Buy Heart Disease - Presoquin (Brand Name Cardizem) Online - Order Cheap Diltiazem - Purchase Heart

Cardizem is used for treating supraventricular tachycardia, a rhythm disturbance of the heart. It is also used for controlling heart rate response to other rhythm disturbances, specifically, atrial fibrillation and flutter. Cardizem is a calcium channel blocker. It works by slowing the electrical conduction in the heart, slowing heart rate, and/or normalizing heart rhythm.

Use Cardizem as directed by your doctor.

Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take Cardizem with a full glass of water. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time.

It is important to use Cardizem regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Do not stop taking this medication without first talking to your doctor. If you stop taking Cardizem suddenly, your condition may become worse.

If you are being treated for high blood pressure, keep using this medication even if you feel fine.

If you miss a dose of Cardizem, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

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

Store Cardizem at room temperature away from moisture and heat. Keep Cardizem out of the reach of children and away from pets.

Active Ingredient: Diltiazem.

Do NOT use Cardizem if:

you are allergic to any ingredient in Cardizem

you have sick sinus syndrome or have second - or third-degree heart block and do not have a pacemaker, or very low blood pressure

you have atrial fibrillation or flutter and a pre-excitation syndrome (extra conduction pathway in the heart), such as Wolff-Parkinson-White syndrome (WPW) or Lown-Ganong-Levine syndrome (LGL)

you are receiving injectable beta-blockers (eg, metoprolol) or erythromycin.

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

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

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

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

if you have heart failure or have had a recent heart attack with lung congestion, heart block, low blood pressure, a very slow heart rate, or abnormal heart rhythm

if you have kidney or liver disease.

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

Cimetidine or protease inhibitors (eg, indinavir) because they may increase the actions and side effects of Cardizem

Rifampin because it may decrease the effectiveness of Cardizem

Amiodarone, cisapride, digoxin, erythromycin, protease inhibitors (eg, indinavir), quinidine, tricyclic antidepressants (eg, desipramine), theophylline, or general anesthetics because toxic effects on the heart may occur

Benzodiazepines (eg, midazolam), beta-blockers (eg, metoprolol), buspirone, carbamazepine, cilostazol, corticosteroids (eg, prednisone), cyclosporine, HMG-CoA reductase inhibitors (eg, atorvastatin), macrolide immunomodulators (eg, tacrolimus) because the risk of their side effects, some potentially life-threatening, may be increased by Cardizem.

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

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

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

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

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

Lab tests, including electrocardiogram (ECG), heart rate, and blood pressure monitoring, may be performed while you use Cardizem. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Use Cardizem with caution in the elderly; they may be more sensitive to its effects.

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

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

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

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

Constipation; dizziness; facial flushing; headache; weakness.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); hallucinations; irregular heartbeat; swelling of the feet or hands; symptoms of liver problems (eg, yellowing of the skin or eyes, dark urine, pale stools); tender, bleeding, or swollen gums.

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.

Lockton Expands Aviation Practice, Peter Schmitz To Lead - Kwes Newswest 9, Loctin

Lockton Expands Aviation Practice, Peter Schmitz to Lead - KWES NewsWest 9 / Midland, Odessa, Big Spring, TX: newswest9.com |

Information contained on this page is provided by an independent third-party content provider. Frankly and this Station make no warranties or representations in connection therewith. If you are affiliated with this page and would like it removed please contact pressreleases@franklyinc. com

Prominent aviation insurance veteran joins top independent broker

KANSAS CITY, Mo. Aug. 1, 2016 /PRNewswire/ -- Lockton has named Peter Schmitz Senior Vice President and Aviation Practice Leader as part of a significant long-term investment in its aviation risk management operations. Lockton, the world's largest privately held, independent insurance broker, plans to expand its services to firms across the spectrum of the aviation industry, including corporate aircraft, aircraft management and charter, aircraft parts and component manufacturers, airport operations including fixed base operators (FBOs), aircraft repair and overhaul as well as passenger and cargo airlines.

Schmitz is an aviation insurance industry veteran with 31 years of experience advising clients, structuring insurance programs, and building expert teams. Schmitz will build on Lockton's existing aviation teams in the US and London to enhance its capabilities. Most recently, Schmitz was CEO of Aon's Global Aviation Specialty business. He has also been a leader in Marsh's US Aviation Specialty operations.

" Peter Schmitz has tremendous insight into the risks and business issues facing the aviation industry and has distinguished himself as a client advisor," said Glenn Spencer. Chief Operating Officer and President of Lockton's US operations. "We are very pleased that he will help guide our growth plans and expand our team in the aviation specialty insurance sector. We already have a solid group of clients and talented Associates on which to build. Peter will be a great fit with our collaborative, entrepreneurial culture."

Risk & Insurance magazine has honored him as a "Power Broker" based on his work with clients. He is a graduate of Florida Institute of Technology who began his career as a commercial pilot, later transitioning to become an aviation insurance underwriter. Schmitz is still a licensed commercial and instrument-rated pilot.

Schmitz will be based in Lockton's South Florida operation at 3601 SW 160th Avenue, Suite 200 in Miramar, Florida 33027. The phone number is 954.883.2000

About Lockton More than 6,000 professionals at Lockton provide 50,000 clients around the world with risk management, insurance, employee benefits consulting, and retirement services that improve their businesses. From its founding in 1966 in Kansas City, Missouri. Lockton has attracted entrepreneurial professionals who have driven its growth to become the largest privately held, independent insurance broker in the world and 9th largest overall. For seven consecutive years, Business Insurance magazine has recognized Lockton as a "Best Place to Work in Insurance." To see the latest insights from Lockton's experts, check Lockton Market Update .

©2016 PR Newswire. All Rights Reserved.

Tenasil Online Without Prescriptions, Tenasil

Lamisil is used for treating fungal infections of the fingernails and toenails. Lamisil is an antifungal agent. It works by killing sensitive fungi.

Use Lamisil as directed by your doctor!

Take Lamisil by mouth with or without food.

Lamisil is usually taken for 6 to 12 weeks depending on your condition. Maximum benefits may not be seen for several months after discontinuing treatment; this includes the time period necessary for the outgrowth of healthy nail.

To clear up your infection completely, take Lamisil for the full course of treatment. Keep taking it even if you begin to see improvement before the end of your therapy.

If you miss a dose of Lamisil, 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 Lamisil.

Store Lamisil below 77 degrees F (25 degrees C) in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Lamisil out of the reach of children and away from pets.

Active Ingredient: Terbinafine hydrochloride.

Do NOT use Lamisil if:

you are allergic to any ingredient in Lamisil

you have severe kidney problems or a history of liver problems.

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

Some medical conditions may interact with Lamisil. 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 problems, lupus, psoriasis, or alcohol abuse or dependence

if you have a weakened immune system.

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

Cimetidine because it may increase the risk of Lamisil's side effects

Rifampin because it may decrease Lamisil's effectiveness

Antiarrhythmics (eg, flecainide, propafenone), beta-blockers (eg, metoprolol), monoamine oxidase type B (MAO-B) inhibitors (eg, selegiline), selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine), or tricyclic antidepressants (eg, amitriptyline) because the risk of their side effects may be increased by Lamisil

Anticoagulants (eg, warfarin) because their effectiveness may be decreased or the risk of their side effects may be increased by Lamisil.

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

Avoid large amounts of food or drink that have caffeine (eg, coffee, tea, cocoa, cola, chocolate) while you are taking Lamisil.

Lab tests, such as liver function tests, may be performed while you use Lamisil. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

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

Pregnancy and breast-feeding: Do not use Lamisil if you are pregnant. If you think you may be pregnant, contact your doctor right away. Lamisil is found in breast milk. Do not breastfeed while taking Lamisil.

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

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

Diarrhea; headache; indigestion; taste changes.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); red, blistered, peeling, or swollen skin; symptoms of infection (eg, fever, chills, sore throat); symptoms of liver problems (eg, dark urine; loss of appetite; pale stools; stomach pain; unexplained, persistent nausea; unusual tiredness; vomiting; yellowing of the skin or eyes); unusual bruising or bleeding; vision changes.

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

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Chloroptic (Chloramphenicol) Side Effects, Interactions, Warning, Dosage & Uses, Cloroptic

What are the precautions when taking chloramphenicol (Chloroptic)?

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

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: an eye infection due to a virus (e. g. herpes, varicella), another type of eye infection (e. g. tuberculosis, fungus), history of a bad reaction to chloramphenicol.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, anemia (low red blood cells), radiation therapy.

After you apply.

Last reviewed on RxList: 1/2/2005 This monograph has been modified to include the generic and brand name in many instances.

Ambroxol Tablets, Ambroxol Syrup, Exporters Of Ambroxol Tablets, Ambroxol Syrup Suppliers, Amoxol

Ambroxol Tablets/Ambroxol Syrups

Generic name: Ambroxol

Description of Ambroxol

Ambroxol is kind of strong expectorant, clinically proven active mucolytic agent. The medicine helps to remove sticky phlegm from the respiratory tract easily and quickly by enhancing the bronchial secretions that loosen congested phlegm. It also releases and strengthens tiny striking hairs inside the windpipe and bronchial tubes, which is referred to as the cilia. which can then expel the abnormal phlegm with their conveyor-belt like action. Ambroxol increases the body's production of surfactant which helps to overcome infection in the bronchi.

Available in tablets and syrup forms

Composition of Ambroxol

Each tablet contains ambroxol hydrochloride 30 mg.

Each 5 ml of the syrup contains ambroxol hydrochloride 15 mg.

Uses of Ambroxol

It is used to relieve chronic inflammatory pulmonary conditions.

It is used to treat bronchiectasis, bronchitis with bronchospasm asthma. During acute exacerbations of bronchitis the medicine should be given with the appropriate antibiotic.

The medicine has local anesthetic properties which contribute to the soothing effect of the syrup.

Safety Tips while Using Amboxol Medicine

Avoid using the medicine during the first trimester of pregnancy

Dosage of Ambroxol

For adults, one Ambroxol tablet (30 mg to 120 mg ) taken in 2 to 3 divided doses

Children up to 2 years: half a teaspoonful syrup two times daily

Children 2 - 5 years: half a teaspoonful syrup three times daily

Children over 5 years: One teaspoonful syrup two-three times daily.

Otherwise as directed by your physician.

Side effects of Ambroxil Tablets/Amborxol Syrup

There is no such harmful side effects of the medicine. It is usually well tolerated. In some cases, nausea and vomiting might occur.

Disclaimer: The above information is for general understanding of the visitor. Please consult a registered medical practitioner before taking the aforesaid medicine.

5 Ways To Do Lunges, Longes

How to Do Lunges

Lunges are an easy and efficient exercise to help build strength in your quadriceps, glutes, hamstrings, calves, and core. They are also relatively safe to do as they have simple movements that are easy to follow, and lunges require no special equipment to complete. Lunges are also great to help you improve your balance, increase your hip flexibility, develop better coordination, build muscle strength, improving spine health, enhancing your core stability, and toning a good variety of muscle groups to provide balance in strength and muscle growth. [1]

Steps Edit

Method One of Five: Performing the Forward Lunge Edit

Start in a standing position. Start by standing up straight with your feet hip-width apart and flat on the ground. Relax your shoulders and allow your shoulder blades to sink down towards your hips. Keep yourself in this position by flexing your abdominal muscles to keep your spine straight and stable. [2] [3]

Throughout a lunge exercise your arms and hands can be in any position that helps you maintain your balance. Some people may prefer to put their hands on their hips while others may prefer to keep their arms held out to the side.

Ideally you should keep your back straight throughout a lunge exercise. This means you should try to keep your head upright while looking straight ahead. However, if you need to look down to ensure you’re in the right position, that’s okay.

Some people find it helpful to stare at a particular space on a wall (or another object) directly in front of them to help keep their balance.

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Lift one foot off the floor and move it forward. Lift your right foot off the ground by bending your knee. Move your right foot forward like you’re taking a step. Place your right foot on the ground, heel first. Lean your body forward so you’re balanced on both feet, but keep your back and upper body straight. [4] [5]

/9/9c/Do Lunges Step 2 Version 2.360p. mp4

Lower your body until your right knee is at a 90-degree angle. While keeping your upper body and back straight, continue to move your body forward until your right upper leg (thigh) is parallel to the floor. Your right lower leg (shin) should be perpendicular to the floor. You may need to bend your hips slightly to stay in this position, but keep your back straight. [6] [7]

/c/c6/Do Lunges Step 3 Version 2.360p. mp4

Try not to move your right knee beyond your right foot. Your right knee should be positioned directly above your right ankle.

Once in the lunge position, your left (back) knee should also form a 90-degree angle, but your lower leg (shin) will be parallel to the ground while your upper leg (thigh) will be perpendicular to the ground.

Due to the position you’re in, you will only be able to keep your left toes on the ground. Your left heel will lift off the ground as you lean forward.

Push yourself upwards with your right foot. Use your right foot to push yourself upwards. Return your body to the position you started in, standing straight with your feet hip-width apart. [8] [9]

/5/55/Do Lunges Step 4 Version 2.360p. mp4

Repeat the forward lunge. Once you’ve completed a lunge with your right leg, you can either switch sides and perform a lunge with your left leg, or you can continue to work your right side. It doesn’t matter what order you do lunges in, but try to do an equal number of lunges using both your left and right side before you finish. [10] [11]

/2/2a/Do Lunges Step 5 Version 2.360p. mp4

Another alternative is to keep your right foot and left in the forward position, with your right foot flat on the ground, and unbend both your legs to move upwards.

In this position your legs will be in a v-shape with your right leg in front. In a standing position both your right and left feet will be flat on the ground.

After moving to this standing position, bend your legs and lower your body back into the lunge position. Repeat this several times and then switch to your left side.

Method Two of Five: Reversing the Lunge Edit

Start in a standing position. Start the reverse lunge by standing straight up with your feet flat on the ground, hip-width apart. Keep your shoulders relaxed and keep your back straight and stable by using your abdominal muscles. [12] [13]

Throughout a lunge exercise your arms and hands can be in any position that helps you maintain your balance. Some people may prefer to put their hands on their hips while others may prefer to keep their arms held out to the side.

Move your left foot and leg backward. Lift your left foot off the ground and move it backward. Lower your body until your left foot touches the ground, toes first. [14] [15]

Keep both of your legs at 90-degree angles. Once your left foot touches the ground, continue to shift your body backward until both your right and left legs form 90-degree angles at the knees. Your right lower leg (shin) should be perpendicular to the floor and your right upper leg (thigh) should be parallel to the floor. Your left lower leg (shin) should be parallel to the floor while your left upper leg (thigh) should be perpendicular to the floor. [16] [17]

You’re left foot will remain with only your toes touching the ground.

Return to your starting position. Push off the floor with your left foot until you’re able to return to the starting position. Return your feet beside each other, both flat on the ground, hip-width apart. [18] [19]

Repeat the reverse lunge. Repeat the reverse lunge by either continuing on your left side (left leg going backwards) or switch to your right side (right leg going backwards). It doesn’t matter what order you perform the lunges in, but try to do an equal number of lunges on both sides before you finish your exercise routine. [20] [21]

Method Three of Five: Completing a Side Lunge Edit

Start in a standing position. Start the side lunge by standing up straight with your feet hip-width apart. Your head should stay upwards with your chin tilted slightly upwards. Place the majority of your weight on your heels and flex your abdominal muscles to keep your back stable. Relax your shoulders so they sink down towards your hips. [22] [23]

Throughout a lunge exercise your arms and hands can be in any position that helps you maintain your balance. Some people may prefer to put their hands on their hips while others may prefer to keep their arms held out to the side.

Step to the right. Lift your right foot off the ground, by bending at the knee, and step to the right. Keep your left foot flat on the ground and your back straight. At this stage, your weight should all be on your left leg. Then, shift your weight to the right and place your right foot on the ground. [24] [25]

How far your feet will be apart may depend on your height, but aim to place your right foot at least 2 feet from your left foot.

Adjust your stance as you go to whatever distance allows you to feel the stretch in your leg muscles without any discomfort.

Bend your right knee. Once your right foot is on the ground, bend your right knee so your body continues to move lower. Keep your lower leg (shin) perpendicular to the floor and line up your right knee so it’s above your right ankle. Keep your left leg as straight as possible while your left foot remains flat on the ground. The majority of your weight should now be on your right leg. [26] [27]

Push off the floor with your right foot. Use your right foot to push yourself upwards and return yourself to the starting position standing straight up with both feet flat on the ground, hip-width apart. [28] [29]

Repeat the same steps on the left side. Complete a side lunge to the left following all the same steps, just in the opposite direction. [30] [31]

Alternatively, you can continue performing side lunges to the right and then move to your left side later.

Ensure you perform the same number of lunges on both sides of your body before you finish your exercise routine.

Method Four of Five: Adding Twists to a Forward Walking Lunge Edit

Start in a standing position. Start by standing straight up, with both feet flat on the ground, hip-width apart. Keep your back, upper body, and head straight. Use your abdominal muscles to keep your back stable. [32] [33]

To add some extra strength training to this type of lunge, hold a medicine ball in your hands directly in front of you. A medicine ball is heavier than a regular ball and comes in different weights. Select a weight that works for you.

If you do not yet want to add the extra weight, use a regular ball instead. It is still helpful to hold something in your hands as you do the twist portion of the exercise.

Lift your right foot off the ground. Start by lifting your right foot straight off the ground by bending at the knee. Pause in this position until you feel balanced. Keep your back and upper body straight by using your abdominal muscles. [34] [35]

Place your right foot on the ground heel first. Move your right leg forward and place your right foot on the ground starting with your right heel. Shift your upper body forward so your right knee bends. Your lower leg should be perpendicular to the floor while your upper leg should be parallel to the floor. Do not lean too far forward such that your knee moves beyond your right foot. You may need to lean forward slightly forward from your hips, but keep your back straight. [36] [37]

Twist your upper body to the right. While you’re in the forward lunge position, with your right leg forward and your right foot on the ground, twist your upper body to the right. Keep the medicine ball in both of your hands in front of you as you twist. Once you are facing to the right, twist back to your starting position. [38] [39]

Shift your left leg and foot forward. As this is a walking lunge, the next step is not to move back into the starting position, but rather to continue moving forward. Using the same movements you made with your right leg, lift your left foot off the ground and slowly move it forward like you’re taking a big step. [40] [41]

You will need to balance yourself on your right leg for a moment as you move your left leg forward.

Put your left foot on the ground. Shift your body forwards while placing your left foot on the ground, heel first. Continue to shift your weight until your left upper leg is parallel to the ground and your left lower leg is perpendicular to the ground. Do not lean too far forward such that your left knee moves forward of your left foot. You may need to lean slightly forward at the hips, but keep your upper body and back straight. [42] [43]

Perform a twist to the left. Using the same twist movements, with your medicine ball in your hands in front of you, complete a twist to the left. [44] [45]

Continue the movements as your lunge forward. Repeat the movements with your right and left leg as you continue to lunge forward twist, and lunge forward again. Continue moving forward until you’ve run out of space. You can then turn around and continue the walking lunges in the opposite direction. [46] [47]

Method Five of Five: Pushing Yourself with the 30-Day Lunge Challenge Edit

Pick a 30-day period to complete the challenge. A 30-day lunge challenge is a great way to practice all types of lunges and get a great workout on a regular basis. Having a specific goal in mind when exercising can at times, increase your motivation. Before you get started, however, you’ll need to select a 30-day period that works best for you. Using an actual calendar month will probably be the most convenient and easiest to follow. [48]

Perform at least 100 lunges per week. Ideally, you should perform some lunges on a daily basis, but you don’t need to perform all 100 every day right from day 1. Start by performing 20-30 lunges per day until you can build up your endurance. However, try to fit in at least 100 lunges every week. [49]

Work your way up to 100 lunges per day. Once you’ve built up some endurance and energy, try to perform all 100 lunges every day. The lunges can be broken down as follows: [50]

30 forward lunges, 15 for each leg

40 side lunges, 20 to each side

30 reverse lunges, 15 for each leg

Track your achievement. Keep track of the number of lunges you do every day, and which lunges you were able to perform. Even if you are not able to work your way up to 100 lunges a day, by tracking your progress you’ll be able to see how much you’ve improved over the 30 days. [51]

Regardless of your progress, reward yourself with something at the end of the 30 days. Keep that reward in mind throughout the 30 days as an incentive to keep going.

In order to help you visualize the movements of a forward stationary and walking lunge, you may want to watch the following video on the Mayo Clinic website — http://www. mayoclinic. org/healthy-lifestyle/fitness/multimedia/lunge/vid-20084662 .

For added resistance, you can hold weights or dumbbells in both your hands while you perform the forward lunges. The amount of weight should be based on what you are comfortable with, don’t use weights that are too heavy. If you don’t have “real” weights or dumbbells, you can use household items like cans, plastic bottles filled with water (or another liquid), etc. [52]

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Zentel Drug Information, Professional, Alzental

Zentel

Commonly used brand name(s): Albenza.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

† Not commercially available in Canada.

Note: Bracketed information in the Indications section refers to uses that are not included in U. S. product labeling. In addition, because albendazole is not commercially available in Canada, the use of the superscript 1 in this monograph reflects the lack of labeled (approved) indications for this medication.

General considerations Albendazole is a broad-spectrum anthelmintic. It is structurally related to mebendazole and has similar anthelmintic activity against many helminths . Accepted

Hydatid disease (treatment) 1 —Albendazole is used in the treatment of hydatid disease (echinococcosis) of the liver, lung, and peritoneum caused by Echinococcus granulosus (dog tapeworm) . It is also used as an adjunct to surgery of hydatid cysts, either preoperatively or postoperatively, to reduce the risk of recurrence due to operative spillage.

Neurocysticercosis (treatment) 1 —Albendazole is used in the treatment of parenchymal neurocysticercosis caused by the larval form of Taenia solium (pork tapeworm). It is the only agent used in the treatment of ocular neurocysticercosis.

[Capillariasis (treatment)] 1 —Albendazole is used as a secondary agent in the treatment of capillariasis caused by Capillaria philippinensis . Mebendazole is preferred for the treatment of capillariasis.

[Cutaneous larva migrans] 1 —Albendazole is used in the treatment of cutaneous larva migrans.

[Enterobiasis (treatment)] 1 —Albendazole is used in the treatment of enterobiasis (oxyuriasis) caused by Enterobius vermicularis (pinworm).

[Hookworm infections (treatment)] 1 —Albendazole is used in the treatment of hookworm infections, such as ancylostomiasis caused by Ancylostoma duodenale (common hookworm; Old World hookworm) and necatoriasis caused by Necator americanus (American hookworm; New World hookworm).

[Taeniasis (treatment)] 1 —Albendazole is used as an alternative treatment for taeniasis caused by T. solium (pork tapeworm) or Taenia saginata (beef tapeworm). Niclosamide or praziquantel is preferred for the treatment of taeniasis. Although albendazole is known to offer little therapeutic advantage in the treatment of taeniasis, it is generally preferred in developing countries because it is cheaper and has a broader spectrum of anthelmintic activity than niclosamide or praziquantel.

[Trichostrongyliasis (treatment)] 1 —Albendazole is used as a secondary agent in the treatment of trichostrongyliasis caused by Trichostrongylus species. Pyrantel pamoate is preferred for the treatment of trichostrongyliasis.

[Trichuriasis (treatment)] 1 —Albendazole is used in the treatment of trichuriasis caused by Trichuris trichiura (whipworm). Acceptance not established Preliminary studies suggest albendazole may be used as an alternative agent to treat giardiasis caused by Giardia species. However, data are limited and results of recent clinical evaluations have shown variable efficacy of albendazole for this indication. Metronidazole or quinacrine is generally preferred in the treatment of giardiasis.

Albendazole is used as an experimental therapeutic agent in trichinosis caused by Trichinella spiralis . Currently, there are insufficient data to establish efficacy of albendazole for this indication. Mebendazole is preferred for the treatment of trichinosis.

Albendazole has been used for treatment of toxocariasis . However, data to establish the efficacy of albendazole for this indication are limited.

1 Not included in Canadian product labeling.

Physicochemical characteristics: Molecular weight— 265.34 Mechanism of action/Effect:

Vermicidal; albendazole causes degenerative alterations in the tegument and intestinal cells of the worm by binding to the colchicine-sensitive site of tubulin, thus inhibiting its polymerization or assembly into microtubules. The loss of the cytoplasmic microtubules leads to impaired uptake of glucose by the larval and adult stages of the susceptible parasites, and depletes their glycogen stores. Degenerative changes in the endoplasmic reticulum, the mitochondria of the germinal layer, and the subsequent release of lysosomes result in decreased production of adenosine triphosphate (ATP), which is the energy required for the survival of the helminth. Due to diminished energy production, the parasite is immobilized and eventually dies.

Albendazole also has been shown to inhibit the enzyme fumarate reductase, which is helminth-specific. This action may be considered secondary to the effect on the microtubules due to the decreased absorption of glucose. This action occurs in the presence of reduced amounts of nicotinamide-adenine dinucleotide in reduced form (NADH), which is a coenzyme involved in many cellular oxidation-reduction reactions.

Albendazole has larvicidal effects in necatoriasis and ovicidal effects in ascariasis, ancylostomiasis, and trichuriasis. Absorption:

Poorly and erratically absorbed from the gastrointestinal tract. Absorption of albendazole is greatly increased if the medication is taken with food containing relatively high concentrations of fat. Distribution:

Widely distributed throughout the body into bile, cerebrospinal fluid (CSF), fluid in hydatid cysts, liver, serum, and urine. Protein binding:

Hepatic; rapidly and extensively metabolized mainly to the active metabolite, albendazole sulfoxide, which appears in the systemic circulation at detectable concentrations. Albendazole is also metabolized to the 6-hydroxy sulfoxide and sulfone metabolites, but not in sufficient quantities to be detected consistently in the plasma. Half-life:

15 mg/kg: Approximately 10 to 15 hours.

Time to peak concentration:

15 mg/kg: Approximately 4 hours.

Peak serum concentration:

400 mg: Approximately 0.46 to 1.58 mcg/mL .

15 mg/kg: Approximately 0.45 to 2.96 mcg/mL.

Elimination: Renal—Approximately 1% is excreted in the urine as albendazole sulfoxide during the first 24 hours. Other metabolites also are renally excreted. Fecal—A small amount is found in the feces.

Precautions to Consider Carcinogenicity/Mutagenicity

Albendazole has been tested in different species of animals and has not been found to be carcinogenic or mutagenic. Pregnancy/Reproduction Fertility— Albendazole has not been shown to cause adverse effects on male or female fertility.

Pregnancy— Adequate and well-controlled studies in humans have not been done. However, albendazole is not recommended for use in pregnant women because of its teratogenic effects in animals. For women of childbearing age, it is recommended that albendazole be administered within 7 days after the start of normal menstruation. Following a negative pregnancy test, contraceptive measures must be used for the duration of treatment and for 1 month after cessation of treatment.

Albendazole was teratogenic (embryotoxicity and skeletal malformations) in pregnant rats and rabbits. Teratogenicity occurred in rats given oral doses of 10 and 30 mg per kg of body weight (mg/kg) per day during gestation days 6 to 15 and in rabbits given oral doses of 30 mg/kg per day during gestation days 7 to 19. In the rabbit study, maternal toxicity (33% mortality) was noted at 30 mg/kg per day. However, no teratogenic effects were observed in mice given oral doses of up to 30 mg/kg per day during gestation days 6 to 15 .

FDA Pregnancy Category C . Breast-feeding

Albendazole is distributed into the milk of lactating animals . It is not known whether albendazole is distributed into human breast milk . However, problems in humans have not been documented. Pediatrics

Limited studies on the relationship of age to the effects of albendazole have been performed in children up to 6 years of age. Although hydatid disease is uncommon in infants and young children, no pediatrics-specific problems have been documented in infants and young children who were treated with albendazole for hydatid disease. In addition, five studies involving children as young as 1 year of age treated with albendazole for neurocysticercosis, which occurs more frequently than hydatid disease in children, did not document pediatrics-specific problems.

Appropriate studies on the relationship of age to the effects of albendazole have not been performed in the geriatric population. However, no geriatrics-specific problems have been documented to date. Drug interactions and/or related problems The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive ( » = major clinical significance):

» Cimetidine (albendazole sulfoxide concentrations are increased in patients treated with cimetidine; increased concentrations are observed in bile and cystic fluid )

» Corticosteroids (concurrent use with albendazole increases steady-state trough concentrations of albendazole sulfoxide )

» Praziquantel (concurrent use with albendazole increases mean plasma concentration and area under the plasma concentration–time curve of albendazole sulfoxide )

Theophylline (albendazole induces cytochrome P450 1A in human hepatic cells; plasma concentrations of theophylline should be monitored during and after concurrent treatment with albendazole )

Laboratory value alterations The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive ( » = major clinical significance):

With physiology/laboratory test values » Alanine aminotransferase (ALT [SGPT]), serum and » Aspartate aminotransferase (AST [SGOT]), serum (values may be transiently elevated )

Medical considerations/Contraindications The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive ( » = major clinical significance).

Risk-benefit should be considered when the following medical problems exist » Cysticercosis involving the retina (before the initiation of therapy for neurocysticercosis, the patient should be examined for retinal lesions; benefits of the anticysticeral therapy should be weighed against the possibility of retinal damage caused by albendazole-induced changes to existing lesions )

» Hepatic function impairment, such as in hepatic cirrhosis (albendazole is extensively metabolized in the liver; intrahepatic hemodynamics caused by a disordered liver architecture as in hepatic cirrhosis may impair the rate of hepatic clearance, thereby resulting in albendazole accumulation and an increased incidence of side effects )

Hypersensitivity to albendazole Patient monitoring The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

For ascariasis, hookworm infections, and trichuriasis » Stool examinations (may be required prior to treatment to detect the presence of eggs, and approximately 1 to 3 weeks following treatment with albendazole to determine efficacy of medication or establish proof of cure )

For enterobiasis » Perianal examinations (cellophane tape swabbing of the perianal area to detect the presence of eggs may be required prior to treatment to confirm the diagnosis of pinworms, and starting 1 week following treatment with albendazole, especially in patients with persisting symptoms; swabbing should be done every morning after getting out of bed and prior to defecation and bathing for at least 3 days to determine efficacy of medication or establish proof of cure; perianal examinations also may be required to detect the presence of adult worms in the perianal area; perianal swabbings should be negative for 7 consecutive days for the patient to be considered cured )

For strongyloidiasis » Stool examinations (routine stool examinations and special concentration examinations, preferably the Baermann technique [which is especially useful when there is a high index of suspicion for strongyloidiasis and when routine stool examinations are negative for the organism], may be required prior to treatment to detect the presence of larvae, and repeated at intervals of 3 months along with clinical assessment of the patient, beginning at 6 weeks after completion of treatment with albendazole, to determine efficacy of the medication or establish proof of cure; however, determination of cure may be difficult since the parasite is not easily eradicated and, therefore, re-treatment may be necessary )

For taeniasis » Cellophane tape swabbing or » Stool examinations (may be required prior to treatment to detect the presence of eggs or proglottids, and approximately 3 and 6 months following treatment to determine efficacy of medication or establish proof of cure )

For patients on long-term therapy » Complete blood counts (CBCs) and » Liver function tests (since albendazole may cause a reduction in total white cell counts and an elevation in hepatic enzymes with prolonged use, it is recommended that blood counts and liver function tests be carried out prior to treatment and every 2 weeks during treatment with albendazole; re-treatment should not be initiated if significant depression in total white cell counts or elevation in liver enzymes persists )

Theophylline concentration (plasma concentrations of theophylline should be monitored during and after albendazole treatment because albendazole induces cyctochrome P450 1A in human hepatic cells )

Side/Adverse Effects The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive: Those indicating need for medical attention Incidence more frequent Abnormal liver function test results

Overdose For more information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see Poison Control Center Listing ). Treatment of overdose Since no specific antidote is known, recommended treatment of albendazole overdose consists of the following:

To decrease absorption—Gastric lavage may be undertaken within the first 2 to 3 hours after ingestion.

Symptomatic treatment may be given.

Supportive measures such as maintaining an open airway, respiration, and circulation may be instituted. Patients in whom intentional overdose is confirmed or suspected should be referred for psychiatric consultation.

Patient Consultation As an aid to patient consultation, refer to Advice for the Patient, Albendazole (Systemic) .

In providing consultation, consider emphasizing the following selected information ( » = major clinical significance): Before using this medication » Conditions affecting use, especially: Hypersensitivity to albendazole

Pregnancy—Not recommended for use in pregnancy because albendazole has been found to be teratogenic in animals; for women of childbearing age, taking the medication within 7 days after the start of normal menstruation; after a negative pregnancy test, using contraceptive measures during treatment and for 1 month after cessation of treatment Other medications, especially cimetidine, corticosteroids, and praziquantel Other medical problems, especially cysticercosis involving the retina and hepatic function impairment Proper use of this medication No specific procedures such as fasting or purging or other measures are required before, during, or immediately after treatment with albendazole

Proper administration for tablet dosage form—Swallowing whole with a small amount of liquid

» Compliance with full course of therapy; treatment program may be repeated in 2 to 3 weeks for heavy infection

» Proper dosing Missed dose: Taking as soon as possible; not taking if almost time for next dose; not doubling doses

» Proper storage Precautions while using this medication Regular visits to physician to check progress

Checking with physician if no improvement after the full course of treatment or if symptoms persist

For women of childbearing age, using contraception since albendazole has been found to be embryotoxic and teratogenic in animals

Side/adverse effects Signs of potential side effects, especially abnormal liver function test results, hypersensitivity, and neutropenia

General Dosing Information Patients who are heavily infected with helminths may require a second treatment.

If giardiasis is present, asymptomatic patients may be treated with albendazole to prevent spread of infection to others. Parasitologic and clinical relapse of giardiasis may occur after the completion of therapy; long-term follow-up with the physician may be necessary.

If using albendazole to treat trichinosis . concurrent use of corticosteroids may be required to alleviate the allergic and inflammatory symptoms. However, concurrent use with corticosteroids may alter the trough concentrations for steady-state . For enterobiasis Because of the high probability of transfer of pinworms, it is usually recommended that all members of the household be treated simultaneously. For neurocysticercosis Corticosteroids have been shown to increase the plasma levels of albendazole. Concurrent use may be required to relieve the exacerbated symptoms due to the inflammatory response around the dying parasites and should be considered to prevent cerebral hypertension during the first week of treatment.

Patients should receive anticonvulsant therapy as required.

Oral Dosage Forms ALBENDAZOLE ORAL SUSPENSION

Note: Because albendazole oral suspension is not commercially available in the U. S. or Canada, the bracketed uses and the use of the superscript 1 in this section reflect the lack of labeled (approved) indications for this medication in these countries.

Usual adult and adolescent dose [Ascariasis ] 1 or [ Enterobiasis] 1 or [Hookworm infections] 1 or [Trichuriasis ] 1 Oral, 400 mg as a single dose for one day. Treatment may be repeated in three weeks.

[Cutaneous larva migrans] 1 Oral, 400 mg once a day for three days .

[Hydatid disease] 1 Oral, 800 mg per day for twenty-eight days. Treatment may be repeated as necessary. Up to two or three cycles of albendazole treatment may be given. For inoperable hydatid cysts, up to five cycles may be given.

Note: In hydatid disease, the dose of albendazole for patients under 60 kg of body weight is 12 mg per kg of body weight per day.

[Neurocysticercosis ] 1 Oral, 15 mg per kg of body weight per day for thirty days. Treatment may be repeated as necessary.

[Strongyloidiasis ] 1 or [Taeniasis] 1 Oral, 400 mg as a single dose per day for three days. Treatment may be repeated in three weeks.

[Trichostrongyliasis ] 1 Oral, 400 mg as a single dose.

Note: In the treatment of giardiasis, an oral dose of 400 mg per day for five days has been used.

Usual pediatric dose [Ascariasis ] 1 or [ Enterobiasis] 1 or [Hookworm infections] 1 or [Trichuriasis ] 1 Children up to 2 years of age: Oral, 200 mg as a single dose for one day. Treatment may be repeated in three weeks.

[Cutaneous larva migrans] 1 Children: Oral, 5 mg per kg of body weight per day for three days .

[Hydatid disease] 1 Children up to 6 years of age: Dosage has not been established.

Children 6 years of age and over: Oral, 10 to 15 mg per kg of body weight per day for twenty-eight days. Treatment may be repeated as necessary.

[Strongyloidiasis ] 1 or [Taeniasis] 1 Children up to 2 years of age: Oral, 200 mg as a single dose per day for three consecutive days. Treatment may be repeated in three weeks.

Strength(s) usually available U. S.— Not commercially available.

Canada— Not commercially available. Packaging and storage: Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing and direct sunlight. Auxiliary labeling: • Shake well. • Take with meals. • Continue medication for full time of treatment.

Note: Because albendazole tablets are not commercially available in Canada, the use of the superscript 1 in this section reflects the lack of labeled (approved) indications for this medication in Canada.

Usual adult and adolescent dose Hydatid disease 1 Adults and adolescents weighing 60 kg or more: Oral, 400 mg two times a day for twenty-eight days. Treatment may be repeated in fourteen days. Up to three cycles of albendazole treatment may be given.

Adults and adolescents weighing less than 60 kg: Oral, 15 mg per kg of body weight per day, given in divided doses two times a day for twenty-eight days. Treatment may be repeated in fourteen days. Up to three cycles of albendazole treatment may be given.

Note: To achieve optimal killing of the cysts, albendazole is best given as three courses of therapy in a presurgical or postsurgical setting.

Neurocysticercosis 1 Adults and adolescents weighing 60 kg or more: Oral, 400 mg two times a day for eight to thirty days.

Adults and adolescents weighing less than 60 kg: Oral, 15 mg per kg of body weight per day, given in divided doses two times a day for eight to thirty days.

[Cutaneous larva migrans] 1 Oral, 400mg once a day for three days .

Usual adult and adolescent prescribing limits 800 mg for patients weighing less than 60 kg . Usual pediatric dose Hydatid disease 1 or Neurocysticercosis 1 See Usual adult and adolescent dose .

Usual pediatric prescribing limits Maximum total daily dose for patients weighing less than 60 kg is 800 mg. Strength(s) usually available U. S.—

200 mg (Rx) [ Albenza (carnauba wax) ( hydroxypropyl methylcellulose) (lactose monohydrate ) (magnesium stearate) ( microcrystalline cellulose) (povidone) (sodium lauryl sulfate) (sodium saccharin ) (sodium starch glycolate) ( starch) ]

Canada— Not commercially available. Packaging and storage: Store between 20 and 25 °C (68 and 77 °F), in a well-closed container, unless otherwise specified by manufacturer. Protect from direct sunlight. Auxiliary labeling: • Tablets should be swallowed whole. • Take with meals. • Continue medication for full time of treatment.

References

Zentel master data sheet (SmithKline Beecham—UK), Rec 1/19/93.

Albendazole product profile: Eskazole, clinical and technical review 1990 (SmithKline Beecham—US), Rec 1/11/93.

Fleeger CA, editor. USP dictionary of USAN and international drug names 1996. Rockville, MD: The United States Pharmacopeial Convention Inc; 1995. p. 27.

Zentel abbreviated prescribing information (SmithKline Beecham—UK), Rec 1/19/93.

Eskazole prescribing information (SmithKline Beecham—UK), Rec 1/11/93.

Goldsmith RS. Clinical pharmacology of the anthelmintic drugs. In: Katzung BG, editor. Basic and clinical pharmacology. Norwalk: Appleton and Lange; 1992. p. 742, 748-65.

WHO Model Prescribing Information: Drugs used in parasitic diseases. WHO, Geneva, 1990: 80-1, 83-8, 95.

Reynolds JEF, editor. Martindale: the extra pharmacopeia. 29th ed. London: The Pharmaceutical Press; 1989. p. 47-8.

Markell EK, Voge M, John DT. Medical parasitology. 7th ed. Philadelphia: W. B. Saunders Company; 1992. p. 226-344.

Van Reken DE, Pearson RD. Antiparasitic agents. In: Mandell GL, Douglas RG, Bennett JE, editors. Principles and practice of infectious diseases. New York: Churchill Livingstone, Inc.; 1990. p. 398-427.

Jung H, Hurtado M, Sanchez M, Medina MT, et al. Clinical pharmacokinetics of albendazole in patients with brain cysticercosis. J Clin Pharmacol 1992 Jan; 32(1): 28-31.

De Rosa F, Teggi A. Treatment of Echinococcus granulosus hydatid disease with albendazole. Ann Trop Med Parasitol 1990 Oct; 84(5): 467-72.

Nies AS. Principles of drug therapy. In: Wyngaarden JB, Smith LH Jr, editors. Cecil's textbook of medicine. Philadelphia: W. B. Saunders Company; 1988. p. 87-98.

Plorde JJ, Ramsey PG. Nematodes, cestodes and hermaphroditic trematodes. In: Wilson JD, Braunwald E, Isselbacher KJ, et al, editors. Harrison's principles of internal medicine. New York: McGraw-Hill Inc; 1991. p. 803, 817-31.

Monthly Index of Medical Specialties. London: Haymarket Publishing Services Ltd, 1993 Feb: 179.

Open.

Teggi A, Lastilla MG, De Rosa F. Therapy of human hydatid disease with mebendazole and albendazole. Antimicrob Agents Chemother 1993 Aug; 37(8): 1679-84.

Meulemans A, Giovanangeli MD, Mohler J, et al. High performance liquid chromatography of albendazole and its sulfoxide metabolite in human organs and fluids during hydatidosis. J Liq Chromatogr 1984; 7: 669-80.

Ramalingam S, Sinniah B, Krishnan U. Albendazole, an effective single dose, broad spectrum anthelmintic drug. Am J Trop Med Hyg 1983 Sep; 32(5): 984-9.

Pene P, Mojon M, Garin JP, et al. Albendazole: a new broad spectrum anthelmintic. Double-blind multi-center clinical trial. Am J Trop Med Hyg 1982 Mar; 31(2): 263-6.

Steiger U, Cotting J, Reichen J. Albendazole treatment of echinococcosis in humans: effects on microsomal metabolism and drug tolerance. Clin Pharmacol Ther 1990 Mar; 47(3): 347-53.

Todorov T, Vutova K, Mechkov G, et al. Chemotherapy of human cystic echinococcosis: comparative efficacy of mebendazole and albendazole. Ann Trop Med Parasitol 1992 Feb; 86(1): 59-66.

Brown HW, Neva FA. Basic clinical parasitology. 5th ed. Norwalk: Appleton-Century-Crofts; 1983. p. 105-42.

Macedo NA, Pineyro MI, Carmona C. Contact urticaria and contact dermatitis from albendazole. Contact Dermatitis 1991 Jul; 25(1): 73-5.

Rossignol JF, Maisonneuve H. Albendazole: placebo-controlled study in 870 patients with intestinal helminthiasis. Trans R Soc Trop Med Hyg 1983; 77(5): 707-11.

Horton RJ. Chemotherapy of Echinococcus infection in man with albendazole. Trans R Soc Trop Med Hyg 1989 Jan-Feb; 83(1): 97-102.

Takanayagui OM, Jardim E. Therapy for neurocysticercosis: comparison between albendazole and praziquantel. Arch Neurol 1992 Mar; 49(3): 290-4.

Del Brutto OH, Sotelo J, Aguirre R, et al. Albendazole therapy for giant subarachnoid cysticerci. Arch Neurol 1992 May; 49(5): 535-8.

Cruz M, Cruz I, Horton J. Clinical evaluation of albendazole and praziquantel in the treatment of cerebral cysticercosis. Trans R Soc Trop Med Hyg 1991; 85: 244-7.

Liu YH, Wang XG, Gao P, Qiang MX. Experimental and clinical trial of albendazole in the treatment of clonorchiasis sinensis. Chin Med J (Engl) 1991 Jan; 104(1): 27-31.

Morgan UM, Reynoldson JA, Thompson RCA. Activities of several benzimidazoles and tubulin inhibitors against Giardia spp. in vitro. Antimicrob Agents Chemother 1993 Feb; 37(2): 328-31.

Cline BL, Little MD, Bartholomew RK, et al. Larvicidal activity of albendazole against Necatur americanus in human volunteers. Am J Trop Med Hyg 1984; 33(3): 387-94.

Zhong HL, Cao WJ, Rossignol JF, et al. Albendazole in nematode, cestode, trematode and protozoan (Giardia) infections. Chin Med J (Engl) 1986; 99(11): 912-5.

Panel comment, 6/93.

Panel comment, 6/93.

Abramowicz M, editor. Drugs for parasitic infections. Med Lett Drugs Ther 1992; 34(865): 17-26.

Panel comment, 6/93.

Panel comment, 6/93.

Panel comment, 6/93, 10/95.

Panel comment, 6/93.

Panel comment, 6/93.

Hall A, Nahar O. Albendazole as a treatment for infections with Giardia duodenalis in children in Bangladesh. Trans R Soc Med Hyg 1993; 87: 84-6.

Jung H, Hurtado M, Medina MT, et al. Dexamethasone increases plasma levels of albendazole. J Neurol 1990; 237: 279-80.

de Kaminsky RG. Albendazole treatment in human taeniasis. Trans R Soc Trop Med Hyg 1991; 85, 648-50.

Chung WC, Fan PC, Lin CY, et al. Poor efficacy of albendazole for the treatment of human taeniasis. Int J Parasitol 1991 Apr; 21(2): 269-70.

Barry M, Kaldjian L. Neurocysticercosis seminars in neurology. Semin Neurol 1993 June; 13(2): 131-43.

Open.

Edlind TD, Hang TL, Chakraborty PR. Activity of the anthelmintic benzimidazoles against Giardia lamblia in vitro. J Infect Dis 1990; 162: 1408-11.

Panel comment, 7/93.

Panel comment, 8/93.

Botero D, et al. Short course albendazole treatment for neurocysticercosis in Colombia. Trans R Soc Trop Med Hyg 1993 Sept; 87(5): 576-7.

Fourestie V, Bougnoux ME, Ancelle T, et al. Randomized trial of albendazole versus tiabendazole plus flubendazole during an outbreak of human trichinellosis. Parasitol Res 1988; 75: 36-41.

USP Parasitic and Tropical Diseases Therapy Advisory Panel meeting recommendations, 11/93.

Eskazole (SmithKline-Beecham). In: Walker G, compiler. ABPI Data Sheet Compendium 1994-95. London: Datapharm Publications Limited; 1994. p. 1583.

Kollaritsch H, Jeschko E, Wiedermann G. Albendazole is highly effective against cutaneous larva migrans but not against Giardia infections: results of an open pilot trial in travellers returning from the tropics. Trans R Soc Trop Med Hyg 1993; 87: 698.

Panel comment, 10/95.

Panel consensus, 10/95.

Albenza package insert (SmithKline Beecham—US), Issued 7/96, Rec 8/13/97.

Parasitic and Tropical Disease Advisory Panel meeting, 9/96.

Learning Activities - Life On Earth, Flogene

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Learning Activities

Life on Earth includes four multi-touch activities designed to advance people’s understanding of biodiversity and the history of life on Earth. All the activities run on multi-touch devices with Windows 7/8 operating system. We have plans for web-based development for these activities during the 2013 – 2014 time frame.

DeepTree is an interactive deep-zoom visualization based on data from the Tree of Life Web Project (tolweb. org ), the Encyclopedia of Life (eol. org). National Center for Biotechnology Information (www. ncbi. nlm. nih. gov ) and the TimeTree knowledge base (timetree. org ).

FloTree is a dynamic visual simulation that links population-level processes to speciation and biodiversity. Players can work together to influence the outcome of the simulation.

Build-A-Tree (BAT) is a multi-level puzzle for learning evolutionary relationships among species on Earth.

FloGene is a dynamic visual simulation of population genetics designed for introductory college biology students. This activity is under development and is being tested in biology classes at the School of Biological Sciences at University of Nebraska, Lincoln.

Best of CHI 2015 Best Paper Award . Proposed a novel Group Identification Algorithm in a dynamic visitor flow and engagement metrics for statistical analysis in interactive informal learning environments. Demonstrated effects of two typical study methodologies (pdf ).

Coming soon! We are working on a digital Evolution Lab with the WGBH/NOVA Labs team.

PBS NOVA Engaging Science blog

Live Showcase of BAT and paper presentation at Games, Learning and Society 2014 (watch video. )

Seeing Science . Biomedical Computation Review writes about the DeepTree. (read more. )

Harvard Gazette: . The watchword is innovation (read more. )

SEAS News Release . Museum exhibit developed at SEAS puts evolution at visitors’ fingertips (read more. )

Buy Avedol (Coreg) Online No Prescription, Avedol

Buy Avedol (Coreg) without Prescription

Avedol Description

Avedol is a perfect remedy in struggle against hypertension, heart failure. Its target is to treat and prevent heart attack.

Avedol acts by affecting circulation and heart. It is a beta-blocker.

Generic name of Avedol is Carvedilol.

Brand names of Avedol are Avedol, Avedol CR.

Avedol Dosage

Avedol is available in:

3.125mg Low Dosage6.25mg Standard Dosage12.5mg Increased Dosage25mg Max Dosage

Avedol is available in tablets and extended-release capsules which are used orally with food.

Do not crush or chew it.

Take Avedol tablets twice a day, extended-release capsules are taken once a day in the morning.

If you want to achieve most effective results do not stop taking Avedol suddenly.

Avedol Missing of dose

Do not take double dose. If you miss a dose you should take it as soon as you remember about your missing. If it is the time for the next dose you should continue your regular dosing schedule.

Avedol Overdose

If you overdose Avedol and you don't feel good you should visit your doctor or health care provider immediately. Symptoms of Avedol overdosage: bluish-colored fingernails, weakness, short breathing, fainting, uneven heartbeats, convulsions, lightheadedness.

Avedol Side effects

Avedol has its side effects. The most common are:

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Avedol Frequently asked questions

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A: Avedol is a perfect remedy in struggle against hypertension, heart failure. Its target is to treat and prevent heart attack.

Q: In what way does Avedol work?

A: Avedol acts by affecting circulation and heart. It is a beta-blocker.

Q: What are Avedol side effects?

A: Avedol has its common side effects such as fatigue, numbness, insomnia, anxiety, cough, migraine, weakness, lightheadedness, nervousness, diarrhea, nausea, vomiting, problems with vision, arthralgia, problems with sexual life. But in case of rejection of Avedol ingredients you can experience more serious side effects: allergic symptoms (difficulties with breathing, throat closing, swelling, rash, and hives), pruritus, stomach pain, slow or uneven heartbeats, fainting, clay-colored stools, weight gain, decreased appetite, frequent urination, dark urine, jaundice, depression, extreme thirst, chest pain, low fever. Possibility of side effects appearing depends on health status and, of course, on your right following Avedol prescriptions.

Q: What are generic and brand names of Avedol?

A: Brand names of Avedol are Avedol, Avedol CR. Generic name of Avedol is Carvedilol.

Q: Is it possible to drink alcohol?

A: No, it is forbidden to drink alcohol.

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Bula Do Medicamento Infectrin, Infectrin

INFECTRIN

Composicao - INFECTRIN cada comprimido: e cada 10 ml de suspensaocontem: trimetoprima 80 mg; sulfametoxazol 400 mg.

Posologia e Administracao - INFECTRIN comprimidos: adultos e criancas com mais de 12 anos: dose maxima (infeccoes graves): 3 comprimidos cada 12 horas. Dose - padrao: 2 comprimidos cada 12 horas. Dose minima: 1 comprimido cada 12 horas (no caso de tratamentos que se prolonguem por mais de 15 dias). Para o tratamento da gonorreia1, administrar 8 comprimidos no primeiro dia e 8 comprimidos no segundo dia. Criancas de 6 a 12 anos: 1 comprimido a cada 12 horas. Suspensao: criancas de 6 a 12 anos: 1 copo-medida (10 ml) a cada 12 horas. Criancas de 6 meses a 5 anos: 1/2 copo-medida (5 ml) a cada 12 horas. Criancas de 6 semanas a 6 meses: 1/4 copo-medida (2,5 ml) a cada 12 horas.

Precaucoes - INFECTRIN em casos de insuficiencia renal2, a posologia deve ser reduzida ou espacada, para evitar o acumulo do medicamento, sendo aconselhavel a determinacao da sua concentracao plasmatica. Nos tratamentos prolongados aconselha - se controle do hemograma. - Interacoes medicamentosas: Infectrin pode prolongar o tempo de protrombina em pacientes que recebem o anticoagulante3 warfarina. Em diabeticos tratados com antidiabeticos orais4 pode ocorrer um aumento do efeito hipoglicemiante5 destas drogas. Sulfonamidas podem aumentar a toxicidade de metotrexato.

Reacoes adversas - INFECTRIN na posologia recomendada, o produto e bem tolerado. Raramente, podem ocorrer nauseas6, vomitos7 e erupcoes cutaneas. Com administracao prolongada e posologia excessiva foram observadas alteracoes hematologicas em alguns casos isolados. Estas alteracoes desaparecem apos a interrupcao do tratamento. Superdosagem: em casos recentes de superdosagem, efetuar lavagem gastrica8 e inducao de vomito9. Para acelerar a eliminacao, aumentar a ingestao de liquidos ou promover diurese10 forcada, com alcalinizacao da urina11. Na ocorrencia de reacoes de hipersensibilidade pode ser necessario o emprego de corticoides.

Contra-Indicacoes - INFECTRIN casos de afeccoes graves do parenquima hepatico, discrasias sanguineas12 e insuficiencia renal2 grave, quando nao se pode determinar regularmente a concentracao plasmatica do medicamento. Hipersensibilidade a sulfas e trimetoprima; gravidez13 e lactacao14. Recomenda - se nao administrar o produto a prematuros e recem-nascidos durante as cinco primeiras semanas de vida.

Indicacoes - INFECTRIN tratamento das infeccoes causadas por germes Gram - positivos e Gram-negativos, sensiveis a associacao sulfametoxazol e trimetoprima. Infeccoes respiratorias: bronquites agudas e cronicas, bronquiectasias infectadas, pneumonias, amigdalites, sinusites e faringites. Infeccoes das vias urinarias: cistites agudas ou cronicas, pielocistites, pielonefrites, uretrites. Infeccoes dos orgaos genitais: inclusive uretrite15 gonococica. Infeccoes intestinais: enterites, febre tifoide16 e paratifoide. Outras infeccoes: piodermites, furunculos, abscessos e feridas infectadas, septicemias e outras infeccoes por germes sensiveis.

Apresentacao - INFECTRIN embalagem com 20 comprimidos. Suspensao: frascos com 50 e 120 ml.

Immunoprin, Immunoprin

azathioprine

azathioprine

a mercaptopurine derivative used as an immunosuppressive agent for prevention of transplant rejection in organ transplantation ; as a disease-modifying antirheumatic drug for treatment of severe, progressive rheumatoid arthritis unresponsive to other agents; and for treatment of a number of autoimmune diseases ; administered orally as the base or intravenously as the sodium salt.

azathioprine

Apo-Azathioprine (CA), Azasan, Gen-Azathioprine (CA), Immunoprin (UK), Imuran, Novo-Azathioprine (CA)

Pharmacologic class: Purine antagonist

Therapeutic class: Immunosuppressant

Pregnancy risk category D

FDA Box Warning

• Drug may cause chronic immunosuppression, increasing neoplasia risk. Physicians using it should be familiar with this risk and with possible hematologic toxicities and mutagenic potential in both sexes.

Action

Prevents proliferation and differentiation of activated B and T cells by interfering with synthesis of purine, DNA, and RNA

Availability

Injection: 100-mg vial

Tablets: 50 mg, 75 mg, 100 mg

⊘ Indications and dosages

➣ To prevent rejection of kidney transplant

Adults and children: Initially, 3 to 5 mg/kg/day P. O. or I. V. as a single dose. Give on day of transplantation or 1 to 3 days before day of transplantation; then 3 to 5 mg/kg/day I. V. after surgery until patient can tolerate P. O. route. Maintenance dosage is 1 to 3 mg/kg/day P. O.

➣ Rheumatoid arthritis

Adults and children: Initially, 1 mg/kg P. O. or I. V. in one or two daily doses. Increase dosage in steps at 6 to 8 weeks and thereafter at 4-week intervals; use dosage increments of 0.5 mg/kg/day, to a maximum dosage of 2.5 mg/kg/day. Once patient stabilizes, decrease in decrements of 0.5 mg/kg/day to lowest effective dosage.

Dosage adjustment

• Renal disease • Concurrent allopurinol therapy • Elderly patients

Off-label uses

• Crohn's disease • Myasthenia gravis • Chronic ulcerative colitis

Contraindications

• Hypersensitivity to drug • Pregnancy or breastfeeding

Precautions

Use cautiously in: • chickenpox, herpes zoster, impaired hepatic or renal function, decreased bone marrow reserve • previous therapy with alkylating agents (cyclophosphamide, chlorambucil, melphalan) for rheumatoid arthritis • elderly patients • women of childbearing age.

Administration

• Give after meals. • Be aware that I. V. administration is intended for use only when patients can't tolerate oral medications.

Adverse reactions

GI: nausea, vomiting, diarrhea, stomatitis, esophagitis, anorexia, mucositis, pancreatitis

Hematologic: anemia, thrombocytopenia, leukopenia, pancytopenia

Hepatic: jaundice, hepatotoxicity

Musculoskeletal: muscle wasting, joint and muscle pain

Skin: rash, alopecia

Other: chills, fever, serum sickness, neoplasms, serious infection

Interactions

Drug-drug. Allopurinol: increased therapeutic and adverse effects of azathioprine

Angiotensin-converting enzyme (ACE) inhibitors, co-trimoxazole: severe leukopenia

Anticoagulants, cyclosporine: decreased actions of these drugs

Atracurium, pancuronium, tubocurarine, vecuronium: reversal of these drugs' actions

Drugs affecting bone marrow and bone marrow cells (such as ACE inhibitors, co-trimoxazole): severe leukopenia

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, bilirubin: increased levels

Albumin, hemoglobin, uric acid: decreased levels

Urine uric acid: decreased level

Drug-herbs. Astragalus, echinacea, melatonin: interference with immunosuppressant action

Patient monitoring

☞ Monitor CBC, platelet level, and liver function test results. • Assess for signs and symptoms of hepatotoxicity (clay-colored stools, pruritus, jaundice, and dark urine). • Watch for signs and symptoms of infection. • Monitor for bleeding tendency and hemorrhage.

Patient teaching

☞ Tell patient that drug lowers resistance to infection. Instruct him to immediately report fever, cough, breathing problems, chills, and other symptoms.

☞ Instruct patient to immediately report unusual bleeding or bruising. • Tell patient that drug effects may not be obvious for up to 8 weeks in immunosuppression and up to 12 weeks for rheumatoid arthritis relief.

☞ Emphasize importance of avoiding pregnancy during therapy and for 4 months afterward. • Caution patient to avoid activities that may cause injury. Tell him to use soft toothbrush and electric razor to avoid gum and skin injury. • Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. • Tell patient he'll undergo regular blood testing during therapy. • As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

a·za·thi·o·prine

A derivative of 6-mercaptopurine, used as a cytotoxic and immunosuppressive agent.

azathioprine

/aza·thio·prine/ ( az″ah-thi?o-prēn ) a 6-mercaptopurine derivative used as the base or the sodium salt as an immunosuppressant for prevention of transplant rejection and for treatment of rheumatoid arthritis and various autoimmune diseases.

azathioprine

An immunosuppressive agent used to prevent organ rejection in kidney transplant recipients and to treat severe rheumatoid arthritis.

azathioprine

indications It is prescribed to prevent organ rejection after transplantation and to treat lupus erythematosus and other systemic inflammatory diseases, such as rheumatoid arthritis unresponsive to other agents.

contraindications Known hypersensitivity to this drug prohibits its use. It is contraindicated in rheumatoid arthritis and in pregnant women.

adverse effects Among the most serious adverse reactions are bone marrow depression and hepatotoxicity. Nausea and fever are common.

azathioprine

A thiolated purine analogue/immunosuppressant used to prevent rejection of heart, kidney, lung and other allografts, acting primarily on T cells; it is used in rheumatoid arthritis and myasthenia gravis.

Adverse effects Dose-related marrow suppression—leukopaenia, thrombocytopaenia, macrocytic anaemia); GI tract—nausea, vomiting, diarrhoea, fever, malaise, myalgia, liver enzyme defects, hepatotoxicity, pancreatitis. Azathiprineshould not be given with allopurinol.

Chemistry Azathioprine is 6-mercaptopurine with a side chain to protect the labile sulfhydryl group, which is split off in the liver; full metabolic activity follows addition of ribose 5-phosphate from phosphoribosyl pyrophosphate that is metabolised to the cytotoxic derivative 6-mercaptopurine.

azathioprine

Imuran ® Immunology An immunosuppressant used to prevent rejection of heart, kidney, lung and other allografts, acting primarily on T-cells; it is used in rheumatoid arthritis, myasthenia gravis Adverse effects BM suppression–leukopenia, thrombocytopenia, macrocytic anemia, GI tract–N&V, diarrhea, fever, malaise, myalgia, LFT abnormalities, hepatotoxicity, pancreatitis; should not be given with allopurinol. See Heart transplant, Kidney transplant, Lung transplant. Transplantation.

azathioprine

A drug used to suppress the immune system so as to avoid rejection of donor transplants. Immune suppression may have serious side effects such as the flare-up of latent infections and an increased risk of malignant tumours such as lymphomas, but azathioprine is safer than other immunosuppressive drugs. Also used to treat rheumatism. The drug is on the WHO official list. A brand name is Imuran.

azathioprine

immunosuppressive agent used in the treatment of autoimmune and chronic inflammatory conditions, e. g. severe rheumatoid arthritis and psoriasis, when corticosteroid treatment alone is no longer effective

immunosuppressants

Drugs that prevent or reduce the immune response. They are used in the treatment of a variety of severe inflammations such as uveitis, scleritis, keratoconjunctivitis sicca, Behcet's syndrome, sympathetic ophthalmia, and to prevent corneal graft rejection. They include the corticosteroids (e. g. prednisolone), ciclosporin (cyclosporine), tacrolimus, and cytotoxic agents (e. g. azathioprine, chlorambucil, cyclophosphamide, methotrexate). It must be noted that immunosuppressants render the patient more susceptible to infection because immunity is reduced.

a·za·thi·o·prine

Derivative of 6-mercaptopurine, used as cytotoxic and immunosuppressive agent.

azathioprine (az´əthīōprēn) ,

n brand name: Imuran; drug class: immunosuppressant; action: inhibits purine synthesis in cells, thereby preventing RNA and DNA synthesis; uses: renal transplants to prevent graft rejection, refractory rheumatoid arthritis, bone marrow transplants, glomerulonephritis.

azathioprine

a mercaptopurine derivative used as a cytotoxic and immunosuppressive agent in the treatment of leukemia and autoimmune diseases and in transplantation therapy.

Link to this page:

Immune system

immune

1. being highly resistant to a disease because of the formation of humoral antibodies or the development of immunologically competent cells, or both, or as a result of some other mechanism, as interferon activities in viral infections.

2. characterized by the development of humoral antibodies or cellular immunity. or both, following antigenic challenge .

3. produced in response to antigenic challenge, as immune serum globulin.

immune response the reaction to and interaction with substances interpreted by the body as not-self. the result being humoral and cellular immunity. Called also immune reaction. The immune response depends on a functioning thymus and the conversion of stem cells to B and T lymphocytes. These lymphocytes contribute to antibody production, cellular immunity, and immunologic memory.

Disorders of the Immune Response. Pathologic conditions associated with an abnormal immune response (immunopathy) may result from (1) immunodepression, that is, an absent or deficient supply of the components of either humoral or cellular immunity, or both; (2) excessive production of gamma globulins; (3) overreaction to antigens of extrinsic origin, that is, antigens from outside the body; and (4) abnormal response of the body to its own cells and tissues.

Those conditions arising from immunosuppression include agammaglobulinemia (absence of gamma globulins ) and hypogammaglobulinemia (a decrease of circulating antibodies). Factors that may cause or contribute to suppression of the immune response include (1) congenital absence of the thymus or of the stem cells that are precursors of B and T lymphocytes; (2) malnutrition, in which there is a deficiency of the specific nutrients essential to the life of antibody-synthesizing cells; (3) cancer, viral infections, and extensive burns, all of which overburden the immune response mechanisms and rapidly deplete the supply of antigen-specific antibody; (4) certain drugs, including alcohol and heroin, some antibiotics, antipsychotics, and the antineoplastics used in the treatment of cancer.

Overproduction of gamma globulins is manifested by an excessive proliferation of plasma cells ( multiple myeloma ). hypersensitivity is the result of an overreaction to substances entering the body. Examples of this kind of inappropriate immune response include hay fever. drug and food allergies. extrinsic asthma. serum sickness. and anaphylaxis .

Autoimmune diseases are manifestations of the body's abnormal response to and inability to tolerate its own cells and tissues. For reasons not yet fully understood, the body fails to interpret its own cells as self and, as it would with other foreign ( not-self ) substances, utilizes antibodies and immunologically competent cells to destroy and contain them.

immune system a complex system of cellular and molecular components whose primary function is distinguishing self from nonself and defense against foreign organisms or substances; see also immune response. The primary cellular components are lymphocytes and macrophages. and the primary molecular components are antibodies and lymphokines ; granulocytes and the complement system are also involved in immune responses but are not always considered part of the immune system per se.

Major organs and tissues of the immune system in the child. From McKinney et al. 2000.

immune complex disease local or systemic disease caused by the formation of circulating antibody-antigen immune complexes and their deposition in tissue, due to activation of complement and to recruitment and activation of leukocytes in type III hypersensitivity reactions .

system

1. a set or series of interconnected or interdependent parts or entities (objects, organs, or organisms) that act together in a common purpose or produce results impossible by action of one alone.

2. an organized set of principles or ideas. adj. adj systemat´ic, system´ic.

The parts of a system can be referred to as its elements or components; the environment of the system is defined as all of the factors that affect the system and are affected by it. A living system is capable of taking in matter, energy, and information from its environment (input), processing them in some way, and returning matter, energy, and information to its environment as output.

An open system is one in which there is an exchange of matter, energy, and information with the environment; in a closed system there is no such exchange. A living system cannot survive without this exchange, but in order to survive it must maintain pattern and organization in the midst of constant change. Control of self-regulation of an open system is achieved by dynamic interactions among its elements or components. The result of self-regulation is referred to as the steady state; that is, a state of equilibrium. homeostasis is an assemblage of organic regulations that act to maintain steady states of a living organism.

A system can be divided hierarchically into subsystems, which can be further subdivided into sub-subsystems and components. A system and its environment could be considered as a unified whole for purposes of study, or a subsystem could be studied as a system. For example, the collection of glands in the endocrine system can be thought of as a system, each endocrine gland could be viewed as a system, or even specific cells of a single gland could be studied as a system. It is also possible to think of the human body as a living system and the endocrine system as a subsystem. The division of a system into a subsystem and its environment is dependent on the perspective chosen by the person studying a particular phenomenon.

Systems, subsystems, and suprasystems. Within the environment there are suprasystems, such as human society, and systems within the suprasystem, such as the educational and industrial systems and the health care delivery system. Within the health care delivery system are subsystems, such as the patient, family members, the nurse, the physician, and allied health care professionals and paraprofessionals.

behavioral system in the behavioral system model of nursing, the patterned, repetitive, and purposeful behaviors of an individual.

cardiovascular system the heart and blood vessels, by which blood is pumped and circulated through the body; see also circulatory system .

CD system ( c luster d esignation ) a system for classifying cell-surface markers expressed by lymphocytes based on a computer analysis of monoclonal antibodies against hla antigens. with antibodies having similar specificity characteristics being grouped together and assigned a number (CD1, CD2, CD3, etc.); these CD numbers are also applied to the specific antigens recognized by the various groups of monoclonal antibodies . See also CD antigen .

centimeter-gram-second system (CGS) (cgs) a system of measurements in which the units are based on the centimeter as the unit of length. the gram as the unit of mass. and the second as the unit of time .

centrencephalic system the neurons in the central core of the brainstem from the thalamus to the medulla oblongata, connecting the cerebral hemispheres .

client system in the general systems framework and theory of goal attainment. the composite of physiological, psychological, sociocultural, and developmental variables that make up the total person.

colloid system ( colloidal system ) colloid (def. 3).

conduction system ( conductive system (of heart) ) the system of atypical cardiac muscle fibers, comprising the sinoatrial and atrioventricular nodes, internodal tracts, atrioventricular bundle, bundle branch, and terminal ramifications into the Purkinje network.

Emergency Medical Services (EMS) system a comprehensive program designed to provide services to the patient in the prehospital setting. The system is activated when a call is made to the EMS operator, who then dispatches an ambulance to the patient. The patient receives critical interventions and is stabilized at the scene. A communication system allows the health care workers at the scene to contact a trauma center for information regarding further treatment and disposition of the patient, followed by transportation of the patient to the most appropriate facility for treatment.

endocrine system the system of ductless glands and other structures that produce internal secretions ( hormones ) that are released directly into the circulatory system, influencing metabolism and other body processes; see endocrine glands .

expert system a set of computer programs designed to serve as an aid in decision making.

gateway system a software interface between an online searcher and one or more search systems, facilitating the use of the system by searchers who are unfamiliar with it, or with online retrieval in general.

genitourinary system the organs concerned with production and excretion of urine, together with the reproductive organs. (See Plates.) Called also urogenital system .

haversian system a haversian canal and its concentrically arranged lamellae, constituting the basic unit of structure in compact bone ( osteon ).

Haversian system: Structures of compact and spongy bone with the central haversian canal surrounded by the lamellae. From Applegate, 2000.

heterogeneous system a system or structure made up of mechanically separable parts, as an emulsion or suspension.

His-Purkinje system the intraventricular conduction system from the bundle of His to the distal Purkinje fibers, which carries the impulse to the ventricles.

Home Health Care Classification system see home health care classification system .

homogeneous system a system or structure made up of parts that cannot be mechanically separated, as a solution.

hypophyseoportal system ( hypophysioportal system ) ( hypothalamo-hypophysial portal system ) the venules connecting the hypothalamus with the sinusoidal capillaries of the anterior lobe of the pituitary gland ; they carry releasing substances to the pituitary.

interpersonal system in the general systems framework and theory of goal attainment. two or more individuals interacting in a given situation.

lay health system a system comprising an informal referral network and sources of treatment outside the formal biomedical sources of health care; it includes individual consultation and information-seeking through significant others and peers concerning health behaviors, symptoms, and evaluation of treatment before, during, and after consultation with health care professionals.

legal system in the omaha system. anything connected with law or its administration; it includes legal aid, attorney, courts, or Child Protective Services (CPS), and many other agencies and officials.

limbic system a system of brain structures common to the brains of all mammals, comprising the phylogenetically old cortex (archipallium and paleopallium) and its primarily related nuclei. It is associated with olfaction, autonomic functions, and certain aspects of emotion and behavior.

lymphoid system the lymphoid tissue of the body, collectively; it consists of primary (or central) lymphoid tissues, the bone marrow, and thymus, and secondary (or peripheral) tissues, the lymph nodes, spleen, and gut-associated lymphoid tissue (tonsils, Peyer's patches).

mononuclear phagocyte system the group of highly phagocytic cells that have a common origin from stem cells of the bone marrow and develop circulating monocytes and tissue macrophages, which develop from monocytes that have migrated to connective tissue of the liver ( kupffer's cells ), lung, spleen, and lymph nodes. The term has been proposed to replace reticuloendothelial system. which includes some cells of different origin and does not include all macrophages.

nursing system in the self-care model of nursing, all the actions and interactions of nurses and patients in nursing practice situations; nursing systems fall into three categories: wholly compensatory, partly compensatory, and supportive-educative.

oxygen delivery system a device that delivers oxygen through the upper airways to the lungs at concentrations above that of ambient air. There are two general types: the fixed performance or high flow type, which can supply all of the needs of a patient for inspired gas at a given fractional inspired oxygen; and the variable performance or low flow type, which cannot supply all of the patient's needs for oxygen and delivers fractional inspired oxygen that varies with ventilatory demand.

peripheral nervous system the portion of the nervous system consisting of the nerves and ganglia outside the brain and spinal cord.

personal system in the general systems framework and theory of goal attainment. the unified self, a complex whole that is rational, conscious, and feeling and that sets goals and decides on the means of achieving them.

portal system an arrangement by which blood collected from one set of capillaries passes through a large vessel or vessels and another set of capillaries before returning to the systemic circulation, as in the pituitary gland (the hypothalamo-hypophysial portal system ) or the liver (the hepatic portal circulation).

respiratory system the group of specialized organs whose specific function is to provide for the transfer of oxygen from the air to the blood and of waste carbon dioxide from the blood to the air. The organs of the system include the nose. the pharynx. the larynx. the trachea. the bronchi. and the lungs. See also respiration and Plates 7 and 8.

social system in the general systems framework and theory of goal attainment. an organized boundary system of social roles, behaviors, and practices developed to maintain balance for growth, development, and performance, which involves an exchange of energy and information between the person and the environment for regulation and control of stressors.

support system in the omaha system. the circle of friends, family, and associates that provide love, care, and need gratification; it may include church, school, workplace, or other groupings.

unit dose system a method of delivery of patient medications directly to the patient care unit. Following review by a nurse, a copy of the physician's original order is sent to the pharmacy, where the pharmacist reviews it again. The pharmacist then fills the order and delivers the medication to the patient care unit, usually in a 24-hour supply. Each patient has an individual supply of medications prepared and labeled by the pharmacist.

urinary system the system formed in the body by the kidneys. ureters. urinary bladder. and urethra. the organs concerned in the production and excretion of urine .

vasomotor system the part of the nervous system that controls the caliber of the blood vessels.

im·mune sys·tem

an intricate complex of interrelated cellular, molecular, and genetic components that provides a defense, the immune response, against foreign organisms or substances and aberrant native cells.

immune system

The integrated body system of organs, tissues, cells, and cell products such as antibodies that differentiates self from nonself and neutralizes potentially pathogenic organisms or substances.

immune system

a system of tissues, organs, and cells that protects the body against pathogenic organisms and other foreign bodies. The principal components of the immune system include the bone marrow, the thymus, and the lymphoid tissues. The system also uses peripheral organs, such as the lymph nodes, the spleen, and the lymphatic vessels. The immune system protects the body initially by creating local barriers and inflammation. The local barriers provide chemical and mechanical defenses through the skin, the mucous membranes, and the conjunctiva. Inflammation draws polymorphonuclear leukocytes and neutrophils to the site of injury, where these phagocytes engulf the invading pathogens. If these first-line defenses fail or are inadequate to protect the body, the humoral immune response and the cell-mediated immune response are activated. See also immune response.

im·mune sys·tem

An intricate complex of interrelated cellular, molecular, and genetic components, which provides a defense (immune response) against foreign organisms or substances and aberrant native cells.

immune system

that system of cells and tissues which enables vertebrate animals to create a defence mechanism against invading organisms and often allows them to establish long-lasting immunity.

Immune system

The system of the body that is responsible for producing various cells and chemicals that fight off infection by viruses, bacteria, fungi, and other foreign invaders. In autoimmune disease, these cells and chemicals are turned against the body itself.

immune system

the body's protective measures against threats of damage or disease from invading antigens (micro-organisms, foreign proteins, implants or grafts) or in pathological conditions from 'self antigens' (malignant cells, healthy or damaged tissue). antibodies (immunoglobulins) are produced, each specific against a particular antigen, and circulate in the blood plasma and tissue fluids. The immune response involves interaction of antigen and antibody. See also allergy. anaphylaxis. immunity. lymphatic system.

immune system,

n the group of organs, cells, and chemicals that protect the body from harmful viruses, bacteria, and abnormal cells. It includes bone marrow, proteins, the thymus, the spleen, the lymphocytes, and other white blood cells.

im·mune sys·tem

Intricate complex of interrelated cellular, molecular, and genetic components that provides a defense, the immune response, against foreign organisms or substances and aberrant native cells.

immune system,

n a biochemical complex that protects the body against pathogenic organisms and other foreign bodies. It incorporates the humoral immune response, which produces antibodies to react with specific antigents, and the cell-mediated response, which uses T cells to mobilize tissue macrophages in the presence of a foreign body. It also protects the body from invasion by creating local barriers and inflammation. The principal organs include the bone marrow, the thymus, and the lymphoid tissues.

immune system, duality of ,

n the division of lymphocyte white blood cells into two classes of cells, types B and T. Type B cells help develop humoral immunities, while type T cells are active in cellular immunity.

immune

1. being highly resistant to a disease because of the formation of humoral antibodies or the development of immunologically competent cells, or both, or as a result of some other mechanism, such as interferon activities in viral infections.

2. characterized by the development of antibodies or cellular immunity. or both, following exposure to antigen.

3. produced in response to antigen, such as immune serum globulin. The essential feature of antibody and cell-mediated immunity is that they are highly antigen specific.

the binding of antibody-antigen-complement complexes to complement receptors found on red blood cells.

immune complex disease

disease induced by the deposition of or association with antigen-antibody-complement complexes in the microvasculature of tissues. Fixation of complement component C3 by the complexes initiates inflammation. See also serum sickness, hypersensitivity .

immune complex reaction

immune deficiency disease

one in which animals have inadequate immune responses and so are more susceptible to infectious disease. The defect may be primary (inherited), or secondary (acquired) which usually develops after birth because of toxins or infectious agents. See also combined immune deficiency syndrome. hypogammaglobulinemia. agammaglobulinemia. inherited parakeratosis. chediak-higashi syndrome and canine granulocytopathy syndrome.

see immune-mediated hemolytic anemia (below).

immune reaction fever

aseptic fever occurring in anaphylaxis, angioedema.

the specific response to substances interpreted by the body as not-self, the result being humoral and cellular immunity. The immune response depends on a functioning thymus and the conversion of stem cells to B and T lymphocytes. These B and T lymphocytes contribute to antibody production, cellular immunity and immunological memory. See also humoral immunity .

immune response (Ir) genes

see immune response genes.

the detection by lymphocytes, especially T lymphocytes, of new antigens, particularly on tumor cells.

consists of the primary lymphoid organs (thymus and Bursa of Fabricius or its equivalent (bone marrow) in mammals) and secondary lymphoid organs (lymph nodes, spleen and other lymphoid tissue).

Patient discussion about Immune system

Q. Why does the body attack itself in autoimmune diseases? And if it’s possible - How come it doesn’t happen most of the time?

A. Some say cell-wall deficient (CWD) bacteria can live inside your cells (were apparently photographed in immune cells under electron microscope). See www. marshallprotocol. com and autoimmunityresearch. org (run by the autoimmunity research foundation). Also see bacteriality. com. I have been on the MP for just over a year. It has helped a lot of my symptoms, including lowering my TSH (thyroid) from hashimoto's thyroiditis (autoimmune thyroid condition). I hope that my thyroid will eventually regain all of it's function (still taking some thyroid hormone supplement, but less). The MP is not without "side effects," which are said to be from bacterial die-off and cell death when the bacteria are killed. It is experimental and should only be undertaken with that in mind. The marshallprotocol. com website is currently moderated by volunteers. There needs to be more research on CWD bacterial colonies and their possible role in autoimmune diseases. Please mention this to your doctor(s).

Link to this page:

Cardizem (Diltiazem) 100% Guarantee Of Pleasure 6 Per Pill $, Acasmul

Product Description

Cardizem belongs to a family of medications known as calcium channel blockers. It is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders. It works by relaxing blood vessels and by reducing the workload of the heart. Cardizem may also be used to control your heart rate if you have a fast or irregular heartbeat (such as atrial fibrillation).

Take Cardizem exactly as prescribed by your doctor. The recommended dose can range from 30 mg to 360 mg daily which is usually taken 3 or 4 times a day. The recommended starting dose for treatment of chest pain (angina) is 30 mg four times daily (before meals and at bedtime). If necessary, your doctor may increase your dose to better control your chest pain. The dosage can also be decreased if you experience bothersome side effects.

Before taking Cardizem you should talk with your doctor if you have heart disease, congestive heart failure, irregular heart rhythm that slows down your heart rate (arrhythmia), sick sinus syndrome, liver or kidney disease, cirrhosis, low blood pressure, any allergies. The medication can increase liver enzymes which may be a sign of liver damage. This drug may make you dizzy. Do not drive or perform tasks that require alertness. Avoid drinking alcohol. Grapefruit and grapefruit juice may interact with diltiazem and lead to potentially dangerous effects.

Do not take Cardizem if you are allergic to diltiazem or any ingredients of the medication, are pregnant or breastfeeding, or if you have certain types of heart rhythm problems, low blood pressure, weakened pumping action of the heart (left ventricular failure), fluid in your lungs.

Possible side effect

Get emergency medical help if you have diarrhea, heartburn, constipation, difficulty breathing, flushing, dizziness, lightheadedness, nausea, headache, nervousness, tiredness, abdominal pain, weakness, coughing, wheezing, fainting, irregular or fast heartbeat, skin rash, swelling of ankles, feet, vomiting. If you notice other effects not listed above, contact your doctor.

Tell your doctor about all other medications you use, especially: benzodiazepines (clobazam, quazepam, diazepam, flurazepam), cimetidine, beta blockers (labetalol, bisoprolol, propranolol), clonidine, statins (atorvastatin, simvastatin, lovastatin), quinidine, digoxin, rifampin, cyclosporine. Interaction between two medications does not always mean that you must stop taking one of them. Tell your doctor about all prescription, over-the-counter, and herbal medications you are taking.

Take the missed dose as soon as possible. Skip the missed dose if it is time for your next scheduled dose. Don't take extra medicine to make up the missed dose.

If you think you have overdosed the medicine seek emergency medical help at once. The overdose symptoms are lightheadedness, dizziness, fainting, difficulty breathing, fluid retention, low blood pressure (hypotension), heart failure, slow heart rate (bradycardia).

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

The information presented at the site has a general character. Note please this information cannot be used for self-treatment and self diagnosis. You should consult with your doctor or health care adviser regarding any specific instructions of your condition. The information is reliable, but we concede it could contain mistakes. We are not responsible for any direct, indirect, special or other damage caused by use of this information on the site and also for consequences of self-treatment.

Customers Who Bought This Product Also Bought:

Dholak - North Indian Hand Drum, Dolak

DHOLAK

Dholak is a very popular folk drum of northern India. It is barrel shaped with a simple membrane on the right hand side; basically it is just a smaller version of the dhol . The left hand is also a single membrane with a special application on the inner surface. This application is a mixture of tar, clay and sand ( dholak masala ) which lowers the pitch and provides a well defined tone. There are two ways of tightening the dholak . Sometimes they are laced with rope, in which case, a series of metal rings are pulled to tighten the instrument. Sometimes metal turnbuckles are employed. It is said that this instrument used to occupy a position of considerable prestige. Today it is merely relegated to filmi and folk music.

Musical Styles That Use Dholak

Selected Video

The Making of a Dholak

The Making of a Dholak, Part Two

Sagar Kalika "Dholmaster"

Joven m?sico del desierto

local festival in india

This page last updated

© 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016 David and Chandrakantha Courtney

For comments, corrections, and suggestions, kindly contact David Courtney at david@chandrakantha. com

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SITE LINKS

Quetiapine (By Mouth) - National Library Of Medicine - Pubmed Health, Quetiapina

Quetiapine (By mouth)

Drug classes

Uses

Uses of This Medicine

Quetiapine is used alone or together with other medicines to treat depression. bipolar disorder (depressive and manic episodes), and schizophrenia. This medicine should not be used to treat behavioral problems in older adult patients who have dementia or Alzheimer disease . Quetiapine is an antipsychotic medicine that works in the brain.

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

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, quetiapine is used in certain patients with the following medical conditions:

How To Use

Tablet, Long Acting Tablet

Take your medicine as directed. Your dose may need to be changed several times to find what works best for you. You need to start with a low dose, even if you have used this medicine before.

Your doctor may tell you to take the medicine at bedtime, because quetiapine can make you sleepy.

Extended-release tablets . Take this medicine either without food or with a light snack (approximately 300 calories).

Swallow the extended-release tablet whole. Do not crush, break, or chew it.

This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.

Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.

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

Drugs and Foods to Avoid

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

Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol.

Do not drink alcohol while you are using this medicine.

When Not To Use

This medicine is not right for everyone. Do not use if you had an allergic reaction to quetiapine .

Warnings

Tell your doctor if you are pregnant or breastfeeding, or if you have liver disease, breast cancer. diabetes. underactive thyroid. or a history of seizures or neuroleptic malignant syndrome (NMS). Tell your doctor if you have any kind of blood vessel or heart problems, including low or high blood pressure. heart failure. heart rhythm problems (such as QT prolongation, slow heartbeat), high cholesterol. or a history of heart attack or stroke .

This medicine may cause the following problems:

Neuroleptic malignant syndrome (NMS)

Changes in blood pressure. especially in children

Changes in body temperature

This medicine may cause depression or thoughts of suicide. Make sure family members know about this. Always tell your doctor about any behavior changes, depression, intense feelings, or thoughts of hurting yourself or others.

This medicine may make you dizzy, lightheaded, or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Stand or sit up slowly if you feel dizzy.

This medicine may cause you to get infections easily because it can lower the number of white blood cells. Take precautions to prevent illness. Avoid people who are ill, and wash your hands often.

Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.

Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments. You may also need to have your eyes tested on a regular basis.

Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.

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

Possible side effects

Summary More details

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

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

Changes in mood or behavior, agitation, anxiety. restlessness, or thoughts of hurting yourself or others

Constant muscle movement that you cannot control (often in your lips. tongue. jaw, arms. or legs)

Fast, slow, pounding, or uneven heartbeat

Fever. sweating, confusion, uneven heartbeat, muscle stiffness

Increase in how much or how often you urinate, increased thirst, increased hunger, or weakness

Lightheadedness, dizziness, fainting, or clumsiness

If you notice these less serious side effects, talk with your doctor:

Tiredness, dizziness, or sleepiness

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

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

Brand names include

Seroquel, Seroquel XR, Seroquel XR 14-Day Sample Kit

There may be other brand names for this medicine.

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

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

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

Omez - 10 (Capsule); Omez - 20 (Capsule); Omez - 40 (Capsule), Omezyn

PROPRIETARY NAME (and dosage form):

OMEZ 10 (capsule) OMEZ 20 (capsule) OMEZ 40 (capsule)

COMPOSITION: OMEZ 10: Each capsule contains omeprazole 10 mg OMEZ 20: Each capsule contains omeprazole 20 mg OMEZ 40: Each capsule contains omeprazole 40 mg

PHARMACOLOGICAL CLASSIFICATION A 11.4.3 Medicines acting on the gastrointestinal tract –Other

PHARMACOLOGICAL ACTION Omeprazole is an inhibitor of the gastric proton pump (H+, K+-ATPase). It inhibits both basal and stimulated gastric acid secretion by parietal cells, whether induced by acetylcholine, gastrin or histamine. Omeprazole has no effect on acetylcholine, histamine or gastric receptors. Pharmacokinetics Orally administered omeprazole is well absorbed but to a variable extent. Absorption of omeprazole takes place in the small intestine and is usually completed within three to six hours. Bioavailability depends on dose and gastric pH and may reach 70% with repeated administration. Food has no influence on the bioavailability of omeprazole. Omeprazole is more than 95% bound to plasma proteins. Clearance from the circulation is by hepatic metabolism with a plasma half-life of 30 to 90 minutes. Hepatic metabolism occurs primarily via the cytochrome P450 (CYP) isoform (CYP2C19). The inactive metabolites are excreted mainly in the urine (80%) whilst the remaining 20% are excreted via the faeces. The average half-life of the terminal phase of the plasma concentration-time curve is approximately 40 minutes. There is no change in plasma half - life during treatment. The inhibition of acid secretion is related to the area under the plasma concentration - time curve (AUC) and not to the actual plasma concentration at a given time.

Treatment of duodenal ulcer, including prevention of relapse gastric ulcer and reflux oesophagitis.

Long-term management of reflux oesophagitis and Zollinger-Ellison Syndrome.

Symptomatic relief of heartburn in patients with gastro-oesophageal reflux disease (GORD) and the short-term relief of functional dyspepsia.

Helicobacter pylori-positive duodenal ulcers as part of an eradication programme with appropriate antibiotics.

Treatment of non-steroidal anti-inflammatory drugs (NSAID)-associated gastric and/or duodenal ulcer/erosions.

Reduction of the risk to develop gastric and/or duodenal ulcer/erosions and reduction of the risk of relapse for previously healed gastric and/or duodenal ulcer/erosions in patients on NSAID treatment.

Short-term (up to 3 months) treatment of severe ulcerative reflux oesophagitis resistant to previous medical treatment.

CONTRA-INDICATIONS Hypersensitivity to any of the ingredients Safety in pregnancy and lactation has not been established

WARNINGS Symptomatic response to OMEZ therapy does not preclude the presence of gastric ulcer or malignancy or a malignant disease of the oesophagus. The administration of OMEZ in this situation may delay diagnosis (see Special Precautions). Hepatic impairment may require a reduction in dose (see DOSAGE AND DIRECTIONS FOR USE). THERE IS VERY LIMITED EXPERIENCE WITH THE USE OF OMEZ IN CHILDREN. THE LONG-TERM SAFETY OF OMEZ IN PATIENTS WITH RENAL AND/OR HEPATIC IMPAIRMENT HAS NOT BEEN ESTABLISHED. THIS MEDICINE MAY LEAD TO DROWSINESS AND IMPAIRED CONCENTRATION THAT MAY BE AGGRAVATED BY THE SIMULTANEOUS INTAKE OF ALCOHOL OR OTHER CENTRAL NERVOUS SYSTEM DEPRESSANTS. PATIENTS SHOULD BE ADVISED, PARTICULARLY AT THE INITIATION OF THERAPY, AGAINST TAKING CHARGE OF VEHICLES OR MACHINERY OR PERFORMING POTENTIALLY HAZARDOUS TASKS WHERE LOSS OF CONCENTRATION COULD LEAD TO ACCIDENTS.

INTERACTIONS OMEZ is metabolised via the hepatic P450 cytochrome enzyme system, which may affect the metabolism of other medications metabolised by these enzymes, when given concomitantly. The elimination of diazepam, warfarin and phenytoin may be prolonged when OMEZ is given concomitantly. Monitoring of INR and phenytoin serum levels is recommended and dosage reductions may be necessary when OMEZ is given concomitantly. There is a possible interaction of OMEZ with digoxin and a 10% increase in digoxin bioavailability may be expected. There may be interactions with other medicines, which are also metabolised via the cytochrome P450 enzyme system.

PREGNANCY AND LACTATION Safety in pregnancy and lactation has not been established (see CONTRAINDICATIONS).

DOSAGE AND DIRECTIONS FOR USE OMEZ is recommended to be given in the morning and swallowed whole with a half glass of liquid. The capsules should not be chewed or crushed. RECOMMENDED DOSAGES FOR ADULTS Duodenal ulcer 20 mg once daily for two to four weeks. In some duodenal ulcer patients refractory to other treatment regimens, 40 mg once daily may be effective. Prevention of relapse in patients with duodenal ulcer 10 mg once daily. If necessary the dose can be increased to 20 –40 mg once daily. The above recommended dosage regimens are inclusive of Helicobacter pylori-positive duodenal ulcers as part of the eradication programme with appropriate antibiotics. Gastric ulcer and reflux oesophagitis 20 mg once daily for four to eight weeks. In some gastric ulcer and reflux oesophagitis patients refractory to other treatment regimens, 40 mg once daily may be effective. For the long-term management of patients with reflux oesophagitis the recommended dose is 20 mg once daily. If necessary the dose can be increased to 20 –40 mg once daily. In patients with severe or symptomatic recurrent reflux oesophagitis treatment can be continued with OMEZ at a dosage of 20 mg once daily. NSAID-associated gastro-duodenal lesions with or without continued NSAID treatment 20 mg once daily. In most patients healing occurs within 4 weeks. For patients who may not be fully healed after the initial course healing usually occurs during a further 4 weeks of treatment. Prevention of NSAID-associated gastro-duodenal lesions and dyspeptic symptoms 20 mg once daily. Symptomatic gastro-oesophageal reflux disease 20 mg daily. Patients may respond adequately to 10 mg daily, therefore individual dose adjustments should be considered. If symptom control has not been achieved after 2 weeks of treatment with 20 mg daily further investigation is recommended. Zollinger-Ellison Syndrome 60 mg once daily. The dosage should be adjusted individually and treatment continued as long as it is clinically indicated. With doses above 80 mg daily the dose should be divided and given twice daily. There is very limited experience with the use of OMEZ in children (see WARNINGS). Severe ulcerative reflux oesophagitis in children from one year and older Recommended dosages:

10 mg once daily.

If needed increase to 20 mg once daily

20 mg once daily.

If needed increase to 40 mg once daily

Elderly Dose reductions are not necessary in elderly patients. The long-term safety of OMEZ in patients with renal and hepatic impairment has not been established (see WARNINGS). Impaired renal function Dose reductions are not necessary in renal impairment. Impaired hepatic function Bioavailability and plasma half-life of OMEZ are increased in patients with impaired hepatic function, therefore a daily dose of 10 –20 mg is generally sufficient.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS Side-effects Blood and lymphatic system disorders Rare . Leucopenia, thrombocytopenia, agranulocytosis, pancytopenia Endocrine disorders Rare . Gynaecomastia Metabolic and nutritional disorders Rare . Hyponatraemia Psychiatric disorders Rare . Reversible mental confusion, agitation, aggression, depression and hallucinations (predominantly in severely ill patients) Nervous system disorders Common . Headache (severe enough to cause discontinuation in some patients) Uncommon . Dizziness, somnolence, insomnia, parasthaesias Eye disorders Rare . Blurred vision Vascular disorders Rare . Peripheral oedema Respiratory, thoracic and mediastinal disorders Rare . Bronchospasm Gastrointestinal disorders Common . Diarrhoea (severe enough to require discontinuation of therapy in some patients), constipation, abdominal pain or colic, nausea, vomiting, flatulence Rare . Dry mouth, stomatitis, oesophageal candidiasis, taste disturbances Hepato-biliary disorders Uncommon . Raised liver enzymes Rare . Hepatitis with or without jaundice, hepatic encephalopathy Skin and subcutaneous tissue disorders Uncommon . Skin rash, urticaria, pruritus Rare . Photosensitivity, bullous eruption, toxic epidermal necrolysis, Stevens-Johnson syndrome, alopecia, erythema multiforme Musculoskeletal, connective tissue and bone disorders Rare . Asthenia, arthralgia, myalgia Renal and urinary disorders Rare . Interstitial nephritis Other Uncommon . Malaise Rare . Hypersensitivity reactions (e. g. fever, angioedema, bronchospasm, interstitial nephritis) and anaphylactic shock

Special precautions Effects related to acid inhibition: During long-term treatment gastric glandular cysts have been reported in increased frequency. These physiological changes result from pronounced inhibition of gastric acid secretion. Decreased gastric acidity increases gastric counts of bacteria normally present in the gastro-intestinal tract. Treatment with OMEZ may lead to an increased risk of gastro-intestinal infections such as Salmonella and Campylobacter. In the presence of symptoms such as significant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis, or melaena, and when gastric ulcer is suspected or present, malignancy should be excluded, as treatment with OMEZ may alleviate symptoms and delay diagnosis.

KNOWN SYMPTOMS OF OVER-DOSAGE AND PARTICULARS OF ITS TREATMENT Blurred vision, confusion, diaphoresis, flushing, headache, malaise, nausea and tachycardia have been reported from over-dosage with omeprazole. There is no specific antidote for overdose with omeprazole. TREATMENT IS SYMPTOMATIC AND SUPPORTIVE. Due to extensive protein binding omeprazole is not readily dialysable. Patients in whom overdose is confirmed or suspected should be referred for medical practitioner/ doctor consultation.

IDENTIFICATION OMEZ 10 . Off-white to pale yellow elliptical to spherical enteric-coated pellets, filled in a hard gelatin capsule with opaque lavender coloured cap and opaque yellow coloured body. “Omeprazole 10 mg”imprinted with black ink on cap and “R157”imprinted with black ink on body. OMEZ 20 . Off-white to pale yellow elliptical to spherical enteric-coated pellets, filled in a hard gelatin capsule with opaque lavender coloured cap and opaque iron grey coloured body. “Omeprazole 20 mg” imprinted with black ink on cap and “R158”imprinted with black ink on body. OMEZ 40 . Off-white to pale yellow elliptical to spherical enteric-coated pellets, filled in a hard gelatin capsule with opaque yellow coloured cap and opaque lavender coloured body. “Omeprazole 40 mg”imprinted with black ink on cap and “R159”imprinted with black ink on body.

Blister packaging containing 30 capsules

Blister packaging containing 30 capsules

White plastic bottles containing 30 capsules

Blister packaging containing 14 capsules

STORAGE INSTRUCTIONS Store below 25°C. Protect from light and moisture. Store the blisters in the outer carton until required for use. Store the container well closed. KEEP OUT OF REACH OF CHILDREN.

REGISTRATION NUMBER OMEZ 10 . 34/11.4.3/0299 OMEZ 20 . 34/11.4.3/0300 OMEZ 40 . 34/11.4.3/0301

NAME AND BUSINESS ADDRESS OF THE HOLDER OF THE CERTIFICATE OF REGISTRATION Dr. Reddy’s Laboratories (Pty) Ltd 3rd Floor, TA Bank Building 160 Jan Smuts Avenue Rosebank 2196 Johannesburg

DATE OF PUBLICATION OF THE PACKAGE INSERT April 2007

New addition to this site: January 2008 Source: Pharmaceutical Industry SAEPI HOME PAGE TRADE NAME INDEX GENERIC NAME INDEX FEEDBACK Information presented by Malahyde Information Systems © Copyright 1996-2008

Kliacef, Kliacef

Cefaclor

Chemical Name

5-tia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid, 7-[(aminophenylacetyl)amino]-3-chloro-8-oxo-, [6R-[6?,7?(R*)]]-

Foreign Names

Cefaclorum (Latin)

Cefaclor (German)

Cefaclor (French)

Cefaclor (Spanish)

Generic Names

Cefaclor (OS: USAN, JAN, BAN)

Cefacloro (OS: DCIT)

Cefeaclor (OS: DCF)

Cephaclor (IS)

Compound 99638 (IS: Lilly)

Cefaclor (PH: JP XVI, USP 38)

Cephaclor-1-Wasser (IS)

S 6472 (IS)

Cefaclor (PH: BP 2016, Ph. Eur. 8, USP 38)

Cefaclor (PH: Ph. Eur. 8)

Cefaclor-Monohydrat (PH: Ph. Eur. 8)

Cefaclorum (PH: Ph. Eur. 8)

Brand Names

Cephalexin - Fda Prescribing Information, Side Effects And Uses, Cephadar

Cephalexin

Respiratory Tract Infections

Cephalexin is indicated for the treatment of respiratory tract infections caused by susceptible isolates of Streptococcus pneumoniae and Streptococcus pyogenes.

Otitis Media

Cephalexin is indicated for the treatment of otitis media caused by susceptible isolates of Streptococcus pneumoniae. Haemophilus influenzae. Staphylococcus aureus. Streptococcus pyogenes. and Moraxella catarrhalis.

Skin and Skin Structure Infections

Cephalexin is indicated for the treatment of skin and skin structure infections caused by susceptible isolates of the following Gram-positive bacteria: Staphylococcus aureus and Streptococcus pyogenes .

Bone Infections

Cephalexin is indicated for the treatment of bone infections caused by susceptible isolates of Staphylococcus aureus and Proteus mirabilis.

Genitourinary Tract Infections

Cephalexin is indicated for the treatment of genitourinary tract infections, including acute prostatitis, caused by susceptible isolates of Escherichia coli. Proteus mirabilis. and Klebsiella pneumoniae .

Usage

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Cephalexin capsules, Cephalexin for oral suspension, and Cephalexin tablets and other antibacterial drugs, Cephalexin capsules, Cephalexin for oral suspension, and Cephalexin tablets should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information is available, this information should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Cephalexin Dosage and Administration

Adults and Pediatric Patients At Least 15 Years of Age

The usual dose of oral Cephalexin is 250 mg every 6 hours, but a dose of 500 mg every 12 hours may be administered. Treatment is administered for 7 to 14 days.

For more severe infections larger doses of oral Cephalexin may be needed, up to 4 grams daily in two to four equally divided doses.

Pediatric Patients (Over 1 Year of Age)

The recommended total daily dose of oral Cephalexin for pediatric patients is 25 to 50 mg/kg given in equally divided doses for 7 to 14 days. In the treatment of β-hemolytic streptococcal infections, duration of at least 10 days is recommended. In severe infections, a total daily dose of 50 to 100 mg/kg may be administered in equally divided doses.

For the treatment of otitis media, the recommended daily dose is 75 to 100 mg/kg given in equally divided doses.

Directions for Mixing

125 mg per 5 mL (100 mL when mixed): Prepare suspension at time of dispensing. Add to the bottle a total of 71 mL of water. For ease in preparation, tap bottle to loosen powder, add the water in 2 portions, shaking well after each addition. The resulting suspension will contain Cephalexin monohydrate equivalent to 125 mg Cephalexin in each 5 mL (teaspoonful).

125 mg per 5 mL (200 mL when mixed): Prepare suspension at time of dispensing. Add to the bottle a total of 140 mL of water. For ease in preparation, tap bottle to loosen powder, add the water in 2 portions, shaking well after each addition. The resulting suspension will contain Cephalexin monohydrate equivalent to 125 mg Cephalexin in each 5 mL (teaspoonful).

250 mg per 5 mL (100 mL when mixed): Prepare suspension at time of dispensing. Add to the bottle a total of 71 mL of water. For ease in preparation, tap bottle to loosen powder, add the water in 2 portions, shaking well after each addition. The resulting suspension will contain Cephalexin monohydrate equivalent to 250 mg Cephalexin in each 5 mL (teaspoonful).

250 mg per 5 mL (200 mL when mixed): Prepare suspension at time of dispensing. Add to the bottle a total of 140 mL of water. For ease in preparation, tap bottle to loosen powder, add the water in 2 portions, shaking well after each addition. The resulting suspension will contain Cephalexin monohydrate equivalent to 250 mg Cephalexin in each 5 mL (teaspoonful).

* After mixing, store in refrigerator. May be kept for 14 days without significant loss of potency.

Dosage Adjustments in Adult and Pediatric Patients At Least 15 Years of Age With Renal Impairment

Administer the following dosing regimens for Cephalexin to patients with impaired renal function [see Warnings and Precautions ( 5.4 ) and Use in Specific Populations (8.6 ) ].

Table 1. Recommended Dose Regimen for Patients with Renal Impairment

* There is insufficient information to make dose adjustment recommendations in patients on hemodialysis.

Dosage Forms and Strengths

Cephalexin capsules USP

250 mg: Swedish orange body and gray cap imprinted “TEVA” on the cap and “3145” on the body

500 mg: Swedish orange body and Swedish orange cap imprinted “TEVA” on the cap and “3147” on the body

Cephalexin for oral suspension USP

A cherry mixed fruit flavored formula - 125 mg/5 mL and 250 mg/5 mL

Cephalexin tablets USP

250 mg: Tablet identification number and color: white, capsule-shaped tablet, debossed “2238” on one side with a score between the “2” and the “3” and “TEVA” on the reverse side.

500 mg: Tablet identification number and color: white, capsule-shaped tablet, debossed “2240” on one side with a score between the “2” and the “4” and “TEVA” on the reverse side.

Contraindications

Cephalexin is contraindicated in patients with known hypersensitivity to Cephalexin or other members of the cephalosporin class of antibacterial drugs.

Warnings and Precautions

Hypersensitivity Reactions

Allergic reactions in the form of rash, urticaria, angioedema, anaphylaxis, erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis have been reported with the use of Cephalexin. Before therapy with Cephalexin is instituted, inquire whether the patient has a history of hypersensitivity reactions to Cephalexin, cephalosporins, penicillins, or other drugs. Cross-hypersensitivity among beta-lactam antibacterial drugs may occur in up to 10% of patients with a history of penicillin allergy.

If an allergic reaction to Cephalexin occurs, discontinue the drug and institute appropriate treatment.

Clostridium difficile - Associated Diarrhea

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

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

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

Direct Coombs’ Test Seroconversion

Positive direct Coombs’ tests have been reported during treatment with the cephalosporin antibacterial drugs including Cephalexin. Acute intravascular hemolysis induced by Cephalexin therapy has been reported. If anemia develops during or after Cephalexin therapy, perform a diagnostic work-up for drug-induced hemolytic anemia, discontinue Cephalexin and institute appropriate therapy.

Seizure Potential

Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment when the dosage was not reduced. If seizures occur, discontinue Cephalexin. Anticonvulsant therapy can be given if clinically indicated.

Prolonged Prothrombin Time

Cephalosporins may be associated with prolonged prothrombin time. Those at risk include patients with renal or hepatic impairment, or poor nutritional state, as well as patients receiving a protracted course of antibacterial therapy, and patients receiving anticoagulant therapy. Monitor prothrombin time in patients at risk and manage as indicated.

Development of Drug-Resistant Bacteria

Prescribing Cephalexin in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Prolonged use of Cephalexin may result in the overgrowth of nonsusceptible organisms. Careful observation of the patient is essential. If superinfection occurs during therapy, appropriate measures should be taken.

Adverse Reactions

The following serious events are described in greater detail in the Warning and Precautions section:

• Hypersensitivity reactions [ see Warning and Precautions ( 5.1 ) ] • Clostridium difficile - associated diarrhea [ see Warnings and Precautions ( 5.2 ) ] • Direct Coombs’ Test Seroconversion [ see Warnings and Precautions ( 5.3 ) ] • Seizure Potential [ see Warnings and Precautions ( 5.4 ) ] • Effect on Prothrombin Activity [ see Warnings and Precautions ( 5.5 ) ] • Development of Drug-Resistant Bacteria [ see Warnings and Precautions ( 5.6 ) ]

Clinical Trials Experience

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

In clinical trials, the most frequent adverse reaction was diarrhea. Nausea and vomiting, dyspepsia, gastritis, and abdominal pain have also occurred. As with penicillins and other cephalosporins, transient hepatitis and cholestatic jaundice have been reported.

Other reactions have included hypersensitivity reactions, genital and anal pruritus, genital candidiasis, vaginitis and vaginal discharge, dizziness, fatigue, headache, agitation, confusion, hallucinations, arthralgia, arthritis, and joint disorder. Reversible interstitial nephritis has been reported. Eosinophilia, neutropenia, thrombocytopenia, hemolytic anemia, and slight elevations in aspartate transaminase (AST) and alanine transaminase (ALT) have been reported.

In addition to the adverse reactions listed above that have been observed in patients treated with Cephalexin, the following adverse reactions and other altered laboratory tests have been reported for cephalosporin class antibacterial drugs:

Other Adverse Reactions. Fever, colitis, aplastic anemia, hemorrhage, renal dysfunction, and toxic nephropathy.

Altered Laboratory Tests: Prolonged prothrombin time, increased blood urea nitrogen (BUN), increased creatinine, elevated alkaline phosphatase, elevated bilirubin, elevated lactate dehydrogenase (LDH), pancytopenia, leukopenia, and agranulocytosis.

Drug Interactions

Metformin

Administration of Cephalexin with metformin results in increased plasma metformin concentrations and decreased renal clearance of metformin.

Careful patient monitoring and dose adjustment of metformin is recommended in patients concomitantly taking Cephalexin and metformin [ see Clinical Pharmacology ( 12.3 ) ].

Probenecid

The renal excretion of Cephalexin is inhibited by probenecid. Coadministration of probenecid with Cephalexin is not recommended.

Interaction With Laboratory or Diagnostic Testing

A false-positive reaction may occur when testing for the presence of glucose in the urine using Benedict’s solution or Fehling’s solution.

USE IN SPECIFIC POPULATIONS

Pregnancy

Pregnancy Category B

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

Reproduction studies have been performed on mice and rats using oral doses of Cephalexin monohydrate 0.6 and 1.5 times the maximum daily human dose (66 mg/kg/day) based upon body surface area basis, and have revealed no evidence of impaired fertility or harm to the fetus.

Nursing Mothers

Cephalexin is excreted in human milk. Caution should be exercised when Cephalexin is administered to a nursing woman.

Pediatric Use

The safety and effectiveness of Cephalexin in pediatric patients was established in clinical trials for the dosages described in the dosage and administration section [ see Dosage and Administration ( 2.2 ) ].

Geriatric Use

Of the 701 subjects in 3 published clinical studies of Cephalexin, 433 (62%) were 65 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients.

This drug is substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection [ see Warnings and Precautions ( 5.4 ) ].

Renal Impairment

Cephalexin should be administered with caution in the presence of impaired renal function (creatinine clearance < 30 mL/min, with or without dialysis). Under such conditions, careful clinical observation and laboratory studies renal function monitoring should be conducted because safe dosage may be lower than that usually recommended [see Dosage and Administration ( 2.3 )] .

Overdosage

Symptoms of oral overdose may include nausea, vomiting, epigastric distress, diarrhea, and hematuria. In the event of an overdose, institute general supportive measures.

Forced diuresis, peritoneal dialysis, hemodialysis, or charcoal hemoperfusion have not been established as beneficial for an overdose of Cephalexin.

Cephalexin Description

Cephalexin, USP is a semisynthetic cephalosporin antibiotic intended for oral administration. It is 7-(D-α-amino-α-phenylacetamido)-3-methyl-3-cephem-4-carboxylic acid, monohydrate.

Cephalexin, USP has the following structural formula:

C 16 H 17 N 3 O 4 S•H 2 O M. W. 365.41

The nucleus of Cephalexin, USP is related to that of other cephalosporin antibiotics. The compound is a zwitterion; i. e. the molecule contains both a basic and an acidic group. The isoelectric point of Cephalexin, USP in water is approximately 4.5 to 5.

The crystalline form of Cephalexin, USP which is available is a monohydrate. It is a white crystalline solid having a bitter taste. Solubility in water is low at room temperature; 1 or 2 mg/mL may be dissolved readily, but higher concentrations are obtained with increasing difficulty.

The cephalosporins differ from penicillins in the structure of the bicyclic ring system. Cephalexin, USP has a D - phenylglycyl group as substituent at the 7-amino position and an unsubstituted methyl group at the 3-position.

Each capsule contains Cephalexin monohydrate, USP equivalent to 250 mg (720 μmol) or 500 mg (1,439 μmol) of Cephalexin.

Inactive Ingredients: CAPSULES: magnesium stearate, silicon dioxide, and sodium starch glycolate.

Capsule Shell and Print Constituents: black iron oxide, D&C Yellow #10 Aluminum Lake, FD&C Blue #1 Aluminum Lake, FD&C Blue #2 Aluminum Lake, FD&C Red #40 Aluminum Lake, gelatin, pharmaceutical glaze modified in SD-45, silicon dioxide or carboxymethylcellulose sodium, sodium lauryl sulfate, titanium dioxide and may contain propylene glycol. In addition, the 250 mg capsule shell contains yellow iron oxide.

After mixing, each 5 mL of Cephalexin for oral suspension USP will contain Cephalexin monohydrate, USP equivalent to 125 mg (360 μmol) or 250 mg (720 μmol) of Cephalexin.

Inactive Ingredients: SUSPENSION: FD&C Red #40, cherry mixed fruit flavor (artificial flavors, benzyl alcohol, maltodextrin, and modified corn starch), silicon dioxide, sodium benzoate, sugar (fruit granulated), and xanthan gum.

Each tablet contains Cephalexin monohydrate, USP equivalent to 250 mg (720 μmol) or 500 mg (1,439 μmol) of Cephalexin.

Inactive Ingredients: TABLETS: hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, sodium starch glycolate, and titanium dioxide.

Cephalexin - Clinical Pharmacology

Mechanism of Action

Cephalexin is a cephalosporin antibacterial drug [see Microbiology ( 12.4 )] .

Pharmacokinetics

Absorption: Cephalexin is acid stable and may be given without regard to meals. Following doses of 250 mg, 500 mg, and 1 g, average peak serum levels of approximately 9, 18, and 32 mcg/mL, respectively, were obtained at 1 hour. Serum levels were detectable 6 hours after administration (at a level of detection of 0.2 mcg/mL).

Distribution: Cephalexin is approximately 10% to 15% bound to plasma proteins.

Excretion: Cephalexin is excreted in the urine by glomerular filtration and tubular secretion. Studies showed that over 90% of the drug was excreted unchanged in the urine within 8 hours. During this period, peak urine concentrations following the 250 mg, 500 mg, and 1 g doses were approximately 1000, 2200, and 5000 mcg/mL respectively.

Drug Interactions In healthy subjects given single 500 mg doses of Cephalexin and metformin, plasma metformin mean Cmax and AUC increased by an average of 34% and 24%, respectively, and metformin mean renal clearance decreased by 14%. No information is available about the interaction of Cephalexin and metformin following multiple doses of either drug.

Microbiology

Mechanism of Action

Cephalexin is a bactericidal agent that acts by the inhibition of bacterial cell-wall synthesis.

Methicillin-resistant staphylococci and most isolates of enterococci are resistant to Cephalexin. Cephalexin is not active against most isolates of Enterobacter spp. Morganella morganii. and Proteus vulgaris. Cephalexin has no activity against Pseudomonas spp. or Acinetobacter calcoaceticus. Penicillin-resistant Streptococcus pneumoniae is usually cross-resistant to beta-lactam antibacterial drugs.

Cephalexin has been shown to be active against most isolates of the following bacteria both in vitro and in clinical infections [ see Indications and Usage ( 1 ) ].

Staphylococcus aureus (methicillin-susceptible isolates only) Streptococcus pneumoniae (penicillin-susceptible isolates) Streptococcus pyogenes

Escherichia coli Haemophilus influenzae Klebsiella pneumoniae Moraxella catarrhalis Proteus mirabilis

Susceptibility Tests Methods

When available, the clinical microbiology laboratory should provide the results of in vitro susceptibility test results for antimicrobial drug products used in resident hospitals to the physician as periodic reports that describe the susceptibility profile of nosocomial and community-acquired pathogens. These reports should aid the physician in selecting an antibacterial drug product for treatment.

In cases of uncomplicated urinary tract infection only, susceptibility of E. coli. K. pneumoniae. and P. mirabilis to Cephalexin may be inferred by testing cefazolin 2 .

Quantitative methods are used to determine antimicrobial minimal inhibitory concentrations (MICs). These MICs provide estimates of the susceptibility of bacteria to antimicrobial compounds. The MICs should be determined using a standardized test methods (broth or agar) 1,2 .

Quantitative methods that require measurement of zone diameters also provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. The zone size provides an estimate of the susceptibility of bacteria to antimicrobial compounds. The zone size should be determined using a standardized test method 2,3 .

A report of Susceptible (S) indicates that the antimicrobial drug is likely to inhibit growth of the pathogen if the antimicrobial drug reaches the concentration usually achievable at the site of infection. A report of Intermediate (I) indicates that the result should be considered equivocal, and if the microorganism is not fully susceptible to alternative clinically feasible drugs, the test should be repeated. This category implies possible clinical applicability in body sites where the drug is physiologically concentrated or in situations where a high dosage of the drug can be used. This category also provides a buffer zone that prevents small uncontrolled technical factors from causing major discrepancies in interpretation. A report of Resistant (R) indicates that the antimicrobial drug is not likely to inhibit growth of the pathogen if the antimicrobial drug reaches the concentrations usually achievable at the infection site; other therapy should be selected.

Standardized susceptibility test procedures require the use of laboratory controls to monitor and ensure the accuracy and precision of supplies and reagents used in the assay, and the techniques of the individual performing the test 1,2,3 .

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

Lifetime studies in animals have not been performed to evaluate the carcinogenic potential of Cephalexin. Tests to determine the mutagenic potential of Cephalexin have not been performed. In male and female rats, fertility and reproductive performance were not affected by Cephalexin oral doses up to 1.5 times the highest recommended human dose based upon body surface area.

REFERENCES

1. Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically; Approved Standard - Tenth Edition. CLSI document M07-A10, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2015. 2. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobials Susceptibility Tests; Twenty-Fifth Informational Supplement. CLSI document M100-S25, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2015. 3. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard - Twelfth Edition. CLSI document M02-A12, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2015.

How Supplied/Storage and Handling

Cephalexin capsules USP—

250 mg: Swedish orange body and gray cap imprinted “TEVA” on the cap and “3145” on the body, in bottles of 100 (NDC 0093-3145-01) and 500 (NDC 0093-3145-05).

500 mg: Swedish orange body and Swedish orange cap imprinted “TEVA” on the cap and “3147” on the body, in bottles of 100 (NDC 0093-3147-01) and 500 (NDC 0093-3147-05).

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

Dispense in a tight, light-resistant container.

Cephalexin for oral suspension * USP

(a cherry mixed fruit flavored formula)—

125 mg/5 mL: bottles of 100 mL (NDC 0093-4175-73) and 200 mL (NDC 0093-4175-74).

250 mg/5 mL: bottles of 100 mL (NDC 0093-4177-73) and 200 mL (NDC 0093-4177-74).

Directions for mixing are included on the label.

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

Shake well before using. Keep tightly closed.

* After mixing, store in refrigerator. May be kept for 14 days without significant loss of potency.

Cephalexin tablets USP—

250 mg: bottles of 100 (NDC 0093-2238-01). Tablet identification number and color: white, capsule-shaped tablet, debossed “2238” on one side with a score between the “2” and the “3” and “TEVA” on the reverse side.

500 mg: bottles of 100 (NDC 0093-2240-01). Tablet identification number and color: white, capsule-shaped tablet, debossed “2240” on one side with a score between the “2” and the “4” and “TEVA” on the reverse side.

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

Patient Counseling Information

• Advise patients that allergic reactions, including serious allergic reactions, could occur and that serious reactions require immediate treatment. Ask the patient about any previous hypersensitivity reactions to Cephalexin, other beta-lactams (including cephalosporins) or other allergens (5.1 ) • Advise patients that diarrhea is a common problem caused by antibacterial drugs and usually resolves when the drug is discontinued. Sometimes, frequent watery or bloody diarrhea may occur and may be a sign of a more serious intestinal infection. If severe watery or bloody diarrhea develops, advise patients to contact their healthcare provider. • Counsel patients that antibacterial drugs including Cephalexin capsules, Cephalexin for oral suspension, and Cephalexin tablets, should only be used to treat bacterial infections. They do not treat viral infections (e. g. the common cold). When Cephalexin capsules, Cephalexin for oral suspension, and Cephalexin tablets are prescribed to treat a bacterial infection, tell patients that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Cephalexin capsules, Cephalexin for oral suspension, and Cephalexin tablets or other antibacterial drugs in the future.

TEVA PHARMACEUTICALS USA, INC.

North Wales, PA 19454

Package/Label Display Panel

Cephalexin Capsules USP 250 mg 100s Label Text

NDC 0093- 3145 -01

Etionizina, Etionizina

Etionizina

Etionizina - General Information

A second-line antitubercular agent that inhibits mycolic acid synthesis. It also may be used for treatment of leprosy. (From Smith and Reynard, Textbook of Pharmacology, 1992, p868)

Pharmacology of Etionizina

Ethinamate is bacteriostatic against M. tuberculosis . In a study examining ethionamide resistance, ethionamide administered orally initially decreased the number of culturable Mycobacterium tuberculosis organisms from the lungs of H37Rv infected mice. Drug resistance developed with continued ethionamide monotherapy, but did not occur when mice received ethionamide in combination with streptomycin or isoniazid.

Etionizina for patients

Patients should be advised to consult their physician should blurred vision or any loss of vision, with or without eye pain, occur during treatment. Excessive ethanol ingestion should be avoided because a psychotic reaction has been reported.

Etionizina Interactions

Trecator has been found to temporarily raise serum concentrations of isoniazid. Trecator may potentiate the adverse effects of other antituberculous drugs administered concomitantly. In particular, convulsions have been reported when ethionamide is administered with cycloserine and special care should be taken when the treatment regimen includes both of these drugs. Excessive ethanol ingestion should be avoided because a psychotic reaction has been reported.

Etionizina Contraindications

Ethionamide is contraindicated in patients with severe hepatic impairment and in patients who are hypersensitive to the drug.

Additional information about Etionizina

Etionizina Indication: For use in the treatment of pulmonary and extrapulmonary tuberculosis when other antitubercular drugs have failed. Mechanism Of Action: Etionizina may be bacteriostatic or bactericidal in action, depending on the concentration of the drug attained at the site of infection and the susceptibility of the infecting organism. Etionizina, like prothionamide and pyrazinamide, is a nicotinic acid derivative related to isoniazid. It is thought that ethionamide undergoes intracellular modification and acts in a similar fashion to isoniazid. Isoniazid inhibits the synthesis of mycoloic acids, an essential component of the bacterial cell wall. Specifically isoniazid inhibits InhA, the enoyl reductase from Mycobacterium tuberculosis . by forming a covalent adduct with the NAD cofactor. It is the INH-NAD adduct that acts as a slow, tight-binding competitive inhibitor of InhA. Drug Interactions: Not Available Food Interactions: Not Available Generic Name: Ethionamide Synonyms: Etionamide [DCIT]; Etionamida [INN-Spanish]; Etionamid; Etioniamid; Ethioniamide; Ethylisothiamide; Ethyonomide; Ethionamidum [INN-Latin]; Ethionamid prothionamid; Ethinamide; ETH; ET; ETP Drug Category: Antitubercular Agents; Leprostatic Agents Drug Type: Small Molecule; Approved Other Brand Names containing Ethionamide: Aethionamidum; Aetina; Aetiva; Amidazin; Amidazine; Atina; Bayer 5312; Ethimide; Ethina; Etimid; Etiocidan; Etionid; Etionizin; Etionizina; Etionizine; Fatoliamid; Iridocin; Iridozin; Isothin; Isotiamida; Itiocide; Nicotion; Nisotin; Nizotin; Rigenicid; Sertinon; Teberus; Thianid; Thianide; Thioamide; Thiomid; Thioniden; Tianid; Tio-Mid; Tiomid; Trecator; Trecator-SC; Trekator; Trescatyl; Trescazide; Tubenamide; Tubermin; Tuberoid; Tuberoson; Absorption: Essentially completely absorbed following oral administration and not subjected to any appreciable first pass metabolism. Bioavailability approximately 100%. Toxicity (Overdose): Symptoms of overdose include convulsions, nausea, and vomiting. Protein Binding: Approximately 30% bound to proteins. Biotransformation: Hepatic and extensive. Metabolized to the active metabolite sulfoxide, and several inactive metabolites. The sulphoxide metabolite has been demonstrated to have antimicrobial activity against Mycobacterium tuberculosis . Half Life: 2 to 3 hours Dosage Forms of Etionizina: Tablet, film coated Oral Chemical IUPAC Name: 2-ethylpyridine-4-carbothioamide Chemical Formula: C8H10N2S Ethionamide on Wikipedia: http://en. wikipedia. org/wiki/Ethionamide Organisms Affected: Mycobacteria

Interactions Between Indogesic Oral And Strong-Cyp3a4-Inducers-Quetiapine-150-Mg, Indogesic

Interactions

Quetiapine (> 150 mg)/Strong CYP3A4 Inducers

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e. g. doctor or pharmacist) for more information.

How the interaction occurs:

Barbiturates, carbamazepine, enzalutamide, mitotane, phenytoin/fosphenytoin, rifabutin, rifampin and St. John's Wort speed up how quickly your liver processes quetiapine.

What might happen:

The amount of quetiapine in your blood may decrease and it may not work as well.

What you should do about this interaction:

Make sure your healthcare professionals (e. g. doctor or pharmacist) know that you are taking these medicines together and let your doctor know if you notice any change in your condition. If you are taking quetiapine, your doctor may want to change your quetiapine dose so that it will be effective while you are also taking the interacting medicine. Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

References:

1.Seroquel (quetiapine) US prescribing information. AstraZeneca Pharmaceuticals LP October, 2013.

2.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: http://www. fda. gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/D rugInteractionsLabeling/ucm093664.htm. Updated 08/05/2011.

3.This information is based on or an extract from the UW Metabolism and Transport Drug Interaction Database (DIDB) Platform, Copyright University of Washington 1999-2014..

4.Grimm SW, Richtand NM, Winter HR, Stams KR, Reele SB. Effects of cytochrome P450 3A modulators ketoconazole and carbamazepine on quetiapine pharmacokinetics. Br J Clin Pharmacol 2006 Jan;61(1):58-69.

5.Nickl-Jockschat T, Paulzen M, Schneider F, Grozinger M. Drug interaction can lead to undetectable serum concentrations of quetiapine in the presence of carbamazepine. Clin Neuropharmacol 2009 Jan-Feb;32(1):55.

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Iron Deficiency Symptoms, Treatment, Causes - What Causes Iron Deficiency, Refluxon

Iron and Iron Deficiency

Quick Guide The 14 Most Common Causes of Fatigue

What causes iron deficiency?

Iron deficiency has many causes. (See table below for a summary). These causes fall into two main categories:

Many common conditions can cause people to need additional iron:

Because of their rapid growth, infants and toddlers need more iron than older children. Sometimes it can be hard for them to get enough iron from their normal diet .

Women who are pregnant have higher iron needs. To get enough, most women must take an iron supplement as recommended by their healthcare provider.

When people lose blood, they also lose iron. They need extra iron to replace what they have lost. Increased blood loss can occur with heavy menstrual periods, frequent blood donation, as well as with some stomach and intestinal conditions (food sensitivity, hookworms.)

Decreased iron intake or absorption (not enough iron taken into the body)

The amount of iron absorbed from the diet depends on many factors:

Iron from meat, poultry, and fish (i. e. heme iron) is absorbed two to three times more efficiently than iron from plants (i. e. non-heme iron).

The amount of iron absorbed from plant foods (non-heme iron) depends on the other types of foods eaten at the same meal.

Foods containing heme iron (meat, poultry, and fish) enhance iron absorption from foods that contain non-heme iron (e. g. fortified cereals, some beans, and spinach).

Foods containing vitamin C (see Dietary Sources of vitamin C) also enhance non-heme iron absorption when eaten at the same meal.

Substances (such as polyphenols, phytates, or calcium) that are part of some foods or drinks such as tea, coffee, whole grains, legumes and milk or dairy products can decrease the amount of non-heme iron absorbed at a meal. Calcium can also decrease the amount heme-iron absorbed at a meal. However, for healthy individuals who consume a varied diet that conforms to the Dietary Guidelines for Americans, the amount of iron inhibition from these substances is usually not of concern.

Vegetarian diets are low in heme iron, but careful meal planning can help increase the amount of iron absorbed.

Some other factors (such as taking antacids beyond the recommended dose or medicine used to treat peptic ulcer disease and acid reflux ) can reduce the amount of acid in the stomach and the iron absorbed and cause iron deficiency.

Increased Iron Needs

Decreased Iron Intake and Absorption

Rapid growth

Pregnancy

Blood loss

Heavy menstrual periods

Frequent blood donation

Some stomach and intestinal conditions (food sensitivity, hookworms)

Lack of heme iron sources in the diet (e. g. vegetarian diets)

Low absorption

Taking antacids beyond the recommended dose or medicine used to treat peptic ulcer disease and acid reflux can reduce the amount of iron absorbed in the stomach.

Ulcelac Suspension Para Que Sirve, Ulcelac

ULCELAC SUSPENSION

Acceso rapido al contenido

Tenga especial cuidado durante el embarazo .

No usar ULCELAC SUSPENSION con lactantes.

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

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

Prospecto e indicaciones

Laboratorio

Composición

Cada 100 ml de suspensión preparada contiene Famotidina 400 mg; Alginato de sodio 5,000 mg; Esencia frutal 100 mg; otros excipientes y agua c. s.p. 100 ml

Para Que Sirve

Antagonista de los receptores histamínicos H2. Antiulceroso.

Presentación

Envase conteniendo 25 g de polvo para preparar 100 ml de suspensión y un vasito medida.

Como tomar

5 ml (1 cucharada de las de postre) 1 o 2 veces por día. De considerarse conveniente, pueden administrarse 10 ml (1 cucharada de las de sopa) en una toma diaria.

Contraindicaciones

Antecedentes de alergia a la famotidina. Embarazo y lactancia.

Efectos colaterales

A las dosis recomendadas el producto es bien tolerado.

TroquelNombre. ComercialVar. Pres. FormaPrecio publicoCob. IomaCob. Pami

Gastrostad, Gastrostad

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Pantoprazole

Click for further information on drug naming conventions and International Nonproprietary Names .

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

Neotretin, Neotretin

Neotretin

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Products And Equipment, Sipirac

Products and equipment

SPIRAC's® product range of machines and packages for wastewater handling includes screening, grit and sludge solutions.

All our products are made according to your individual specifications and use stainless steel to supply you with products of the highest quality. Over the last 40 years considerable experience and competence has been collected in the manufacturing of stainless steel products for the water and wastewater industry.

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Wingate At Niagara Falls - Review Of Wingate By Wyndham Niagara Falls, Niagara Falls, Ny, Fibrotina

Judith M (3 reviews)

This is a brand new facility. However, there were several problems - the breakfast area was way too crowded for the # of guests. Oatmeal always cold, coffee usually had grounds in it. The tub in handicapped room had no slip-proof surface on the bottom -- slippery even for non-handicapped. Chair lift at the pool (for handicapped) did not work during our entire stay of 5 nites. Staff was very friendly, but they did not get our request for handicapped room right -- with three phone calls! Finally arranged for the room the day we arrived.

Frank S, General Manager at Wingate by Wyndham Niagara Falls, responded to this review

First let me say I am sorry to hear that you experienced a difficulty in your stay at the Wingate, however I would like to thank you for letting us know where we need to focus on improvements. As a new hotel we are working hard to meet the highest guest standards and value your imput. Now we will be able to correct errors and continue to grow and meet all of our guests needs. We hope upon your next stay you will notice that we have corrected such issues and go above and beyond your service expectations.

Gary Pacioni General manager

“ Modern hotel with great location ”

I was reading the other reviews and we all agreed. It is dirty. The cleaning crew are not well trained or the manager just doesn't care. Hair all over (pillows, bathroom, floor) crumbs on the tiles and carpet, funny odor. And the hallway carpets are filthy! I was itchy and the Pillow smelled. Wifi is really bad too. How can they let that happen to a nice place in only a couple of months! I could hear the conversation next door, I can even understand that, but not how disgusting it is.

Frank S, General Manager at Wingate by Wyndham Niagara Falls, responded to this review

First let me say I am sorry to hear that you experienced a difficulty in your stay at the Wingate. however I would like to thank you for letting us know where we need to focus on improvements. As a new hotel we are working hard to meet the highest standards and value your input. Now we will be able to correct errors and continue to grow and meet all of our guests needs. We hope upon your next stay you will notice that we have corrected such issues and go above and beyond your service expectations.

Gary Pacioni General Manager

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Mazda CX 3 Mazda 3 Every element that makes driving rewarding takes a leap ahead in Mazda3. It delivers sophisticated design and sports performance, yet achieves outstanding fuel economy thanks to SKYACTIV TECHNOLOGY. It also brings a level of connectivity that's unprecedented in a Mazda, and the advanced safety of i-ACTIVSENSE.

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Risperdal - Tablets, Prisdal

PROPRIETARY NAME (and dosage form):

RISPERDAL ® tablets

RISPERDAL* 0,5 mg tablets. RISPERDAL* 1 mg tablets. RISPERDAL* 2 mg tablets. RISPERDAL* 3 mg tablets. RISPERDAL* 4 mg tablets.

COMPOSITION Each tablet contains risperidone 0,5 mg. Each tablet contains risperidone 1 mg. Each tablet contains risperidone 2 mg. Each tablet contains risperidone 3 mg. Each tablet contains risperidone 4 mg.

PHARMACOLOGICAL CLASSIFICATION A.2.6.5 Central nervous system depressants. Miscellaneous structures.

PHARMACOLOGICAL ACTION Pharmacodynamic properties: RISPERDAL (risperidone) is an antipsychotic of the benzisoxazol derivatives. It is a selective monoaminergic antagonist. RISPERDAL has affinity for serotonin-5-HT 2. dopamine-D 2. H 1 - histamine, alpha 1 - and alpha 2 - adrenergic receptors. Risperidone has no affinity for cholinergic receptors. It is a potent D 2 - antagonist. Pharmacokinetic properties: Risperidone is completely absorbed after oral administration. Peak plasma concentrations are attained within 1 to 2 hours. Food does not affect the absorption of risperidone. RISPERDAL is metabolized by cytochrome P-450 IID6 to 9-hydroxy-risperidone which has a similar pharmacological activity to risperidone. Risperidone and 9-hydroxy-risperidone form the active antipsychotic fraction. After oral administration to psychotic patients, risperidone's half-life is about 3 hours. The elimination half-life of 9-hydroxy-risperidone and the active antipsychotic fraction is 24 hours. Following 6 mg or 8 mg once daily, peak levels of the active moiety were about 30% higher and trough levels about 30% lower than the peaks and troughs following 3 and 4 mg twice daily. Steady state is reached within 1 day for risperidone in most patients and 4-5 days for 9-hydroxyrisperidone. RISPERDAL plasma concentration is dose-proportional within the therapeutic dose-range. RISPERDAL is bound to albumin and alpha 1 - acid glycoprotein. Plasma protein binding of risperidone is 88% and 77% for 9-hydroxy-risperidone. One week after administration, 70% of the dose is excreted in the urine and 14% in the faeces. In urine, risperidone and 9-hydroxy-risperidone represent 35 - 45% of the dose. RISPERDAL showed higher active plasma concentrations and slower elimination in the elderly and in patients with renal insufficiency. The plasma concentrations of RISPERDAL were normal in patients with liver insufficiency. The pharmacokinetics of risperidone, 9-hydroxy-risperidone and the active moiety in children are similar to those in adults.

INDICATIONS RISPERDAL is indicated for the treatment of:

acute and chronic schizophrenic psychoses and related psychosis in which positive symptoms (such as hallucinations, delusions, thought disturbances, hostility, suspiciousness) and/or the negative symptoms (such as blunted affect, emotional and social withdrawal, poverty of speech) are prominent. RISPERDAL also alleviates affective symptoms (such as depression, guilt feelings, anxiety) associated with schizophrenia. In patients who have shown an initial treatment response, Risperdal is also effective in maintaining the clinical improvement.

behavioural disturbances in patients with dementia in whom symptoms such as aggressiveness (verbal outbursts, physical violence), activity disturbances (agitation, wandering) or psychotic symptoms are prominent.

conduct and other disruptive behaviour disorders in children (aged 5 - 12 years), with subaverage intellectual functioning or mental retardation in whom destructive behaviours (e. g. aggression, impulsivity and self-injurious behaviours) are prominent.

CONTRA-INDICATIONS RISPERDAL is contra-indicated in patients with known sensitivity to the medicine. Safety of RISPERDAL in pregnancy or lactating women has not been established. Risperidone and 9-hydroxy-risperidone are excreted in human breast milk. Therefore, women receiving RISPERDAL should not breast feed. Conduct and other disruptive behaviour disorders children: Not for children under 5 years as efficacy and safety in children under the age of 5 years have not been demonstrated.

DOSAGE AND DIRECTIONS FOR USE Schizophrenia Switching from other antipsychotics to RISPERDAL: When medically appropriate, gradual discontinuation of the previous treatment, while RISPERDAL therapy is initiated, is recommended. Also if medically appropriate, when switching patients from depot antipsychotics, initiate RISPERDAL therapy in place of the next scheduled injection. The need for continuing existing anti-Parkinson medications should be re-evaluated periodically. Adults: RISPERDAL may be given once or twice daily. Patients should start with 2 mg/day RISPERDAL. The dosage may be increased on the second day to 4 mg/day. From then on, the dosage can be maintained unchanged, or further individualised, if needed. Most patients will benefit from daily doses of between 4 mg/day and 8 mg/day. Doses above 6 mg/day (when administered twice daily) were associated with more extrapyramidal symptoms and other adverse effects and are not generally recommended. In some patients, particularly with first episode acute psychosis, a slower titration phase and a lower starting and maintenance dose may be appropriate. Doses above 10 mg/day have not been shown to be superior in efficacy to lower doses and may cause an increased incidence of side-effects such as extrapyramidal symptoms. Dosages above 10 mg/day should only be considered if the benefits outweighs the risk. The maximum total daily dose is 16 mg/day. A benzodiazepine may be added to RISPERDAL if additional sedation is required. Renal - and liver-diseased patients: Caution should be exercised with these groups of patients, as clinical experience is lacking in these patient populations. It is recommended to halve both the starting dose and the subsequent dose increments. Elderly patients: A starting dose of 0.5 mg b. i.d. is recommended. This dosage can be individually adjusted with 0,5 mg b. i.d. increments to 1 - 2 mg b. i.d. Children: Not for children under 15 years as efficacy and safety in children under the age of 15 years have not been demonstrated in schizophrenia. Behavioural disturbances in patients with dementia: A starting dose of 0.25 mg b. i.d. is recommended. This dosage can be individually adjusted by increments of 0,25 mg b. i.d, not more frequently than every other day, if needed. The optimum dose is 0,5 mg b. i.d. for most patients. Some patients, however, may benefit from doses up to 1 mg b. i.d. Once patients have reached their target dose, a once-daily dosing regimen can be considered. Conduct and other disruptive behaviour disorders in children 5 -12 years of age: Subjects <50 kg : A starting dose of 0,01 mg/kg once daily is recommended. This dosage can be individually adjusted by increments of 0,01 mg/kg once daily not more frequently than every other day, if needed. The recommended maintenance dose is 0,02 - 0,04 mg/kg once daily. The mean dose is 0,03 mg/kg once daily. The continued use of RISPERDAL must be evaluated and justified on an ongoing basis. Experience is lacking in children aged less than 5 years.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS In some instances it has been difficult to differentiate adverse events from symptoms of the underlying psychosis. The most frequent side-effects observed with RISPERDAL are: insomnia, agitation, extrapyramidal disorder, anxiety, headache. Sedation has been reported more frequently in children and adolescents than in adults. Less commonly observed are: somnolence, fatigue, dizziness, impaired concentration, constipation, dyspepsia, nausea, vomiting, abdominal pain, weight gain, blurred vision, priapism, erectile dysfunction, ejaculatory dysfunction, orgastic dysfunction, urinary incontinence, rhinitis, rash and other allergic reactions have been observed. The following dose dependent extrapyramidal symptoms have been observed: tremor, rigidity, hypersalivation, bradykinesia, oculogyric crisis, akathisia (hyperkinesia) and acute dystonia, hypokinesia. These are usually mild and reversible upon dose reduction and/or administration of anti-Parkinson medication, if necessary. Tardive dyskinesia (TD), a syndrome consisting of potentially irreversible, involuntary dyskinetic movements may develop in patients treated with conventional neuroleptics. Although this syndrome of TD appears to be most prevalent in the elderly, especially elderly females, it is impossible to predict at the onset of treatment which patients are likely to develop TD. It has been suggested that the occurrence of Parkinsonian side-effects is a predictor for the development of TD. The risk of developing TD and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of the antipsychotic administered to the patient increase. However, the syndrome can develop, although less commonly, after relatively brief periods of treatment at low doses. There is no known treatment for an established case of TD. The syndrome may remit partially or completely if the antipsychotic medicine treatment is withdrawn. The antipsychotic drug treatment itself however, may suppress the signs and symptoms of TD, thereby masking the underlying process. The effect of symptom suppression upon the long-term course of TD is unknown. In view of these considerations, RISPERDAL should be prescribed in a manner that is most likely to minimise the risk of TD. As with any antipsychotic medicine, RISPERDAL should be reserved for patients who appear to be obtaining substantial benefit from the medicine. In such patients the smallest dose and the shortest duration of treatment should be sought. The benefit for continued treatment should be reassessed periodically. If signs and symptoms of TD appear in a patient on antipsychotics, medicine discontinuation should be considered. However, some patients may require treatment despite the presence of this syndrome. Neuroleptic Malignant Syndrome (NMS) is a potentially fatal symptom complex that has been reported in association with antipsychotic medicines, including risperidone. Clinical manifestations of NMS are hyperthermia, muscle rigidity, altered mental status (including catatonic signs) and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, cardiac arrhythmias and diaphoresis). Additional signs may include elevated creatine phosphokinase (CPK) levels, myoglobinuria (rhabdomyolysis), and acute renal failure. In arriving at a diagnosis, it is important to identify cases where the clinical presentation includes both serious medical illnesses (e. g. pneumonia, systemic infection, etc.) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, medicine fever and primary central nervous system pathology. The management of NMS should include

immediate discontinuation of all antipsychotic medicines and other drugs not essential to concurrent therapy;

intensive symptomatic treatment and medical monitoring; and

treatment of any concomitant serious medical problems for which specific treatments are available.

There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS. If a patient requires antipsychotic medicine treatment after recovery from NMS, the potential reintroduction of medicine therapy should be carefully considered. The patient should be carefully monitored, since recurrences of NMS have been reported. Classical neuroleptics are known to lower the seizure threshold. Seizures have been reported after treatment with RISPERDAL. Caution is recommended when treating patients with epilepsy (Orthostatic) hypotension and (reflex) tachycardia or hypertension have been observed. A mild fall in neutrophil and/or thrombocytes count has been reported. RISPERDAL can induce a dose-dependent increase in plasma prolactin concentration. Possible associated manifestations are: galactorrhoea, gynaecomastia, disturbances of the menstrual cycle and amenorrhoea. Premenopausal women who develop secondary amenorrhea of greater than six months duration should receive appropriate preventative therapy to avoid hypo-oestrogenic bone loss. Cerebrovascular accidents have been observed during treatment with risperidone. Water intoxication, either due to polydipsia or the syndrome of inappropriate secretion of the antidiuretic hormone (SIADH), and body temperature disregulation, have been reported. Precautions: RISPERDAL may impair mental alertness. Therefore patients should be advised not to drive or operate machinery until their individual susceptibility is known. It is recommended to halve both the starting dose and the subsequent dose increments in geriatric patients and patients with renal or liver insufficiency. Due to the alpha-blocking activity of RISPERDAL, (orthostatic) hypotension can occur, especially during the initial dose-titration period. RISPERDAL should be used with caution in patients with known cardiovascular disease, and the dosage should be gradually titrated as recommended. A dose reduction should be considered if hypotension occurs. Caution should be used when prescribing RISPERDAL to patients with Parkinson disease since, theoretically, it might cause a deterioration of the disease. Patients may be advised to refrain from excessive eating in view of the possibility of weight gain. Interactions: The risk of using RISPERDAL in combination with other medicines has not been systematically evaluated. RISPERDAL should be used with caution in combination with alcohol and other centrally acting medicines. It may antagonise the effect of levodopa and other dopamine agonists. Carbamazepine has been shown to decrease the plasma levels of the active antipsychotic fraction of RISPERDAL. Similar effects may be observed with other hepatic enzyme inducers. On discontinuation of carbamazepine or other hepatic enzyme inducers the dosage of RISPERDAL should be re-evaluated and, if necessary, decreased. Phenothiazines, tricyclic antidepressants and some beta-blockers may increase the plasma concentration of risperidone but not that of the antipsychotic fraction. Fluoxetine may increase the plasma concentration of risperidone but less so of the anti-psychotic fraction. When RISPERDAL is taken together with other highly protein-bound medicines (e. g. diazepam, warfarin, digitoxin, imipramine and propranolol), there is no clinically relevant displacement of either agent from the plasma proteins.

KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT Reported signs and symptoms have been those resulting from an exaggeration of the medicine's known pharmacological effects. Symptoms of acute overdosage include drowsiness, sedation, hypotension tachycardia and extrapyramidal symptoms. In overdose, rare cases of QT-prolongation have been reported. In the case of acute overdosage, the possibility of multiple medicine involvement should be considered. Treatment: Establish and maintain a clear airway and ensure adequate oxygenation and ventilation. Gastric lavage (after intubation, if the patient is unconscious) and administration of activated charcoal together with a laxative should be considered. Cardiovascular monitoring should commence immediately and should include continuous electrocardiographic monitoring to detect possible arrhythmias. Since there is no known antidote if accidental poisoning or overdosage is suspected, appropriate supportive measures should be instituted. Hypotension and circulatory collapse should be treated with appropriate measures such as intravenous fluids and/or sympathomimetic agents. In case of severe extrapyramidal symptoms, anticholinergic medication should be administered. Close medical supervision and monitoring should continue until the patient recovers.

IDENTIFICATION RISPERDAL 0,5 mg A brownish-red, oblong, biconvex, half-scored, film-coated tablet with "Ris 0.5" inscription on one side and with or without "JANSSEN" inscription on the other side. RISPERDAL 1 mg A white, oblong, film-coated, half-scored tablet with "Ris 1" inscription on one side and with or without "JANSSEN" inscription on the other side. RISPERDAL 2 mg An orange, oblong, film-coated, half-scored tablet with "Ris 2" inscription on one side and with or without "JANSSEN" inscription on the other side RISPERDAL 3 mg A yellow, oblong, film-coated, half-scored tablet with "Ris 3" inscription on one side and with or without "JANSSEN" inscription on the other side. RISPERDAL 4 mg A green, oblong, film-coated, half-scored tablet with "Ris 4" inscription on one side and with or without "JANSSEN" inscription on the other side.

PRESENTATION Cartons containing one or more blisters of 10 tablets each.

STORAGE INSTRUCTIONS Store below 25°C. KEEP OUT OF REACH OF CHILDREN.

REGISTRATION NUMBERS 0,5 mg - 33/2.6.5/0111 1 mg; 2 mg; 3 mg; 4 mg - 27/2.6.5/0235/6/7/8

NAME AND BUSINESS ADDRESS OF THE APPLICANT JANSSEN - CILAG logo JANSSEN PHARMACEUTICA (PTY) LTD (Reg. No. 1980/011122/07) 15th Road HALFWAY HOUSE 1685 Website: www. janssencilag. co. za

DATE OF PUBLICATION OF THIS PACKAGE INSERT 11 July 2002

Code: 024295 2002J Britepak

Updated on this site: May 2004 Source: Pharmaceutical Industry SAEPI HOME PAGE TRADE NAME INDEX GENERIC NAME INDEX FEEDBACK Information presented by Malahyde Information Systems © Copyright 1996-2004

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