be taken with food if it upsets your stomach. Taking it with food may not lower the risk of stomach or bowel problems (eg, bleeding, ulcers). Talk with your doctor or pharmacist if you have persistent stomach upset.

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

If you miss a dose of Diclofenac, 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 Diclofenac.

Store Diclofenac 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 Diclofenac out of the reach of children and away from pets.

Do NOT use Diclofenac if:

you are allergic to any ingredient in Diclofenac or to bovine (cow) protein

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

you have recently had or will be having bypass heart surgery

you have severe kidney problems

you are in the last 3 months of pregnancy.

Contact your doctor or health care provider right away if this applies to you.

Some medical conditions may interact with Diclofenac. 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, diabetes, or stomach or bowel problems (eg, bleeding, perforation, ulcers)

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

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

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

if you are taking an antibiotic or an anti-seizure medicine. The risk of liver problems may be increased with some of these medicines.

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

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

Acetaminophen because the risk of liver problems may be increased

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

Cyclosporine, lithium, metformin, methotrexate, oral NSAIDs (eg, ibuprofen), or quinolones (eg, ciprofloxacin) because the risk of their side effects may be increased by Diclofenac

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

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

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

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

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

Diclofenac is an NSAID. Before you start any new medicine, check the label to see if it has an NSAID (eg, ibuprofen) in it too. If it does or if you are not sure, check with your doctor or pharmacist.

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

Check with your doctor or pharmacist before you take acetaminophen while you are taking Diclofenac. The risk of liver problems may be increased.

Do not switch between different forms of Diclofenac (eg, enteric-coated tablets, immediate-release tablets, capsules) unless your doctor tells you to. They may not provide the same amount of medicine to your body.

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

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

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

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

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

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

Constipation; diarrhea; dizziness; drowsiness; headache; mild stomach pain or heartburn; nausea; vomiting.

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

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

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.

Customers who bought this product also bought

Thu?c Az, Cotrimstada

Cotrimstada Forte

Thu?c la gi?

Sulfamethoxazole va trimethoprim la c? hai lo?i khang sinh di?u tr? cac lo?i nhi?m trung gay ra b?i vi khu?n.

S? k?t h?p c?a sulfamethoxazole va trimethoprim du?c s? d?ng d? di?u tr? nhi?m trung tai, nhi?m trung du?ng ti?t ni?u, viem ph? qu?n, tieu ch?y du l?ch, B?nh vi khu?n Shigella, va Pneumocystis jiroveci viem ph?i.

Sulfamethoxazole va trimethoprim cung co th? du?c s? d?ng cho cac m?c dich khong du?c li?t ke trong hu?ng d?n thu?c.

Thong tin quan tr?ng toi c?n bi?t v? Cotrimstada Forte la gi ?

B?n khong nen s? d?ng thu?c nay n?u b?n b? d? ?ng v?i sulfamethoxazol hay trimethoprim, n?u b?n dang mang thai ho?c cho con bu, ho?c n?u b?n b? thi?u mau (thi?u h?ng huy?t c?u) do thi?u axit folic.

Tru?c khi s? d?ng thu?c nay, noi v?i bac si c?a b?n n?u b?n co th?n ho?c b?nh gan, s? thi?u h?t axit folic, hen suy?n ho?c d? ?ng n?ng, r?i lo?n tuy?n giap, nhi?m HIV ho?c AIDS, lo?n chuy?n hoa porphyrin, thi?u G6PD, ho?c n?u b?n b? suy dinh du?ng.

Dung thu?c nay trong chi?u dai quy d?nh d?y d? th?i gian. Cac tri?u ch?ng c?a b?n co th? c?i thi?n tru?c khi nhi?m trung la hoan toan xoa. Li?u b? qua cung co th? lam tang nguy co nhi?m trung hon n?a co kh? nang khang thu?c khang sinh. Sulfamethoxazole va trimethoprim s? khong di?u tr? nhi?m trung do virus nhu c?m l?nh thong thu?ng ho?c cum.

Thu?c khang sinh co th? gay ra tieu ch?y, co th? la m?t d?u hi?u c?a m?t nhi?m trung m?i. N?u b?n b? tieu ch?y la ch?y nu?c ho?c co mau trong no, g?i bac si c?a b?n. Khong s? d?ng thu?c nao d? ngan ch?n tieu ch?y tr? khi bac si da noi v?i b?n.

Tranh ti?p xuc v?i anh sang m?t tr?i ho?c giu?ng t?m n?ng. Thu?c nay co th? lam cho b?n b? chay n?ng d? dang hon. M?c qu?n ao b?o h? va s? d?ng kem ch?ng n?ng (SPF 30 ho?c cao hon) khi b?n dang ? ngoai tr?i.

Tru?c khi d? d?ng Cotrimstada Forte

B?n khong nen s? d?ng thu?c nay n?u b?n b? d? ?ng v?i sulfamethoxazol hay trimethoprim, n?u b?n dang mang thai ho?c cho con bu, ho?c n?u b?n b? thi?u mau (thi?u h?ng huy?t c?u) do thi?u axit folic.

D? d?m b?o thu?c nay la an toan cho b?n, noi v?i bac si c?a b?n n?u b?n co b?t k? cac di?u ki?n khac:

th?n ho?c b?nh gan;

s? thi?u h?t axit folic;

suy?n ho?c d? ?ng nghiem tr?ng;

m?t r?i lo?n tuy?n giap;

lo?n chuy?n hoa porphyrin (m?t r?i lo?n enzyme di truy?n gay ra cac tri?u ch?ng ?nh hu?ng d?n da ho?c h? th?n kinh);

m?t thi?u h?t glucose-6-phosphate (thi?u h?t G6PD), ho?c

n?u b?n b? suy dinh du?ng.

FDA thai k? lo?i C. Ngu?i ta khong bi?t li?u sulfamethoxazole va trimethoprim s? gay t?n h?i cho thai nhi. Cho bac si bi?t n?u b?n dang mang thai ho?c d? d?nh co thai trong khi s? d?ng thu?c nay.

Sulfamethoxazole va trimethoprim co th? di vao s?a m? va co th? gay h?i cho em be bu. Khong s? d?ng thu?c nay ma khong noi v?i bac si c?a b?n n?u b?n dang cho con bu.

Khong cho thu?c nay cho tr? em du?i 2 thang tu?i.

Ngu?i l?n tu?i co th? co nhi?u kh? nang co tac d?ng ph? t? thu?c nay.

Lam th? nao d? dung Cotrimstada Forte

Co chinh xac theo quy d?nh c?a bac si. Khong co s? lu?ng l?n hon ho?c nh? hon ho?c lau hon du?c d? ngh?. Th?c hi?n theo cac hu?ng d?n tren nhan thu?c c?a b?n.

Do thu?c l?ng v?i m?t mu?ng d?c bi?t do li?u ho?c c?c, khong m?t mu?ng b?ng thong thu?ng. N?u b?n khong co m?t thi?t b? do li?u, hay h?i du?c si m?t.

Dung thu?c nay trong chi?u dai quy d?nh d?y d? th?i gian. Cac tri?u ch?ng c?a b?n co th? c?i thi?n tru?c khi nhi?m trung la hoan toan xoa. Li?u b? qua cung co th? lam tang nguy co nhi?m trung hon n?a co kh? nang khang thu?c khang sinh. Sulfamethoxazole va trimethoprim s? khong di?u tr? nhi?m trung do virus nhu c?m l?nh thong thu?ng ho?c cum.

U?ng nhi?u nu?c d? ngan ng?a s?i th?n trong khi b?n dang dung trimethoprim va sulfamethoxazol.

Thu?c nay co th? gay ra k?t qu? b?t thu?ng v?i cac xet nghi?m y t? nh?t d?nh. Cho b?t k? bac si di?u tr? cho b?n r?ng b?n dang s? d?ng sulfamethoxazole va trimethoprim.

B?o qu?n ? nhi?t d? phong tranh ?m, nhi?t, va anh sang.

D?u gi x?y ra n?u toi quen m?t li?u

Dung li?u do ngay khi nh? ra. B? qua li?u da quen n?u no g?n nhu la th?i gian cho li?u k? ho?ch ti?p theo c?a b?n. Khong dung thu?c them d? t?o nen li?u da quen.

Di?u gi x?y ra n?u toi qua li?u

Tim ki?m s? cham soc y t? kh?n c?p ho?c g?i du?ng day 115.

Qua li?u cac tri?u ch?ng co th? bao g?m cac hinh th?c nghiem tr?ng c?a m?t s? cac tac d?ng ph? du?c li?t ke trong hu?ng d?n thu?c.

Toi nen tranh nh?ng gi khi dung Cotrimstada Forte

Thu?c khang sinh co th? gay ra tieu ch?y, co th? la m?t d?u hi?u c?a m?t nhi?m trung m?i. N?u b?n b? tieu ch?y la ch?y nu?c ho?c co mau, ngung dung thu?c nay va g?i cho bac si c?a b?n. Khong s? d?ng thu?c ch?ng tieu ch?y tr? khi bac si noi v?i b?n.

Tranh ti?p xuc v?i anh sang m?t tr?i ho?c giu?ng t?m n?ng. Thu?c nay co th? lam cho b?n b? chay n?ng d? dang hon. M?c qu?n ao b?o h? va s? d?ng kem ch?ng n?ng (SPF 30 ho?c cao hon) khi b?n dang ? ngoai tr?i.

Tac d?ng ph? c?a Cotrimstada Forte

Nh?n tr? giup y t? kh?n c?p n?u b?n co b?t c? d?u hi?u c?a m?t ph?n ?ng d? ?ng: phat ban, kho th?, sung m?t, moi, lu?i, ho?c h?ng.

G?i cho bac si ngay n?u b?n co m?t tac d?ng ph? nghiem tr?ng nhu:

tieu ch?y la ch?y nu?c ho?c co mau;

s?t, ?n l?nh, sung h?ch, dau nh?c co th?, cac tri?u ch?ng cum, l? loet trong mi?ng va c? h?ng c?a b?n;

m?i ho?c x?u di ho;

da xanh xao, c?m th?y choang vang, nh?p tim nhanh, kho t?p trung;

d? b? b?m tim, ch?y mau b?t thu?ng (mui, mi?ng, am d?o, ho?c tr?c trang), di?m pinpoint mau tim ho?c d? du?i da;

ng?a ran ho?c te li?t nghiem tr?ng, nh?p tim ch?m, m?ch y?u, suy nhu?c co b?p;

bu?n non, dau b?ng tren, ng?a, chan an, nu?c ti?u d?m mau, phan mau d?t set, vang da (vang da ho?c m?t);

di ti?u it hon binh thu?ng ho?c khong gi c?;

?o giac, co gi?t (co gi?t);

du?ng trong mau th?p (dau d?u, doi, m?t m?i, d? m? hoi, r?i lo?n, kho ch?u, ho?c c?m giac b?n ch?n);

d?u hi?u d?u tien c?a b?t k? phat ban da, du nh?, ho?c

ph?n ?ng da nghiem tr?ng - s?t, dau h?ng, sung m?t ho?c lu?i c?a b?n, d?t chay trong doi m?t c?a b?n, dau da, ti?p theo la m?t phat ban da mau d? ho?c mau tim do lay lan (d?c bi?t la trong cac khuon m?t ho?c co th? phia tren) va gay ph?ng r?p va bong troc.

Tac d?ng ph? it nghiem tr?ng co th? bao g?m:

dau ho?c sung lu?i;

chong m?t, quay c?m giac;

c?m giac m?t m?i, kho ng? (m?t ng?).

Day khong ph?i la m?t danh sach d?y d? cac tac d?ng ph? va nh?ng di?u khac co th? x?y ra. G?i cho bac si d? du?c tu v?n y t? v? tac d?ng ph?.

Thong tin d?nh lu?ng c?a Cotrimstada Forte

Li?u thong thu?ng danh cho ngu?i l?n cho viem ph?i Viem ph?i:

15-20 mg / kg / ngay (thanh ph?n trimethoprim) du?ng u?ng ho?c IV trong 3-4 li?u chia d?u cho m?i 6-8 gi?; theo 1 di?u tra vien, t? 10 d?n 15 mg / kg / ngay (thanh ph?n trimethoprim) IV da d? 10 b?nh nhan Th?i gian: 14 d?n 21 ngay; di?u tr? nen du?c theo sau b?i di?u tr? ?c ch? man tinh N?u b?nh nhan gi?m oxy mau, di?u tr? IV du?c khuy?n khich. Thu?c theo du?ng u?ng co th? du?c thay th? m?t khi b?nh nhan co th? ch?u d?ng du?c thu?c u?ng va c?i thi?n lam sang. Trong khi di?u tr? rang mi?ng, m?c sulfamethoxazole mong mu?n la 100-150 mg / l. M?c d? vu?t qua 200 mg / l du?c nh?ng tac d?ng ph? hon. M?c d? trimethoprim nen du?c duy tri gi?a 5-8 mg / l.

Li?u thong thu?ng danh cho ngu?i l?n cho viem ph?i Viem ph?i Di?u tr? d? phong:

Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) u?ng m?i ngay m?t l?n ho?c 3 l?n m?t tu?n Li?u dung nen du?c tang g?p doi len 2 vien n?u b?nh nhan ti?m tang nhi?m toxoplasmosis. Th?i gian: tr? li?u nen du?c ti?p t?c cho d?n khi nao b?nh nhan co nguy co b? nhi?m trung. H?u h?t cac chuyen gia th?c hi?n d? phong mi?n la s? CD4 du?i 200 ho?c CD4% la it hon 15% ? nh?ng b?nh nhan nhi?m HIV, trong it nh?t 1 nam ? b?nh nhan ghep, va vo th?i h?n cho b?nh nhan ghep ph?i va b?nh nhan t? ch?i tai phat.

Li?u thong thu?ng danh cho ngu?i l?n cho nhi?m trung du?ng ti?t ni?u:

Mi?ng: Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi? trong 10 d?n 14 ngay IV: nhi?m trung n?ng: 8-10 mg / kg / ngay (thanh ph?n trimethoprim) IV trong 2-4 chia d?u li?u m?i 6, 8, ho?c 12 gi? cho d?n 14 ngay, li?u t?i da la 960 mg (thanh ph?n trimethoprim) m?i ngay

Li?u thong thu?ng danh cho ngu?i l?n cho Viem b? th?n:

Khong bi?n ch?ng: Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi? trong 7 d?n 14 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho viem ph? qu?n:

C?p tinh tr?m tr?ng c?a vi khu?n viem ph? qu?n man tinh: Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi? trong 14 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho Traveler c?a Tieu ch?y:

Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi? trong 5 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho B?nh vi khu?n Shigella:

Mi?ng: Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi? trong 5 ngay IV: 8-10 mg / kg / ngay (thanh ph?n trimethoprim) IV trong 2-4 li?u chia d?u m?i 6, 8. ho?c 12 gi? trong 5 ngay, li?u t?i da la 960 mg (thanh ph?n trimethoprim) m?i ngay B?nh nhan c?n du?c hu?ng d?n s? d?ng bi?n phap phong ng?a v? sinh d?c bi?t k? t? khi vi khu?n Shigella lay truy?n qua du?ng phan-mi?ng, ch? y?u la do ti?p xuc tay-mi?ng.

Li?u thong thu?ng danh cho ngu?i l?n cho viem tai gi?a Media:

Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi? trong 10 d?n 14 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho viem bang quang Di?u tr? d? phong:

Trimethoprim-sulfamethoxazole 80 mg-400 mg (1 don s?c m?nh may tinh b?ng) u?ng m?i ngay m?t l?n ho?c 3 l?n m?t tu?n tru?c khi di ng? M?t s? bac si khuyen b?nh nhan n? c?a h? dung li?u th?p nay postcoitally ho?c 3 l?n m?t tu?n, nao la it thu?ng xuyen hon. Di?u tr? nen du?c ti?p t?c cho d?n khi b?nh nhan co nguy co b? nhi?m trung.

Li?u thong thu?ng danh cho ngu?i l?n cho viem tui th?a:

Nh?, b?nh nhan ngo?i tru: Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi? trong s? k?t h?p v?i metronidazole 500 mg u?ng m?i 6 gi? Th?i gian: 7 d?n 10 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho viem n?p thanh qu?n:

2,5 mg / kg (thanh ph?n trimethoprim) IV m?i 6 gi? ho?c 3,3 mg / kg (thanh ph?n trimethoprim) IV m?i 8 gi? ho?c 5 mg / kg (thanh ph?n trimethoprim) IV m?i 12 gi? di?u tr? rang mi?ng co th? du?c thay th? m?t khi b?nh nhan du?c c?i thi?n va co th? ch?u d?ng du?c thu?c u?ng.

Li?u thong thu?ng danh cho ngu?i l?n cho u h?t Inguinale:

Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) u?ng hai l?n m?i ngay trong it nh?t 3 tu?n

Li?u thong thu?ng danh cho ngu?i l?n cho nhi?m D? phong:

Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) u?ng m?i ngay hai l?n Th?i gian: tr? li?u thu?ng du?c ti?p t?c mi?n la co nguy co nhi?m trung. B?nh nhan b?ch c?u trung tinh thu?ng du?c di?u tr? cho d?n khi h?t s?t trong 24 gi? va cac b?ch c?u trung tinh tuy?t d?i l?n hon 500 t? bao/mm3. Thu?ng xuyen d? phong thu?ng khong du?c khuy?n cao cho cac b?nh nhan granulocytic tr? khi h? co nguy co b? viem ph?i do viem ph?i.

Li?u thong thu?ng danh cho ngu?i l?n cho melioidosis:

Sau khi ban d?u la 10 ngay di?u tr? tiem v?i ceftazidime, imipenem, meropenem ho?c: 5 mg / kg (thanh ph?n trimethoprim) u?ng hai l?n m?t ngay c?ng v?i doxycycline 100 mg u?ng hai l?n m?t ngay c?ng v?i chloramphenicol 10 mg / kg u?ng (khong co s?n ? M? ) b?n l?n m?t ngay Duration: Trimethoprim-sulfamethoxazole va doxycycline cho 20 tu?n; chloramphenicol trong 8 tu?n d?u tien

Li?u thong thu?ng danh cho ngu?i l?n cho Viem mang nao:

5 mg / kg (thanh ph?n trimethoprim) IV m?i 6, 8, ho?c 12 gi? trong 21 ngay d?n 6 tu?n s? d?ng k?t h?p v?i chloramphenicol la m?t thay th? cho cac b?nh nhan v?i beta-lactam d? ?ng.

Li?u thong thu?ng danh cho ngu?i l?n cho Nocardiosis:

Nhi?m trung da: 5-10 mg / kg / ngay (thanh ph?n trimethoprim) IV ho?c u?ng trong 2-4 chia lam nhi?m trung n?ng (ph?i / nao): 15 mg / kg / ngay (thanh ph?n trimethoprim) trong 2-4 li?u chia cho 3 d?n 4 tu?n, sau do 10 mg / kg / ngay (thanh ph?n trimethoprim) trong 2-4 chia lam nhi?u l?n; co th? du?c b?t d?u IV va chuy?n d?i sang di?u tr? b?ng mi?ng (thu?ng xuyen chuy?n d?i li?u lu?ng g?n dung c?a cac d?ng bao ch? r?n u?ng: 2 vien doi s?c m?nh [320 mg-1600 mg] m?i 8 d?n 12 gi?) Do n?ng d? huy?t thanh du?c khuy?n khich. N?ng d? t?i da (Cmax) t? 100 d?n 150 mg / l du?c khuy?n khich. B?nh n?ng thu?ng du?c di?u tr? b?ng b? sung cac tac nhan khac, ch?ng h?n nhu ceftriaxone, imipenem, ho?c amikacin. Th?i gian: Khong t?t tieu chu?n, h?u h?t cac chuyen gia khuyen b?n nen it nh?t la 6 thang d?i v?i can b?nh d?a phuong ? nh?ng b?nh nhan co h? mi?n d?ch va 6 d?n 12 thang ho?c nhi?u hon cho b?nh nhan suy gi?m mi?n d?ch ho?c b?nh nhan b? b?nh th?n kinh trung uong

Li?u thong thu?ng danh cho ngu?i l?n cho Viem ph?i:

2,5 mg / kg (thanh ph?n trimethoprim) du?ng u?ng ho?c IV m?i 6 gi? ho?c 3,3 mg / kg (thanh ph?n trimethoprim) du?ng u?ng ho?c IV m?i 8 gi? ho?c 5 mg / kg (thanh ph?n trimethoprim) du?ng u?ng ho?c IV m?i 12 gi? Th?i gian: 21 ngay; ph? c?u khu?n viem ph?i co th? du?c hoan toan di?u tr? trong 7 d?n 10 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho Viem tuy?n ti?n li?t:

Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi? Th?i gian: c?p tinh, 10 d?n 14 ngay; man tinh, 1 d?n 3 thang

Li?u thong thu?ng danh cho ngu?i l?n cho Viem xoang:

Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi? Th?i gian: 10 d?n 14 ngay, trong m?t s? tru?ng h?p viem xoang tai phat ho?c v?t li?u ch?u l?a, di?u tr? co th? du?c yeu c?u cho d?n 3-4 tu?n

Li?u thong thu?ng danh cho ngu?i l?n cho Toxoplasmosis:

5 mg / kg (thanh ph?n trimethoprim) IV m?i 12 gi? Th?i gian: 4 tu?n d?n 6 thang ho?c hon, tuy theo tinh ch?t va m?c d? nghiem tr?ng c?a nhi?m trung, b?nh nhan AIDS thu?ng du?c dua ra di?u tr? li?u cao t? 4 d?n 6 tu?n sau do duy tri tren mi?ng trimethoprim-sulfamethoxazole cho cu?c s?ng

Li?u thong thu?ng danh cho ngu?i l?n cho Toxoplasmosis - D? phong:

Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) ho?c 80 mg-400 mg (1 don s?c m?nh may tinh b?ng) u?ng m?i ngay m?t l?n Th?i gian: tr? li?u nen du?c ti?p t?c cho d?n khi b?nh nhan co nguy co b? nhi?m trung.

Li?u thong thu?ng danh cho ngu?i l?n cho ho h?p tren nhi?m trung du?ng:

Trimethoprim-sulfamethoxazole 160 mg-800 mg (1 doi s?c m?nh may tinh b?ng) du?ng u?ng m?i 12 gi?

Li?u thong thu?ng cho tr? em viem tai gi?a Media:

2 thang tu?i tr? len: 4 mg / kg (thanh ph?n trimethoprim) du?ng u?ng m?i 12 gi? trong 10 ngay

Li?u thong thu?ng cho tr? em nhi?m trung du?ng ti?t ni?u:

2 thang tu?i tr? len: U?ng: 4 mg / kg (thanh ph?n trimethoprim) du?ng u?ng m?i 12 gi? trong 10 d?n 14 ngay IV: nhi?m trung n?ng: 8-10 mg / kg / ngay (thanh ph?n trimethoprim) IV trong 2-4 li?u chia d?u cho t?t c? 6, 8, ho?c 12 gi? cho d?n 14 ngay, li?u t?i da la 960 mg (thanh ph?n trimethoprim) m?i ngay

Li?u tr? em thong thu?ng cho B?nh vi khu?n Shigella:

2 thang tu?i tr? len: U?ng: 4 mg / kg (thanh ph?n trimethoprim) du?ng u?ng m?i 12 gi? trong 5 ngay IV: 8-10 mg / kg / ngay (thanh ph?n trimethoprim) IV trong 2-4 li?u chia d?u m?i 6, 8, ho?c 12 gi? trong 5 ngay, li?u t?i da la 960 mg (thanh ph?n trimethoprim) m?i ngay

Li?u thong thu?ng cho tr? em viem ph?i Viem ph?i:

2 thang tu?i tr? len: 15-20 mg / kg / ngay (thanh ph?n trimethoprim) du?ng u?ng ho?c IV trong 3-4 li?u chia d?u m?i 6 d?n 8 gi? 14 d?n 21 ngay

Li?u thong thu?ng cho tr? em viem ph?i Viem ph?i Di?u tr? d? phong:

2 thang tu?i tr? len: 75 mg/m2 (thanh ph?n trimethoprim) u?ng hai l?n m?t ngay, vao ngay 3 ngay lien t?c m?i tu?n T?ng li?u hang ngay khong nen vu?t qua 320 mg (thanh ph?n trimethoprim).

Nh?ng lo?i nao ?nh hu?ng d?n Cotrimstada Forte

Cho bac si c?a b?n v? t?t c? cac lo?i thu?c khac ma b?n s? d?ng, d?c bi?t la:

thu?c ch?ng tr?m c?m;

Aciclovir Cream 5%, Activir

ACICLOVIR CREAM 5%

Transcript

Aciclovir cream 5% Read all of this leaflet carefully because it contains important information for you. • Keep this leaflet. You may need to read it again. • Ask your doctor or pharmacist if you need more information or advice. • You must contact a doctor if your symptoms worsen or do not improve. • If you have any unusual effects after using this product, tell your doctor or pharmacist.

What is Aciclovir cream is and what is it used for? Before you use Aciclovir cream How to use Aciclovir cream Possible side effects How to store Aciclovir cream Further information

What is Aciclovir cream and what is it used for?

Aciclovir cream is used in the treatment of genital herpes and cold sores. Once genital herpes or a cold sore has appeared, treatment with Aciclovir cream can accelerate the healing process. The active substance in Aciclovir cream is aciclovir. Aciclovir is an antiviral agent that has been shown to be effective in treating infections caused by the herpes simplex virus, such as genital herpes and cold sores.

Before you use Aciclovir cream

Do not use Aciclovir cream and tell your doctor: • If you are allergic (hypersensitive) to aciclovir, valaciclovir or any of the other ingredients of Aciclovir cream (listed in section 6, Further Information). Cetyl alcohol, propylene glycol or sorbic acid may cause local skin reactions or irritation (e. g. contact dermatitis). • In the eyes, inside the mouth or genitals. Check with your doctor or pharmacist before using Aciclovir cream if: • Your immune system is not working properly (for instance you have had a bone marrow transplant or you have AIDS). Taking other medicines: Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. This is especially important if you are taking: • Probenecid (used for gout). Pregnancy and breast-feeding: As with all medicines, Aciclovir cream should not be used during pregnancy or breast-feeding, unless you are advised to do so by your doctor. Ask you doctor or pharmacist for advice before taking any medicine. 3.

How to use Aciclovir cream

It is important to start treatment as soon as possible. Always use Aciclovir cream exactly as your doctor has told you. You should check with your doctor or pharmacist if you are unsure how to use this medicine. Adults and the elderly: • Wash your hands before and after applying the cream. This will prevent your cold sore or genital herpes from getting worse or spreading, or you infecting someone else. • Apply the cream to the affected area 5 times daily (about every four hours)

for 5 days. If your cold sore or genital herpes has not healed after five days of treatment you can continue using the cream for another five days.

If you forget to use Aciclovir cream: If you forget to apply the cream, apply it as soon as you remember and then apply the next treatment at the usual time. If you accidentally swallow Aciclovir cream: Aciclovir cream is for use on cold sores on the lips and surrounding skin and herpes on the genitals only. You are very unlikely to suffer any bad effects if you accidentally swallow Aciclovir cream. However, if you notice any unusual effects or are worried tell your doctor or contact the Accident and Emergency Department of your nearest hospital. 4.

Possible side effects

Like all medicines, Aciclovir cream can cause side effects, although not everybody gets them. Some people may experience side effects, particularly when they first start using the product. Stop using Aciclovir cream and contact your doctor immediately if you have • an allergic reaction: urticaria/hives (pale/red raised skin with severe itching) or any swelling of the face, mouth, tongue or airways or difficulty breathing. Uncommon (affects 1 to 10 users in 1,000): • burning or stinging where the cream has been applied, mild dry flaking of the skin, itching. Rare (affects 1 to 10 users in 10,000): • erythema (redness of the skin) If any of these side effects become troublesome or you react badly to the cream in any other way, tell your doctor or pharmacist immediately. 5.

How to store Aciclovir cream

Keep out of the reach and sight of children. Store below 25?C. Do not refrigerate or freeze. Do not use Aciclovir cream after the expiry date which is stated at one end of the carton and on the tube. The expiry date refers to the last day of that month. Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

What Aciclovir cream contains: • The active substance is aciclovir (5% w/w). • The other ingredients are cetyl alcohol, dimethicone, heavy liquid paraffin, polyethylene glycol - 5 glyceryl stearate, propylene glycol, sorbic acid, white soft paraffin and water. What Aciclovir cream looks like and contents of the pack: Aciclovir cream is available in tubes containing 2g or 10g of a smooth white to off-white cream. Marketing Authorisation Holder: Actavis, Barnstaple, EX32 8NS, UK Manufacturer: Patheon UK Limited, Swindon, SN3 5BZ, England This leaflet was last revised in March 2011

Source: Medicines and Healthcare Products Regulatory Agency

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

Omep, Omep

OMEP is an international non – governmental and non-profit organisation with Consultative Status at the United Nations and UNESCO. Founded in 1948, we defend and promote the well - being and education of children from birth to eight. Our UK Executive Committee is responsible for directing OMEP activities in UK.

If you are interested in joining us then please go to our Membership page >

See details of our successful 2016 European Assembly and Conference at Canterbury Christ Church University >

Join the OMEP UK Facebook Group >

We welcome as members everyone with an interest in the education and well-being of children and their families. Our members are practitioners, academics, students, teachers, policy makers, local authority staff, and professionals from a range of disciplines and we value the experience of those who are now retired. We welcome parents and volunteers.

OMEP is a UK organisation and we need members who represent all countries in UK.

Go to Latest News for upcoming events and conferences >

Ulcotenal Without Prescription, Ulcotenal

Welcome to RXBrandMeds. com

Thanks to Internet Technology you can now have access to affordable Ulcotenal without leaving the comfort of your home. A prior permission is NOT required but we do recommend you consult a physician before place Ulcotenal ordering. Order Ulcotenal drugs on Sale.

Q. What countries do you Ulcotenal ship to? A. RxBrandMeds. com ships Ulcotenal to all countries.

Q. Will my drugs be shipped in a discreet package? A. Yes! All goods, including Ulcotenal, are packaged discreetly. The Ulcotenal cannot be identified from the packaging. We do not include company logo's etc on the outside of the package.

Q. Are USA, Canada, UK and Europe within your shipping range? A. Yes. We can ship Ulcotenal anywhere in the world.

Q. When shall I receive my Ulcotenal order? A. We will ship Ulcotenal within 24 hours. Shipping using regular airmail takes between 7-14 days worldwide.

Q. What is a brand name drug Ulcotenal? A. A brand name drug Ulcotenal is approved by the Food and Drug Administration (FDA), and is supplied by one company (the pharmaceutical manufacturer). The drug is protected by a patent and is marketed under the manufacturer's brand name.

Mitomycin - Fda Prescribing Information, Side Effects And Uses, Micromycin

Mitomycin

Mitomycin should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents. Appropriate management of therapy and complications is possible only when adequate diagnostic and treatment facilities are readily available.

Bone marrow suppression, notably thrombocytopenia and leukopenia, which may contribute to overwhelming infections in an already compromised patient, is the most common and severe of the toxic effects of Mitomycin (see WARNINGS and ADVERSE REACTIONS sections).

Hemolytic Uremic Syndrome (HUS) a serious complication of chemotherapy, consisting primarily of microangiopathic hemolytic anemia, thrombocytopenia, and irreversible renal failure has been reported in patients receiving systemic Mitomycin. The syndrome may occur at any time during systemic therapy with Mitomycin as a single agent or in combination with other cytotoxic drugs, however, most cases occur at doses ≥60 mg of Mitomycin. Blood product transfusion may exacerbate the symptoms associated with this syndrome.

The incidence of the syndrome has not been defined.

Mitomycin Description

Mitomycin (also known as Mitomycin and/or Mitomycin-C) is an antibiotic isolated from the broth of Streptomyces caespitosus which has been shown to have antitumor activity. The compound is heat stable, has a high melting point, and is freely soluble in organic solvents.

Mitomycin for Injection is a sterile dry mixture of Mitomycin and mannitol, which when reconstituted with Sterile Water for Injection provides a solution for intravenous administration. Each vial contains either Mitomycin 5 mg and mannitol 10 mg, or Mitomycin 20 mg and mannitol 40 mg, or Mitomycin 40 mg and mannitol 80 mg. Each mL of reconstituted solution will contain 0.5 mg Mitomycin and have a pH between 6.0 and 8.0.

Mitomycin is a blue-violet crystalline powder with the molecular formula of C 15 H 18 N 4 O 5. and a molecular weight of 334.33. Its chemical name is 7-amino-9α-methoxymitosane and it has the following structural formula;

Mitomycin - Clinical Pharmacology

Mitomycin selectively inhibits the synthesis of deoxyribonucleic acid (DNA). The guanine and cytosine content correlates with the degree of Mitomycin-induced cross-linking. At high concentrations of the drug, cellular RNA and protein synthesis are also suppressed.

In humans, Mitomycin is rapidly cleared from the serum after intravenous administration. Time required to reduce the serum concentration by 50% after a 30 mg bolus injection is 17 minutes. After injection of 30 mg, 20 mg, or 10 mg I. V. the maximal serum concentrations were 2.4 mcg/mL, 1.7 mcg/mL, and 0.52 mcg/mL, respectively. Clearance is effected primarily by metabolism in the liver, but metabolism occurs in other tissues as well. The rate of clearance is inversely proportional to the maximal serum concentration because, it is thought, of saturation of the degradative pathways.

Approximately 10% of a dose of Mitomycin is excreted unchanged in the urine. Since metabolic pathways are saturated at relatively low doses, the percent of a dose excreted in urine increases with increasing dose. In children, excretion of intravenously administered Mitomycin is similar.

Animal Toxicology

Mitomycin has been found to be carcinogenic in rats and mice. At doses approximating the recommended clinical dose in man, it produces a greater than 100 percent increase in tumor incidence in male Sprague-Dawley rats, and a greater than 50 percent increase in tumor incidence in female Swiss mice.

Indications and Usage for Mitomycin

Mitomycin for Injection is not recommended as single-agent, primary therapy. It has been shown to be useful in the therapy of disseminated adenocarcinoma of the stomach or pancreas in proven combinations with other approved chemotherapeutic agents and as palliative treatment when other modalities have failed. Mitomycin is not recommended to replace appropriate surgery and/or radiotherapy.

Contraindications

Mitomycin is contraindicated in patients who have demonstrated a hypersensitive or idiosyncratic reaction to it in the past.

Mitomycin is contraindicated in patients with thrombocytopenia, coagulation disorder, or an increase in bleeding tendency due to other causes.

Warnings

Patients being treated with Mitomycin must be observed carefully and frequently during and after therapy.

The use of Mitomycin results in a high incidence of bone marrow suppression, particularly thrombocytopenia and leukopenia. Therefore, the following studies should be obtained repeatedly during therapy and for at least eight weeks following therapy: platelet count, white blood cell count, differential, and hemoglobin. The occurrence of a platelet count below 100,000/mm 3 or a WBC below 4,000/mm 3 or a progressive decline in either is an indication to withhold further therapy until blood counts have recovered above these levels.

Patients should be advised of the potential toxicity of this drug, particularly bone marrow suppression. Deaths have been reported due to septicemia as a result of leukopenia due to the drug.

Patients receiving Mitomycin should be observed for evidence of renal toxicity. Mitomycin should not be given to patients with a serum creatinine greater than 1.7 mg percent.

Usage in Pregnancy

Safe use of Mitomycin in pregnant women has not been established. Teratological changes have been noted in animal studies. The effect of Mitomycin on fertility is unknown.

Precautions

Acute shortness of breath and severe bronchospasm have been reported following the administration of vinca alkaloids in patients who had previously or simultaneously received Mitomycin. The onset of this acute respiratory distress occurred within minutes to hours after the vinca alkaloid injection. The total number of doses for each drug has varied considerably. Bronchodilators, steroids and/or oxygen have produced symptomatic relief.

A few cases of adult respiratory distress syndrome have been reported in patients receiving Mitomycin in combination with other chemotherapy and maintained at FlO 2 concentrations greater than 50% perioperatively. Therefore, caution should be exercised using only enough oxygen to provide adequate arterial saturation since oxygen itself is toxic to the lungs. Careful attention should be paid to fluid balance and overhydration should be avoided.

Bladder fibrosis/contraction has been reported with intravesical administration (not an approved route of administration), which in rare cases has required cystectomy.

Nursing Mothers

It is not known if Mitomycin is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Mitomycin, it is recommended that nursing be discontinued when receiving Mitomycin therapy.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Geriatric Use

Insufficient data from clinical studies of Mitomycin are available for patients 65 years of age and older to determine whether they respond differently than younger patients. Postmarketing surveillance suggests that elderly patients may be more susceptible than younger patients to injection site reactions (see ADVERSE REACTIONS. Integument and Mucous Membrane Toxicity) and hypersensitivity reactions. In general, caution should be exercised when prescribing to elderly patients, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Adverse Reactions

Bone Marrow Toxicity

This was the most common and most serious toxicity, occurring in 605 of 937 patients (64.4%). Thrombocytopenia and/or leukopenia may occur anytime within 8 weeks after onset of therapy with an average time of 4 weeks. Recovery after cessation of therapy was within 10 weeks. About 25% of the leukopenic or thrombocytopenic episodes did not recover. Mitomycin produces cumulative myelosuppression.

Integument and Mucous Membrane Toxicity

This has occurred in approximately 4% of patients treated with Mitomycin. Cellulitis at the injection site has been reported and is occasionally severe. Stomatitis and alopecia also occur frequently. Rashes are rarely reported. The most important dermatological problem with this drug, however, is the necrosis and consequent sloughing of tissue which results if the drug is extravasated during injection. Extravasation may occur with or without an accompanying stinging or burning sensation and even if there is adequate blood return when the injection needle is aspirated. There have been reports of delayed erythema and/or ulceration occurring either at or distant from the injection site, weeks to months after Mitomycin, even when no obvious evidence of extravasation was observed during administration. Skin grafting has been required in some of the cases. Elderly patients may be more susceptible than younger patients to injection site reactions (see PRECAUTIONS: Geriatric Use ).

Renal Toxicity

2% of 1,281 patients demonstrated a statistically significant rise in creatinine. There appeared to be no correlation between total dose administered or duration of therapy and the degree of renal impairment.

Pulmonary Toxicity

This has occurred infrequently but can be severe and may be life-threatening. Dyspnea with a nonproductive cough and radiographic evidence of pulmonary infiltrates may be indicative of Mitomycin-induced pulmonary toxicity. If other etiologies are eliminated, Mitomycin therapy should be discontinued. Steroids have been employed as treatment of this toxicity, but the therapeutic value has not been determined. A few cases of adult respiratory distress syndrome have been reported in patients receiving Mitomycin in combination with other chemotherapy and maintained at FlO 2 concentrations greater than 50% perioperatively.

Hemolytic Uremic Syndrome (HUS)

This serious complication of chemotherapy, consisting primarily of microangiopathic hemolytic anemia (hematocrit ≤25%), thrombocytopenia (≤100,000/mm 3 ), and irreversible renal failure (serum creatinine ≥1.6 mg/dL) has been reported in patients receiving systemic Mitomycin. Microangiopathic hemolysis with fragmented red blood cells on peripheral blood smears has occurred in 98% of patients with the syndrome. Other less frequent complications of the syndrome may include pulmonary edema (65%), neurologic abnormalities (16%), and hypertension. Exacerbation of the symptoms associated with HUS has been reported in some patients receiving blood product transfusions. A high mortality rate (52%) has been associated with this syndrome.

The syndrome may occur at any time during systemic therapy with Mitomycin as a single agent or in combination with other cytotoxic drugs. Less frequently, HUS has also been reported in patients receiving combinations of cytotoxic drugs not including Mitomycin. Of 83 patients studied, 72 developed the syndrome at total doses exceeding 60 mg of Mitomycin. Consequently, patients receiving ≥60 mg of Mitomycin should be monitored closely for unexplained anemia with fragmented cells on peripheral blood smear, thrombocytopenia, and decreased renal function.

The incidence of the syndrome has not been defined.

Therapy for the syndrome is investigational.

Cardiac Toxicity

Congestive heart failure, often treated effectively with diuretics and cardiac glycosides, has rarely been reported. Almost all patients who experienced this side effect had received prior doxorubicin therapy.

Acute Side Effects Due to Mitomycin were fever, anorexia, nausea, and vomiting. They occurred in about 14% of 1,281 patients.

Other

Headache, blurring of vision, confusion, drowsiness, syncope, fatigue, edema, thrombophlebitis, hematemesis, diarrhea, and pain. These did not appear to be dose related and were not unequivocally drug related. They may have been due to the primary or metastatic disease processes. Malaise and asthenia have been reported as part of postmarketing surveillance. Bladder fibrosis/contraction has been reported with intravesical administration (see PRECAUTIONS ).

Mitomycin Dosage and Administration

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.

Mitomycin should be given intravenously only, using care to avoid extravasation of the compound. If extravasation occurs, cellulitis, ulceration, and slough may result.

Each vial contains either Mitomycin 5 mg and mannitol 10 mg, Mitomycin, 20 mg and mannitol 40 mg or Mitomycin 40 mg and mannitol 80 mg. To administer, add Sterile Water for Injection, 10 mL, 40 mL or 80 mL respectively. Shake to dissolve. If product does not dissolve immediately, allow to stand at room temperature until solution is obtained.

After full hematological recovery (see guide to dosage adjustment) from any previous chemotherapy, the following dosage schedule may be used at 6 to 8 week intervals:

20 mg/m 2 intravenously as a single dose via a functioning intravenous catheter.

Because of cumulative myelosuppression, patients should be fully reevaluated after each course of Mitomycin, and the dose reduced if the patient has experienced any toxicities. Doses greater than 20 mg/m 2 have not been shown to be more effective, and are more toxic than lower doses.

The following schedule is suggested as a guide to dosage adjustment:

Nadir After Prior Dose

No repeat dosage should be given until leukocyte count has returned to 4000/mm 3 and a platelet count to 100,000/mm 3. When Mitomycin is used in combination with other myelosuppressive agents, the doses should be adjusted accordingly. If the disease continues to progress after two courses of Mitomycin, the drug should be stopped since chances of response are minimal.

STABILITY

Unreconstituted Mitomycin stored at room temperature is stable for the lot life indicated on the package. Avoid excessive heat (over 40°C, 104°F).

Reconstituted with Sterile Water for Injection to a concentration of 0.5 mg per mL, Mitomycin is stable for 14 days refrigerated or 7 days at room temperature.

Diluted in various I. V. fluids at room temperature, to a concentration of 20 to 40 micrograms per mL:

0.9% Sodium Chloride Injection

Sodium Lactate Injection

The combination of Mitomycin (5 mg to 15 mg) and heparin (1,000 units to 10,000 units) in 30 mL of 0.9% Sodium Chloride Injection is stable for 48 hours at room temperature.

Procedures for proper handling and disposal of anticancer drugs should be considered. Several guidelines on this subject have been published. 1-8 There is no general agreement that all of the procedures recommended in the guidelines are necessary or appropriate.

How is Mitomycin Supplied

Mitomycin for Injection USP

NDC 16729-115-05—Each amber vial contains 5 mg Mitomycin, individually packed in single carton.

NDC 16729-108-11—Each amber vial contains 20 mg Mitomycin, individually packed in single carton.

NDC 16729-116-38—Each amber vial contains 40 mg Mitomycin, individually packed in single carton.

Storage: Store dry powder at 25°C, excursion permitted between 15°C and 30°C, protected from light. Avoid excessive heat, over 40 °C (104° F). Protect reconstituted solution from light. Store solution under refrigeration 2° to 8 °C (36° to 46°F), discard after 14 days. If unrefrigerated, discard after 7 days.

References

ONS Clinical Practice Committee. Cancer Chemotherapy Guidelines and Recommendations for Practice Pittsburgh, PA: Oncology Nursing Society; 1999:32-41.

Recommendations for the safe handling of parenteral antineoplastic drugs. Washington, DC: Division of Safety, National Institutes of Health; 1983. US Dept of Health and Human Services, Public Health Service publication NIH 83-2621.

AMA Council on Scientific Affairs. Guidelines for handling parenteral antineoplastics. JAMA. 1985;253:1590-1591.

National Study Commission on Cytotoxic Exposure. – Recommendations for handling cytotoxic agents. 1987. Available from Louis P. Jeffrey, Chairman, National Study Commission on Cytotoxic Exposure. Massachusetts College of Pharmacy and Allied Health Sciences, 179 Longwood Avenue, Boston, MA 02115.

Clinical Oncological Society of Australia. Guidelines and recommendations for safe handling of antineoplastic agents. Med J Australia. 1983;1:426-428.

Jones RB, Frank R, Mass T. Safe handling of chemotherapeutic agents: a report from the Mount Sinai Medical Center. CA-A Cancer J for Clin. 1983;33:258-263.

American Society of Hospital Pharmacists. ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs. Am J Hosp Pharm. 1990;47:1033-1049.

Controlling Occupational Exposure to Hazardous Drugs. (OSHA Work-Practice Guidelines.). Am J Health SystPharm. 1996;53:1669-1685.

Accord Healthcare, Inc.

1009 Slater Road, Suite 210-B,

Durham, NC 27703. USA

Intas Pharmaceuticals Limited,

Plot No. 457, 458, Village – Matoda,

Bavla Road, Ta.- Sanand,

Dist.- Ahmedabad – 382 210. India.

Intas Pharmaceuticals Limited,

Plot No. 5, 6 and 7, Pharmez

Sarkhej-Bavla, National Highway No. 8-A,

Near Village Matoda, Tal Sanand,

Ahmedabad - 382 213, Gujarat, India

Issued - April, 2011.

10 5479 3 629917

Isuued - October, 2013.

51 1116 1 705596

Carton Label-Mitomycin for injection USP 40 mg/vial

Mitomycin for injection USP 40 mg

WARNING: MUST BE ADMINISTERED IV TO AVOID TISSUE DAMAGE

Carton Label-Mitomycin for injection USP 20 mg/vial

Mitomycin for injection USP 20 mg

WARNING: MUST BE ADMINISTERED IV TO AVOID TISSUE DAMAGE

Carton Label-Mitomycin for injection USP 20 mg/vial

Mitomycin for injection USP 5 mg

WARNING: MUST BE ADMINISTERED IV TO AVOID TISSUE DAMAGE

Herpes Zoster Practice Essentials, Background, Pathophysiology, Zoter

Herpes Zoster

Practice Essentials

Reactivation of varicella-zoster virus (VZV) that has remained dormant within dorsal root ganglia, often for decades after the patient’s initial exposure to the virus in the form of varicella (chickenpox), results in herpes zoster (shingles). [1] Although it is usually a self-limited dermatomal rash with pain, herpes zoster can be far more serious; in addition, acute cases often lead to postherpetic neuralgia (PHN) and is responsible for a significant economic burden. [2] See the image below.

See 15 Rashes You Need to Know: Common Dermatologic Diagnoses, a Critical Images slideshow, for help identifying and treating various rashes.

Signs and symptoms

The clinical manifestations of herpes zoster can be divided into the following 3 phases:

Preeruptive phase (preherpetic neuralgia)

Acute eruptive phase

Chronic phase (PHN)

The preeruptive phase is characterized by the following:

Sensory phenomena along 1 or more skin dermatomes, lasting 1-10 days (average, 48 hours)

Phenomena usually are noted as pain or, less commonly, itching or paresthesias [3]

Pain may simulate headache, iritis, pleurisy, brachial neuritis, cardiac pain, appendicitis or other intra-abdominal disease, or sciatica

Other symptoms, such as malaise, myalgia, headache, photophobia, and, uncommonly, fever

The acute eruptive phase is marked by the following:

Patchy erythema, occasionally accompanied by induration, in the dermatomal area of involvement

Regional lymphadenopathy, either at this stage or subsequently

Grouped herpetiform vesicles developing on the erythematous base (the classic finding)

Cutaneous findings that typically appear unilaterally, stopping abruptly at the midline of the limit of sensory coverage of the involved dermatome

Vesicular involution: Vesicles initially are clear but eventually cloud, rupture, crust, and involute

After vesicular involution, slow resolution of the remaining erythematous plaques, typically without visible sequelae

Scarring can occur if deeper epidermal and dermal layers have been compromised by excoriation, secondary infection, or other complications

Almost all adults experience pain, typically severe

A few experience severe pain without a vesicular eruption (ie, zoster sine herpete)

Symptoms tend to resolve over 10-15 days

Complete healing of lesions may require up to a month

PHN is characterized by the following:

Persistent or recurring pain lasting 30 or more days after the acute infection or after all lesions have crusted (9-45% of all cases) [4]

Pain usually is confined to the area of original dermatomal involvement

The pain can be severe and incapacitating

Pain can persist for weeks, months, or years

Slow resolution of pain is especially common in the elderly [5]

PHN is observed more frequently after cases of herpes zoster ophthalmicus (HZO) and in instances of upper-body dermatomal involvement

Less common postherpetic sequelae include hyperesthesia or, more rarely, hypoesthesia or anesthesia in the area of involvement

Common features of herpes zoster ophthalmicus are as follows:

Classic symptoms and lesions of herpes zoster

Ophthalmic manifestations including conjunctivitis, scleritis, episcleritis, keratitis iridocyclitis, Argyll-Robertson pupil, glaucoma, retinitis, choroiditis, optic neuritis, optic atrophy, retrobulbar neuritis, exophthalmos, lid retraction, ptosis, and extraocular muscle palsies

Other forms of herpes zoster include the following:

Herpes zoster of maxillary branch of cranial nerve (CN) V

Herpes zoster of mandibular branch of CN V

Herpes zoster oticus (Ramsay Hunt syndrome)

Glossopharyngeal and vagal herpes zoster

Herpes occipitocollaris (vertebral nerves C2 and C3 involvement)

Herpes zoster encephalomyelitis

Disseminated herpes zoster

Unilateral herpes zoster involving multiple dermatomes

Recurrent herpes zoster

Herpes zoster involving urinary bladder, bronchi, pleural spaces, or gastrointestinal tract

Herpes zoster with motor complications

See Clinical Presentation for more detail.

Diagnosis

Diagnosis of herpes zoster is based primarily on the history and physical findings. In most cases, confirming the diagnosis via laboratory testing has no utility. In select patient populations, however—particularly immunocompromised patients—the presentation of herpes zoster can be atypical and may require additional testing.

Laboratory studies for VZV include the following:

Direct fluorescent antibody (DFA) testing of vesicular fluid or a corneal lesion

Polymerase chain reaction (PCR) testing of vesicular fluid, a corneal lesion, or blood

Tzanck smear of vesicular fluid (lower sensitivity and specificity than DFA or PCR)

See Workup for more detail.

Management

Episodes of herpes zoster are generally self-limited and resolve without intervention; they tend to be more benign and mild in children than in adults.

Conservative therapy includes the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Wet dressings with 5% aluminum acetate (Burrow solution), applied for 30-60 minutes 4-6 times daily

Lotions (eg, calamine)

Primary medications for acute zoster–associated pain include the following:

Narcotic and nonnarcotic analgesics (both systemic and topical)

Neuroactive agents (eg, tricyclic antidepressants [TCAs])

Steroid treatment for herpes zoster is traditional but controversial. Typically, a substantial dose (eg, 40-60 mg of oral prednisone every morning) typically is administered as early as possible in the course of the disease and is continued for 1 week, followed by a rapid taper over 1-2 weeks.

Antiviral therapy for herpes zoster may decrease the length of time for new vesicle formation, the number of days to attain complete crusting, and the days of acute discomfort. Usually, the earlier antiviral medications are started, the more effective they are in shortening the duration of zoster and in preventing or decreasing the severity of PHN. Ideally, therapy should be initiated within 72 hours of symptom onset.

Oral treatment with the following has been found beneficial:

Hospital admission should be considered for patients with any of the following:

Atypical presentations (eg, myelitis)

Involvement of more than 2 dermatomes

Significant facial bacterial superinfection

Disseminated herpes zoster

Prevention and treatment of postherpetic neuralgia

Prompt treatment of acute zoster and its associated pain (eg, with antiviral therapy) can prevent the development of PHN. Once PHN has developed, various treatments are available, including the following:

Neuroactive agents (eg, TCAs) [6]

Anticonvulsant agents (eg, gabapentin, [7] pregabalin)

Narcotic and nonnarcotic analgesics, both systemic (eg, opioids) and topical

A live attenuated VZV vaccine introduced in 2005 (Zostavax) has demonstrated a reduction in the incidence rate of herpes zoster. It is approved for use in patients 50 years of age and older and has been judged to be cost-effective. [8]

See Treatment and Medication for more detail.

Background

Herpes zoster (shingles) is an acute, cutaneous viral infection caused by the reactivation of varicella-zoster virus (VZV), a herpesvirus that is the cause of varicella (chickenpox). Differences in clinical manifestations between varicella and herpes zoster apparently depend on an individual's immune status; those with no previous exposure to VZV, most commonly children, develop the clinical syndrome of varicella, whereas those with circulating varicella antibodies develop a localized recrudescence, zoster.

Zoster probably results most often from a failure of the immune system to contain latent VZV replication. Whether other factors, such as radiation, physical trauma, certain medications, other infections, and stress, also can trigger zoster has not been determined with certainty. Nor is it entirely clear why circulating varicella antibodies and cell-mediated immune mechanisms do not prevent recurrent overt disease, as is common with most other viral illnesses.

The incidence of zoster appears to be inversely correlated with the host’s capacity to mount a cellular immune response. However, many patients with zoster apparently have normal immunity. In these patients, zoster is postulated to occur when VZV antibody titers and cellular immunity drop to levels that no longer are completely effective in preventing viral invasion. Evidence for this hypothesis includes the observation that pediatricians, who presumably are routinely reexposed to VZV and thus maintain high levels of immunity, seldom develop zoster.

Herpes zoster manifests in many ways. It should not be considered simply a self-limited dermatomal rash with pain. VZV infection is an acute neurologic disease that warrants immediate evaluation. That VZV is always a benign disorder is a common misperception. Once VZV infection resolves, many individuals continue to suffer pain—a condition known as postherpetic neuralgia (PHN).

Pathophysiology

VZV infection gives rise to 2 distinct syndromes. The primary infection, chickenpox, is a contagious and usually benign febrile illness. After this infection resolves, viral particles remain in the dorsal root or other sensory ganglia, where they may lay dormant for years to decades.

In this latent period, host immunologic mechanisms suppress replication of the virus, but VZV reactivates when the host mechanisms fail to contain the virus. Such failure may result from a wide spectrum of conditions, ranging from stress to severe immunosuppression; occasionally, it follows direct trauma. VZV viremia occurs frequently with chickenpox but also may arise with herpes zoster, albeit with a lower viral load.

Once VZV is activated at the spinal root or cranial nerve neurons, an inflammatory response occurs that also encompasses the leptomeninges; both plasma cells and lymphocytes are noted. This inflammation in the dorsal root ganglion can be accompanied by hemorrhagic necrosis of nerve cells. The result is neuronal loss and fibrosis.

The frequency of dermatologic involvement is correlated with the centripetal distribution of the initial varicella lesions. This pattern suggests that the latency may arise from contiguous spread of the virus during varicella from infected skin cells to sensory nerve endings, with subsequent ascent to the ganglia. Alternatively, the ganglia may become infected hematogenously during the viremic phase of varicella, and the frequency of the dermatome involvement in herpes zoster may reflect the ganglia most often exposed to reactivating stimuli.

The appearance of the cutaneous rash due to herpes zoster coincides with a profound VZV-specific T-cell proliferation. Production of interferon alfa appears with the resolution of herpes zoster. In immunocompetent patients, specific antibodies (immunoglobulins G, M, and A [IgG, IgM, and IgA]) appear more rapidly and reach higher titers during reactivation (herpes zoster) than during the primary infection. The patient has a long-lasting, enhanced, cell-mediated immunity response to VZV. [9, 10, 11]

The anatomic location of the involved dermatome often determines the specific manifestations. When cervical and lumbar roots are involved, motor involvement, which is often overlooked, may be evident, depending on the virulence or extent of migration. In at least 1 case of motor neuron involvement, lymphocytic infiltration and myelin breakdown were observed with preservation of axons.

Herpes zoster infections are contagious to persons with no previous immunity to VZV. However, herpes zoster is estimated to be only one third as contagious as primary varicella. It is transmitted either via direct contact with the lesions or via the respiratory route.

Organ system involvement

Central nervous system

Whereas herpes zoster is classically described in sensory (dorsal root) ganglia, it can spread to affect any portion of the central nervous system (CNS). Involvement of the anterior horn cells can produce muscular weakness, cranial nerve palsies, diaphragmatic paralysis, neurogenic bladder, and colonic pseudo-obstruction. Wider involvement of the spinal cord can produce Guillain-Barre syndrome, transverse myelitis, and myositis.

In severely ill or immunocompromised patients, general CNS involvement can be observed in the form of meningoencephalitis or encephalitis. Such presentations may be indistinguishable from those of other forms of meningoencephalitis, though other evidence of acute zoster usually is present. [12] Cerebrospinal fluid (CSF) studies frequently reveal pleocytosis without elevated protein. These infections can be life-threatening.

Herpes zoster ophthalmicus (HZO), a potentially devastating form of acute herpes zoster, results from the reactivation of VZV in the trigeminal (fifth cranial) nerve. Any branch of the nerve may be affected, though the frontal branch within the first division of the trigeminal nerve is most commonly involved. This branch innervates nearly all of the ocular and periocular structures.

Polymerase chain reaction (PCR) nerve studies have detected latent trigeminal VZV in as many as 87% of patients. [13] Clinical disease has been reported in as few as 8% and as many as 56% of patients in studies focused on ophthalmic involvement. [14]

Herpes zoster oticus (also known as Ramsay Hunt syndrome, geniculate neuralgia, or herpes zoster auricularis) is caused by VZV reactivation involving the facial and auditory nerves. This syndrome may go unnoticed and be difficult to diagnose, especially in elderly patients.

Vesicular eruptions may manifest on the pinna, tragus, or tympanic membrane or in the auditory canal, as well as anywhere in the facial nerve distribution. The patient may experience hearing impairment, nystagmus, vertigo, or a facial nerve palsy mimicking Bell palsy. [15] Patients may lose taste sensation in the anterior two thirds of the tongue. [15]

Clinical phases of disease

The clinical manifestations of herpes zoster can be divided into the following 3 phases:

Preeruptive phase (preherpetic neuralgia)

Acute eruptive phase

Chronic phase (PHN)

The preeruptive phase is characterized by unusual skin sensations or pain within the affected dermatome that heralds the onset of lesions by 48-72 hours. During this time, patients may also experience other symptoms, such as malaise, myalgia, headache, photophobia, and, uncommonly, fever.

The acute eruptive phase is marked by the emergence of vesicular eruptions. Patients may also experience some of the other symptoms seen in the preeruptive phase. Lesions begin as erythematous macules and papules that quickly develop into vesicles. New lesions tend to form over a period of 3-5 days, sometimes coalescing to form bullae. After they form vesicles, lesions progress through stages in which they rupture, release their contents, ulcerate, and finally crust over and become dry. Patients remain infectious until the lesions have dried.

During this phase, almost all adult patients experience pain (ie, acute neuritis). A few experience severe pain without any evidence of a vesicular eruption (ie, zoster sine herpete), and a small number have a characteristic eruption but do not experience pain. Symptoms and lesions in the acute eruptive phase tend to resolve over 10-15 days. However, lesions may require up to a month to completely heal, and the associated pain may become chronic.

PHN, the chronic phase, is characterized by persistent or recurring pain lasting 30 or more days after the acute infection or after all lesions have crusted. It is the most frequent complication of herpes zoster, observed in 9-45% of all cases. [4] Most people report a deep burning or aching pain, paresthesia, dysesthesia, hyperesthesia, or electric shock–like pains. The pain can be severe and incapacitating, and may take a long time to resolve, especially in the elderly; it lasts longer than 12 months in nearly 50% of patients older than 70 years. [5]

Etiology

Herpes zoster is caused by VZV infection. VZV is an enveloped, double-stranded DNA virus belonging to the Herpesviridae family; its genome encodes approximately 70 proteins. In humans, primary infection with VZV occurs when the virus comes into contact with the mucosa of the respiratory tract or conjunctiva. From these sites, it is distributed throughout the body. After primary infection, the virus migrates along sensory nerve fibers to the satellite cells of dorsal root ganglia where it becomes dormant.

Reactivation of VZV that has remained dormant within dorsal root ganglia, often for decades after the patient’s initial exposure to the virus in the form of varicella (chickenpox), results in herpes zoster. [1] Exactly what triggers this reactivation has not yet been determined precisely, but likely candidates (alone, or in combination) include the following:

External reexposure to the virus

Acute or chronic disease processes (particularly malignancies and infections)

Medications of various types

The reason why one dorsal root ganglion experiences reactivation of its stored viral load preferentially over another ganglia is unclear. Diminished cellular immunity seems to increase the risk of reactivation, in that the incidence increases with age and in immunocompromised persons. [16]

Zoster can be a presenting symptom of hyperparathyroidism, and it occurs twice as often (frequency, 3.7%) among patients with hypercalcemia as it does among age-matched cohorts of patients older than 40 years who have normal calcium levels. [17]

The cause of PHN also remains a mystery. Rapid initiation of treatment decreases the incidence of PHN substantially, an effect that can be explained by the theory that incessant pain of active zoster sets up a positive feedback loop within the thalamus and the cortex, creating a central pain syndrome similar to phantom leg pain. According to this theory, prompt treatment breaks the loop by providing pain-free periods early in the disease course.

Risk factors

Known risk factors for developing herpes zoster relate to the status of cell-mediated immunity to VZV. Risk factors in children and adults include the following:

VZV-specific immunity and cell-mediated immunity, which generally declines with age

Primary VZV infection in utero or in early infancy, when the normal immune response is decreased

Anti-tumor necrosis factor (TNF)-a agents (may pose an increased risk) [33]

Immune reconstitution inflammatory syndrome (IRIS)

Acute lymphocytic leukemia and other malignancies

IRIS is a paradoxical deterioration in clinical status that develops in a patient receiving antiretroviral treatment despite satisfactory control of viral replication and improvement of the patient’s CD4 count. Such patients may have signs and symptoms of a previously subclinical and unrecognized herpes zoster infection, as a paradoxical worsening of treatment response several weeks into therapy in the context of immune recovery on antiretroviral therapy (ART).

The appearance of herpes zoster within an 8- to 12-week period after initiation of ART should prompt consideration of IRIS. Early recognition and prompt treatment, along with continuation of highly active ART, are especially important in such cases. [34]

Research indicates that patients with inflammatory bowel disease (IBD) are at significantly increased risk for herpes zoster. [9] In an analysis of more than 108,000 IBD patients and 430,000 matched controls, the overall annual incidence of herpes zoster per 100,000 person-years was 734 among IBD patients, compared with 437 in non-IBD patients. The elevated risk in IBD patients remained after adjustment for comorbidities and other factors. Treatment with thiopurines, corticosteroids, and biologic antitumor necrosis factor–alpha (anti-TNF) agents was independently associated with an increased risk of herpes zoster. [35, 36]

Patients with multiple myeloma and colon cancer treated with arsenic trioxide may have a propensity to develop herpes zoster (shingles). Arsenic compounds have been suggested as a possible predisposing factor for herpes viral reactivation in these patients. [37]

Ambilateral reactivation of herpes zoster after cataract operations on both eyes has been described. [38]

In a population-based case-control study from the United Kingdom aimed at quantifying the effects of herpes zoster risk factors at various ages, 144,959 adults diagnosed with herpes zoster between 2000 and 2011 were compared with 549,336 age-, sex-, and practice-matched control subjects (median age, 62 years). [39] The following factors were associated with increased risk of zoster:

Rheumatoid arthritis (2.1% vs 1.5%)

Inflammatory bowel disease (1.3% vs 0.9%)

Chronic obstructive pulmonary disease (4.7% vs 3.7%)

Asthma (7.1% vs 5.8%)

Chronic kidney disease (6.0% vs 5.4%)

Depression (4.7% vs 4.0%)

For many of the risk factors evaluated, the relative effects were greater in younger individuals. [39] The greatest risk of zoster was observed in patients with severely immunosuppressive conditions (eg, lymphoma and myeloma), but current vaccines are contraindicated in these individuals.

United States statistics

In the United States, approximately 95% of adults—and 99.5% of adults aged 40 years or older—have antibodies to VZV and thus are vulnerable to reactivation of infection. [40] A person of any age with a previous varicella infection may develop zoster, but the incidence increases with advancing age as a consequence of declining immunity.

Approximately 4% of patients with herpes zoster will develop a recurrent episode later in life. [41] Recurrent zoster occurs almost exclusively in people who are immunosuppressed. Approximately 25% of patients with HIV and 7-9% of those receiving renal transplantation or cardiac transplantation experience a bout of zoster.

HZO represents 10-15% of all cases of HZ. Approximately half of these patients develop complications of HZO. The risk of ophthalmic complications in patients with herpes zoster does not seem to correlate with age, sex, or severity of the rash.

Before the advent of widespread vaccination, an estimated 4 million cases of primary VZV infection occurred annually in the United States alone. [40] Infection was nearly universal by the end of the teenage years, with studies showing only 10% of persons older than age 15 years as remaining susceptible to infection. [41]

Over the period of a lifetime, 10-20% of those with primary infections went on to experience episodes of herpes zoster. [42] High-risk groups, such as elderly populations and immunocompromised people, might experience cumulative incidences as high as 50%. [43] The estimated annual number of herpes zoster cases in the United States is approximately 1 million. [17]

Since the introduction of widespread vaccination for varicella in 1995, the incidence of primary VZV infection in the United States has been reduced by up to 90%. [40] However, the effect of this vaccination, as well as that of the subsequently approved vaccination for herpes zoster, on the current and future incidence of herpes zoster remains to be determined.

International statistics

Internationally, the incidence of zoster has not been well studied, but it is probably in the same range as that reported in the United States. [44] A German study of data on patients in the country’s statutory health system (SHI) for the year 2010 estimated that the mean annual incidence of herpes zoster was 5.79 cases per 1000 person-years, equivalent to 403,625 cases annually in the SHI population (which comprised about 85% of the total German population). [45]

Age-related demographics

Herpes zoster is rare in children and young adults, except in younger patients with AIDS, lymphoma, other malignancies, and other immune deficiencies and in patients who have received bone marrow or kidney transplants. Fewer than 10% of zoster patients are younger than 20 years, and only 5% are younger than 15 years. Even though zoster is primarily a disease of adults, it has been noted as early as the first week of life, occurring in infants born to mothers who had primary VZV infection (chickenpox) during pregnancy.

The incidence of herpes zoster increases with age. [46] In the general population, the lifetime incidence rate of herpes zoster is 10-20%, which rises to 50% in those individuals surviving to age 85 years. [16] More than 66% of patients are older than 50 years. The incidence of PHN also rises with advancing age. [47]

Sex-related demographics

Herpes zoster generally has not been considered to have a sex predilection. However, one study reported a higher prevalence in women than in men. [48] Ertunc et al suggested both that zoster frequency is higher in right-handed patients and that the rash appears more frequently on the left side in females. [49] The pathophysiology for these differences is uncertain.

Race-related demographics

Blacks are reported to have a significantly lower risk of developing zoster than whites do; however, zoster has been reported as an early manifestation of HIV infection in young Africans. Research has shown that elderly blacks are up to 75% less likely to develop herpes zoster than elderlys. [43] Similar findings have been demonstrated in children. [50] In a meta-analysis of controlled herpes zoster clinical trials, a nonwhite racial group was found to be associated with a younger age at zoster onset. [46]

Dexpak Tablets (Dose Pack) Indications, Side Effects, Warnings, Dexpak

DexPak tablets (dose pack)

DexPak tablets (dose pack) is used for:

Treating certain conditions associated with decreased adrenal gland function. It is also used to treat severe inflammation due to certain conditions, including severe asthma, severe allergies, rheumatoid arthritis, ulcerative colitis, certain blood disorders, lupus, multiple sclerosis, and certain eye and skin conditions. It may also be used for other conditions as determined by your doctor.

DexPak tablets (dose pack) is a corticosteroid. It works by decreasing or preventing tissues from responding to inflammation. It also modifies the body's response to certain immune stimulation.

Do NOT use DexPak tablets (dose pack) if:

you are allergic to any ingredient in DexPak tablets (dose pack)

you have a systemic fungal infection

you are taking mifepristone

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

Before using DexPak tablets (dose pack):

Some medical conditions may interact with DexPak tablets (dose pack). 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 are scheduled for a vaccination with a live virus vaccine (eg, smallpox)

if you have an underactive thyroid, liver or kidney problems, diabetes, or ulcerative colitis

if you have heart problems, esophagitis, gastritis, stomach obstruction or perforation, or an ulcer

if you have a history of mental problems (eg, depression), glaucoma, cataracts, or other eye problems

if you have a herpes infection in your eye or any other type of infection (bacterial, fungal, or viral); have or recently had tuberculosis (TB) or tested positive for TB, measles, or chickenpox

Some MEDICINES MAY INTERACT with DexPak tablets (dose pack). Tell your health care provider if you are taking any other medicines, especially any of the following:

Barbiturates (eg, phenobarbital), carbamazepine, hydantoins (eg, phenytoin), or rifampin because they may decrease DexPak tablets (dose pack)'s effectiveness

Clarithromycin, azole antifungals (eg, ketoconazole), steroidal contraceptives (eg, desogestrel), or troleandomycin because because weakness, confusion, muscle aches, joint pain, or low blood sugar, may occur

Methotrexate or ritodrine because the risk of their side effects may be increased by DexPak tablets (dose pack)

Hydantoins (eg, phenytoin),mifepristone, or live vaccines because their effectiveness may be decreased by DexPak tablets (dose pack)

Anticoagulants (eg, warfarin) or aspirin because their actions and side effects may be increased or decreased by DexPak tablets (dose pack)

This may not be a complete list of all interactions that may occur. Ask your health care provider if DexPak tablets (dose pack) may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use DexPak tablets (dose pack):

Use DexPak tablets (dose pack) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take DexPak tablets (dose pack) by mouth with food.

DexPak tablets (dose pack) is a dose pack. Unless otherwise directed by your doctor, follow the instructions on the pack for taking DexPak tablets (dose pack).

If you miss a dose of DexPak tablets (dose pack), 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 DexPak tablets (dose pack).

Important safety information:

DexPak tablets (dose pack) may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.

Tell your doctor or dentist that you take DexPak tablets (dose pack) before you receive any medical or dental care, emergency care, or surgery.

DexPak tablets (dose pack) may cause an elevation in blood pressure, salt and water retention, and increased potassium loss. You may need to restrict the use of salt and take a calcium supplement.

DexPak tablets (dose pack) can cause calcium loss and promote the development of osteoporosis. Take adequate calcium and vitamin D supplements.

Diabetes patients -- DexPak tablets (dose pack) may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.

Caution is advised when using DexPak tablets (dose pack) in CHILDREN; they may be more sensitive to its effects.

Corticosteroids may affect growth rate in CHILDREN and teenagers in some cases. They may need regular growth checks while they take DexPak tablets (dose pack).

PREGNANCY and BREAST-FEEDING: It is not known if DexPak tablets (dose pack) can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using DexPak tablets (dose pack) while you are pregnant. DexPak tablets (dose pack) is found in breast milk. Do not breast-feed while taking DexPak tablets (dose pack).

Possible side effects of DexPak tablets (dose pack):

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:

Difficulty sleeping; feeling of a whirling motion; increased appetite; increased sweating; indigestion; mood changes; nervousness.

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); appetite loss; black, tarry stools; changes in menstrual periods; convulsions; depression; diarrhea; dizziness; exaggerated sense of well-being; fever; general body discomfort; headache; increased pressure in the eye; joint or muscle pain; mood swings; muscle weakness; personality changes; prolonged sore throat, cold, or fever; puffing of the face; severe nausea or vomiting; swelling of feet or legs; unusual weight gain; vomiting material that looks like coffee grounds; weakness; weight loss.

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

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center. or emergency room immediately.

Proper storage of DexPak tablets (dose pack):

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

General information:

If you have any questions about DexPak tablets (dose pack), please talk with your doctor, pharmacist, or other health care provider.

DexPak tablets (dose pack) is to be used only by the patient for whom it is prescribed. Do not share it with other people.

If your symptoms do not improve or if they become worse, check with your doctor.

Check with your pharmacist about how to dispose of unused medicine.

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

Review Date: August 8, 2016

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

More about Dexpak Taperpak (dexamethasone)

Kitchen - Bathroom Cabinets, Tevax

Kitchen & Bathroom Cabinets

Click here for Countertops – Caesarstone, Silestone, and more. Stunning cabinetry is the cornerstone of a modern kitchen or bathroom. Functionality as well as style are the distinctive features found in every cabinet option available today through Teevax Home Appliance & Kitchen Center. We are also your one-stop shop for design and installation. Teevax is proud to offer cabinets to Santa Rosa. Petaluma. Healsburg. Sonoma. Sebastopol residents from these leading manufacturers:

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Acetal Mechanism, Acetak

Last time I left you with a problem, "what is the mechanism for the base catalyzed addition of water to a carbonyl group?" Let's go through that and see how it goes.

First let's check out the electronic structure of the OH -. If we find unshared pairs we can say that the OH - is a Lewis base and a nucleophile . That would tell us that an electron pair is ready to be used to make a new bond. Then we have the question of where that bond will go. In the carbonyl group, we know that the carbon is the more positive end of the C=O dipole, so let's try to make our new bond there.

This seems to be the right place to make the bond, but if we do that, the carbonyl carbon has five bonds ( * ). That means ten electrons in the valence shell, so it doesn't happen. We must find a way to reduce the number of bonds to four. We can think back to the mechanism we worked out for the acid catalyzed addition of water. In that mechanism we broke the pi bond by using its electrons to make a new bond to H +.

Let's look into the possibility that the C=O pi bond breaks as the C-O sigma bond forms. After all, the electrons in the pi bond are farther from the nuclei than those in a sigma bond, so they should be easier to push around.

Another way to say this is that the pi bond is weaker than the sigma bond, so it takes less energy to break it. The energy required to break the pi bond comes from making the new sigma bond to the OH -. (In the acid catalyzed case, the new bond which is being formed is the bond beween the carbonyl oxygen and the H +. Breaking old bonds is usually assisted by the formation of new bonds.

We finish this mechanism by making the only bond which is left to do, the O-H bond.

Here again, the breaking of one bond is assisted by the formation of another bond. Also, this mechanism makes a new OH - to replace the one which was used in the first step, consistent with the observation that the reaction is base catalyzed, which means that the OH - is not used up.

Now let's use what we know about the acid catalyzed addition of water to make a prediction of what will happen when we mix an aldehyde with an alcohol and add a drop or two of an acid catalyst.

We want to use our mechanism to predict the structure of the product. Recall the mechanism of acid-catalyzed addition of water

If we follow closely the bonding changes that happen around the water oxygen, we notice that one of the hydrogens always stays attached. That bond doesn't break. That bond could just as well be a C-O bond as is the situation in an alcohol. What would happen if we just replaced water by methanol in the mechanism for acid-catalyzed hydration?

Indeed, the same mechanism seems to work just fine. The OH group in methanol is a nucleophile just like the OH group in water. Another way to say this is that the functional group of water is the same as the functional group of any alcohol, an OH group. If we learn a reaction for one alcohol, it will work very much the same way for any other alcohol - often including water as the smallest possible alcohol.

When we do the experiment to test our prediction, we find that yes, the product we have predicted is formed. But, we also find another product, one which hadn't been predicted.

(The new product is called an acetal. The one we predicted is called a hemiacetal.) Since the hemiacetal seems to be about halfway to the acetal, we'll explore converting the hemiacetal into the acetal.

If we look closely at the differences between these two products, we see that to do this, we need to replace the OH group of the hemiacetal with the OCH 3 group of the acetal. (We can rule out the seemingly simpler alternative of replacing the H with the CH 3 because isotopic labelling experiments show that the O-CH 3 bond is not broken and the bond between the central carbon and the OH oxygen is broken.) This reaction is also acid catalyzed, so we may begin by making a bond between H + and the OH oxygen, using the Lewis base electrons of the oxygen (electron pairs are often symbolized by bars).

In the next step the bond between the central carbon and the oxygen we have just broken is broken. This produces water and leaves the central carbon atom with only three bonds and a vacancy in its valence shell. A formal charge calculation tells us that this atom is also positively charged, but it is the electron pair vacancy which is more important.

The central atom is consequently an electrophile, open to making a bond with a nucleophile. The nucleophile is the oxygen of another molecule of methanol, whose unshared electron pair becomes the new carbon oxygen bond.

It remains to break the bond between the hydrogen and the positively charged oxygen which produces the acetal and replaces the H + to regenerate the catalyst.

Just to have the whole process in one place, here's the full mechanism from the aldehyde through the hemiacetal to the acetal:

There are a couple of general ideas we can extract from what we did in working out this mechanism.

Charge and Reactivity: Let's contrast two postively charged molecules we found in this mechanism, one with three bonds to oxygen and one with three bonds to carbon.

Both molecules are positively charged, and formal charge calculations tell us where that charge is. But there is an important difference in their structures and that difference makes an important difference in their reactions.

The positively charged cation (we call it a carbocation) with three bonds has only six electrons in its valence shell. It is an electrophile. It makes a fourth bond using electrons from a nucleophile (the methanol oxygen atom here).

The positively charged oxygen (we call it an oxonium ion) has three bonds and an unshared pair. It has a complete octet in its valence shell. It needs no more electrons so it makes no more bonds. It is not an electrophile. Its reaction is to break a bond, keeping the electrons, by dropping off an H +.

This distinction is important. The charge alone does not tell us what to expect. It does provide a means of determining whether a positively charged atom has a vancancy or not. From that we can decide whether a such an atom is an electrophile -- ready to accept electrons to make a bond -- or not.

ROH as Nucleophile: Notice that whenever we used an alcohol (general formula, ROH) as a nucleophile, the order of the steps was:

Reaction of the unshared pair on oxygen to form a new covalent bond. The oxygen gets a positive charge.

Then an H + is lost from the positively charged oxygen (oxonium ion).

Students often wonder why we don't reverse the order so that the H + comes off first to make RO -. which would then act as the nucleophile. This does not happen because the reaction is occuring in an acidic solution. A srong base like RO - (about as basic as OH - ) would be immediately consumed by reaction with the acid and would not survive. The alcohol (weaker base, about as basic as water) is the solvent, so there are many alcohol molecules surrounding the carbocation. This makes its reaction with an alcohol rather than RO - (called an alkoxide ion) very likely.

Intermediates: The aldehyde, the methanol, the hemiacetal, and the acetal are all stable molecules. They can be isolated and studied over a period of time. All the other molecules in this mechanism are much less stable. They have relatively high energies and thus short lifetimes. When they are formed, they react quickly. The main clue to this in their structures is that they have unusual bonding patterns such as three bonds to carbon (with a positive charge) instead of four, or three bonds to oxygen instead of two. Such molecules are called reactive intermediates; reactive because their unusual bonding pattern suggest that a change in bonding will happen, and intermediates because they appear between the reactants and the products.

To finish up, let's return to one of our carbocation intermediates. Recall that we began thinking about acid catalyzed reactions of aldehydes by using a C-O pi bond to supply the electrons to make a new bond with H +.

There is an alternative. We could also think about using one of the unshared electron pairs on the oxygen atom.

Let's compare the two molecules we obtain in this way.

Notice first that the "connectivity" of these two structures is identical. That is, each atom is connected to exactly the same atoms in one structure as it is in the other. Then, notice that the only difference is in the location of an electron pair. On the left, an electron pair is shown as unshared on the oxygen. On the right, that pair is shown as making a pi bond.

When two (or more) structures differ only in the location of electrons, without changing which atoms are bonded to which other atoms, those structures are different ways of describing a single molecule. The symbols differ, but there is only one molecule being described. The notation for this is to connect the two structures by a double headed arrow, which does not imply equilibrium. (We can use the curved arrow symbol to keep track of the formal electron motions.)

This situation is called resonance. When resonance is involved the real structure (called a resonance hybrid) is more stable than any of the formal (called contributing) structures we might draw. This is called resonance stabilization.

Often, I will only draw one structure and expect that you will recognize that resonance is involved and know what other structures might be included in describing the resonance hybrid. The structure presented will be the one which most directly connects to the reaction being described.

We will use resonance many more times during the semester, so there will be many opportunities to clarify your understanding.

Megapen, Megapen

Product Description Common use Amoxil is a broad-spectrum antibiotic from aminopenicillin group. Its mechanism of action is anti-bacterial and consists in inhibition of construction of bacteria cell walls sensitive to Amoxicillin. Cell walls serve to protect bacteria from environment and action of Amoxicillin prevents their propagation. Amoxicillin can be effective against H. influenzae, N. gonorrhoea, E. coli, Pneumococci, Streptococci, and certain strains of Staphylococci. Microorganisms producing penicillase are resistible to Amoxicillin. The medication is not active toward mycobacteria, mycoplasmas, genus Rickettsia, fungi, amoeba, plasmodium, viruses and also Pseudomonas aeruginosa and Proteus spp. (excluding P. mirabilis).

Dosage and directions Take exactly as prescribed by your doctor. Tell your doctor before taking this medication if you are allergic to cephalosporins (Ceclor, Ceftin, Duricef, Keflex), have had asthma, serious liver or kidney impairement, a bleeding or blood clotting disorders, mononucleosis or any type of allergic reaction in history. You may take Amoxillin with or without food. The chewable tablet should be chewed before you swallow it. Swallow Amoxillin capsules whole with a glass of water.

Precautions This medication diminishes effect of certain contraception drugs. Continue to take this drug even if you feel fine as life circle of bacteria has certain peculiarities. If you stopped to take the drug having not completed the course of treatment it may result in their further propagation and producing of strains resistant to this medication. Do not give this drug to the sick who have similar symptoms as their illness maybe provoked by other type of microorganisms. Antibiotic medicines can cause diarrhea, inform your doctor if you have it. If you breastfeed and take Amoxicillin, the medication may excrete in milk and cause diarrhea in your baby. Warn your doctor if you suffer from asthma.

Contraindications Allergy to Amoxicillin or to any other penicillin antibiotic.

Possible side effect Besides allergy (hives, swelling, rash) possible reaction to Amoxicillin may be diarrhea, dizziness, heartburn, insomnia, nausea, itching, vomiting, confusion, abdominal pain, easy bruising.

Amoxicillin is not known to decrease effect of birth control pills, increases absorption of digoxin, increases toxicity of metotrexat. Excretion of Amoxicillin by kidneys is slowed by aspirin.

Missed dose Never take a double dose of this medication. If it is almost time of the next dose just skip the missed portion and continue to take the medicine according to the schedule.

Overdose Symptoms of Amoxicillin overdose may be vomiting, nausea, diarrhea, disorders of water and electrolytes balance. Contact your doctor for help.

Storage Store at room temperature between 59 and 86F (15-30C) away from light and moisture.

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 advisor 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.

Alka-Mints Disease Interactions, Alka-Mints

Alka-Mints (calcium carbonate) Disease Interactions

Cuvitru Cuvitru immune globulin subcutaneous (human) is indicated as replacement therapy in the treatment.

Yosprala Yosprala (aspirin and omeprazole) is a platelet aggregation inhibitor and proton pump inhibitor.

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

Alka-Mints Rating

Alka-Mints (calcium carbonate) 850 mg

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Neelix - Memory Alpha, Talixane

Neelix

For additional meanings of "Neelix", please see Neelix .

" Without a doubt, he's the most versatile member of our crew. "

Neelix was a mainly Talaxian hybrid (he was one-eighth Mylean ) who lived in the 24th century. He joined the USS Voyager when it was pulled into the Delta Quadrant by the Caretaker's array in 2371. While Voyager made a seven-year journey through the Delta Quadrant, he served as the ship's chef. morale officer. "ambassador to the Delta Quadrant" and navigator. in addition to forming close personal friendships with many crew members and becoming a valuable member of the stranded Starfleet crew. ( VOY. " Caretaker ", " The Cloud ", " Macrocosm ", " Fair Trade ", " Homestead ")

Contents

Early life Edit

Neelix grew up with his parents, his sisters, and his brothers on Rinax. a moon of the Talaxian homeworld. with the most temperate climate in the entire Talaxian system. Behind their house was a large forest, in which he and his sisters would go exploring every day. His favorite sister was always Alixia. ( VOY. " Jetrel ", " Rise ", " Once Upon a Time ") He lived near the Rinax marshlands. where the summers were the hottest in the sector. ( VOY. " Macrocosm ")

For two years, Neelix worked with an orbital tether team on Rinax. He didn't actually serve on one, but worked heavily with scale models. ( VOY. " Rise ")

For a number of years, the Haakonians were at war with the Talaxians. At some point, the Talaxian government called on Neelix to serve, but he went to Talax to avoid military duty (and anyone refusing to serve during wartime was given a death penalty) because he felt the war was wrong. While he was on Talax, the Haakonians unleashed the metreon cascade on Rinax whereby in the blink of an eye Rinax was enveloped by a deadly cloud and the planet that once had the most temperate climate in the entire system was turned into one endless, frigid night, killing more than 300,000, including his family. The day after the cascade, Talax surrendered to the Haakonian Order. ( VOY. " Jetrel ")

After the death of his family and the destruction of his homeworld and what was left under alien rule, Neelix left the system to move on with his life. He served on a mining colony for a while and worked for two years as an engineer's assistant aboard a Trabalian freighter where he became well-versed in warp theory. ( VOY. " Blood Fever ", " Threshold ", " One ")

Neelix also spent six years aboard a Talaxian garbage scow. a duty that familiarized him with waste management. While Neelix was aboard, the scow once ran into a theta radiation field that disabled the ship's propulsion. He and the other crew members of the scow had no choice but to remain where they were and were barely alive when they were rescued. ( VOY. " Juggernaut ")

Life as a merchant Edit

At some point, Neelix befriended fellow Talaxian Wixiban. Although the two had a run-in with Ubean authorities, Neelix was able to escape thanks to Wixiban, who was unfortunately caught and forced to serve a brutal prison sentence. ( VOY. " Fair Trade ")

Neelix also befriended a Talaxian man named Laxeth. and while the two may have conducted some illegitimate business at one time, Laxeth had cleaned up by 2372 and was working as a communications master for a Talaxian convoy. ( VOY. " Investigations ")

Neelix eventually bought his own cargo ship. the Baxial . When he first laid eyes on it, he thought she was ugly, but eventually couldn't imagine life without her. ( VOY. " Alice ")

Caretaker and USS Voyager Edit

At some point, Neelix discovered a debris field near the Ocampa homeworld and claimed it for himself. When he was discovered there in 2371 by the crew of the Starfleet vessel Voyager . Neelix told them that he didn't mind their presence there, as long as they didn't take "his" debris. The Starfleet crew were searching for several missing officers, who Neelix suspected may have been transported by the Caretaker to a city beneath the surface of the Ocampa homeworld. Neelix offered to serve as the crew's guide and took them to the Ocampa homeworld, which was controlled by a Kazon sect led by Jabin. Water being incredibly scarce in the region, Neelix proposed to trade water from Voyager for the release of an Ocampan prisoner named Kes. who could lead the crew to the underground city. Even though the Kazon refused to trade, the crew members were able to escape with Kes, who was actually Neelix' lover. After rescuing the crewmen who were indeed underground, both Neelix and Kes joined Voyager 's crew and Neelix was assigned his position as a guide to the Delta Quadrant. since the region was largely unexplored by Starfleet. ( VOY. " Caretaker ")

Life aboard Voyager Edit

The first year Edit

Aboard Voyager . Neelix served as a chef, "Special Consultant for the Delta Quadrant", and occasionally as a self-appointed "chief morale officer ". Captain Kathryn Janeway gave Neelix the unofficial title of "ambassador" when he proved to have a flair for diplomacy. ( VOY. " Macrocosm ")

Neelix could be considered a "renaissance man" for his many duties and qualities.

Although Neelix never officially had a uniform until much later in the series, he did wear clothing that was very specific to him. He wore very colorful suits that often incorporated one, two, or in the case of his chef outfit, all three, of the command colors from Starfleet uniforms. It is unclear who tailored these uniforms (although it seems logical that he would have replicated them to his specifications, or even sewn them himself, given his various other talents), or whether or not it was customary for all Talaxians to wear this style of clothing (there have been others on screen, but none of them wore this style). He also owned a fur trench-coat, which it appears other Talaxian traders did in fact wear. On away missions, Neelix occasionally wore something similar to a Starfleet uniform, but all in shades of red. Neelix on several occasions donned an operations gold Starfleet uniform.

On one of his first official away missions. in which he prepared for a week studying dilithium geophysics. Neelix' lungs were removed by a Vidiian weapon. There was no way to replicate new lungs for Neelix since Talaxian lungs were too complex to be replicated, because they were attached to his upper spinal column, so The Doctor was forced to replace Neelix' lungs with holographic replicas. The flaw in this plan was that Neelix would not be able to move, and would thus be forced to stay confined in an isotropic restraint until real replacement lungs were available. When the Vidiians who stole Neelix' lungs were found, they were able to devise a way for The Doctor to transplant one of Kes' lungs into Neelix. The procedure was a success. ( VOY. " Phage ")

When Commander Chakotay was comatose, he influenced Neelix to use his medicine wheel in order to plot a safe course for Voyager out of a nebula in which aliens wished to steal the crew's neural energy. ( VOY. " Cathexis ")

Later that year, Neelix met Ma'Bor Jetrel. the Haakonian scientist who had developed the weapon used to destroy the majority of Neelix' people, including his family. Jetrel informed Neelix that when he had evacuated people from his planet, he had been exposed to the biological weapon and might be dying from metremia. Jetrel claimed that he wanted to help cure Neelix and try to make amends. Jetrel's presence resurrected painful memories for Neelix – not only the horrors of Rinax' destruction, but his shame over dodging the Talaxian draft. Neelix hated Jetrel and questioned him about his ethics and motivations. He told Jetrel about watching Palaxia die and his hope that Jetrel would have to live with his agonizing guilt for a very long time. However, when he discovered Jetrel's experiments in sickbay. Jetrel revealed his true purpose: to try and bring back the victims of the Metreon cascade. Neelix' supposed metrimia had never existed. It was Jetrel who had the disease. His attempt to reconstruct the dead in the Metreon cloud around Rinax ultimately failed and he died of his illness not long after. However, his genuine remorse and efforts to undo his crime earned Neelix' forgiveness. ( VOY. " Jetrel ")

Neelix almost became a father in 2371. Kes was affected by alien creatures that caused her to become fertile which happens just once in an Ocampa's lifetime, and if she was going to have a baby it needed to be then. Neelix was discomfited by the idea, having never given serious thought to fatherhood, but after talking through the matter with Kes and Tuvok he felt that he might like to be a parent. After the aliens were driven away, Kes decided not to have a baby, and The Doctor stated that this may have been a false alarm brought on by the aliens. Later that year, during a surprise birthday Neelix was giving for Kes, Voyager was disrupted by a spatial anomaly that seemed to change the structure of the ship. Neelix tried to find the bridge but was unsuccessful. ( VOY. " Elogium ", " Twisted ")

The second year (2372) Edit

Neelix also became jealous of Tom Paris. who he accused of trying to take Kes away from him. He and Paris got into a fight in the mess hall. Later, they were stranded on a hostile planet. They had to work together to save themselves. After being rescued, they returned to Voyager as friends. ( VOY. " Parturition ")

During the second year, Voyager continued its tumultuous journey through Kazon territory. Additionally, Paris decided to leave the ship after a period of malcontent and friction with Janeway and Chakotay. During this time, Neelix had started a daily broadcast, "A Briefing with Neelix ", designed to boost morale by highlighting the good things happening on Voyager . Paris' departure upset Neelix greatly and he dedicated part of his next broadcast to defending him. Following the advice of Harry Kim. Neelix began using the program to practice some real journalism and soon found evidence that Paris has been in contact with the Kazon-Nistrim. Janeway hurried to correct him in a closed-door briefing with Tuvok and Chakotay, informing him that Paris' misbehavior was part of an investigation into the suspected espionage. Neelix continued his investigation and discovered that Michael Jonas. one of the former Maquis. was passing information to Seska. Jonas attacked Neelix and was killed when he fell into a plasma fire. Neelix stopped Jonas' sabotage and later interviewed Paris, allowing him to set the record straight for the rest of the crew. ( VOY. " Investigations ")

Also in that year, a bizarre occurrence took place. While on an away mission, Tuvok and Neelix were fused into a new being due to a transporter accident with a symbiotic plant. The combined person called himself "Tuvix " and began an independent life. With the skills and personality of both individuals, he became a valuable member of the crew over a period of two weeks, but Tuvok and Neelix's close friends were still upset. The Doctor figured out a way to restore Tuvok and Neelix, but Tuvix refused to consent to the procedure because he enjoyed his existence. In the end, Janeway forced him to undergo the procedure. ( VOY. " Tuvix ")

The third year (2373) Edit

Neelix posing as the Grand Proxy

The year 2373 brought many adventures to Neelix. When Voyager discovered a planet that two Ferengi. who arrived through an unstable wormhole. were exploiting, Neelix, in disguise as the Grand Proxy. tried to stop them. The plot failed and he was almost burned at the stake with the Ferengi before Voyager beamed them out. Neelix and Kes, while visiting a Nechisti shrine. were struck by an energy bolt that rendered Kes comatose. Janeway, after performing Nechisti rituals, was able to save her. ( VOY. " False Profits ", " Sacred Ground ")

When Tieran. a despot ruler of Ilari. transferred his mind into Kes, Neelix helped save her when he attached a synaptic stimulator on her neck that drove Tieran from her mind. The incident also resulted in the end of their romantic relationship. Later, Neelix helped resolve a diplomatic snafu with the Tak Tak. a species that communicated with elaborate displays of body language, when Janeway accidentally offended them by putting her hands on her hips. He tried to help Janeway fight off the giant mutated viruses that had infected Voyager but was soon infected himself. He was cured with the rest of the crew when The Doctor developed an antigen. ( VOY. " Warlord ", " Macrocosm ")

Neelix became worried that he would be dismissed from the crew when Voyager reached the Nekrit Expanse. the boundary of the space he was familiar with. He frantically tried to find a new occupation for himself, from engineering to security. When the ship stopped at a supply depot. Neelix encountered his old friend and partner-in-crime Wixiban. Wixiban claimed that he had also gone straight and asked for Neelix's help in a trade deal. Neelix agreed so that he could get a map of the Expanse as well as to repay Wixiban for going to prison in his place. However, Wixiban was actually dealing in drugs and the deal went bad when the goods were stolen and one of the criminals killed. The rest of the gang demanded more contraband in exchange for Neelix and Wixiban's lives. Neelix argued with Wixiban over digging themselves even deeper, and the situation was further complicated when Chakotay and Paris were arrested for the criminal's murder. Neelix told Janeway and the head of the station about the crime and made a deal to trap the criminals in exchange for dropping the charges. The plan succeeded, mostly, though Neelix was injured. He offered to leave the ship in disgrace, but Janeway angrily replied that he was part of the family and punished him with two weeks of hard labor instead, an outcome Neelix was quite pleased with. ( VOY. " Fair Trade ")

Neelix's next adventure brought him into conflict with Tuvok. Tuvok found Neelix annoying, and Neelix felt that Tuvok was condescending. Together, they went on a mission to discover why the planet Nezu was being bombarded with asteroids and to rescue a group of scientists. Their shuttle crashed on the planet. They found out from one of the scientists that the bombardment had been created by an enemy of the Nezu and that there was a traitor among them. Neelix not only rescued Tuvok, but discovered who the traitor was. He fixed the carriage that was tethered to an orbital space station so they could escape. After this, Tuvok had a new-found respect for Neelix. ( VOY. " Rise ")

The fourth year (2374) Edit

While visiting the Mari. Neelix became interested in a Mari woman named Talli. He intended to ask her out and wore an overpowering cologne made of musk. Talli was killed a few days later by a woman infected with violent thoughts. Neelix was very upset and asked Tuvok to bring justice to her killer. ( VOY. " Random Thoughts ")

In 2374. Neelix was killed in a shuttle accident. Seven of Nine brought him back to life by using her nanoprobes. Although his life was saved, Neelix began to question his very existence and his religious beliefs. When a Talaxian dies, they believe they go to the afterlife in the Great Forest. There they are reunited with their relatives and guided to the afterlife. Neelix experienced none of this. He had a vision quest under the guidance of Chakotay. and met his sister Alixia. who told him the afterlife is a lie and his life is worthless. When he had awakened, he decided to kill himself. Chakotay talked him out of it, explaining that visions can mean many things and that his friends on Voyager needed him. ( VOY. " Mortal Coil ")

He participated in the battle against the Hirogen when the Voyager crew was being used for a training game in the Hirogen holodeck hunts on Voyager . He first was a resistance fighter who was killed by the Nazi Hirogen. Later, as a Klingon. he rallied the holographic Klingon army to attack the Hirogen. ( VOY. " The Killing Game ")

Last year on Voyager (2377-2378) Edit

In his last year on Voyager . he helped find The Doctor, who had been kidnapped and sold by an alien named Gar. He put spices in Gar's food that were incompatible with his physiology, and told him only The Doctor could cure him. This persuaded Gar to give them the location of The Doctor. Neelix, however, had only given him an upset stomach.

He took pity on prisoners that were aboard a prison transport that was damaged in space. The prisoners were housed in a cargo bay made into a prison on Voyager . One of the prisoners, Joleg. told Neelix he was sentenced to die just because he was in the vicinity of a murder and that his race was discriminated against by the Nyrians whose prison ship he was on. But Joleg was only manipulating Neelix. When the time was right, he tried to escape and tried to kill the guards.

Neelix helped free most of the crew from the Quarren workforce. They had been captured and brainwashed into believing that they were willing to work for the Quarren. ( VOY. " Critical Care ", " Repentance ", " Workforce ", " Workforce, Part II ")

Neelix was part of an away team that was held captive by a race whose world was contaminated by an old Earth probe. During the captivity, he helped Paris deliver and save a newborn's life. After he was rescued, he asked Janeway to help the people. Voyager was able to help stop the radiation poisoning and the planet began to regenerate itself. ( VOY. " Friendship One ")

Leaving Voyager Edit

Neelix's new family

In 2378. Voyager discovered a group of Talaxians living inside an asteroid located in the Delta Quadrant. Neelix helped them defend themselves against a group of miners that wanted them to leave the ore-rich asteroid. It was also at this time that Captain Janeway offered him a chance to serve as Starfleet 's permanent ambassador in the Delta Quadrant. He accepted the position and soon left the starship to live with the other Talaxians inside the asteroid. Neelix stayed with Dexa. a widow, and her son, Brax. He kept the combadge he was issued as a souvenir of his time on Voyager . ( VOY. " Homestead ", " Endgame ")

However, Neelix also continued to keep in contact with the crew of Voyager . Following his departure, he suggested to Seven of Nine that a picnic might be a suitable option for her third date with Commander Chakotay. Later, Neelix also played a game of kadis-kot with her. During the game, Seven of Nine thanked Neelix for his earlier suggestion. The Talaxian informed Seven of Nine that he was considering making a marriage proposal to Dexa. Their game came to an abrupt end when Seven detected large levels of neutrino emissions on long range sensors and Seven told Neelix that she would contact him at the usual time during the following day. ( VOY. " Endgame ")

It is never revealed if she replied. The game of kadis-kot that they play is the last appearance of Neelix.

It can be assumed once Voyager returned to the Alpha Quadrant contact with Neelix was no longer possible and that Voyager never heard from him again.

Kazon Edit

Neelix's knowledge of the Kazon proved invaluable during Voyager 's deals with the various Kazon sects.

He took part in contacting Kazon sects and set in motion the plan to form alliances with them. He would also meet Mabus. the leader of the Trabe. who had ruled the Kazon before they rebelled. Voyager would form an alliance with them, which persuaded the Kazon to attend the proposed peace conference. Neelix, alerted by one of his contacts, informed Janeway that the conference might be sabotaged.

After the failure of the peace conference, Neelix helped discover who on Voyager was betraying them to Maje Culluh. It was discovered that it was crewman Michael Jonas. Neelix found him in engineering trying to sabotage the engines, stopped him, and in the ensuing fight, Jonas was killed.

When Voyager was captured by Culluh and the crew was stranded on a primitive planet, Neelix helped them survive until they were able to retake the ship. ( VOY. " Alliances ", " Investigations ", " Basics, Part I ", " Basics, Part II ")

First contacts Edit

He did some adult babysitting when he was in charge of showing Tomin. a Kadi ambassador, around Voyager . Tomin became a handful as he got drunk and made a pass at Seven. ( VOY. " Someone to Watch Over Me ")

Neelix was part of the away team that tried to shut down a Malon ship whose engines were going to explode and release deadly radiation. ( VOY. " Juggernaut ")

In 2376. after returning from an away mission, Tuvok was attacked by an invisible alien and suffered brain damage. Neelix helped nurse him back to health. ( VOY. " Riddles ")

He was the first one to become suspicious of the Vaadwaur. a race that Voyager had awakened from stasis. He remembered that their race was a hostile and aggressive one. ( VOY. " Dragon's Teeth ")

Later he returned from another away mission with visions of a massacre he participated in. These images were implanted in him from a memorial left behind by the race that had some of its members killed. His memories were that he could not protect the children and they were massacred. He, along with some other crew members, were captured by a Borg ship that was commanded by Borg children. Eventually Voyager rescued him. The children were taken aboard Voyager since they had been severed from the hive. These same children were entertained by him when Voyager encountered an electric being and was transporting it back to its home in a nebula. He did this so they would not be scared. ( VOY. " Memorial ", " Collective ", " The Haunting of Deck Twelve ")

Personal interests Edit

Because of his varied career, Neelix developed a variety of personal interests that he continued to express on Voyager .

Cooking Edit

Neelix was an enthusiastic cook and ran the ship's mess hall. He was fond of experimenting and often tried to adapt crew members' recipes with the limited ingredients available in the Delta Quadrant, although they often complained about the results. Early on, Tom Paris remarked that Neelix's cooking was "always interesting" and the glutinous "Even better than coffee substitute " Neelix developed from native plants strongly motivated Janeway to seek new sources of energy for the ship so that she could use the replicator guilt-free. ( VOY. " The Cloud ") However, he was able to successfully cook a Rokeg blood pie for B'Elanna. ( VOY. " Day of Honor ") He enjoyed finding new ingredients to work with, which usually took the form of produce rather than meat. ( VOY. " Random Thoughts ")

Engineering Edit

Neelix served as an engineering assistant and tried to learn more about the field to be more useful to the crew. He was able to defeat a group of criminals with a canister of leaking warp plasma. ( VOY. " Fair Trade "). He also knew how to transport protomatter. a valuable energy resource, although the mission went awry and resulted in his temporary death and subsequent crisis of faith ( VOY. " Mortal Coil ").

Culture Edit

As part of his self-appointed duties as morale officer, Neelix familiarized himself with the various traditions and cultures of crew members. ( VOY. " Day of Honor "). He also enjoyed Talaxian holidays and established an annual celebration of Prixin aboard the ship, asking Tuvok to read the traditional salutation one year. ( VOY. " Mortal Coil ")

This article or section is incomplete This page is marked as lacking essential detail, and needs attention . Information regarding expansion requirements may be found on the article's talk page. Feel free to edit this page to assist with this expansion.

Personal relationships Edit

Family Edit

Alixia Edit

Alixia was Neelix's favorite sister. She and Neelix were very close, and often explored such places as the forest behind their house, the Caves of Touth and the Dunes of Talmouth. They also hunted arctic spiders together. She was killed on Rinax during the Haakonian War. ( VOY. " Jetrel ")

When he was struck by an energy blast and killed, only to be saved by Seven's nanoprobes, he questioned his belief in the afterlife. During a vision quest, Alixia told him that the afterlife was a lie – a place made-up because Talaxians feared death. This vision was probably just an expression of his anxiety over his beliefs. ( VOY. " Mortal Coil ")

Friendships Edit

Kathryn Janeway Edit

Neelix considered Kathryn Janeway a good friend and mentor of sorts. Neelix proved to be a valuable asset to the captain in terms of his knowledge of local cultures and customs. Additionally, Neelix proved a strong resource for information on local politics and locations where supplies could be obtained. Neelix also served as a diplomatic contact for Voyager and served as the official ambassador for the crew, helping to negotiate trade agreements and build relationships where necessary. He also advised the captain on tactical decisions in some instances. Neelix also counseled the captain when she needed a fresh perspective

Tom Paris Edit

While Tom Paris and Neelix originally got along only because they each knew that the other had come from a somewhat "less than legal" background, Neelix came to believe that Tom was a rival for Kes' affections after seeing Tom and Kes being friendly with each other. Tom did worry about his attraction to Kes and resolved not to act on his feelings, but Neelix was still jealous and suspicious of him. He started a food fight with Tom, but the two men resolved their differences when they were forced to rely on each other to survive and protect an alien infant on an away mission. ( VOY. " Elogium ", " Parturition ")

In 2376. they were together on the Delta Flyer looking for dilithium. when they came across two "clerics". It later turned out that they had been con artists, and Paris and Neelix consoled each other, feeling that they'd lost their touch. ( VOY. " Live Fast and Prosper ")

Tuvok Edit

"When Neelix met Tuvok. "

Tuvok met Neelix when he was sent to the transporter room to bring him aboard for the first time in mid-2371. When correcting Neelix's assumption that the "Federations" were a single culture, Tuvok described himself as "Vulcan ", and for the next seven years, Neelix often referred to him as "Mr. Vulcan". ( VOY. " Caretaker ")

Neelix often tried to get Tuvok to show emotion, especially happiness, in spite of Tuvok's Vulcan nature. Tuvok found this tiresome and unbeknownst to Neelix, used a simulation of Neelix's behavior to test if he was losing his emotional control after a mindmeld with the homicidal Lon Suder ; the simulation ended with Tuvok killing the Talaxian. ( VOY. " Meld ")

Around stardate 49655.2, Tuvok and Neelix were temporarily merged into one lifeform by a transporter malfunction. This lifeform named himself "Tuvix ". Tuvix lived aboard Voyager for a few weeks, before The Doctor managed to find a way to reverse the malfunction. ( VOY. " Tuvix ")

Neelix always admired Tuvok and was constantly seeking his approval. During Kes' premature elogium . Neelix asked Tuvok about being a parent; Tuvok's insights helped Neelix to accept the idea that he and Kes might have a child. ( VOY. " Elogium ") He gained Tuvok's respect during the incident on the Nezu homeworld. ( VOY. " Rise ") During one celebration of Prixin. Neelix had Tuvok recite the traditional salutation. Tuvok agreed, although he did abridge it somewhat. ( VOY. " Mortal Coil ") During the Year of Hell, Neelix joined Tuvok's security team, although this development was undone when the destruction of the Krenim temporal weapon ship reset the timeline. ( VOY. " Before and After ", " Year of Hell ")

Neelix helped Tuvok recover his memory when he was attacked by mysterious aliens called the Ba'neth. This strengthened their friendship. ( VOY. " Riddles ")

Tuvok encouraged Neelix to assist a Talaxian settlement in defending their home against miners, and reunite with his people. As a going away gift, Tuvok danced a brief step to the delight of Neelix. ( VOY. " Homestead ")

The dynamics of Tuvok and Neelix resemble Neil Simon's play, The Odd Couple. The two opposite characters come together and form a relationship with comic effects.

Naomi Edit

Neelix became very fond of Naomi Wildman. his goddaughter. He tucked her into bed every night and told her stories about the Great Forest. He cared for her while her mother was on away missions and chased away "monsters" so she could sleep. When a shuttlecraft her mother was on crashed, he took care of her and tried to reassure her that her mother would be all right. He took her to the holodeck to get her mind off her mother's plight. He decided that he would become her adoptive father should her mother not return from the mission. ( VOY. " Mortal Coil ", " Once Upon a Time ")

Seven of Nine Edit

Neelix was polite to Seven of Nine and became one of her better friends. He assisted her in learning the basics of Human behavior, such as eating. Seven recognized that he was valuable to the crew for a number of reasons and used Borg nanoprobes to revive him when he died in an accident. ( VOY. " Mortal Coil ") Because of his talent for assisting in emotional and relationship issues, Seven consulted him for dating tips and ideas when she started her relationship with Chakotay.

Romance Edit

Kes Edit

Neelix and the Ocampan named Kes had a romantic relationship before and during their early years aboard Voyager . Neelix met her while she was being held captive by the Kazon-Ogla. The two fell in love, and Neelix rescued her with the aid of the Voyager crew and the two asked to stay on the ship. ( VOY. " Caretaker ") Neelix was extremely resistant to the suggestion that Kes donate one of her lungs after his were stolen by Vidiians, but he eventually agreed. ( VOY. " Phage ")

When Kes went through a premature elogium . she and Neelix were caught off-guard. Kes told Neelix that they needed to decide now if they wanted to have a child due to the nature of Ocampan physiology. Neelix was concerned about possible danger to Kes and whether or not Ocampan and Talaxian physiology was even compatible. There was also the daunting prospect of becoming a father, something Neelix had never considered before. His indecision and reluctance upset Kes, who had always assumed she would have a child someday. After thinking it over and talking with Tuvok, Neelix decided he could become a father and was disappointed when Kes decided not to conceive after having doubts of her own. However, because the Elogium was a false one, Kes and Neelix looked forward to the prospect of becoming parents later on. ( VOY. " Elogium ")

Neelix was very jealous of Kes' relationship with Tom Paris, which caused tension between the two of them. Kes was upset that Neelix didn't trust her, although Neelix said that it was Paris he distrusted. Her friendly behavior with Paris made Neelix jealous to the point of starting a fight with him, to Kes' displeasure. ( VOY. " Elogium ", " Parturition ")

In 2373, Neelix and Kes ended their romance after her possession by Tieran. While possessed by him, she broke up with Neelix, telling him that she'd like to spend some time apart from him. ( VOY. " Warlord ")

Although Kes was not herself when she ended the relationship, they did not reconcile when she was freed from Tieran. A scene written for " Fair Trade " had Neelix and Kes discussing the matter, but it was cut from the final episode.

After the end of their romantic relationship, Neelix and Kes remained friends.

Kes' telepathic powers eventually progressed to the point that she could not stay on Voyager . Her transformation and changing cellular flux was causing malfunctions on the ship. He would see her again in 2376 when an aged Kes returned to seek vengeance on Voyager . She believed that she was kidnapped by Voyager . and she wanted to capture her past self by betraying Voyager to the Vidiians. Her anger was defused by seeing how happy she was on Voyager . After a brief reunion with Neelix, she returned to her people. ( VOY. " Fury ")

Talli Edit

When Voyager visited the Mari homeworld in 2374, Neelix became attracted to a grocer named Talli. At first he was awkward because it had been some time since he'd dated anyone and wore too much cologne (according to Paris) and Talli, as a telepath, read his desire to have her tug his whiskers. The attraction was mutual, however, and she was happy to spend time with Neelix. Any development of their relationship was cut short when Talli was stabbed to death by a woman under the influence of violent thoughts, to Neelix's sorrow. ( VOY. " Random Thoughts ")

Ch'Rega Edit

In 2377 Neelix was briefly involved with Ch'Rega. a Klingon woman who served under Kohlar and whom Neelix described as "a fine specimen of Klingon womanhood." Ch'Rega was transported onto Voyager and initially pursued Harry Kim. When Neelix found Kim hiding from her, he decided to take her off of Kim's hands. He staged an elaborate scene in her presence in which he threw Kim against a bulkhead for supposedly taking more than two servings of gagh . The Klingon quickly transferred her affections to the Talaxian. Tuvok. who was sharing his quarters with Neelix at the time, later discovered that Neelix and Ch'rega's liaison had left the room in a shamble. Ch'Rega and the other Klingons from her ship settled on a new planet soon after. ( VOY. " Prophecy ")

Dexa Edit

Dexa was a Talaxian woman who, along with five hundred other Talaxians, took refuge on an asteroid that they turned into their home. She had a son named Brax. and was widowed. Neelix, who coincidentally shared his name with her uncle. was nursed back to health after he crashed on the asteroid in a shuttle. He helped her and the other Talaxians defend themselves against a group of miners who attempted to drive them off the asteroid. Neelix, having fallen in love with Dexa, elected to stay behind with her while Voyager continued towards Earth. ( VOY. " Homestead ") A few weeks later, Neelix told Seven of Nine he was thinking of asking Dexa to marry him. ( VOY. " Endgame ")

Alternate Neelixes Edit

Holograms Edit

Neelix observes his own death via a hologram

Neelix was holographically duplicated on a number of occasions:

Recreations of crew members from Voyager and the Jupiter Station Holoprogramming Center were seen by The Doctor during a holographic malfunction in 2371. This simulation, or daydream, included Neelix fighting a Kazon with a frying pan. ( VOY. " Projections ")

Tuvok created a holoprogram in 2372 to deal with violent feelings he absorbed during a mind meld with Lon Suder. This program was nothing more than a holographic copy of Neelix that would annoy Tuvok until he killed him. ( VOY. " Meld ")

The entire crew of Voyager was recreated by Tuvok from his Insurrection Alpha program, including Neelix. ( VOY. " Worst Case Scenario ")

In 2374 Chakotay created a holographic simulation of a shuttle accident where Neelix was struck by an energy discharge and died. ( VOY. " Mortal Coil ")

The Kyrian Museum of Heritage in the 31st century used the program The Voyager Encounter to detail their encounter with the warship Voyager . as an aid to a history lesson. ( VOY. " Living Witness ")

In 2374. The Doctor created a program to help Seven of Nine improve her social skills. ( VOY. " One ")

In 2378. Seven recreated the crew of Voyager to perfect her social skills, including Neelix. ( VOY. " Human Error ")

Ensign Harry Kim and Seven of Nine projected The Doctor's daydreams into the holodeck aboard Voyager in order to better understand what was malfunctioning. In this daydream, Neelix attended The Doctor's award ceremony. ( VOY. " Tinker Tenor Doctor Spy ")

Reginald Barclay created a holoprogram with the Voyager crew including Neelix. At his home, Barclay had a real white cat named Neelix. ( VOY. " Pathfinder ")

Chronology Edit

2355   Loses his family on Rinax after all of the moon 's inhabitants are killed by the metreon cascade. ( VOY. " Jetrel ") 2370   Meets and falls in love with Kes. The two are separated in some incident involving the Kazon-Ogla. 2371   Assists the USS Voyager in finding several lost crewmen, and is reunited with his lover, Kes. The two of them ask to remain on Voyager . ( VOY. " Caretaker ") 2372   Samantha Wildman asks Neelix to be godfather of her daughter, Naomi. 2374   Neelix dies in an accident aboard a shuttle, but is brought back using Borg nanoprobe technology. He seriously reconsiders his religion, and his views of the afterlife. He almost attempts suicide, but is stopped by Chakotay with the help of Naomi and Samantha Wildman. ( VOY. " Mortal Coil ") 2378   Decides to stay on the Talaxian colony with Dexa and Brax, leaves Voyager . and is named "Federation Ambassador to the Delta Quadrant". ( VOY. " Homestead ")

Memorable quotes Edit

" I wonder what a Vulcan nightmare would be like. " " Alone, exiled on a planet, where the only form of communication is laughter. "

Appendices Edit

Background information Edit

Neelix was one of the last characters to be developed for Star Trek: Voyager . The guide aspect of Neelix was developed from Kes initially being referred to with the description, " She might function as a scout/gang expert, " at a point when the Kazon were commonly referred to as being gangs. By the end of September 1993. Neelix was present in the series' first draft writers' bible, albeit named Felux. His job description was referred to therein as "Gofer/Guide". ( A Vision of the Future - Star Trek: Voyager . pp. 189 & 208) According to VOY Season 2 DVD 's text commentary for " The 37's ", another early production name for Neelix was Felox. In the first draft script of VOY. " Caretaker ", Neelix was described as "a short, plump, unkempt being." The script went on to say, " He has adopted an air of cultivated elegance and charm that is at odds with his seedy appearance. "

Neelix was played by Star Trek veteran actor Ethan Phillips. According to Star Trek makeup artist Michael Westmore. Neelix's spotted, warthog-like design was based on a combination of various animals from the Disney film The Lion King . [X] wbm

Apocrypha Edit

Neelix (again voiced by Ethan Phillips) appears in Delta Rising . the second expansion to Star Trek Online . He maintains his title of Ambassador between the Federation and the Delta Quadrant, and has become the de-facto leader of the Talaxian asteroid colony he and Dexa live in. The player, joined by now-Admiral Tuvok, arrives at Neelix's colony and offer to help them find a "New Talax", with Tuvok remarking that the recent experience with aiding the Romulans in a similar search would prove invaluable. Later on, Neelix helps broker an agreement between the Delta Alliance (the Federation, the Klingon Empire, and the Romulan Republic) and the Hazari to counter the threat of the Vaadwaur.

External links Edit

Optibetol (Optibetol), Kapli Glaznye 0, Optibetol

ОПТИБЕТОЛ (OPTIBETOL)

Торговое название: ОПТИБЕТОЛ (OPTIBETOL) (расширенная инструкция) (аналоги и цены)

Активное вещество: бетаксолол (betaxolol)

Международное непатентованное название: Rec. INN / зарегистрированное ВОЗ

Форма выпуска: капли глазные 0.5%: 5 мл фл.

Фармакологическая группа: Противоглаукомное средство - бета-адреноблокатор

Клиническая группа: Противоглаукомный препарат - бета-адреноблокатор

Регистрационный номер: ЛП-001572

Дата регистрации: 2012-03-06 19:42:00

Статус регистрации: Действующее

Отпуск: По рецепту

Владелец регистрационного удостоверения: WARSAW PHARMACEUTICAL WORK POLFA, S. A. (Польша)

Подозрение на глаукому (глазная гипертензия)

Первичная открытоугольная глаукома

Эссенциальная [первичная] гипертензия

Форма выпуска, состав и упаковка

Капли глазные прозрачные бесцветные или светло-желтые.

 что соответствует бетаксолола гидрохлориду

Вспомогательные вещества . динатрия эдетата дигидрат 0.5 мг, натрия хлорид 8 мг, бензалкония хлорид 50% раствор 0.2 мг, натрия гидроксида р-р 10% до pH 4.0-8.0, вода очищенная до 1 мл.

5 мл - флаконы с капельницей (1) - пачки картонные.

Для системного применения: в качестве монотерапии и в составе комбинированной терапии - артериальная гипертензия, профилактика приступов стенокардии напряжения.

Для местного применения в офтальмологии: хроническая открытоугольная глаукома, повышение внутриглазного давления, состояние после лазерной трабекулопластики.

Для системного применения при приеме внутрь - по 20 мг 1 раз/сут. Для больных, находящихся на постоянном гемодиализе или перитонеальном диализе, начальная доза составляет 10 мг/сут; время приема бетаксолола устанавливают независимо от режима проведения сеансов диализа.

Для местного применения в офтальмологии - по 1 капле 2 раза/сут в пораженный глаз. В течение первого месяца терапия проводится под контролем уровня внутриглазного давления, в дальнейшем частота измерения внутриглазного давления определяется индивидуально. В случае применения бетаксолола после предшествующего лечения другим аналогичным препаратом режим дозирования устанавливают индивидуально.

Со стороны сердечно-сосудистой системы: в начале лечения - AV-блокада, синусовая брадикардия, артериальная гипотензия, сердечная недостаточность, синдром Рейно.

Со стороны пищеварительной системы: редко - боли в животе, тошнота, рвота.

Со стороны ЦНС и периферической нервной системы: в начале лечения - астения, парестезии конечностей, нарушения сна, депрессия, сонливость, головокружение.

Со стороны дыхательной системы: редко - бронхоспазм.

Аллергические реакции: редко - псориазоподобные кожные проявления.

Местные реакции: при применении в форме глазных капель сразу после закапывания возможны кратковременный дискомфорт в глазах, иногда слезотечение; редко - уменьшение чувствительности роговицы, эритема, зуд, пятнистая окрашенность роговицы, кератит, анизокория, светобоязнь.

Противопоказания к применению

Кардиогенный шок; острая сердечная недостаточность, хроническая сердечная недостаточность в стадии декомпенсации, не компенсирующаяся в результате лечения диуретиками, инотропными средствами, ингибиторами АПФ, другими вазодилататорами; AV-блокада II и III степени (без установленного искусственного водителя ритма); стенокардия Принцметала (противопоказана монотерапия); СССУ, синоатриальная блокада; выраженная брадикардия (ЧСС менее 45-50 уд./мин); выраженные нарушения периферического кровообращения, тяжелые формы бронхиальной астмы и ХОБЛ; тяжелые формы болезни Рейно и облитерирующих заболеваний периферических артерий; феохромоцитома без одновременного приема альфа-адреноблокаторов; артериальная гипотензия (систолическое АД <100 мм рт. ст.); анафилактические реакции в анамнезе; метаболический ацидоз; кардиомегалия (без признаков сердечной недостаточности); одновременное применение с сультопридом и флоктафенином; одновременный прием ингибиторов МАО; детский и подростковый возраст до 18 лет; повышенная чувствительность к бетаксололу.

Применение при беременности и кормлении грудью

При беременности и в период лактации (грудного вскармливания) применение бетаксолола возможно только в случаях, когда предполагаемая польза для матери превышает возможный риск для плода или ребенка.

Применение при нарушениях функции печени

При применении внутрь при печеночной недостаточности нет необходимости корректировать режим дозирования, однако в течение первых нескольких дней лечения рекомендуется регулярное клиническое наблюдение.

Применение при нарушениях функции почек

При применении внутрь при почечной недостаточности (КК менее 20 мл/мин) нет необходимости корректировать режим дозирования, однако в течение первых нескольких дней лечения рекомендуется регулярное клиническое наблюдение.

Применение у детей

Не рекомендуется применять бетаксолол у детей.

С осторожностью следует применять при бронхиальной астме и ХОБЛ среднетяжелого течения (начинать лечение с малых доз и желательно под контролем показателей функции внешнего дыхания; благодаря бета 1 - селективности бетаксолола при возникновении приступа бронхиальной астмы на фоне его приема возможно купирование приступа бета 2 - адреномиметиками); при хронической сердечной недостаточности в стадии компенсации (лечение бетаксололом возможно только под строгим медицинским наблюдением; лечение следует начинать с очень малых доз с постепенным их повышением); при AV-блокаде I степени (требуется тщательное наблюдение, включая ЭКГ-контроль); при облитерирующих заболеваниях периферических артерий, синдроме Рейно (за исключением тяжелой формы) (возможно усиление нарушений периферического кровообращения); при стенокардии Принцметала (возможно учащение приступов стенокардии; применение селективного бета 1 - адреноблокатора возможно только при одновременном применении вазодилататоров); при леченной феохромоцитоме (требуется тщательное наблюдение за показателями АД); у пациентов пожилого возраста (следует начинать лечение с малых доз и под тщательным медицинским наблюдением); при почечной недостаточности (при КК более 20 мл/мин - тщательное наблюдение за пациентом в течение первых нескольких дней лечения; при КК менее 20 мл/мин и/или проведении гемодиализа требуется коррекция режима дозирования); при печеночной недостаточности (требуется более тщательное клиническое наблюдение в начале лечения); у пациентов с сахарным диабетом (необходим регулярный контроль концентрации глюкозы в крови, включая активный самоконтроль пациентом, в начале лечения; возможно уменьшение выраженности предвестников развития гипогликемии, таких как тахикардия, ощущение сердцебиения и повышенное потоотделение); при псориазе (бета-адреноблокаторы могут ухудшать течение псориаза); при проведении десенсибилизирующей терапии.

Отмену бетаксолола следует проводить постепенно, особенно у пациентов, страдающих ИБС, стенокардией.

Бетаксолол не влияет на величину зрачка, поэтому при закрытоугольной глаукоме препарат следует применять только в сочетании с миотиками. При переводе пациента на бетаксолол после лечения несколькими антиглаукомными препаратами последние отменяют постепенно, в срок не менее 1 недели на препарат.

При одновременном применении бетаксолола в форме глазных капель и бета-адреноблокаторов внутрь возможно развитие аддитивных эффектов как со стороны внутриглазного давления, так и проявлений системного действия бета-адреноблокаторов.

Перед проведением плановой операции бета-адреноблокаторы, в т. ч. бетаксолол, следует отменить.

При местном применении бетаксолола не следует носить контактные линзы.

Не рекомендуется применять бетаксолол у детей.

Влияние на способность к вождению автотранспорта и управлению механизмами

С осторожностью применяют у пациентов, деятельность которых требует повышенного внимания и быстрых психомоторных реакций.

При одновременном применении с адреномиметиками, производными ксантина уменьшается эффективность бетаксолола.

При одновременном применении с антацидами и противодиарейными средствами возможно уменьшение абсорбции бета-адреноблокаторов.

При одновременном применении с антигипертензивными средствами усиливается антигипертензивное действие.

При одновременном применении галогеносодержащих средств для ингаляционного наркоза возможно усиление отрицательного инотропного действия.

При одновременном применении недеполяризующих миорелаксантов возможно увеличение их длительности действия.

При одновременном применении НПВС, ГКС уменьшается антигипертензивное действие бетаксолола.

При одновременном применении сердечных гликозидов возможно усиление брадикардии.

При одновременном применении трициклических антидепрессантов (имипрамина) снижается АД, возникает риск развития ортостатической гипотензии.

При одновременном применении амиодарона, верапамила, дилтиазема, бета-адреноблокаторов для местного применения при глаукоме возможны усиление отрицательного инотропного действия и нарушения проводимости.

При одновременном применении лидокаина повышается концентрация лидокаина в плазме крови.

При одновременном применении с препаратами, истощающими запасы катехоламинов (в т. ч. с резерпином), возможно усиление гипотензивного эффекта и брадикардии.

При одновременном применении с сульфасалазином повышается концентрация бетаксолола в плазме крови.

Smilitene, Smilitene

The name „Smiltene” originated from the Latgallian word „smiltesele”; it was first mentioned in historic source in 1427 as a settlement of tradesmen and craftsmen, but its beginning can be traced back already in the 13th century. Smiltene is a town with an ancient and rich history.

During the centuries, the town has witnessed both the rough and smooth. Since the 17th – 18th centuries, different troops destroyed the town several times, but the local inhabitants persistently built the ruined houses anew and the town was reborn again and again.

It is generally known that the history and development of a town and district is determined by the personalities who live there. At the turn of the centuries (the19th -20th cent.), in Smiltene, a small town in the north-east of Latvia, lived a man who cannot be compared to anybody else due to the scope of his activities for the benefit of the town and the surrounding area. Thanks to this man who was the landlord of the Smiltene manor at that time, the town experienced a rapid growth - they built a hospital, the first hydroelectric power station in the Baltic, a shelter for the poor, a sawmill, a narrow-gauge railway, etc. This man was the Prince Paul Lieven.

Smiltene was conferred the town rights in 1920.

Over the years, Smiltene has developed a characteristic construction of few-storied buildings, peculiar relief shape – hills and valleys, forests, parks and lakes. The river Abuls flows through the town; and the lakes of Teperis, vidus and Tiltleju has been created on its dams. The lake Klievezers is located in the southern part of the town. The favorable geographical location promoted the development of entrepreneurship and infrastructure in Smiltene. The favorable environment has made the local companies competitive not only in the Latvian, but also the European market, making the name of Smiltene known in the world.

The largest enterprises are the following: A/S „Smiltenes piens” (milk processing), SIA „Troll” (production of wooden furniture), A/S „8CBR” (construction and maintenance of roads and bridges), „Madara 89” (groceries), etc. Different kinds of services are offered to the inhabitants as well.

Smiltene is called a town of youth because education of all levels is available in the town – there is a pre-school education establishment „Piladzitis”, the elementary school „Tris pakalnu pamatskola”, the Smiltene Centre Secondary school, the Smiltene Gymnasium, the Smiltene Professional Secondary School (the only school in Latvia that prepares road building specialists), the Smiltene branch of the Baltic International Academy (higher education). Children can attend out-of-class activities at the art school, music and sport schools, as well as different interest groups.

Smiltene is also called the capital of the Latvian schlager music because several well-known and favorite Latvian pop groups, such as „Apvedcelš”, „Sesta judze”, „Kreisais pagrieziens”, „Velves”, etc. have been established and work here.

Cultural and sports traditions are very well developed in the town. There is a number of dance groups for different ages and choirs. The most popular groups in the town and district are following: the folk dance group „Ievina” (winner of international competitions), the choirs „Vidzemite”, „Pakalni”, „Lido”. In the town, there is also an amateur theatre, a studio of national applied art, a museum, a cinema, a library for adults and children with a public internet access. There are also several sports groups and clubs – in football, volleyball, basketball, orienteering, track-and-field athletics, ice hockey, cycling, motor sports, etc. Some of the annual culture and sports events have become popular in the town and the district not only with the local inhabitants, but also guests from other countries.

Today Smiltene has become a beautiful, tidy, green, clean, Latvian and cozy provincial town and the centre of the Smiltene district in North Vidzeme of Latvia. Smiltene is popular with guests from Latvia and foreign countries; they come here to find peace and silence, to enjoy the beauty of nature, to admire the development of the town, culture and sports traditions and a busy life of the local inhabitants. The town is proud of its active people who live, study and work here.

Pedejas izmainas: 20.09.2016 16:07:18

Copyright © 2011 Smiltenes novada dome. All Rights Reserved. Parpublicejot informaciju, atsauce uz Smiltenes novada domi ir obligata! Web design & programming: SIA LaGET

22.09 Izrade berniem "Kung Fu Panda"

23.09 Izstades "No vecmaminu pura ladem" atklasana

23.09 Koncertprogramma "Kungi uzludz damas"

24.09 Svecisu vakars Smiltenes kapos

25.09 Smiltenes TT izrade "Dazi vasaras vakari zem saules"

02.10 Rudens ieskanas pasakums senioriem

07.10 I. Sterna akustiska koncertprogramma "Kalnup"

15.10 RUDENS GADATIRGUS

15.10 Vokalistu konkurss "Smiltenes balsis 2016"

15.10 Rudens balle Smiltene

15.10 Grundzales kulturas nama rudens balle ar grupu "Mustangi"

22.10 Smiltenes pilsetas KC kolektivu sezonas ieskanas koncerts un Smiltenes Tautas teatrim 50

25.10 Smiltenes TT izrade "Dazi vasaras vakari zem saules"

27.10 NBS bigbenda koncerts

02.11 Izrade "Septini vecpuisi"

12.11 Ivo Fomina koncerts "Nekas jau nebeidzas"

18.11 Valsts svetku pasakums Smiltene

25.11 Izrade berniem "Baltais Lacis-superzvaigzne"

Smiltene

Contract notice: Electricity procurement smiltene municipality authorities.

TEXT NOT REPRODUCIBLE IN ASCII]], Trikata [[TEXT NOT REPRODUCIBLE IN ASCII]], Smiltene. Burtniek, Rauna [[TEXT NOT REPRODUCIBLE IN ASCII]], and all the counties and villages and the landed properties of these towns, and my son Ivan shall take this money from King Artsymagnus, or in place of money he shall take the towns pledged for this money, but my [other] son Fyodor shall have nothing to do with it.

Contract award: the power supply smiltene district authorities in 2013-2015th year.

Contract award: long-term loan for a simplified multi-dwelling residential renovation smiltene. riga street 3 (the second body) limbazhi street 10, riga street 8, abulas street 6, 8 hill street, garden street 26, riga street, 10th

Smiltene District Council

According to the Latvian Republic administrative reform that was formed on 1 July 2009 Smiltene district, which includes the city of Smiltene and eight surrounding parishes - Smiltene, Blome, Branti, Launkalne, Varini, Palsmane, Grundzale and Bilska parish.

According to the law "Par pašvaldibam", the municipal main functions are:

organizing public utilities;

to take care of their administrative spatial planning and sanitary cleanness;

to establish procedures for the use of publicly accessible woods and waters, unless the law provides otherwise;

to take care of public education, culture and to promote the preservation of traditional cultural values and folk development of creativity;

to provide access to health care, as well as promoting a healthy lifestyle;

to provide social assistance;

to organize custody, guardianship and adoption cases;

to give assistance to housing issues;

to promote the business in the administrative territory, take care for the reduction of unemployment;

to issue permits and business licenses, if required by law;

to ensure public order, fighting against dipsomania and depravity;

in accordance with the administrative development plans to determine the construction of it;

to manage the construction in the administrative territories;

etc.

City Council in accordance with the City Council and District Council Elections Act consists of 15 Members. In order to ensure that its operates and develop council resolutions, there have been established three substantive committees:

Financial Affairs and Development substantive Committee, composed of 11 deputies;

Culture, education and sport in the substantive Committee, composed of 7 members;

Social and health issue substantive Committee, composed of 5 members.

Council meetings are held the last Wednesday of every month from 15:00, they are open and are open to all district residents.

In order to ensure that urban and rural population equal access to government services, citizens have the opportunity to receive basic services in their districts. Parish administration:

Ensure the competence of the local directory service and provide information on local government related issues;

Municipalities provide social benefits expenditure on social services and social assistance as provided by law;

Accepting submissions, complaints and proposals from the inhabitants from that area;

provides access to information on council decisions;

provides parishes economic activities according to the approved budget, powers and procedures approved by the City Council Rules;

provide district administrations institutions and bodies situated in the territory;

Etc.

Pedejas izmainas: 20.09.2016 16:07:18

Copyright © 2011 Smiltenes novada dome. All Rights Reserved. Parpublicejot informaciju, atsauce uz Smiltenes novada domi ir obligata! Web design & programming: SIA LaGET

22.09 Izrade berniem "Kung Fu Panda"

23.09 Izstades "No vecmaminu pura ladem" atklasana

23.09 Koncertprogramma "Kungi uzludz damas"

24.09 Svecisu vakars Smiltenes kapos

25.09 Smiltenes TT izrade "Dazi vasaras vakari zem saules"

02.10 Rudens ieskanas pasakums senioriem

07.10 I. Sterna akustiska koncertprogramma "Kalnup"

15.10 RUDENS GADATIRGUS

15.10 Vokalistu konkurss "Smiltenes balsis 2016"

15.10 Rudens balle Smiltene

15.10 Grundzales kulturas nama rudens balle ar grupu "Mustangi"

22.10 Smiltenes pilsetas KC kolektivu sezonas ieskanas koncerts un Smiltenes Tautas teatrim 50

25.10 Smiltenes TT izrade "Dazi vasaras vakari zem saules"

27.10 NBS bigbenda koncerts

02.11 Izrade "Septini vecpuisi"

12.11 Ivo Fomina koncerts "Nekas jau nebeidzas"

18.11 Valsts svetku pasakums Smiltene

25.11 Izrade berniem "Baltais Lacis-superzvaigzne"

Palsmane is situated in the eastern part of the Smiltene district, on the banks of the Palsa river, at the motorway Riga – Veclaicene. The distance till the centre of the district is 23 km. The area of Palsmane parish is 99.5 km2, the population -1034. The largest populated places are Palsmane and Rauza.

The Palsmane parish was first mentioned in 1615, during the Swedish times, when it was separated from Smiltene castle district. The parish was established around 1920 as a result of the land reform process.

Several rivers flow through the territory: the Palsa, the Vidaga, the Vizla and the Rauza. Half of the territory is covered by forests.

The largest producer of agricultural products is the company SIA “Palsmane” (grain and grassland seed farming, cultivation of potatoes, cattle breeding); the farm “Lejasgrivas” (dairy and beef-cattle farming).

The largest enterprises are the following – SIA “Zikeri”(wood processing), the farm “Atvases”(wood processing and joinery), SIA “Baltegle”(cultivation and renovation of forest plants), SIA “Agle”, SIA “Livas V” (production of soft drinks).

There is an elementary school with a bit more than 100 pupils. There is also the Palsmane Specialized Boarding School, which is located in the castle built by baron von Beer in 1880; since 1966, the building houses a school for children with special needs. The parish has also a cozy pre-school educational establishment.

In the building of the old church pub, which is more than 100 years old, the Culture House has found its premises; it makes use of old and interesting traditions. Many local inhabitants and people from the whole district gather here in the evenings. In the parish, there is dance group of middle-aged people – “Cirulis”; young and old are its members. Some more interest groups have found their home in the Culture House: a senior dance group, a line dance group, theatre lovers and venturous players of board games. More than 180 people participate in the activities of the amateur groups.

The Culture House also houses a library with an access to the internet. In the parish, there is also a doctor’s office, a pharmacy and a post-office.

There are number of interesting sights in the parish – the Palsmane Evangelic Lutheran Church that was built in 1817 in an octagonal shape, the Palsmane manor (the boarding school) and a park. the Rauza mill (excerpts of the film “A short instruction in Love” were shot here), the lakes of the Rauza and Palsmane mills. the Palsmane Parish House.

In the Palsmane Elementary School, you can have a look at an exposition of the history of the school and old household objects.

The motto of Palsmane parish is the following: “It is better to see once than to read ten times!”

Pedejas izmainas: 20.09.2016 16:07:18

Copyright © 2011 Smiltenes novada dome. All Rights Reserved. Parpublicejot informaciju, atsauce uz Smiltenes novada domi ir obligata! Web design & programming: SIA LaGET

22.09 Izrade berniem "Kung Fu Panda"

23.09 Izstades "No vecmaminu pura ladem" atklasana

23.09 Koncertprogramma "Kungi uzludz damas"

24.09 Svecisu vakars Smiltenes kapos

25.09 Smiltenes TT izrade "Dazi vasaras vakari zem saules"

02.10 Rudens ieskanas pasakums senioriem

07.10 I. Sterna akustiska koncertprogramma "Kalnup"

15.10 RUDENS GADATIRGUS

15.10 Vokalistu konkurss "Smiltenes balsis 2016"

15.10 Rudens balle Smiltene

15.10 Grundzales kulturas nama rudens balle ar grupu "Mustangi"

22.10 Smiltenes pilsetas KC kolektivu sezonas ieskanas koncerts un Smiltenes Tautas teatrim 50

25.10 Smiltenes TT izrade "Dazi vasaras vakari zem saules"

27.10 NBS bigbenda koncerts

02.11 Izrade "Septini vecpuisi"

12.11 Ivo Fomina koncerts "Nekas jau nebeidzas"

18.11 Valsts svetku pasakums Smiltene

25.11 Izrade berniem "Baltais Lacis-superzvaigzne"

Borraza-G, Borraza-G

How are haemorrhoids treated?

Treatment is dependent on the stage of the disease (Recommendations of the German Society of Coloproctology). There are basically non-surgical (conservative) and surgical treatment options. Treatment-related links: recommendations at http://www. awmf-leitlinien. de/. Society of Coloproctology: www. koloproktologie. org/dgk/etap/

a) General measures: The following measures are useful in order to avoid haemorrhoids and to aid treatment:

high-fibre diet

adequate fluid intake in the form of drinks such as water

marked straining on defecation to be avoided

laxatives not to be used

appropriate anal hygiene (no soap, wet wipes or cosmetics, just lukewarm water)

careful drying of the anal region without rubbing

b) Non-surgical treatment options:

The aim is to control the broad spectrum of symptoms such as pain, burning, itching, inflammation, swelling and discharge. These treatments are used for all grades of haemorrhoids. They often contain local anaesthetics, astringents, Escherichia coli culture suspensions and anti-inflammatories. Depending on the site of the inflammation, the products are prescribed as creams, ointments, suppositories and suppositories with gauze inserts (?anal tampon suppositories?). Ointments have a more solid consistency and are highly suitable for dry skin. In comparison, creams are more fluid. Suppositories or tampon suppositories are inserted into the rectum and are used preferably for inflammation in the rectum or the anal canal. Tampon suppositories are particularly suitable for the anal canal, so that the suppository remains in the anal canal after insertion and does not slip deep into the rectum. It is important to note that the measures can only treat the symptoms of haemorrhoidal disease and can only have a sustained action against haemorrhoids in the early stages.

One common side effect of the products is burning after application, although this is usually attributable to the irritated skin. A further problem is development of a ?contact allergy? (type IV sensitisation) to the diverse ingredients of haemorrhoidal ointments, creams or suppositories. Such an allergy may develop both to the active ingredient and to excipients. Contact allergies to the active ingredient bufexamac are common. Compared with control groups, patients with anogenital skin disorders show a higher prevalence of sensitisation at 3.5%. Products containing corticosteroids should only be used short-term under specialist supervision so as to avoid the chronic occurrence of characteristic side effects such as thinning of the skin or vascular fragility.

The products most commonly used worldwide are as follows.

Internationally leading topical products in treating haemorrhoidal disease

Main drug active substance*

1. Products without corticosteroid

squalus carchorious, hamamelis, glycerol, phenylephrine, cacao butter and others

bufexamac, cinchocaine, lidocaine, bismuth, titanium

Procto-Glyvenol, Borraza G

zinc, peru balsam, bismuth, lidocaine, pramocaine, boric acid, hamamelis

titanium, zinc, lidocaine

2 Products with corticosteroid

hydrocortisone, Escheria coli

* drug active substances and tradenames may vary from country to country

Supplementary local treatment options:

antiseptic sitz baths, e. g. with potassium permanganate or tannins in lukewarm water for approximately 10 minutes

c) Surgical treatment options

The surgical treatments should be performed by dermatologists, surgeons or gastroenterologists with proctological experience. Most procedures are performed on an outpatient basis without anaesthesia with the aid of a proctoscope. After all procedures, the patient may temporarily experience light anal bleeding and possibly pain and rectal urgency for 1 ? 5 days.

Sclerotherapy (similar to the procedure for varicose veins of the legs): for haemorrhoids of grade I and above, injection of sclerosants (e. g. polidocanol 0.3 ml) can be performed with proctoscopic guidance approximately 5 ? 7 times at 2 ? 3-week intervals. An inflammatory reaction with scarring then results in ?shrinkage? of the haemorrhoids.

Rubber band ligation: for haemorrhoids of grade II and above, a small rubber band can be placed in the region of the haemorrhoidal nodules with proctoscopic guidance every 3 ? 4 weeks. The ligated tissue falls off and is excreted with the stool.

Haemorrhoidectomy: for large grade III or IV haemorrhoids, surgical removal of the enlarged haemorrhoidal nodules is usually performed by a surgeon under general anaesthesia or ?regional anaesthesia? (spinal anaesthesia).

The Diagnosis and Management of Haemorrhoidal Disease from a Global Perspective [ More. ]

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Zdv - Definition Of Zdv By The Free Dictionary, Zdv

The median time between the booking visit and commencement of antenatal ZDV for PMTCT was 5 days (IQR 0-48), with no difference between age groups (p=0.

In the RAVE study [37], patients who had been taking ZDV showed better recovery of limb fat when they switched to ABC.

However, PLSCS is recommended for all women taking ZDV monotherapy, women on combination therapy with detectable viraemia and women with HIV/HCV co-infection.

The editorial note states that "to implement these findings, ministries of health, donor agencies, and other interested agents should develop policies and practices to strengthen access to prenatal care, testing and counseling for HIV infections, and provision of ZDV for HIV-infected pregnant woman.

Zidovudine (Retrovir or azidothymidine [AZT]) was approved in March 1987 as the first antiviral therapy for HIV disease, when a clinical thai of ZDV versus placebo in patients with advanced disease was terminated early based on evidence of improved survival (Fischl, Richman, Grieco, et al.

12] The Paediatric European Network for Treatment of AIDS (PENTA) 5 study clearly showed that ABC plus 3TC combined with unboosted nelfinavir (NFV) performed better than ZDV plus 3TC or ZDV plus ABC with unboosted-NFV.

In this issue, Agarwal et al (15) in their retrospective study report a high incidence of ZDV induced anaemia in HIV infected patients from eastern part of India.

Elective caesarean section, together with intrapartum intravenous ZDV. is offered and ZDV is given to the neonate.

ACTG 229 compared saquinavir, zidovudine ( ZDV ) and zalcitabine with ZDV combined with either saquinavir or zalcitabine.

Patients taking a fixed-dose combination of lamivudine (3TC) 150 mg and zidovudine ( ZDV ) 300 mg (COMBIVIR(R)) achieved >/= 95 percent adherence more than twice as often as patients whose regimens included 3TC and ZDV as separate pills.

This descriptive study identified factors in 322 HIV-infected women that influence intention to take ZDV if becoming pregnant and to give it to their newborns.

Clinical trials assessing the efficacy of antiretroviral agents in preventing maternal-fetal transmission of HIV Study (ref) Regimen(a) Timing(b) Outcome (%) Connor (15) ZDV A+L+P 8.

Neurax, Neurax

neuraxis

neu·rax·is

The axial, unpaired part of the central nervous system: spinal cord, rhombencephalon, mesencephalon, and diencephalon, in contrast to the paired cerebral hemisphere, or telencephalon.

neu·rax·is

The axial, unpaired part of the central nervous system: spinal cord, rhombencephalon, mesencephalon, and diencephalon, in contrast to the paired cerebral hemispheres, or telencephalon.

neuraxis

2. central nervous system.

Patient discussion about neuraxis

Q. Fibromyalgia deeply affect the CNS? Do fibromyalgia deeply affect the CNS (central nervous system)?

A. Fibromyalgia is somewhat related to central nervous system. Fibromyalgia can ultimately disrupt the flow of neurotransmitters between the body and the brain. As a result, fibromyalgia can cause the patient to feel continuous pain, and create chronic muscle spasms. In addition, fibromyalgia patients are often subject to abnormally light a sleeping pattern which prevents the normal production of serotonin and growth hormone normally produced during stage 4 (deep) sleep. This inhibits the body’s ability to heal itself, and may contribute to the overwhelming fatigue and depression experienced by those with FMS.

Q. Is fibromyalgia related to Central Nervous System? Is fibromyalgia related to Central Nervous System? Among men and women who is more prone to the symptoms of fibromyalgia?

A. here is a quote from the National Fibromyalgia Association site:

"Little research has been conducted that measures the prevalence of fibromyalgia, and estimates vary widely as to the proportion of male versus female patients. A 1999 epidemiology study conducted in London found a female to male ratio of roughly three to one. However, a 2001 review of the research literature in Current Rheumatology Reports stated the ratio was nine to one."

Link to this page:

Calcified pseudoneoplasm of the neuraxis (CPN) is a highly distinctive lesion of indeterminate nature.

The trigger for remote microglial activation after SCI at multiple locations along the sensory neuraxis. including the lumbar dorsal horn and thalamus, has recently been elucidated [13].

If these tumours are encountered or suspected, Gd-enhanced MRI of the entire neuraxis before surgery is essential.

The whole neuraxis behaves as an inverted tree with branches down as peripheral nerves and the roots of the tree are open to infinity (Inverted Neuraxis )

The results of our gaming experiment, coupled with findings from prior studies of the anticipation and experience of positive and negative outcomes in humans and laboratory animals, suggest that a network of interrelated structures at different levels of the neuraxis coordinate the processing of goal-related stimuli," says Dr.

Over the past several decades, however, intensive care units (ICUs) have become increasingly sophisticated "surrogate brainstems," replacing both the respiratory functions as well as the hormonal and other regulatory activities of the damaged neuraxis .

The entire neuraxis should be imaged, as leptomeningeal seeding has been documented (2).

25) Relative fixation of the cerebellum by the tentorium, with repetitive pivoting at the incisura, may cause distortion in the brainstem at the floor of the fourth ventricle with neuraxis damage during these internal brain movements.

The increase suggests that rehabilitation strategies that use an enhanced sensory environment may induce greater activation along the neuraxis to mediate improved lower-limb function.

The significant correlation between HIV risk behaviors measured by RAB scores and neurological dysfunction based upon a detailed, standardized neurological examination is important because such examinations provide an objective assessment of the relationship between the integrity of the neuraxis and HIV risk behaviors.

In this situation, neuraxis behaves as if it is an inverted tree with roots in the eternity and branches below, down in the peripheral nerves, where the informational geometry in the neural manifold of the cerebral cortex is in dynamic harmony with that in the nature consciousness.

The underlying mechanisms are hypothesized to be similar to those mediating reorganization after cortical injury, including disinhibition of latent cortical connections and axonal sprouting in multiple levels of the neuraxis [9,22,28].

Secalip, Secalip

Secalip

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Livertox

Introduction

Fenofibrate is a fibric acid derivative used in the therapy of hypertriglyceridemia and dyslipidemia. Fenofibrate therapy is associated with mild and transient serum aminotransferase elevations and with rare instances of acute liver injury, which can be severe and prolonged and lead to significant hepatic fibrosis.

Background

Fenofibrate (fen" oh fye' brate) is a fibric acid derivative. Its lipid lowering activity is probably mediated by its interactions with the peroxisome proliferator activated receptor alpha (PPARα), which regulates gene expression of enzymes involved in fatty acid oxidation. Fenofibrate increases lipoprotein lipase levels which enhance clearance of triglyceride-rich lipoproteins. Fenofibrate is recommended for therapy of hypertriglyceridemia (Fredrickson types IV and V hyperlipidemia) and hypercholesterolemia (Fredrickson types IIa and IIb). Fenofibrate was approved for use in Europe in 1975 and in the United States in 1993. Fenofibrate is available in multiple generic forms and under the brand names of Antara, Lipofen, Lofibra, TriCor and Triglide as capsules and tablets of multiple concentrations, ranging from 43 to 200 mg each. The recommended initial dosage in adults is 43 to 130 mg daily with adjustment to as high as 200 mg daily (depending upon the formulation). Common side effects of fenofibrate include nausea, gastrointestinal upset, headache, muscle cramps and rash. Fibrates have multiple drug interactions requiring careful review and use.

Hepatotoxicity

Mild, transient serum aminotransferase elevations develop in up to 20% of patients receiving fenofibrate, but values above 3 times normal in only 3% to 5%. These abnormalities are usually asymptomatic and transient, resolving even with continuation of fenofibrate, but they occasionally may require drug discontinuation. Monitoring of aminotransferase levels is recommended for patients receiving fenofibrate and discontinuation if enzymes persist above 3 times the upper limit of normal (ULN).

There have also been multiple reports of clinically apparent liver injury in patients on fenofibrate. Onset of injury is variable; cases resembling acute hepatitis usually arise within a few weeks or months of starting therapy (Case 2), whereas cases resembling chronic hepatitis and cirrhosis typically arise after more than 6 months or even years of treatment (Case 1). The pattern of serum enzyme elevations is typically hepatocellular, but both mixed and cholestatic patterns have also been described. Some instances of acute injury with a short latency (2 to 8 weeks) are associated with fever, rash and eosinophilia, suggesting immunoallergic hepatitis. Cases with a longer latency typically present with nonspecific symptoms of weakness and fatigue, have autoimmune features with hyperglobulinemia, smooth muscle or antinuclear antibody, and a chronic hepatitis-like clinical and histological picture that is sometimes prolonged and associated with significant fibrosis or cirrhosis.

Mechanism of Injury

The mechanism of hepatotoxicity of fenofibrate is not known but appears to be immunologic. Cases of autoimmune-like hepatitis due to fenofibrate suggest that there is induction of immune reactivity to altered metabolites or fenofibrate-protein haptens in the liver.

Outcome and Management

Several instances of chronic liver injury and fibrosis have been reported with fenofibrate use, typically in patients who were continued on therapy despite evidence of liver injury. However, in most cases, serum aminotransferase levels eventually fall to normal within 2 to as long as 12 months after stopping. Rechallenge is usually followed by recurrence of liver injury and should be avoided. While many cases of fenofibrate associated liver injury have been prolonged and severe, there have been no instances of acute liver failure due to the fibrates. Chronic injury with vanishing bile duct syndrome may underlie many of the instances of chronic liver disease due to fenofibrate. In other instances, features of autoimmune hepatitis are present (ANA, SMA or high immunoglobulin levels). Corticosteroids have been used with apparent effect on serum enzyme levels, but their efficacy in altering the outcome of injury is less clear. If corticosteroids are used, the dose and duration of therapy should be kept to a minimum. Although not proven, there may be some degree of cross reactivity to hepatic injury among the different fibrates.

Drug Class: Antilipemic Agents

Other Drugs in the Subclass, Fibrates. Clofibrate. Gemfibrozil

Comment

Acute hepatocellular injury arising during fenofibrate therapy. Somewhat unusual was the long latency to onset of injury. The hepatic injury was severe and associated with prolongation of prothrombin time and worsening liver function tests. Liver biopsy was not performed, but most cases of fenofibrate induced liver injury with a prolonged time to onset have been associated with hepatic fibrosis and, in some cases, cirrhosis. Ultimate recovery and return of serum enzyme levels into the normal range is typical even in cases with chronic hepatitis and cirrhosis.

Case 2. Acute hepatitis due to fenofibrate. [Modified from: Ho CY, Kuo TH, Chen TS, Tsay SH, Chang FY, Lee SD. Fenofibrate-induced acute cholestatic hepatitis. J Chin Med Assoc 2004; 67: 245-7. PubMed Citation ]

A 61 year old man with diabetes, hyperlipidemia and hypertension was started on fenofibrate (300 mg daily) and developed dark urine and fatigue two weeks later. After another two weeks, he presented to his physician and was found to be jaundiced. Fenofibrate was stopped, and he was admitted for evaluation. Serum aminotransferase and alkaline phosphatase levels were elevated, and total bilirubin was 9.3 mg/dL (Table). Tests for markers of acute hepatitis A, B and C were negative. Serum autoantibodies were not detected. An abdominal ultrasound and endoscopic retrograde cholangiography showed no evidence of biliary obstruction. A liver biopsy showed intrahepatic cholestasis, mild degrees of steatosis, and inflammatory cells and mild fibrosis in portal areas. His liver tests improved slowly and were normal two months later.

Key Points

* Estimated from Figure 1.

Comment

An acute hepatitis arising 2 weeks after starting fenofibrate with a mixed, evolving into a cholestatic, pattern of serum enzyme elevations. Testing closer to the time of onset (2 weeks before presentation) may have shown a more hepatocellular pattern. Recovery is usually prompt and complete in cases of acute injury due to fenofibrate with a short latency period. This patient was treated with ursodiol which is frequently used in cholestatic liver disease, but is of unproven benefit.

REPRESENTATIVE TRADE NAMES Fenofibrate – Antara®, Lipofen®, Lofibra®, Tricor®, Triglide®

DRUG CLASS Antilipemic Agents

References updated: 24 March 2014

Zimmerman HJ. Drugs used in the treatment of hypercholesterolemia and hyperlipidemia. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 660-2. (Expert review of hepatotoxicity of lipid lowering agents including clofibrate, fenofibrate and gemfibrozil, all three of which can lead to mild-to-moderate serum aminotransferase elevations, and which have been associated with hepatic injury).

De Marzio DH, Navarro VJ. Fibrates. Hepatotoxicity of cardiovascular and antidiabetic drugs: fibrates. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 527. (Review of hepatotoxicity of fibrates; fenofibrate is the most commonly implicated fibrate in causing liver injury, which can be severe and prolonged with autoimmune features and the potential for chronicity).

Bersot TP. Drug therapy for hypercholesterolemia and dyslipidemia. In, Brunton LL, Chabner BA, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill, 2011, pp. 877-908. (Textbook of pharmacology and therapeutics).

de Gennes JL, Truffert J. [Elevation of glutamic-pyruvic transaminases under procetofene treatment of idiopathic hyperlipemia: incidence and significance in 443 treated cases]. Nouv Presse Med 1978; 7: 2398-9. French. PubMed Citation (Report of 443 patients treated with fenofibrate in a dose of 300-400 mg daily for an average of 1 year, found ALT elevations in 19%, >100 U/L in 3%, and persistence in 4%).

Aron E, Metman EH, Bougnoux P. [Hepatitis due to procetofene? 1 case]. Nouv Presse Med 1979; 8: 783. French. PubMed Citation (77 year old man developed fatigue shortly after starting fenofibrate; after 3 months, bilirubin was 1.2 mg/dL, ALT 205 U/L, Alk P normal; also on amiodarone, but biopsy showed little fat; resolution in 2 months after stopping).

Couzigou P, Boutillier P, Boisseau C, Faucher P, De Mascarel A, Amouretti M, Beraud C, et al. [Drug-induced hepatitis due to fenofibrate] Therapie 1980; 35: 403. PubMed Citation (74 year old woman developed fatigue after 2 years of therapy with fenofibrate [bilirubin 2.9 mg/dL, ALT 75 U/L], with no improvement over following 6 months; no further follow up available).

Vachon JM. [Hepatitis caused by procetofen]. Nouv Presse Med 1980; 9: 2740. French. PubMed Citation (63 year old woman developed fatigue 6 months after starting fenofibrate [bilirubin 1.5 mg/dL, ALT 110 U/L, Alk P 30 U/L], resolving in 7 weeks, recurrence with rechallenge with 1.5 month latency [ALT rising to 207 U/L]).

Fromantin M, Gautier D, Quatre JM, Bon R. Efficacite et tolerance due fenofibrate au cours de traitements a long terme. [Efficacy and tolerance of longterm treatment with fenofibrate]. Therapie 1982; 36: 473-6. PubMed Citation (Among 121 patients treated with fenofibrate for 3 years, 10 [9%] had ALT elevations usually arising within 3-4 months of starting, largely mild, transient and asymptomatic).

Homberg JC, Abuaf N, Helmy-Khalil S, Biour M, Poupon R, Islam S, Darnis F, et al. Drug-induced hepatitis associated with anticytoplasmic organelle autoantibodies. Hepatology 1985; 5: 722-7. PubMed Citation (Tested serum from 157 cases of drug induced liver disease for ANA and anti-cytoplasmic autoantibodies; 11% had ANA [methyldopa, papaverine, clometacin and oxyphenisatin], none had AMA, 5 anti-LKM [halothane and ticrynafen], 21% had SMA, mostly clometacin, fenofibrate, oxyphenisatin and papaverine; most antibodies decreased in titer and/or disappeared within 6 months of stopping; all 4 fenofibrate cases had SMA).

Migneco G, Mascarella A, La Ferla A, Attianese R. [Clofibrate hepatitis. A case report] Minerva Med 1986; 77: 799-800. PubMed Citation (51 year old woman developed abdominal pain and fatigue 3 months after starting clofibrate [bilirubin normal, ALT 210 U/L], rapid resolution on stopping; 4 months later presented again having taken fenofibrate for 1 month [ALT 76 U/L, Alk P normal], and rapid resolution again on stopping).

Massen H, Furet Y. [Hepatitis caused by fenofibrate] Cah Anesthesiol 1986; 34: 249-50. PubMed Citation (77 year old developed jaundice within 2 weeks of starting fenofibrate and allopurinol [bilirubin 5.3 mg/dL, ALT 159 U/L, Alk P 239 U/L], resolution within 7 days of stopping both).

Roberts WC. Safety of fenofibrate: US and worldwide experience. Cardiol 1989; 76: 169-79. PubMed Citation (Review of structure, mechanism of action, preclinical toxicology showing peroxisome proliferation in rodents, and safety in clinical trials; in US trials [n=383] ALT elevations in 4.2% with fenofibrate and 1.6% placebo; rarely required discontinuation; postmarketing surveillance showed 13 cases of hepatitis; no evidence of peroxisome proliferation in human liver biopsies).

Rigal J, Furet Y, Autret E, Breteau M. [Severe mixed hepatitis caused by fenofibrate? A review of the literature apropos of a case] Rev Med Interne 1989; 10: 65-7. PubMed Citation (74 year old developed jaundice 2 years after starting fenofibrate [bilirubin 4.7 mg/dL, ALT 1430 U/L, Alk P 315 U/L], with worsening [bilirubin 8.2 mg/dL] until fenofibrate stopped, and then resolving in 2 months).

Balfour JA, McTavish D, Heel RC. Fenofibrate. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in dyslipidaemia. Drugs 1990; 40: 260-90. PubMed Citation (Review of pharmacology, efficacy and safety of fenofibrate).

Bravo ML, Azagra R, Aguye A, Freixas M. [Acute hepatitis: an adverse reaction to fenofibrate treatment] Aten Primaria 1992; 10: 697-8. PubMed Citation (34 year old man developed asymptomatic elevations in ALT [104 U/L] 6 months after starting fenofibrate; remained elevated 6 and 12 months later before becoming normal, but unclear whether and when fenofibrate was stopped).

Lelouch S, Pelletier G, Sinico M, Ducreux M, Etienne JP. [Fenofibrate-induced acute hepatitis with pseudo-cholangitis] Gastroenterol Clin Biol 1992; 16: 597-9. PubMed Citation (65 year old man developed abdominal pain and fever 1 week after restarting fenofibrate and oxacillin, resolving rapidly on stopping both; pain and fever recurred 2 days after restarting fenofibrate alone [bilirubin

1.8 mg/dL, ALT 12 times ULN, Alk P near normal], resolving within 1 month of stopping).

Chatrenet P, Regimbeau C, Ramain JP, Penot J, Bruandet P. [Chronic active cirrhogenic hepatitis induced by fenofibrate] Gastroenterol Clin Biol 1993; 17: 612-3. PubMed Citation (59 year old woman developed jaundice 14 months after starting fenofibrate [bilirubin 19.5 mg/mL, ALT 34 times and Alk P 1.5 times ULN, IgG high, ANA negative], resolution over 9 months after stopping; biopsy showed chronic hepatitis and fibrosis).

Bernard PH, Lamouliatte H, Le Bail B, Bioulac-Sage P, Quinton A, Balabaud C. [Chronic active hepatitis associated with antinuclear antibodies induced by fenofibrate] Gastroenterol Clin Biol 1994; 18: 1048-9. PubMed Citation (60 year old woman developed asymptomatic rises in ALT [10.9 times ULN], with normal Alk P and bilirubin 22 months after starting fenofibrate; ANA 1:32,000 and biopsy showing chronic active hepatitis and bridging fibrosis, resolution in 2 months with slow and incomplete decline in ANA).

Lepicard A, Mallat A, Zafrani ES, Dhumeaux D. Atteinte chronique des canaux biliares interlobulaires induite par le fenofibrate. Gastroenterol Clin Biol 1994; 18: 1033-5. PubMed Citation (56 year old woman had asymptomatic rise in GGT [16 times ULN], Alk P [1.5 times ULN], ALT [4.5 times ULN] 5 months after starting fenofibrate, with persistent GGT elevations and biopsy showing mild loss of bile ducts).

Rouhier ML, Rifflet H, Rifflet I, Oberti F, Vuillemin E, Chevailler A, Cales P. [Painful acute liver involvement related to ingestion of fenofibrate] Gastroenterol Clin Biol 1996; 20: 1137-8. PubMed Citation (53 year old female developed severe abdominal pain 36 hours after restarting fenofibrate; rechallenge caused the same pain with elevations in ALT [8 times ULN], Alk P [1.5 times ULN], normal bilirubin levels; rapid resolution; persistent ANA of 1:500).

Athyros VG, Athyros VG, Papageorgiou AA, Hatzikonstandinou HA, Didangelos TP, Carina MV, Kranitsas DF, et al. Safety and efficacy of long-term statin-fibrate combinations in patients with refractory familial combined hyperlipidemia. Am J Cardiol 1997; 80: 608-13. PubMed Citation (389 patients treated with statin and fibrate combination for average of 2.5 years; 1.3% stopped because of ALT >3 times normal, all resolving within 4 weeks; no hepatitis or jaundice reported).

Ganne-Carrie N, de Leusse A, Guettier C, Castera L, Levecq H, Bertrand HJ, Plumet Y, et al. [Autoimmune hepatitis induced by fibrates] Gastroenterol Clin Biol 1998; 22: 525-9. PubMed Citation (Retrospective analysis of 5 patients [4 men, 1 woman] with chronic hepatitis due to fibrates identified between 1989-1996; ages 56-73 years, on fenofibrate [n=3] or ciprofibrate [n=2] for 5-36 months; 2 asymptomatic; none with immunoallergic features or eosinophilia, with bilirubin 0.6-36 mg/dL, ALT 4-26 times ULN; all had ANA 1:200-1:2560; liver biopsy showed active cirrhosis in 3 and chronic hepatitis with fibrosis in 2; hepatitis resolved spontaneously in 2, and 3 required corticosteroid therapy in 2 of whom they could be stopped without relapse).

Dumortier J, Slim R, Chevallier M, Boillot O, Thaunat J-L, Vaillant E, Vial T, et al. Hepatite aigue severe cirrhogene apres preise de ciprofibrate. Gastroenterol Clin Biol 1999; 23: 1399-1400. PubMed Citation (72 year old woman developed fatigue after 3 weeks of ciprofibrate [bilirubin 2.9 mg/dL, ALT 25 times ULN, Alk P 2 times ULN, ANA 1:40]; no improvement after 2 months, liver biopsy showed chronic active hepatitis with fibrosis; corticosteroids caused decrease in ALT, but repeat biopsy showed cirrhosis, slow but ultimate resolution).

Krempf M, Rohmer V, Farnier M, Issa-Sayegh M, Corda C, Sirugue I, Gerlinger C, et al. Efficacy and safety of micronized fenofibrate in a randomized double-blind study comparing four doses from 200 mg to 400 mg daily with placebo in patients with hypercholesterolemia. Diabet Metabol 2000; 26: 184-91. PubMed Citation (Controlled trial of 4 doses of micronized fenofibrate vs placebo for 3 months in 340 patients; decreased triglycerides by 27-41%, ALT elevations above 3 times ULN occurred in 3% on fenofibrate vs 1% on placebo).

Fartoux-Heymann L, Narcy-Lambare B, Labayle D, Fischer D. [Acute hepatitis and drug dermatitis due to fenofibrate(Secalip)] Ann Med Interne (Paris) 2001; 152: 353-4. PubMed Citation (43 year old man developed jaundice, rash and fever 2 weeks after starting fenofibrate [300 mg/day] [bilirubin 7.7 mg/dL, ALT 3.2 times ULN, Alk P 2.6 times ULN, atypical lymphocytes without eosinophilia], with rapid recovery and desquamation after stopping fenofibrate).

Punthakee Z, Scully LJ, Cuindi MM, Ooi TC. Liver fibrosis attributed to lipid lowering medications: two cases. J Intern Med 2001; 150: 249-54. PubMed Citation (63 year old woman developed mild fatigue and abnormal ALT [443 U/L]) 2 years after starting fenofibrate, having been on statins and having normal enzymes for years [Ig G 2.2 g/dL, ANA 1:40, SMA negative], biopsy showed chronic hepatitis and bridging fibrosis; resolved within 2 months of stopping, IgG and ANA falling to normal).

Sgro C, Clinard F, Ouazir K, Chanay H, Allard C, Guilleminet C, Lenoir C, et al. Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology 2002; 36: 451-5. PubMed Citation (Over a 3 year period, 34 cases of drug induced liver injury were identified in a population of 81,301 in France (

14 per 100,000), one case being due to fenofibrate).

Pichon N, Vincensini JF, Roziere A, Labrousse F, Sautereau D, Pillegand B. [Acute cytolytic and cholestatic hepatitis induced by fenofibrate] Gastroenterol Clin Biol 2003; 27: 947-9. PubMed Citation (59 year old man developed jaundice 2 months after starting fenofibrate [bilirubin 6.9 rising to 12.3 mg/dL, AST 5.5 times ULN, Alk P 3 times ULN], resolving within 3 months of stopping).

Parra JL, Reddy KR. Hepatotoxicity of hypolipidemic drugs. Clin Liver Dis 2003; 7: 415-33. PubMed Citation (Review and discussion of individual lipid lowering agents; fenofibrate has been associated with both acute and chronic liver injury including cirrhosis; chronic injury often being accompanied by features of autoimmune hepatitis).

Alsheikh-Ali AA, Kuvin JT, Karas RH. Risk of adverse events with fibrates. Am J Cardiol 2004; 94: 935-8. PubMed Citation (Review of adverse event reports to FDA for gemfibrozil and fenofibrate from 1999-2003; hepatotoxicity report rates were 13 per million for gemfibrozil vs 14.6 per million for fenofibrate).

Russo MW, Galanko JA, Shrestha R, Fried MW, Watkins P. Liver transplantation for acute liver failure from drug-induced liver injury in the United States. Liver Transpl 2004; 10: 1018-23. PubMed Citation. (Among

50,000 liver transplants done in the United States between 1990 and 2002, 270 [0.5%] were done for drug induced acute liver failure, but no case was attributed to fenofibrate or other fibrates).

Ho CY, Kuo TH, Chen TS, Tsay SH, Chang FY, Lee SD. Fenofibrate-induced acute cholestatic hepatitis. J Chin Med Assoc 2004; 67: 245-7. PubMed Citation (61 year old man developed jaundice 2 months after starting fenofibrate [bilirubin 9.3 mg/dL, ALT 249 U/L, Alk P 259 U/L], resolving within 2 months of stopping).

Ahmed F, Petrovic L, Rosen E, Gonzalez R, Jacobson IM. Fenofibrate-induced cirrhosis. Dig Dis Sci 2005; 50: 312-3. PubMed Citation (62 year old man had abnormal liver tests without symptoms 11 months after starting fenofibrate [bilirubin 2.8 mg/dL, ALT 662 U/L, Alk P 57 U/L], resolving slowly upon stopping and biopsy showing cirrhosis with mild activity).

K eech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR, Forder P, et al.; FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366(9500): 1849-61. PubMed Citation (Among 9795 patients with diabetes treated with fenofibrate or placebo for an average of 5 years, ALT levels >3 times ULN occurred in 0.4% on fenofibrate vs 0.8% on placebo; clinically apparent hepatitis in 6 [0.1%] of both groups).

Dohmen K, Wen CY, Nagaoka S, Yano K, Abiru S, Ueki T, Komori A, et al. Fenofibrate-induced liver injury. World J Gastroenterol 2005; 11: 7702-3. PubMed Citation (66 year old woman with primary biliary cirrhosis developed fever and rise in ALT [40 to 216 U/L] and Alk P [367 to 537 U/L] with eosinophilia [14%], 11 days after starting fenofibrate, liver enzymes falling to baseline 2 weeks after stopping).

Andrade RJ, Lucena MI, Fernandez MC, Pelaez G, Pachkoria K, Garcia-Ruiz E, Garcia-Munoz B, et al.; Spanish Group for the Study of Drug-Induced Liver Disease. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology 2005; 129: 512-21. PubMed Citation (Analysis of 461 cases of drug-induced liver disease 1984 to 2004 in Spanish Registry; 4 cases were attributed to fibrates, but no specific information given).

Lucena MI, Andrade RJ, Vicioso L, Gonzalez FJ, Pachkoria K, Garcia-Munoz B. Prolonged cholestasis after raloxifene and fenofibrate interaction: a case report. World J Gastroenterol 2006; 12: 5244-6. PubMed Citation (60 year old woman developed dark urine 2 weeks after starting fenofibrate [bilirubin 9.6 mg/dL, ALT 241 U/L, Alk P 174 U/L], developing rash and prolonged jaundice [4 months] and persistence of Alk P elevations, with biopsy showing decrease in bile ducts; concurrent therapy with estrogen receptor modulator may have altered course).

Andrade RJ, Lucena MI, Kaplowitz N, Garcia-Munoz B, Borraz Y, Pachkoria K, Garcia-Cortes M, et al. Outcome of acute idiosyncratic drug-induced liver injury: Long-term follow-up in a hepatotoxicity registry. Hepatology 2006; 44: 1581-8. PubMed Citation (28 of 493 [5.7%] cases of drug induced liver disease were found to have evidence of chronic injury; 2 chronic cholestatic cases were attributed to combinations of fibrates with other agents; gemfibrozil/lovastatin and fenofibrate/raloxifen).

Tudesq N, Bentournes M. [Hepatitis induced by fibrates] Ann Biol Clin(Paris) 2006; 64: 515-6. French. PubMed Citation (79 year old treated with fenofibrate for 4 years developed jaundice and ascites [bilirubin 2.7 mg/dL, ALT 36 U/L, AST 111 U/L, Alk P 639 U/L, IgG 2.4 g/mL, ANA 1:1,280], improving after stopping fenofibrate with jaundice, ascites and enzyme elevations resolving over next few months and ANA titer decreasing to 1:160).

Davidson MH, Armani A, McKenney JM, Jacobson TA. Safety considerations with fibrate therapy. Am J Cardiol 2007; 99(suppl): 3C-18C. PubMed Citation (Review of several safety issues with fibrates; fibrates increase cholesterol levels in bile thus increasing cholesterol saturation; in epidemiologic studies there is a 1.7 increase in relative risk of cholelithiasis in patients on long term fibrates, most clearly shown for clofibrate; no discussion of hepatic injury).

Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J; Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 2008; 135: 1924-34. PubMed Citation (Among 300 cases of drug induced liver disease in the US collected from 2004 to 2008, 1 case was attributed to fenofibrate, but none to clofibrate or gemfibrozil).

Hajdu D, Aiglova K, Vinklerova I, Urbanek K. Acute cholestatic hepatitis induced by fenofibrate. J Clin Pharm Ther 2009; 34: 599-602. PubMed Citation (50 year old woman developed jaundice 2 weeks after adding fenofibrate to a chronic regimen of atorvastatin and citalopram [bilirubin 31.2 mg/dL, ALT 156 U/L, Alk P 525 U/L, ANA and SMA negative], resolving within one month of stopping fenofibrate).

Reuben A, Koch DG, Lee WM; Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U. S. multicenter, prospective study. Hepatology 2010; 52: 2065-76. PubMed Citation (Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury, none of which were attributed to fibrates).

Bjornsson E, Talwalkar J, Treeprasertsuk S, Kamath PS, Takahashi N, Sanderson S, Neuhauser M, et al. Drug-induced autoimmune hepatitis: clinical characteristics and prognosis. Hepatology 2010; 51: 2040-8. PubMed Citation (Retrospective analysis of 261 cases of autoimmune hepatitis, 24 [9%] of which were due to a medication; 11 nitrofurantoin, 11 minocylcine, but none attributed to fibrates).

Liberopoulos EN, Florentin M, Elisaf MS, Mikhailidis DP, Tsianos E. Fenofibrate in primary biliary cirrhosis: a pilot study. Open Cardiovasc Med J 2010; 4: 120-6. PubMed Citation (10 patients with primary biliary cirrhosis were treated either with fenofibrate [n=6] or continued on ursodiol [n=4] for 8 weeks; serum ALT and Alk P improved with fenofibrate therapy and no patient had worsening of disease).

Roth EM, McKenney JM, Kelly MT, Setze CM, Carlson DM, Gold A, Stolzenbach JC, et al. Efficacy and safety of rosuvastatin and fenofibric acid combination therapy versus simvastatin monotherapy in patients with hypercholesterolemia and hypertriglyceridemia: a randomized, double-blind study. Am J Cardiovasc Drugs 2010; 10: 175-86. PubMed Citation (Controlled trial of several doses of fenofibrate combined with rosuvastatin vs simvastatin alone in 474 patients with hypercholesterolemia; 1% of fenofibrate/rosuvastatin vs 0% of simvastatin treated patients had an ALT elevation >5 times ULN, but none had clinically apparent liver injury).

Levy C, Peter JA, Nelson DR, Keach J, Petz J, Cabrera R, Clark V, et al. Pilot study: fenofibrate for patients with primary biliary cirrhosis and an incomplete response to ursodeoxycholic acid. Aliment Pharmacol Ther 2011; 33: 235-42. PubMed Citation (20 patients with primary biliary cirrhosis with an i n complete response to ursodiol were treated with fenofibrate for 48 weeks ; none had worsening of liver disease and mean serum AST and Alk P levels improved).

Czaja AJ. Drug-induced autoimmune-like hepatitis. Dig Dis Sci 2011; 56: 958-76. PubMed Citation (Review of drug induced autoimmune hepatitis, the principal causes being minocycline and nitrofurantoin; other caues being methyldopa, hydralazine, statins, fibrates, diclofenac, anti-TNF agents, interferons, propylthiouracil and isoniazid).

Farnier M, Marcereuil D, De Niet S, Ducobu J, Steinmetz A, Retterstol K, Bryniarski L, et al. Safety of a fixed-dose combination of fenofibrate/pravastatin 160 mg/40 mg in patients with mixed hyperlipidaemia: a pooled analysis from a database of clinical trials. Clin Drug Investig 2012; 32: 281-91. PubMed Citation (Pooled analysis of 5 large trials of fenofibrate vs a statin vs the combination for 12-64 weeks found ALT >3 times ULN in 1.6% of subjects on fenofibrate and 0.4% on the combination; one patient had "hepatic insufficiency of moderate intensity", but the event was considered "non-serious" because it did not lead to "patient withdrawal").

Geng Q, Ren J, Chen H, Lee C, Liang W. Adverse events following statin-fenofibrate therapy versus statin alone: a meta-analysis of randomized controlled trials. Clin Exp Pharmacol Physiol 2013; 40: 219-26. PubMed Citation (Systematic review of the safety of the combination of fenofibrate and statins found higher rates of ALT and AST elevations with the combination than with statins alone).

Bjornsson ES, Bergmann OM, Bjornsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. Gastroenterology 2013; 144: 1419-25. PubMed Citation (In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, of which 2 were attributed to atorvastatin and 1 to simvastatin, but none to fibrates).

OTHER REFERENCE LINKS Fenofibrate

Defendog Price Compare, Defendog

Defendog

Step 1: Read drug prescription

Defendog Defendog is a pyrethroid, prescribed for scabies. Indications: Defendog is a pyrethroid, prescribed for scabies. It works by killing the scabies mite. Contraindications: Hypersensitivity. Dosage: Thoroughly massage the cream into the skin. Usage: It comes as a cream to apply over the affected area, as directed by your physician. Precautions: Caution should be exercised in patients with history of any allergy, asthma, who are taking other medications, during pregnancy and breastfeeding. Side Effects: Local - Skin irritation, rash, redness, swelling, numbness, tingling and rash. Warning: Wash your hand thoroughly after using Defendog. Storage Conditions: Store it at room temperature (15°- 25° C).

Step 3: Select the most affordable brand or generic drugs

Zolacos Cp (Bicalutamide - Goserelin) Drug, Zolacos

ZolaCos CP

NOTICE: This Consumer Medicine Information (CMI) is intended for persons living in Australia. This page contains answers to some common questions about ZolaCos CP. It does not contain all the information that is known about ZolaCos CP. It does not take the place of talking to your doctor or pharmacist. All medicines have risks and benefits. Your doctor has weighed the risk of you using this medicine against the benefits he/she expects it will have for you. If you have any concerns about using this medicine, ask your doctor or pharmacist. Bookmark or print this page, you may need to read it again.

What ZOLACOS CP is for

ZOLACOS CP combination therapy is the brand name for packs containing ZOLADEX (goserelin) 3.6mg or 10.8mg subcutaneous implant plus COSUDEX (bicalutamide) 50mg tablets.

ZOLACOS CP is used to treat advanced prostate cancer in men. It is not a cure for prostate cancer. Bicalutamide tablets can also be used to treat disease flare associated with previous goserelin therapy.

ZOLACOS CP is a combination pack consisting of an anti-androgen (COSUDEX) medicine and a Luteinising Hormone Releasing Hormone (LHRH) agonist (ZOLADEX).

Androgens such as testosterone are natural male sex hormones. In some types of prostate cancer, androgens may help the cancer cells to grow.

LHRH agonists reduce the level of testosterone in men.

ZOLACOS CP interferes with some of the actions of these hormones.

ZOLACOS CP should only be taken by men.

Follow all directions given to you by your doctor.

They may differ from the information in this leaflet.

Your doctor may prescribe this medicine for another use. Ask your doctor if you want more information.

ZOLACOS CP is not addictive.

Before you use ZOLACOS CP

When you must not use it

Do not use ZOLACOS CP if you are a woman or a child.

Women and children are not normally treated with ZOLACOS CP.

Do not use ZOLACOS CP if you are allergic to bicalutamide, goserelin or any of the other ingredients in ZOLACOS CP.

Do not use ZOLACOS CP if you are taking cisapride or the antihistamines, terfenadine and astemizole.

Do not use ZOLACOS CP after the use by (expiry) date printed on the pack.

It may have no effect at all or an unexpected effect if you use it after the expiry date.

Do not use ZOLACOS CP if the packaging is torn or shows signs of tampering.

Do not use it to treat any other complaints unless your doctor tells you to.

Do not give this medicine to anyone else.

Before you start to use it

You must tell your doctor if:

1. you have allergies to:

bicalutamide or goserelin, the active ingredients in ZOLACOS CP

any of the other ingredients of ZOLACOS CP listed at the end of this leaflet

other anti-androgen medicines

other LHRH agonists

any other medicines

any other substances, such as foods, preservatives or dyes.

If you have an allergic reaction, you may get a skin rash, hay fever, or have difficulty breathing or feel faint.

2. you have liver problems

It may not be safe for you to use ZOLACOS CP if you have problems with your liver.

3. you have heart or blood vessel conditions, including heart rhythm problems (arrhythmia), or are being treated with medicines for these conditions.

The risk of you having further heart rhythm problems may increase if you are taking ZOLACOS.

Taking other medicines

Tell your doctor if you are taking any other medicines, including:

cisapride (see When you must not use it)

the antihistamines terfenadine and astemizole (see When you must not use it)

medicines used to prevent blood clots, especially warfarin

medicines used to treat high cholesterol

Mirol A Map, Mirol

Mirol'a Map — Satellite Images of Mirol'a

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Betnesol Eye Ear And Nose Drops Solution 0, Betnesol

BETNESOL EYE EAR AND NOSE DROPS SOLUTION 0.1% W/V

Transcript

1. What Betnesol Drops are for Betnesol Drops belong to a group of medicines called corticosteroids (‘steroids’ for short). Betnesol Drops work by reducing inflammation (redness, itching and soreness). Betnesol Drops are used to treat inflammation of the eye, ear or nose where there is no infection. It is important to use this medicine to prevent any damage to the delicate tissues of your eyes, ear or nose and to prevent any infection developing.

2. Before you use Betnesol Drops Important: Never use this medicine in your eye without first checking with your doctor. If it is used for the wrong condition, it could lead to blindness. Do not use Betnesol Drops if: • You are allergic to betamethasone • You are allergic to any of the other ingredients of Betnesol Drops (listed in section 6) • You have not checked your eye condition with your doctor first. If this medicine is used in your eye, for the wrong

condition, it could lead to blindness. • You have an infection in the eye, or it is producing pus and is sticky • You have ulcers in your eye (shingles) • You have glaucoma (increased pressure in the eye) • You have a perforated ear drum • You wear soft contact lenses. If any of the above applies to you talk to your doctor or pharmacist. Check with your doctor before using Betnesol Drops if: • You have been treated with Betnesol or similar corticosteroid drops recently. You should not use corticosteroids for a long time without regular medical check-ups from your doctor • You have redness in your eyes for which you do not know the cause. Steroid treatment must not be given unless the cause of the redness is known • You have an infection of the lining of your nose, which is not being treated • You have recently had surgery on your nose which has not yet healed • You have tuberculosis (TB). • You have thinning of the cornea or sclera (the tissues which cover the outer surface

of the eye). Using these drops could lead to a hole in the eyeball. • You are giving this medicine to a baby. Using this medicine for a long time in babies may cause the adrenal gland to stop working properly. If any of the above applies to you, talk to your doctor or pharmacist. Taking other medicines Tell your doctor if you are taking any other medicine, including medicines obtained without a prescription. Pregnancy and breast-feeding If you are pregnant, trying to become pregnant or breast-feeding ask your doctor or pharmacist for advice before using Betnesol Drops. If you use this medicine while pregnant, there may be a small risk of cleft palate or retarded growth in the foetus. Driving and using machines Betnesol Drops may cause temporary blurred vision and lightheadedness. If this happens to you, do not drive or use machinery until you return to normal. Warnings about the ingredients in Betnesol Drops

This medicine contains benzalkonium chloride as a preservative which may cause skin reactions or eye irritation. Avoid contact with soft contact lenses. Remove contact lenses prior to application and wait at least 15 minutes before reinsertion. Benzalkonium chloride is known to discolour soft contact lenses.

3. How to use Betnesol Drops Important: Your doctor will choose the dose that is right for you. Your dose will be shown clearly on the label that your pharmacist puts on your medicine. If it does not, or you are not sure, ask your doctor or pharmacist. Things to remember about your dose: • Always use Betnesol exactly as your doctor has told you • How often you use the drops will depend on how your body responds to the treatment • Use as few drops as possible for the shortest possible time. Getting ready to use your medicine Check that the seal on the bottle is not broken before using Betnesol Drops for the first time. Wash and dry your hands. Do not breathe on or touch the dropper nozzle.

Using your medicine If there is no improvement in your symptoms after 7 days, stop using the drops and see your doctor again.

Eyes • The usual dose is 1 or 2 drops put into the eye every one or two hours • Once the redness, itching and soreness starts to feel better, apply the drops less often. 1. Tilt the head back 2. Gently pull lower eyelid downwards and outwards 3.Place drops in the gap between the lid and eye (squeeze bottle very gently if necessary) 4. Blink a few times to spread out the drops 5. Repeat for the other eye if needed. Medical check-ups If you are using this medicine for your eyes and you use it for a number of weeks, your doctor may ask you to have check-ups. These are to make sure that your medicine is working properly and that the dose you are taking is right for you. Your doctor will check your eyes for: • An increase in pressure • Cataracts • Infection.

Patient information Leaflet: Betnesol Eye, Ear & Nose Drops Solution 0.1% w/v Bethamethasone sodium phosphate

Read all of this leaflet carefully before you start using this medicine. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor or pharmacist. • This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. • In this leaflet, Betnesol Eye, Ear & Nose Drops will be called Betnesol Drops. In this leaflet: 1. What Betnesol Drops are for 2. Before you use Betnesol Drops 3. How to use Betnesol Drops 4. Possible side effects 5. How to store Betnesol Drops 6. Further information.

• The usual dose is 2 or 3 drops put into the ear every two or three hours • Once the redness, itching and soreness starts to feel better, apply the drops less often. 1. Tilt the head to one side 2. Place drops in the ear canal (squeeze bottle gently if necessary) 3. Keep head tilted for a minute or two to let the drops soak in 4. Repeat for the other ear if needed.

Nose The usual dose is 2 or 3 drops put into each nostril two or three times each day. 1. Tilt head backwards 2. Place drops in nostril (squeeze bottle gently if necessary) 3. Keep head tilted and sniff gently to let the drops soak in 4. Repeat for other nostril if needed. Medical check-ups Your doctor will regularly check the growth of children who are taking Betnesol by nose over a long period of time. If you use more Betnesol Drops than you should

If you accidentally use too much Betnesol Drops it is unlikely to lead to any serious side effects. However, if you are concerned, contact the nearest hospital casualty department or your doctor. It is important that you take your dose as stated on the pharmacist’s label or as advised by your doctor. You should use only as much as your doctor recommends; using more or less may make your symptoms worse. If you forget to use Betnesol Do not use a double dose to make up for a missed dose. Simply use the next dose as planned. How to stop using Betnesol Drops Do not stop using Betnesol Drops without first talking to your doctor. If you have been using Betnesol Drops for a long period of time (around 6 to 8 weeks), then you should stop using it gradually, to avoid the inflammation coming back. If you have any further questions about the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects Like all medicines Betnesol Drops can cause

side effects, although not everybody gets them. These may include: • Ulcers on the surface of the eye (cornea). Tell your doctor if your eye becomes painful and if you have blurred vision which does not improve after a few minutes • Increased pressure in the eye (glaucoma) which can lead to problems with your sight • A hole in the eyeball (if you have a disease which cause thinning of the surface of the eye) • Cataracts (clouding of the lens of the eye) • Enlarged pupils • Drooping of the eyelid • Swelling and redness of the outer surface of the eye • Blurred vision and other alterations to your sight • Itchy, red or irritated skin. This may not appear until sometime after you have started to use the medicine • A burning or stinging sensation on your skin. This may not appear until sometime after you have started to use the medicine If you are using Betnesol Drops for your nose, you may also experience some of the following side effects:

• If you are a child, Betnesol Drops may slow your growth • Difficulty breathing • A hole or ulcers of the tissue that divides your nose (nasal septum) • Irritation and dryness in the nose • Sneezing • Headache • Light-headedness • Rash • Feeling sick • Nosebleeds • Blocked nose • Changes in your senses of smell and taste. Using too much of this medicine for a long time can prevent your adrenal gland from working properly and producing your body’s own natural steroids (known as adrenal suppression). This means that when you stop using Betnesol Drops, you could experience the following effects: • Low blood pressure which may make you feel faint • Fever • A runny nose • Painful itchy skin • Redness of the eye (conjunctivitis) • Muscle and joint pain • Weight loss.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

5. How to store Betnesol Drops Keep out of the reach and sight of children. Do not use Betnesol Drops after the expiry date on the label. The expiry date refers to the last day of that month. The bottle should be disposed of 28 days after first opening, even if there is solution remaining. Store Betnesol Drops below 25°C and in the original carton to protect it from light. Do not freeze. Medicines should not be disposed of via wastewater or household waste. Return any medicine you no longer need to your pharmacist.

6. Further information What Betnesol Drops contain The active substance is betamethasone sodium phosphate at a concentration of 0.1%. The other ingredients are bezalkonium chloride solution, disodium hydrogen

phosphate anhydrous, sodium chloride, disodium edetate, sodium hydroxide (E524), phosphoric acid and water for injections. What Betnesol Drops look like Betnesol Drops is an eye, ear and nose drops solution. It is a clear, colourless liquid. Betnesol Drops come in 5 ml or 10 ml plastic bottles with a built-in nozzle and a tamper-evident plastic cap. Marketing Authorisation Holder RPH Pharmaceuticals AB, Lagervagen 7, 136 50 Haninge, Sweden. Manufacturer Excelvision, 27, rue de la Lombardiere, ZI La Lombardiere, 07100 Annonay. Distributed by Focus Pharmaceuticals Ltd. This leaflet was last updated in August 2012.

If this leaflet is difficult to see or read or you would like it in a different format, please contact RPH Pharmaceuticals AB, Lagervagen 7, 136 50 Haninge, Sweden.

Source: Medicines and Healthcare Products Regulatory Agency

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

Corosan Generic Name Dipyridamole Online, Corosan

corosan General Information

corosan - Pharmacology:

corosan likely inhibits both adenosine deaminase and phosphodiesterase, preventing the degradation of cAMP, an inhibitor of platelet function. This elevation in cAMP blocks the release of arachidonic acid from membrane phospholipids and reduces thromboxane A2 activity. corosan also directly stimulates the release of prostacyclin, which induces adenylate cyclase activity, thereby raising the intraplatelet concentration of cAMP and further inhibiting platelet aggregation.

corosan for patients

Description

This medicine is sometimes called a "blood thinner". This medicine prevents blood clots form forming and may be given following a stroke or heart attack or for patient who have an irregular heart beat.

General Information

This information is for educational purposes only. Not every known side effect, adverse effect, or drug interaction is in this database. If you have questions about your medicines, talk to your healthcare provider.

Proper use of this medicine

Take this medicine exactly as directed. Do not take more or less of this medicine than prescribed. Your doctor may change the dosage of this medicine. Keep all lab appointments.

Missed Dose

Take your next dose as soon as you remember. If it is time for your next dose, skip the missed dose and go back to your regular schedule. Do not double doses.

Storage

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

Possible Side Effects

Check with your doctor as soon as possible if you experience any of the following:

nosebleeds

excessive bleeding from cuts

bleeding from your gums

excessive bruising

discoloration of urine or stools

black tarry stools

This description is suitable for active ingredient Dipyridamole

corosan Interactions

No pharmacokinetic drug-drug interaction studies were conducted with PERSANTINE® (dipyridamole USP) Tablets. The following information was obtained from the literature.

Adenosine: corosan has been reported to increase the plasma levels and cardiovascular effects of adenosine. Adjustment of adenosine dosage may be necessary.

Cholinesterase Inhibitors: corosan may counteract the anticholinesterase effect of cholinesterase inhibitors, thereby potentially aggravating myasthenia gravis.

corosan Contraindications

Leukase N Kegel (20 St) Preisvergleich, Leukase N Kegel

LEUKASE N Kegel

Deutschland, Albanien, Andorra, Athos, Azoren, Belgien, Bosnien und Herzegowina, Bulgarien, D?nemark, England, Estland, Finnland, Frankreich, F?r?er, Gibraltar, Griechenland, Gro?britannien, Guernsey, Irland, Island, Isle of Man, Italien, Jan Mayen, Jersey, Kasachstan, Kroatien, Lettland, Liechtenstein, Litauen, Luxemburg, Madeira, Malta, Mazedonien, Moldawien, Monaco, Montenegro, Niederlande, Norwegen, Polen, Portugal, Rum?nien, Russland, San Marino, Schweden, Schweiz, Serbien, Slowakei, Slowenien, Spanien, Svalbard, Tschechien, T?rkei, Ukraine, Ungarn, Vatikanstadt, Wei?russland, alle EU-L?nder, ?land, ?sterreich

Daten vom 19.09.16 07:52, Preis kann jetzt höher sein**

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** Preise, Rangfolge, Versandkosten können sich zwischenzeitlich geändert haben.

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Merkzettel

Sie benötigen verschiedene Produkte? Der Merkzettel berechnet den günstigsten Anbieter für die Gesamtbestellung.

LEUKASE N Kegel 20 Stk.

Journal Of Religion & Film The God Behind The Screen Pleasantville & The Truman Show By Linda A, Der

Vol. 5, No. 2 October 2001

The God Behind the Screen: Pleasantville & The Truman Sho w

By Linda A. Mercadante

Two films from 1998 , The Truman Show and Pleasantville . provide a possible basis for theological discussion. They introduce questions of illusion and reality, control and freedom, viewing and being viewed. These two products of the media world themselves ask how much our own interpretations of reality are influenced by our culture's modern media. Have Americans developed an obsessive interest in watching without being known (voyeurism)? Do the films portray society's worst fears about God? What aspects of human freedom and what aspects of God are left out? Effectively raising the questions, the films require richer resources to provide answers regarding the character of God and the power of human freedom.

[1] Life was good for Truman Burbank. He lived in safe and pleasant Seahaven Island. He had a respectable job, an attractive wife, a best friend and a comfortable home. Everyone liked him. The weather was mostly perfect and no one was depressed.

[2] In Pleasantville, too, life was good. Rain never marred a beautiful day. Fire-fighters spent most of their time rescuing cats from trees. Teens trusted their parents and they liked school. The work was easy, everyone had friends, the basketball team always won, and no one had low self-esteem

[3] Contrary to what we might expect - trained as we are by disaster and superhero stories - in these film scenarios from The Truman Show (directed by Peter Weir) and Pleasantville (directed by Gary Ross), what you see is basically what you get. Everything is predictable, pleasant and safe. All seems fight with these worlds; all is according to prevailing standards. Both films focus on a world created by a television situation-comedy and each has a controlling figure behind the screen who maintains the pleasant illusions. Both films construct this ideal environment out of our fondest desires and in opposition to many of our common complaints today. Both depict a devoted audience willing to be absorbed by this carefully constructed image.

[4] It all seems benign enough. However, not everyone is aware that these worlds are constructed, that they are actors, and that they are being viewed. Both films present characters with differing levels of awareness about their true roles and situations. As their knowledge of the situation grows, the characters gain freedom and choice, but they also experience risk, pain, and uncertainty. In each of these film stories, then, "well enough" does not get left alone.

[5] But let's not jump to theological conclusions and assume these are "Adam and Eve" type stories of perfection, temptation and fall. Instead, these are stories of illusion and reality, control and freedom, viewing and being viewed. These films allow us to raise several questions about an age when so many of us spend so much time captivated by moving pictures. Have we become a culture of voyeurs, looking in on manufactured lives? Or are we, instead, the ones being watched? Are we evaluating or regulating our own lives in terms set by the filmic gaze? Also, how adequate are our contemporary desires and how much are we willing to give up to attain them? If someone could produce all the necessary ingredients in the contemporary formula for the good life, would it be enough and what would it require of us?

[6] It is especially engaging that these questions are suggested through the work of an image-producing industry. For this is the same industry that is a major contributor, along with television and advertising, to the panoply of images that attract people today and which feed desires for the typical middle-class Western version of the good life. Regrettably, however, their filmic solutions remain "within the box," that is, within the terms set by popular culture.

[7] In spite of this failing, there is more here than a good parody of some contemporary problems. I don't want to put theological intentions into the minds of the film-makers and I'm not saying these are "Christian" or even "religious" films. Nor am I decrying them as the opposite. Instead, a theologically-attuned interpreter can see how these films -- especially when considered together -- are intriguing because they reflect some common fears and fantasies about God, human life, and freedom. They illustrate well - but provide their own answers for - a contemporary nightmare that God may be the controller behind the screen of our lives, that we are merely actors unaware, and that our best interests are not being served.

[8] As a theologian who builds bridges between cultural and theological issues, I search for films like these that open up productive avenues for discussion in classes, youth groups, and churches. I have used films this way for the past twelve years, and have focused primarily on how seminarians and church people interpret them. My interest in turning a theological eye toward film, then, has grown out of this attention to a particular audience, its viewing habits, and its integration of filmic themes into its theological perspectives.

[9] It has been frequently noted that we live in a "media-saturated" culture. Images from television, film, advertisements, bill-boards, and photo-journalism are everywhere we turn. Yet the situation goes deeper. For more than just media inundation, we have come to live in a media-mediated culture, where our understanding of life, reality and our own experience is filtered through video frames. Most of us in the industrialized world (and many outside of it) have become reliant upon modem media, especially television and films, as we make our interpretations of reality. Without realizing we have become so dependent, we frequently look through these frames as we seek understanding, comfort, reassurance, vision, and structure for our disparate sensory intakes. This is so, even though the images in these frames do not give us a consistent, trustworthy, or self-cohering interpretive pattern.

[10] In the West's past, and in many other cultures', the prevailing religious vision often has provided such a coherent interpretive grid. Today, instead, there are competing visions, many of them poorly developed or self-contradictory. Varying understandings of reality, and prescriptions for life, are given to us through news programs, commercials, soap operas, and the many stories we see on television and in film. Even though it is harder to chart a course amid competing images, the human need for some sort of grid has not changed. Therefore, although the assortment of images we now see are fragmented -- and we are the ones who must pick and choose -- nevertheless, we do select, usually unconsciously, from this salad bar of images as we strive to find and make meaning in our lives. To paraphrase John Calvin, today we look through the "spectacles" of media.

[11] The recent films Pleasantville and The Truman Show are arresting precisely because they highlight an aspect of this situation "from within". Who should know better than the image-makers how constructed these video frames really are? Likewise, in an industry which must gauge, as well as influence, audience desires to ensure its own survival, who should know better the extent of our malleability? And, finally, in an industry well aware of its monetary dependence upon "product placement," who should be more certain about the variability of the components of the good life?

[12] Although the two films do not give the above issues equal weight, both are important as social markers, especially given that they were released less than six month from each other (in 1998) and treat these issues in some similar ways. (The interpretive net can be widened by noting that several others released somewhat later - such as Existenz and Blast From The Past - also deal with related issues.)

Comparing Pleasantville and The Truman Show

[13] In these films knowledge brings control, and the key battle is around predictability and change. At the top of the hierarchy of knowledge is a controlling god-like figure who understands everything, and who takes complete responsibility for sustaining the actors' roles and maintaining the perfected environment. These controllers know what they want and are willing to be adaptive, up to a point, in order to get it. Through advanced technology, they are able to keep an eye on the characters at all times and to direct their actions.

[14] How much power each controller has, though, is different in the two films. In Pleasantville, the controller (played by Don Knotts posing as a television repairman) is not the creator of the sitcom world, although he does maintain it. He can adjust it by putting people into the world, or taking them out. The controller is very careful about bestowing this privilege. Only those who truly long to live in this idealized world are eligible. He only finds one suitable candidate, the teenager David (played by Tobey Maguire) whose real life is disruptive enough to cause him to immerse himself in the details of the program. His twin sister Jennifer (played by Reese Witherspoon) gets dragged along inadvertently. But when David wants to get them out of Pleasantville, the controller is personally offended. He had expected only cooperation and gratitude for this special girl. He becomes petulantly angry, won't make contact, and works against David's wishes.

[15] In The Truman Show, Christof (played by Ed Harris) is the creator, not just the maintainer, of the sitcom world. The show is his idea and passion, and he believes completely in his own vision of utopia. He commands a large number of workers and actors, sophisticated equipment, and a world-like dome to contain it all. He can withdraw or insert characters into the show. In the case of Truman Burbank (played by Jim Carrey), Christof feels the right to make life and death decisions about him, especially since Truman was the first baby to be legally adopted and raised by a corporation. Though distant and unknown to Truman, Christof believes he loves Truman, has given him the perfect life, and does it all for Truman's own good. Yet it is clearly his own will that Christof loves. He is determined to let nothing ultimately alter it. To maintain his ideal world, Christof must go to great lengths to keep Truman in Seahaven and in the dark. Christof does this by frustrating Truman's hopes, instilling phobias and fears, and having his screen father eliminated. When Truman's growing knowledge causes him to act unpredictably, Christof is even willing to have Truman killed.

[16] Next in the hierarchy of knowledge and power are those who know they are in a show. In Pleasantville, that is only David and his sister. David tries to maintain the status quo, but Jennifer works against it. Both feel they are benefiting the others. In The Truman Show everyone knows it's a show but Truman. Their job is to insure the show follows the will of the creator. The actors are tightly controlled and must sustain an ongoing deception of Truman whether as coworker, wife, or best friend. Their jobs on this lucrative, successful show are always at stake. The workers feel controlled by Christof, who appears even in the middle of the night to check on things. Although they protest, they can't prevent Christof from trying to drown Truman in the fabricated storm.

[17] Finally there are the actors who have no idea they are on stage. On the surface they seem content and have no desire for change - at least the controller believes this. But time reveals that they are vaguely unsatisfied. Not knowing change is possible, however, they feel they must cooperate and adjust. As they gain knowledge, things do begin to alter, but not always in their favor. Relationships end, the weather gets worse, choice and risk are introduced, confusion and pain set in. Fulfillment and growth come at the expense of placidity and predictability.

[18] The male lead actors are opposites in these two films. David who becomes Bud in Pleasantville has a fair understanding of the difference between fiction and fact, although he prefers the fictionalized world of the show. For Truman, on the other hand, fiction and fact are the same. David's dissatisfaction and longing get him into the show. Truman's nascent dissatisfaction and growing suspicion are what get him out. Knowing the truth, neither wants to remain in these static worlds. But David/Bud (and his sister) becomes concerned to free the others, while Truman simply wants to free himself.

[19] The shows' viewers have an intriguing place in this hierarchy. They are seemingly free: they know the truth and they are on the outside. But, although they are well aware that this is a television program, they are so absorbed by it that it colors or even replaces their own lives. Thus, even though they have considerable knowledge, they don't affect much change. In Pleasantville, we learn from the controller that the viewers simply want the reruns to stay the same. In The Truman Show, through their viewing habits and purchases, the audience potentially has the power to keep the show alive or to end it. They could alert Truman to his situation, or turn off the set. But most don't do these things because they are so captivated by eavesdropping on him. Some leave it on twenty-four hours a day, and many are formed by this show, owning its products, working in its businesses, intently discussing the characters, arranging their lives around the episodes.

[20] At first glance, these films seem very irreverent towards the cultural ethos that supports their own industry's existence. They suggest that audiences are easily manipulated, overly caught up in screen stories, and also quite fickle. The last scene in The Truman Show is exemplary. Two garage attendants, one minute so obsessively caught up in Truman's life that they ignore their business, the next minute when he's gone just look, with very little emotion, for something else to watch. Perhaps, instead, the films simply represent an in-house poke by movie-makers at the more superficial stories of television programs. But they would know the two media's audiences overlap.

[21] More trenchantly, these films prompt questions about our media-cultivated voyeurism. A voyeur has an obsessive interest in watching without being known or noticed. In the case of screen stories, we know we watch actors, but the best films are the ones that most convincingly foster the illusion that we have a ringside view of a real life. In The Truman Show, this voyeurism is real. Through some 5,000 hidden cameras anyone can watch almost every aspect of Truman's life without being known by him. Of course humans have always watched and evaluated each other, but media-viewing is a peering without chance of participating. So much pseudo-intimacy can only exacerbate for viewers the common contemporary complaint of alienation. In the two films, community of a sort is formed around watching and discussing the shows, but when the program dissolves, there is little left to link the people.

[22] But the filmic gaze does not go only one way. As Michel Foucault indicates, a society that closely watches its members in order to control them is most successful when it gets the members to internalize the gaze and police themselves. Truman does not know he is being watched, but he's been controlled through the camera all his life. No matter what impulse he's ever had to act unpredictably or to break free, he finds himself amazingly blocked. He takes this as a matter of course and adjusts his behavior. But when he eventually figures out the truth he is willing to risk death in order to get off camera. Are we controlled by the filmic gaze? At first glance, we believe we are the viewers, not the viewed. But self-assessment and self-regulation happen regularly as we adjust our self-image and behavior in order to conform more closely to the ideal presented to us through the video frame. In addition, hidden video cameras are an increasing factor in everyday life.

[23] What solutions do the films offer? In Pleasantville sex is equated with liberation. As characters gain sexual knowledge, they become more fully human (and colored). Also, it is ironic that other fictions and images help liberate them. (All the books that surprisingly get words on their formerly blank pages are classic stories, as well as a book of modern art.) Even though the film opens by having teachers in the 1990s giving students dire predictions about the world, the innocence and placidity of 1950s Pleasantville is boring to the time-travelers. But they have nothing to offer except what they have just left. Change, rather than simply being inevitable, is presented as a value in itself

[24] In The Truman Show, too, the problematic standards that prompted the need for an idealized world in the first place are all the film-makers have to liberate Truman. Thus, individual freedom and autonomy, the ability to break connections and defy authority, are the only options for Truman. He can't redeem or reform his community, he can't form a relationship with Christof; he can only rebel and leave.

[25] Both films show, though, that change will bring pain and risk, not just liberation. They are realistic about the price of freedom and knowledge. And they are good at exploding our idealized fantasies about how much we would love the perfect world. However, their image of perfection is limited to material security, comfort, predictability, good weather, and placid relationships.

[26] Whether or not intended, these films graphically portray some of our society's worst fears and fantasies about God, and about God's relationship with humankind. As I said earlier, this is not to claim that the films are 'religious,' 'Christian' or 'anti-Christian.' Nor can they only be read in this way. But I know from experience that some audiences will, in fact, pick up on a film's potential theological implications, and incorporate, dialogue with, or be challenged by them. Although this is often done fleetingly or unconsciously, the process can be accessed and explored when a group gathers to discuss particular films. I believe this effort creatively links theology and culture in ways we can and must productively pursue, especially given the influence of media today.

[27] In Pleasantville, the god-figure is not the creator, but simply the maintainer of the status quo. He has some significant power, but is not omnipotent or sovereign. Reminiscent of George Bum's portrayal of God in the Oh God films, this god speaks to his characters from a television set, so he can be visible when he chooses. But he doesn't necessarily come when you need or want him. In fact, this god comes across as immature, vengeful, easily upset, and sulky when disappointed. He does not have his characters' best interests at heart, and yet has a self-centered need for gratitude and appreciation. If his own interests are at stake, however, he becomes fearful and amenable to compromise.

[28] Doesn't this sound like the root of many persons fear of God, and resulting compliance or rebellion? God is recognized to have great power, but cannot be trusted to use it in a loving manner or for our good. "He" is only available when he feels like it, but is constantly evaluating us from afar. This God seems to have an inordinate interest in getting his own way; his will must be done. In order to avoid trouble, or to get what one needs, one must work to placate such a God and find out what he wants. At the least, one must give the appearance of going along, being grateful, and not disrupting his plans. The only other alternatives, according to the film, are to similarly trick or use such an inadequate God. Or, ideally, one can maturely reject this God and bravely face uncertainty and risk with human strength alone.

[29] The god-figure in The Truman Show is more powerful, but also more dangerous and less reasonable. His ultimate creation doesn't even know he exists. He is never visible, always distant and inaccessible, but his creation feels the control. This god is the ultimate voyeur. He jealously protects his own privacy while giving none to others. With his advanced technology, nothing goes unobserved and uncontrolled. This god is dependent upon his creation; he lives to control it. The world is his grand experiment and those who know him fear him. They rightly recognize him as creator and sustainer, and know their roles and livelihoods depend on obeying and pleasing him. He is creative enough to adapt a measure of unpredictability into his overall plan, but true freedom is not allowed.

[30] This is an excellent parody of a more sophisticated, but no less problematic, theology of God. On the plus side, it is often said that God (like Christof) is determined to have the divine will done, but that we can trust this plan because God knows best. It is said that God is not a petty or petulant despot (unlike the Don Knotts character in Pleasantville). Like Christof, God is uncontrolled by our machinations and is able to accommodate all our choices into the divine vision. Like Christof, too, God does not force people to be robots, but gives them a measure of freedom. In this type of theology, God, from behind the scenes, makes sure everything goes according to the ultimate plan. God has created us and loves us even when we don't realize it. (In a parody of this, Christof is shown stroking Truman's sleeping image on the television screen). Like both Christof and the Don Knotts character, God is constantly watching, and has a hidden side which is inaccessible to humankind. These are standard components in many persons' view of a sovereign and benevolent God. But what is wrong with this picture, when transposed into film?

[31] The gods in these movies (especially The Truman Show), although incorporating some key elements in a contemporary understanding of God, skew or omit others. In both films, full human freedom goes against the gods' arrangements. They are not god enough to permit it. Nor are their plans as good and benevolent as they believe. Christof, in particular, is a self-deluded and obsessive god. He does not truly love Truman - even though he shows some affection for him. This is not a god who created out of overflowing love and is determined to work with humans until they can enjoy true partnership. He is not self-sacrificing and never tries to form a relationship with his creation. Indeed, it is key to the whole scheme that he keeps his existence hidden from Truman. Rather than longing to be known, this god needs to remain secret. In addition, Christof does not really fight evil or remove it from Truman's world. Instead, this god just keeps the prerogative for himself.

[32] Again, all this reflects common, though problematic, views of God. But the films suggest that if we prize our freedom, we have no choice but to rebel and depart from gods such as these. If we are content to believe such a God has our best interests at heart, the films indicate that we, like Truman, are sadly deluded. The implication is that we are allowing ourselves to be bought off by petty favors in order to avoid the risk and pain of bravely facing life on our own strength. Even if we don't put much stock in God, the film hints that we may nevertheless be God's grand experiment, controlled without knowing it, being watched obsessively, subconsciously conforming to the divine plan. The films indicate, too, that we may not always know the difference between illusion and reality, or fiction and fact, and are more malleable than we realize. Even the names in The Truman Show could be taken as tongue-in-cheek parodies. Christof is 'of Christ,' but really an obsessive control-freak. Truman, who seems representative of the ideal or 'true man,' is really just a grand experiment mentally conceived in Burbank, a prime location of the image producing industry.

[33] Both films, then, are good at making graphic some inadequate perceptions of God. This makes it easier to start a theological discussion around the issues. But such a discussion will also challenge believers who have relied on such views or who harbor them unknowingly. As useful as the films are at starting a discussion, however, they give no good answers for people of faith. They show no alternatives for mature human beings except to reject God and accept the consequences. They offer no standard of discernment when trying to separate fiction and fact, no way to tell if we, on a cosmic scale, are the watchers or the watched, no guide for knowing how free we are or how much controlled.

[34] These films offer only flight, change and individual freedom as routes to human liberation, even though they honestly recognize that these contemporary values are not unmixed blessings. But they find the risks preferable to a world where we have only stasis and the illusion of freedom. Many believers would agree with them. In framing the issues this way, the films open up the classic questions of free will versus determinism, or our will versus God's. But it is we who have to ask the further questions. Does the living God stand against human freedom? Does God only support the status quo, or permit, even encourage, change? If God supports freedom and change, what is the price? Can we still trust that God's promises and plans will triumph in the end? And what do we use to help answer these questions?

[35] Anyone leading a theological discussion around these two films should be prepared to depart from the filmic "texts". In any case, this is the key in using films as a bridge to theological discussion. While we should first try to understand the film's point of view, evaluate why it appeals or repels, and appreciate its ability to give pleasure and meaning, we can't stop there. If we want to speak a prophetic, critical, or constructive word to our culture, we will have to deepen the conversation which the film has so graphically launched. In using these two films, facilitators will have to do their homework, and be prepared to present a much richer array of theological options about the character, intentions, and power of God, and a more realistic evaluation of human freedom, with all its potential, limitations, and risks.

Bel Ami - (2012) - Rotten Tomatoes, Beliam

Bel Ami (2012)

Bel Ami (2012)

Possessed by love. Consumed by desire. Not so great of a movie! The choice of Robert Pattinson as the hero, or antihero of Guy de Maupassant's novel is probably the main reason for the overall failure of the movie adaptation. Missing the artistic maturity necessary to sustain the depth of a complex character, he seems to feel uncomfortable in his role, and whereas at the beginning his pale, embarrassed face and posture may be suitable for the part of a former poor soldier entering the glittering world of high society, once he is part of it, those same face and posture reveal his true feeling ill at ease in what is a totally unsuitable role for him. That's why the story, centred on his figure, develops in a boring, pedantic way, showing no punch and no real pathos, in search for a bounce that never comes. Nothing to say against the brilliant female performances, the frivolous Christina Ricci is the only one who enlivens the pale and inexpressive face of Georges, but Uma Thurman and Kristin Scott Thomas compete for the best performance, the first perfect in the role of the ambiguous Madeleine, and the latter courageous in her role of an ageing married woman, losing her mind for a young lover, and the last scene with her dressed in black at her daughter's marriage to Georges proves the only vivid moment within the whole picture. Georges Duroy is a penniless soldier returning from war. He travels to Paris in a search for ways to improve his social and financial status. He uses his wit and powers of seduction to charm wealthy women.

Bel Ami Quotes

Clotilde de Marelle:

You're just one of them, after all. Just another selfish, brutal man. Just another thief.

Clotilde de Marelle:

You're just one of them, after all. Just another selfish, brutal man. Just another thief.

Clotilde de Marelle:

You're just one of them, after all. Just another selfish, brutal man. Just another thief.

Clopidogrel Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Clopivas

clopidogrel

GENERIC NAME(S): CLOPIDOGREL BISULFATE

Uses

Clopidogrel is used to prevent heart attacks and strokes in persons with heart disease (recent heart attack ), recent stroke. or blood circulation disease (peripheral vascular disease).

It is also used with aspirin to treat new/worsening chest pain (new heart attack. unstable angina ) and to keep blood vessels open and prevent blood clots after certain procedures (such as cardiac stent ).

Clopidogrel works by blocking platelets from sticking together and prevents them from forming harmful clots. It is an antiplatelet drug. It helps keep blood flowing smoothly in your body.

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

This medication may also be used to prevent heart attacks and strokes in persons with irregular heartbeat (atrial fibrillation ).

How to use clopidogrel

Read the Medication Guide provided by your pharmacist before you start taking clopidogrel and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually once daily. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

The dosage and length of treatment are based on your medical condition and response to treatment. If you are taking this medication to prevent clots after a stent implant or other procedure, take this medication with aspirin for many months to years after the procedure (depending on the procedure/type of stent) as directed by your doctor. Consult your doctor for more details and about the risks of stopping early. It is important to continue taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.

Get medical help right away if you have any signs that this medication is not working, such as symptoms of a new heart attack or stroke (such as chest/jaw/left arm pain, shortness of breath, unusual sweating. weakness on one side of the body, slurred speech, sudden vision changes, confusion).

Side Effects

Easy bleeding/bruising, stomach upset/pain, diarrhea. and constipation may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

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

Although unlikely, serious bleeding in the stomach. gut, eyes. or brain may occur. Also, clopidogrel can rarely cause a very serious blood disorder (thrombotic thrombocytopenic purpura-TTP). Symptoms may appear any time after starting this medication. Get medical help right away if any of these symptoms occur: severe stomach/abdominal pain. uncontrolled bleeding from gums or nose, bloody/black stools, confusion, fever, extreme skin paleness, purple skin patches, fainting. fast heartbeat, sudden severe headache. unusual weakness/tiredness, vomit with blood or that looks like coffee grounds, slurred speech, vision changes, seizures. yellowing eyes /skin, bloody/red/pink/dark urine, signs of kidney problems (such as change in the amount of urine).

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

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

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

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

Precautions

Before taking clopidogrel, tell your doctor or pharmacist if you are allergic to it; or to similar antiplatelet drugs (thienopyridines such as prasugrel); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding conditions (such as stomach ulcers, bleeding in the brain /eye), recent surgery, serious injury/trauma, liver disease, bleeding disease (such as hemophilia ).

To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Your doctor may instruct you to stop clopidogrel for 5 to 7 days before surgery. Do not stop taking clopidogrel without talking with your heart doctor (cardiologist) first.

This medicine may cause stomach bleeding. Daily use of alcohol while using this medicine may increase your risk for stomach bleeding. Limit alcoholic beverages. Ask your doctor or pharmacist about how much alcohol you may safely drink.

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

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

Interactions

See also How to Use section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: repaglinide, tipranavir.

If you are currently taking aspirin, consult your doctor promptly and ask whether to continue or stop taking it with this medication for your specific condition (aspirin and clopidogrel may be used in combination after a coronary stent procedure, or for some heart conditions). If you are not currently taking aspirin, consult your doctor before starting it for any medical condition.

Other medications can affect the removal of clopidogrel from your body, which may affect how clopidogrel works. Examples include certain acid reducers (proton pump inhibitors/PPIs such as omeprazole, esomeprazole), fluvoxamine, fluoxetine, cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate, and ticlopidine, among others. Promptly ask your doctor or pharmacist for more details.

Clopidogrel can slow down the removal of other drugs from your body, which may affect how they work. An example of an affected drug is dasabuvir.

Do not use non-prescription medications that contain PPIs (such as omeprazole, esomeprazole) or cimetidine for relief of upset stomach or heartburn. These medications can prevent clopidogrel from working well. Ask your doctor or pharmacist about safer alternatives such as liquid antacids, ranitidine, or famotidine.

Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as ibuprofen, naproxen, or aspirin). These drugs may increase the risk of bleeding/antiplatelet effect when used with clopidogrel. Ask your pharmacist about using these products safely.

Overdose

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

Notes

Do not share this medication with others.

Laboratory and/or medical tests (such as complete blood count) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Missed Dose

If you miss a dose, use it as soon as you remember. If it is less than 12 hours before your next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

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

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

Information last revised May 2016. Copyright(c) 2016 First Databank, Inc.

Images

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, expect as may be authorized by the applicable terms of use.

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

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Special Drug Use Investigation For Adoair Metered-Dose Inhaler (Pediatric) - Full Text View, Adoair

Special Drug Use Investigation for ADOAIR Metered-dose Inhaler (Pediatric)

Japanese pediatric patients (aged < 15 years) who diagnosed as having bronchial asthma for which the indication of ADOAIR has been approved and who are using ADOAIR for the first time and expected for a long-term use.

ADOAIR must be used for the first time

ADOAIR used for a long-term

Patients with hypersensitivity to salmeterol and fluticasone

Patients with infection which salmeterol and fluticasone is not effective

Patients with deep mycosis

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials. gov identifier: NCT01332422

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Adenosine Uses, Side Effects, Interactions And Warnings, Adenosan

ADENOSINE

Overview

Adenosine is a chemical that is present in all human cells. It readily combines with phosphate to form various chemical compounds including adenosine monophosphate (AMP) and adenosine triphosphate (ATP). People use it for medicine.

ATP is used under the tongue to increase physical energy. It is also given intravenously (by IV) for treating acute kidney failure. multiple organ failure, high blood pressure in lung arteries (pulmonary hypertension ), cystic fibrosis. lung cancer. weight loss associated with cancer. and controlling blood pressure during anesthesia and surgery. It is also used for cardiac stress tests .

Healthcare providers give adenosine intravenously for treating surgical pain and nerve pain. pulmonary hypertension. and certain types of irregular heartbeat. It is also given for controlling blood pressure during anesthesia and surgery and for heart tests called cardiac stress tests.

Adenosine is injected into the space around the spinal cord to treat nerve pain.

Adenosine phosphate is given by injection into the muscle (intramuscularly) for treating varicose veins. bursitis. pain and swollen tendons (tendonitis ), itchiness, multiple sclerosis (MS), neuropathy. shingles (herpes zoster infection), cold sores and genital herpes (herpes simplex infections), and poor blood circulation.

How does it work?

Adenosine blocks faulty circuitry in the heart, which causes irregular heart rhythm. Adenosine triphosphate (ATP) might prevent changes in energy metabolism that cause weight loss in people with advanced cancer.

Uses

Effective for

Treating certain kinds of irregular heartbeat (as a prescription-only intravenous medicine).

Possibly Effective for

Treating weight loss in people with advanced cancer. Intravenous ATP seems to improve appetite, food intake, and quality of life in people with advanced non-small-cell lung cancer and other tumors.

Wounds, usually in the legs, due to poor circulation (venous stasis ulcers). Intramuscular AMP might relieve fluid retention, itchiness, swelling and redness due to venous stasis ulcers.

Insufficient Evidence for

Shingles (herpes zoster infection). Early research suggests that AMP given by injection into the muscle might be effective for treating herpes zoster (shingles) infection and for preventing nerve pain that follows these infections. Intramuscular AMP might also be effective for treating other kinds of herpes infections, according to limited research.

Lung cancer. Developing studies suggest that ATP is not effective for treating non-small-cell lung cancer.

Pain.

Other conditions.

More evidence is needed to rate the effectiveness of adenosine for these uses.

Side Effects

Adenosine appears to be safe for most people when given by injection by qualified healthcare givers. It can cause breathing problems and chest pain, particularly when given at high doses. Headache, heart pounding, low blood pressure. nausea, sweating, flushing, lightheadedness, sleep problems, coughing, and anxiety can also occur.

Special Precautions & Warnings:

Pregnancy and breast-feeding . Not enough is known about the use of adenosine during pregnancy and breast-feeding. Stay on the safe side and avoid use.

Gout . ATP can raise the level of uric acid in the blood stream and in the urine, and this might trigger a case of gout. Gout causes red, hot, tender, swollen joints. The joint that is most often affected is at the base of the big toe.

Heart disease . ATP can cause reduced blood flow to the heart and chest pain. It might worsen symptoms in patients with heart diseases such as chest pain and heart attack.

Interactions

Major Interaction: Do not take this combination

Dipyridamole (Persantine) interacts with ADENOSINE

The body breaks down adenosine to get rid of it. Dipyridamole (Persantine) can decrease the break down of adenosine. Decreasing the breakdown of adenosine can cause heart problems. Do not take adenosine if you are taking dipyridamole (Persantine).

Moderate Interaction: Be cautious with this combination

Carbamazepine (Tegretol) interacts with ADENOSINE

Adenosine can slow down the heart beat. Taking carbamazepine (Tegretol) with adenosine might cause the heart to beat too slowly. Do not take adenosine if you are taking carbamazepine (Tegretol).

Minor Interaction: Be watchful with this combination

Medications for gout (Antigout drugs) interacts with ADENOSINE

Gout is caused by a build-up of uric acid crystals in the joints. Adenosine can increase uric acid in the body and might reduce the effectiveness of medications for gout. Some medications for gout include allopurinol (Zyloprim), colchicine, probenecid (Benemid), and others.

Methylxanthines interacts with ADENOSINE

Methylxanthines might block the affects of adenosine. Adenosine is often used by doctors to do a test on the heart. This test is called a cardiac stress test. Stop drinking black tea or other caffeine containing products at least 24 hours before a cardiac stress test. Methylxanthines include aminophylline, caffeine, and theophylline.

Dosing

The following doses have been studied in scientific research:

INTRAVENOUS .

For certain types of irregular heartbeat and also for weight loss in people with advanced cancer: Healthcare providers give adenosine as a shot (by injection).

INTRAMUSCULAR .

For treating wounds in the legs due to poor blood circulation: Healthcare providers give adenosine intramuscularly (by injection into the muscle).

Conditions of Use and Important Information: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. Information from this source is evidence-based and objective, and without commercial influence. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version. © Therapeutic Research Faculty 2009.

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Topilep (Topamax) Forklaring

Topilep fokuserar pa kan vara avhjalpa anfall som individer tillsammans med Lennox-Gastaut symtom samt epilepsi. Det anvands ocksa for att undvika migran samt infantila muskelspasmer.

Topilep faktiskt utfor genom att minska sinne turbulensen. Det ar verkligen kramplosande.

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Allmant titeln i samband med Topilep ar faktiskt topiramat.

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Topilep (Topamax) Dose

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Bar den med munnen samtidigt varje dag, utan eller med maltider.

Topilep kan anvandas tva ganger per dag (i en tidsperiod och sjalva kvall).

Forhindra kolhydratfattig och fettrik kost.

Seniorer bor vara forsiktig tillsammans med Topilep.

Om du vill astadkomma basta resultaten brukar inte sluta anvanda Topilep helt plotsligt.

Topilep (Topamax) I brist forknippas med doserings

Vanligtvis far inte dubbel dos. Om du hoppar over dosen du behover for att bara den nar du kom ihag nar det galler din saknas. Nar det ar dags for dosering du behover bara pa din egen normal dosering rutin.

Topilep (Topamax) Overdosering

Om du overdoserar Topilep och du undviker ocksa stor att du behover kolla din lakare eller ens lakare omedelbart. Forknippas med Topilep overdosering: sensation somnig, problem med tal, suddig syn, dubbel syn, trotthet, bristande skicklighet, otillrackliga kunskaper, yrsel, obehag i samband med magen, trotthet, kasta upp, svara mat cravings, kaos, depressioner, dyspne, missforstand, minskad hunger, vissa svaghet i samband med muskelmassa, obehag i samband med benvavnad, bruit, koma.

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Topilep (Topamax) Negativa effekter

Topilep erbjuder de negativa effekterna. Den mest typiska tenderar att vara:

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Mycket mindre typiska och allvarliga negativa effekter i hela anvander Topilep:

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Negativa effekter indikationer beroende av medicin du kanske anvander men dessutom lita pa ditt valbefinnande villkor och en annan aspekter.

Topilep (Topamax) Kontraindikationer

Vanligtvis inte far Topilep om du ar kanslig for att Topilep element.

Vanligtvis inte far Topilep om du vantar, kommer att bli gravid och / eller ammar.

Var forsiktig om du anvander nagon form av lakare ordinerats eller receptfria lakemedel, naturlig beredning, eller ens komplettera.

Var forsiktig om du anvander ipratropium (t. ex. pa grund Atrovent); rorelse sjukdom, atrabiliario intestinal sjukdom, psykisk sjukdom, urin: fragor, Parkinsons sjukdom, sar mediciner; orala p-piller; metazolamid; kramper lakemedel (karbamazepin (sa eftersom Tegretol), fenytoin (sa eftersom Phenytek, Dilantin), metformin (sa eftersom Glucophage), metall, salicylat smartstillande (t. ex. pa grund kolinsalicylat (sa eftersom Arthropan), aspirin, kolin magnesium trisalicylate (t. ex. pa grund Trisalate), diflunisal (sa eftersom Dolobid), magnesiumsalicylat (sa eftersom Doan s), diklorfenamid (sa eftersom Daranide), digoxin (sa eftersom Digitek, Lanoxin), zonisamid (sa eftersom Zonegran), lugnande medel, acetazolamid (sa eftersom Diamox); valproinsyra surhetsgrad (sa eftersom Depakote, Depakene), kolestyramin (t. ex. darfor att Questran), somntabletter, antidepressiva, isoniazid (sa eftersom Nydrazid, INH). antihistaminer, salsalat (sa eftersom Salgesic, Argesic, Disalcid), vila tabletter

Var forsiktig for dem som har brost, njur - eller ens sjukdomar i levern, diabetes, glaukom, ihallande obstruktiv pulmonell sjukdom, narsynthet, diarre, metabolisk acidos, njur adelstenar.

Forhindra kolhydratfattig och fettrik kost.

Forhindra att bli uttorkad.

Seniorer bor vara forsiktig tillsammans med Topilep.

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Om du stoter pa somnighet samt trotthet medan du anvander Topilep maste du forhindra nagon form av atgarder till exempel reser eller ens arbetsutrustning.

For att undvika att bli gravid, hur man anvander ytterligare en typ av preventivmedel bara for att skrap preventivmedel tabletter kanske inte fungerar sa fint nar du utnyttjar Topilep.

Forhindra alkoholhaltiga drycker medan du anvander Topilep.

Det kan vara skadligt att forhindra Topilep anvander helt plotsligt.

Topilep (Topamax) Vanliga fragor

Queen: Vad ar Topilep?

Det ar verkligen anticonvulsant. A

Queen: Vad ar Topilep fokus pa?

Topilep fokus kan vara avhjalpa anfall som individer tillsammans med Lennox-Gastaut symtom samt epilepsi. Det anvands ocksa for att undvika migran samt infantil muskel spasms. A

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