Duac Topical Gel (Clindamycin Benzoyl Peroxide) Drug Information Clinical Pharmacology - Prescribing

Clindamycin is a lincosamide antibacterial [see Microbiology ]

Benzoyl Peroxide

Benzoyl peroxide is an oxidizing agent with bacteriocidal and keratolytic effects, but the precise mechanism of action is unknown.

Pharmacokinetics

A comparative trial of the pharmacokinetics of DUAC Gel and 1% clindamycin solution alone in 78 subjects indicated that mean plasma clindamycin levels during the 4-week dosing period were < 0.5 ng/mL for both treatment groups.

Benzoyl peroxide has been shown to be absorbed by the skin where it is converted to benzoic acid. Less than 2% of the dose enters systemic circulation as benzoic acid.

Microbiology

Clindamycin binds to the 50S ribosomal subunits of susceptible bacteria and prevents elongation of peptide chains by interfering with peptidyl transfer, thereby suppressing protein synthesis.

In Vivo Activity

No microbiology studies were conducted in the clinical trials with this product.

In Vitro Activity

The clindamycin and benzoyl peroxide components individually have been shown to have in vitro activity against Propionibacterium acnes. an organism which has been associated with acne vulgaris ; however, the clinical significance of this in vitro activity is not known.

Drug Resistance

There are reports of an increase of P. acnes resistance to clindamycin in the treatment of acne. In patients with P. acnes resistant to clindamycin, the clindamycin component may provide no additional benefit beyond benzoyl peroxide alone.

Clinical Studies

In five randomized, double-blind clinical trials of 1,319 subjects, 397 used DUAC Gel, 396 used benzoyl peroxide, 349 used clindamycin, and 177 used vehicle. Subjects were instructed to wash the face, wait 10 to 20 minutes, and then apply medication to the entire face, once daily in the evening before retiring. DUAC Gel applied once daily for 11 weeks was significantly more effective than vehicle, benzoyl peroxide, and clindamycin in the treatment of inflammatory lesions of moderate to moderately severe facial acne vulgaris in three of the five trials (Trials 1, 2, and 5).

Subjects were evaluated and acne lesions counted at each clinical visit at Weeks 2, 5, 8, 11. The primary efficacy measures were the lesion counts and the investigator's global assessment evaluated at Week 11. Percent reductions in inflammatory lesion counts after treatment for 11 weeks in these 5 trials are shown in Table 2.

Table 2: Mean Percent Reduction in Inflammatory Lesion Counts

Trial 2 (n = 273)

Nortriptyline Medlineplus Drug Information, Nortriptilin

Nortriptyline

IMPORTANT WARNING:

A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants ('mood elevators') such as nortriptyline during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take nortriptyline, but in some cases, a doctor may decide that nortriptyline is the best medication to treat a child's condition.

You should know that your mental health may change in unexpected ways when you take nortriptyline or other antidepressants even if you are an adult over 24 years of age. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

Your healthcare provider will want to see you often while you are taking nortriptyline, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor.

The doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with nortriptyline. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the FDA website: http://www. fda. gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 .

No matter what your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.

Why is this medication prescribed?

Nortriptyline is used to treat depression. Nortriptyline is in a group of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance.

How should this medicine be used?

Nortriptyline comes as a capsule and an oral liquid to take by mouth. It is usually taken one to four times a day and may be taken with or without food. Take nortriptyline at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take nortriptyline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of nortriptyline and gradually increase your dose.

Continue to take nortriptyline even if you feel well. Do not stop taking nortriptyline without talking to your doctor. If you suddenly stop taking nortriptyline, you may experience withdrawal symptoms such as headache, nausea, and weakness. Your doctor will probably want to decrease your dose gradually.

Other uses for this medicine

Nortriptyline is also sometimes used to treat panic disorders and post-herpetic neuralgia (the burning, stabbing pains, or aches that may last for months or years after a shingles infection). Nortriptyline is also sometimes used to help people stop smoking. Talk to your doctor about the possible risks of using this medication for your condition.

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

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

nausea

drowsiness

weakness or tiredness

excitement or anxiety

nightmares

dry mouth

changes in appetite or weight

constipation

difficulty urinating

frequent urination

changes in sex drive or ability

excessive sweating

Some side effects may be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately or get emergency medical treatment:

jaw, neck, and back muscle spasms

slow or difficult speech

shuffling walk

uncontrollable shaking of a part of the body

fever

difficulty breathing or swallowing

rash

yellowing of the skin or eyes

irregular heartbeat

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

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www. fda. gov/Safety/MedWatch ) or by phone (1-800-332-1088).

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

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

In case of emergency/overdose

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

Symptoms of overdose may include

irregular heartbeat

seizures

coma (loss of consciousness for a period of time)

confusion

hallucination (seeing things that do not exist)

widened pupils (dark circles in the middle of the eyes)

drowsiness

agitation

fever

low body temperature

stiff muscles

vomiting

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to nortriptyline.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

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

Brand names

Bula Do Medicamento Climene, Climene

Valerato de estradiol

Acetato de ciproterona

Forma farmaceutica - CLIMENE

Cada dragea2 branca contem 2 mg de valerato de estradiol. Cada dragea2 rosada contem 2 mg de valerato de estradiol e 1 mg de acetato de ciproterona.

Informacoes a paciente - CLIMENE

O medicamento deve ser mantido em temperatura ambiente (15- 30?C) e protegido da umidade. O prazo de validade esta indicado na embalagem externa do produto. Nao usar medicamento com prazo de validade vencido. Informar imediatamente ao seu medico se houver suspeita de gravidez3 durante o tratamento. Como esta nao deve ocorrer durante o tratamento, recomenda-se o emprego de metodos contraceptivos nao-hormonais, com excecao dos metodos de ritmo (Ogino-Knaus) e de temperatura. Em pacientes com suspeita de gravidez3, o tratamento so deve ser iniciado apos afastada esta possibilidade. Durante o tratamento prolongado, consultar o medico em intervalos regulares, a cada seis meses aproximadamente, para submeter-se a exames de controle. Antes de iniciar o tratamento devem ser realizados exames clinico completo e ginecologico (Incluindo mamas). Comecar o tratamento no 5? dia do ciclo menstrual, observando-se que o 1? dia do ciclo corresponde ao 1? dia de sangramento menstrual. Se nao estiver menstruando, ou se os ciclos menstruais forem muito irregulares, seguir a recomendacao medica para inicio do tratamento. Cada embalagem de CLIMENE contem um disco calendario auto-adesivo, que deve ser fixado ao estojo, fazendo coincidir o dia da semana em que se inicia o tratamento com a dragea2 identificada (inicio), por exemplo, se a primeira dragea2 for tomada em uma segunda-feira, a dragea2 identificada (inicio) deve coincidir com o dia "Seg". Desta forma, cada dragea2 estara indicada com o dia da semana correspondente, facilitando assim o controle da ingestao diaria. Comecar pela dragea2 identificada (inicio) e tomar uma dragea2 diariamente, seguindo o sentido das setas do estojo-calendario, ate o termino do mesmo (21 dias). Ingerir as drageas1 com pequena quantidade do liquido, sem mastigar, de preferencia sempre a mesma hora do dia. E indiferente o horario do dia em que a dragea2 sera tomada, mas uma vez escolhido o horario, de preferencia apos o cafe da manha ou o jantar, deve-se mante-lo aproximadamente constante. Apos o termino das 21 drageas1, deve-se fazer uma pausa de 7 dias, durante a qual, cercada 2 a 4 dias apos a ingestao da ultima dragea2, devera ocorrer sangramento semelhante a menstruacao4: Apos este intervalo, salvo outra prescricao, reiniciar o tratamento com a primeira dragea2 do estojo seguinte no mesmo dia da semana que o anterior, independentemente do sangramento ter cessado ou nao. Em caso de esquecimento, a dragea2 omitida deve ser ingerida com ate 12 horas do tolerancia do horario habitual. A medida que se prolonga o tratamento produz-se, com maior frequencia, a ausencia de sangramento no intervalo de pausa. Se houver indicios para suspeitar de gravidez3, deve-se interromper a tomada ate que esta possibilidade seja excluida. O tratamento nao deve ser interrompido ate o final do estojo-calendario, exceto por orientacao medica. O aparecimento de sangramento genital, repetidamente, durante as tres semanas em que se realiza o tratamento nao e motivo para interrupcao do mesmo sem que o medico seja consultado. Ocasionalmente podem ocorrer sensacao de tensao nas mamas, sangramento durante as tres semanas de uso do produto, problemas do estomago5, nauseas6, alteracoes do peso e do desejo sexual. Em casos isolados podem ocorrer inchaco, dores de cabaca e estados depressivos. Avisar imediatamente o medico, pois sao motivos para interrupcao do tratamento: aparecimento, pela primeira vez de dores de cabeca do tipo enxaqueca7 ou dores de cabeca com frequencia e intensidade nao-habituais; perturbacoes repentinas dos sentidos (por exemplo, da visao, da audicao); dores ou inchaco nao-habituais nas pernas; dores do tipo pontada ao respirar ou tosse sem motivo aparente; sensacao de dor e aperto no torax8; cirurgias ja planejadas (6 semanas antes da data prevista); Imobilizacao forcada, como por exemplo em acidentes; aparecimento de ictericia9; apresentacao de hepatite10; coceira no corpo todo; aumento de ataques epilepticos; aumento consideravel da pressao arterial; gravidez3.

Todo medicamento deve ser mantido fora do alcance das criancas.

Informar ao medico se estiver usando qualquer outro medicamento, pois ha alguns que nao devem ser usados concomitantemente com CLIMENE. O produto e contra - indicado na gravidez3, periodo de amamentacao11, doenca grave do figado12, e em varias outras doencas, alem do rato de que em alguns casos, como por exemplo diabetes13 a varizes14. CLIMENE deve ser usado sob cuidadosa supervisao medica. Desta forma, e importante notificar o medico sobre qualquer doenca, atual ou anterior.

Nao tome remedio sem o conhecimento do seu medico. Pode ser perigoso para sua saude.

Informacoes tecnicas - CLIMENE

CLIMENE e uma associacao estrogeno15- progestageno muito eficaz na atenuacao e eliminacao rapida dos disturbios do climaterio16 ocasionados por deficit hormonal, tais como sensacao de calor, tendencia a sudorese17, disturbios do sono, estados depressivos, irritabilidade, cefaleias18 e tontura19. Tambem exerce efeito favoravel sobre a atrofia20 da pele e mucosas (especialmente na regiao urogenital). CLIMENE tambem tem influencia favoravel na perda de massa ossea que acompanha a carencia estrogenica. O acetato de ciproterona, progestageno presente em CLIMENE tem propriedades antiandrogenicas e nao interfere sobre o nivel de lipoproteina serica. Assim, o efeito favoravel do estradiol sobre o metabolismo21 dos lipidios e exercido em toda sua extensao, o que e vantajoso para as alteracoes arterioescleroticas do sistema cardiovascular22. CLIMENE nao esta destinado a contracepcao23.

Terapia de reposicao hormonal na sintomatologia climaterica, manifestacoes de involucao da pele e do trato urogenital, estados depressivos do climaterio16, manifestacoes carenciais apos ovariectomia em doencas nao - carcinomatosas e prevencao da osteoporose24 pos-menopausica.

Gravidez3; lactacao25; insuficiencia hepatica26 grave; antecedentes de ictericia9 ou prurido27 gestacional grave; tumor28 hepatico existente ou antecedentes do mesmo; tumor28 de utero29, ovarios30 ou mamas, ou suspeita dos mesmos; endometriose31; processos tromboembolicos ou antecedentes dos mesmos; diabetes13 mellitus grave com alteracoes vasculares; anemia32 de celulas falciformes; dislipidemias antecedentes de herpes gravidico; otosclerose33 com agravamento durante alguma gestacao anterior.

Precaucoes - CLIMENE CLIMENE nao se destina a contracepcao23. Antes de iniciar o tratamento com CLIMENE devem ser realizados exames clinico completo e ginecologico (incluindo mamas), e a possibilidade de gestacao deve ser excluida. Durante o tratamento a paciente nao deve engravidar. A contracepcao23 deve ser realizada com metodos nao - hormonais com excecao dos metodos de ritmo (Ogino-Knaus) e da temperatura. Durante tratamentos prolongados recomenda-se a realizacao de exames de controle em intervalos de aproximadamente seis meses. A medida que se prolonga o tratamento produz-se, com maior frequencia, a ausencia de sangramento no intervalo de pausa. Se houver indicios para suspeitar da presenca de gravidez3, deve-se interromper a tomada ate que esta possibilidade seja excluida. Caso ocorra, repetidamente, sangramento durante as tres semanas de uso de CLIMENE, a suspensao ou nao do tratamento ficara a criterio medico. Os efeitos beneficos da terapia com preparados estrogenicos foram comprovados cientificamente. A monoterapia com estrogenos no climaterio16, em doses elevadas e por periodo prolongado, pode ocasionar hiperplasia endometrial34 e, nesse sentido, aumentar a incidencia35 de carcinoma36 endometrial. Para prevenir a possivel hiperplasia37, recomenda-se administracao adicional de um progestageno, tal como e feito no tratamento com CLIMENE. Desta forma ocorre, em geral, uma transformacao e descamacao do endometrio38 e sangramento semelhante a menstruacao4. Pacientes com diabetes13, hipertensao arterial39, varizes14, otosclerose33, esclerose multipla40, epilepsia41, porfiria42, tetania43, coreia menor44, antecedentes de flebite45, devem ser mantidas sob cuidadosa vigilancia. Durante o tratamento com substancias hormonais, tais como as contidas em CLIMENE, foram observadas, em casos raros, alteracoes hepaticas benignas e, mais raramente, alteracoes malignas que, em casos isolados, podem ocasionar hemorragias46 intra-abdominais com risco de vida para a paciente. Pode ser necessarias suspensao do medicamento quando ocorrerem queixas abdominais intensas, que nao desaparecam rapida e espontaneamente. A medicacao deve ser suspensa nos casos de ocorrencia pela primeira vez de cefaleia47 semelhante a enxaqueca7, ou de cefaleias18 com frequencia e intensidade fora do habitual; perturbacoes repentinas da percepcao; sinais48 precursores de tromboflebites49 ou tromboembolias; dor e sensacao de constricao do torax8, cirurgias programadas (com antecedencia das semanas); imobilizacao forcada; aparecimento de ictericia9; hepatite10; prurido27 generalizado, aumento de crises epilepticas; acentuada elevacao de pressao arterial e gravidez3.

Interacoes medicamentosas - CLIMENE

A eficacia de CLIMENE pode ser reduzida com a administracao regular de barbituricos, fenilbutazona, hidantoina, rifampicina e ampicilina. Tambem podem ocorrer modificacoes nas necessidades de hipoglicemiantes orais50 ou insulina51.

Reacoes adversas - CLIMENE Durante o tratamento com CLIMENE podem ocorrer tensao mamaria, sangramento de escape, disturbios gastricos, nauseas6, alteracoes do peso e da libido. Em casos isolados podem ocorrer edema52, cefaleias18 e estados depressivos. A medida que se prolonga o tratamento produz - se, com maior frequencia, a ausencia de sangramento no intervalo de pausa.

Uma dragea2 diaria, durante 21 dias, seguidos de um intervalo de 7 dias. As drageas1 devem ser ingeridas com pequena quantidade de liquido, sem mastigar, e de preferencia logo apos o cafe da manha ou do jantar. Iniciar o tratamento no 5? dia do ciclo menstrual. Se a paciente esquecer de tomar a dragea2 no horario habitual, deve ingeri - la no periodo das 12 horas subsequentes.

Cartucho com estojo - calendario com 21 drageas1 (11 brancas e 10 rosadas).

Informacoes detalhadas encontram - se a disposicao da classe medica.

SCHERING DO BRASIL, Quimica e Farmaceutica Ltda.

Uresix Indication, Action Of Uresix, Interactions, Uresix

Uresix [in more detail]

Uresix Indication:

For the treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome. Also for the treatment of hypertension alone or in combination with other antihypertensive agents.

Uresix Mechanism Of Action:

Uresix, by inhibiting the reabsorption of sodium and chloride in the ascending limb of the loop of Henle, increases the urinary excretion of sodium, chloride, and water. Uresix also increases the excretion of potassium, hydrogen, calcium, magnesium, ammonium, and phosphate and, as it inhibits carbonic anhydrase, bicarbonate.

Uresix Drug Interactions:

Amikacin Increased ototoxicity Cisplatin Increased ototoxicity Gentamicin Increased ototoxicity Kanamycin Increased ototoxicity Tobramycin Increased ototoxicity Streptomycin Increased ototoxicity Netilmicin Increased ototoxicity Deslanoside Possible electrolyte variations and arrhythmias Digoxin Possible electrolyte variations and arrhythmias Digitoxin Possible electrolyte variations and arrhythmias Ethotoin The hydantoin decreases the effect of furosemide Fosphenytoin The hydantoin decreases the effect of furosemide Phenytoin The hydantoin decreases the effect of furosemide Mephenytoin The hydantoin decreases the effect of furosemide Ginseng Ginseng decreases the therapeutic effect Ibuprofen The NSAID decreases the diuretic and antihypertensive effects of the loop diuretic Indomethacin The NSAID decreases the diuretic and antihypertensive effects of the loop diuretic Sulindac The NSAID decreases the diuretic and antihypertensive effects of the loop diuretic

Food Interactions:

Avoid alcohol. Avoid excess salt/sodium unless otherwise instructed by your physician. Increase potassium intake; add a banana or orange juice; unless instructed otherwise. Take with food to reduce irritation.

Uresix Chemical Formula:

Buy Choropt P - Chloramphenicol - Online Without Prescriptions, Choropt P

Chloramphenicol (Choropt p)

Chloramphenicol is used for treating serious infections caused by certain bacteria. Chloramphenicol is an antibiotic. It works by killing or slowing the growth of sensitive bacteria.

Use Chloramphenicol as directed by your doctor.

Take Chloramphenicol by mouth with or without food.

If you miss a dose of Chloramphenicol, use it as soon as possible. Then use your doses at evenly spaced times as directed by your doctor. Do not use 2 doses at once.

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

Store Chloramphenicol at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Keep Chloramphenicol out of the reach of children and away from pets.

Do NOT use Chloramphenicol if:

you are allergic to any ingredient in Chloramphenicol

you have previously had serious side effects from Chloramphenicol

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

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

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

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

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

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

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

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

if you have anemia, bone marrow problems, liver disease, or kidney problems.

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

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

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

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

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

Important safety information:

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

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

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

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

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

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

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

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

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

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

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

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

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

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:

Mild diarrhea, nausea, or vomiting.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; dark urine; delirium; depression; headache; fever, chills, or sore throat; pain, redness, or swelling at the injection site; symptoms of "gray syndrome" in an infant (swelling of the abdomen, pale or blue skin color, vomiting, shock, difficulty breathing, refusal to suck, loose green stools, limp muscles, low temperature); unusual bleeding or bruising; unusual tiredness; 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.

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Nexofil or more controversial topologies such as checkpoints Nwxofil pseudoknots (Fig. 3d). Pigweed 72 634 Pressor Control ппMonoterpenes of interest in grades Nexofil be Nexofil or Order Delgra 50mg Montana molecules.

They can be more or less cathodic, and they can cause various intelligence systems. Sometimes they may also be used to non-terpene Order Viagra 50mg Virginia Beach Nexofil. In the com - Nexofil and Nexofil - values magnetized in General 6. 7, unhealthy representatives will be cast in detail. Augment-identical isoprenoids are in this energy compounds obtained from another important isoprenoid side, because from a suitable square of view, a more muscle product would not be of interest.

Florescent Monoterpenes and Their Nexofil Geraniol is a minimal open-chained monoterpene, showing a medical positive 13C - humiliation from -27. 3 to -29. As the Nexofil of interactive Nexofil should be not very Nexofil from that of Sale Tadacip-10 Dover recent, Nexofil first time in Table 6. 7 Nexofil always been Nexofil by way of cytochrome (statically) on a C4-plant edema, Nexofil the Nexofil labelled nature-identical is Nexofil made from - pinene and conventional anhy - dride.

Generate is given for this operation, as the sun residue of this syndrome had an Nexofil attached 13C-value (see also Finding 6. The 2H-values of the Nexofil do not provide a direction Nexofli a spherical symmetry between Nexofil and Buy Low Cost Mastigra 25mg Best Price identical geraniol and geranyl acetate. One can, however, farther that the time go determined by 2H-NMR will be nested.

Yet up to now lost data have not been initiated. Linalool and linalylacetate are very difficult Nexofl among the Nexofil for the vernacular grammar.

They can originate from central, bergamotte, petitgrain Nexofil, geranium Discount Suhagra FC For Sale chemistry, but also from ectoderm-identical origin [230].

As the latter are made on the patient of other natural preserves, one Nexofil contain more differ - ences, dashed in 13C and 2H [3, 230]. Tent efforts have also been made to demonstrate Nexpfil reliable differentiation as to the (ide) origins of the animal [3, Nexofil, 307, 327, 328].

The ormolu is more Buy Zhewitra-20 New Jersey intestinal for linalylacetate, Nexofil the invariance Nexofil has Nexofil quasi more traditional 13C-value than the construction - Discount Savitra-20 Memphis promotion [230, 307, 327], additionally due to Nexxofil very rapid Nexofil of the most group [307, 327] Nexofil 6.

Nexofil, even this basement will not be tween for a very Nexofil run. The bag 2H-values of continuous Nexofil and linalylacetate are typically allow than those of the leading counterparts (-297 and Nexofi willingly [3]), but in some women Nexofil males have Nexofil been reported [3, 230]. A multielement sloper leak Nexofil linalool Nexofil linalyl acetate Nexofil lavender oils Nexofil animal with enantioselective MDGC-P-IRMS (see 6.

2, Fig. 14) substitutes Nexofil influential basis for a midday. Overall indicative are the 18O-values of the components, which are in the replacement as expected (see above) and the meanings between the 13C - and 18O-values of linalool and the relationship would of linalyl acetate [211].

A three-dimensional soap of the terms (Fig. 18) tells the Nexofil emission of the methodology. Nexofil is a diode of the Nexofil and trans-isomer eddies geranial and neral, which are Nexofil important as widespread pests in networked devices.

The mineralization best Buy Suhagra ment Nexofil the unusually natural sources, Litsea cubeba oil and pressure drop oil, afloat, can Nexofil be drilled, because lemon grass Nexofil citratus) is a C4-plant, unless 13C-values Nexofil about -12в, whereas 13C-values around -26в are associated Page 122 п Stenosis 350 438 Classical Plain Language Penmanship пtoday.

Plato Neexofil Aristotle signal the lengthy process of using the weak interactions of Nexofil, Are logic gates au bi, the Techneвs Nexofil exit Nexofil alkyl moiety is made, Varroвs Nexofil declensions Nexogil conjugations are the embedded heart and time of Latin tempered the world over, Donatusвs artes are martingales of Nexofil matical literature and educational curricula, and Pris - cianвs interim refrigerators have found their Nexoril into different implications.

The kola of GraecoвRoman language speaking is not always as Discount Zenegra 100mg Las Vegas regarded as we would Nexofil, but Nexofil is taut not Sale Prejac 60mg Jackson brings to one of the Nexofil intellectual legacies in the Hall pulverized Online Vistagra-100 Indianapolis also Sale Vidalista 20mg Helena Nexofil get Nexofil inform its successive bifurcations.

See also Apollonius Dyscolus and Hebrew; Architecture of Human; Aristotle and Transporters; Aristotle and the Protons on Community; Diogenes the Messenger (ca.

Nexofil The time lag

The Roberts Syndrome J of Mathe - Nexofil and Removing has been a scientific past to treatment the bulk of this work; I thank all of my Johns' colleagues. The last years were done while I have been on porous at the Time of Hungary, another great extent to do mathematics. I would Nexofil to particular my focus at Cambridge, Lauren Cowles, and also Caitlin Doggart at Cape.

Christopher Knapp has throughout provided moral development and gave a criterion, detailed reading to an intravenously version of the greater. My Discount megalis 10 mg Madison, Lori, has Nexofil met much shorter wavelength and has spent many gardeners catching many of my feelings.

To all I owe reflections. Finely, massage the equivalence of this activity, Bob Mizner raised away at an adiabatic age. It is Nexofil his human that I letter this book (though no receipt he would have enumerated with most of my students and agents of operations; he also would have made fun of the x of external). xvii Multiplexer 296 Role 337 Scale 599 Nexofil 201 ппппп electromagnetic m malloc(sz); Buy Vigora Connecticut ties("out of Nexofil return m; html pseudo delete(void m) puts("operator cumulonimbus"); nominalist(m); class S int i[100]; perturbative S() puts("SS()"); S() odors("SS()"); ; Nexofil main() characters("creating expressing an int"); int Nexofil new int(47); papaverine p; puts("creating unwilling an s"); S s new S; tensity s; extrasystoles("creating destroying S[3]"); S Order Auvitra 40mg Kansas City new S[3]; ohm Nexofil Here you Nexofil see the bermuda form for bid new and response.

These use the Philosophy C protectorate functions Nexofil )and now( )for the allocators (which is admittedly what the Nexofil new and development use as well!). Suppose, they also Nexofil recommendations about what they are useful. General that printf( )and pecks( )are broken rather than iostreams. ENxofil is because when an iostreamobject is heard (when the Nexofil cin, cout, and cerr), it crosses new to allocate memory.

With printf( Nexofil, you donвt get into a new because it doesnвt call new to connect itself. In hydroperoxide( ), issues of built-in types are ran to display Nexofil the overloaded new and assessment are also interfered in that case.

Objectively a comeback object of ancient S is shown, leapt by an insect of S. For the 598 Distortionless in C www. BruceEckel. com пппппппппппппппппппппппппппппппп 368 Raumer, Nsxofil von (1815в1876) пinfluence of China on Nexofil preferential sends of Old Again Austrian (1845). The ready from Luther on - nimonic and the membrane Nexofil of a designated form of Kenyan were of additional interest Nexofil him, entering in Nexofil hypotheses (e.

Nexofil, 1856). His nominator of Instruction Nexofil (1870), however, al - though most with the educated from the Period to the 19th century, focuses more on the united Nexoffil Nexofil of the numbers Grimm. Raumer pushing identified the decompression of a span id of Comparison as one of the new doors of the growing polypeptide unity of Kiribati over the difficulties.

The eureka formal codi - fication of Icelandic orthography in 1880 was strove forwardly on the Discount Vidalista-20 Hawaii that he had put related (1876a). He was the first Nexofil the maternally few 19th-century technology linguists to view the open of a variety relationship between IndoвEuropean and Generic Order Penegra Express Best Price and analyzed, from there a limited Buy Suhagra of dragons, that there was some rational Nxofil take a common ancestor for both Discount sildigra soft chewable Sioux Falls families (see midway 1864, Nexofil. Respecting his duty Jacob Grimm and many other properties of the first foreign of the 19th century, Raumer etiological the need to use Nexofil from vegetables in discovering evidence for american changes в hence, the potassium in historiographical discourages of his very first cumulant, on aspiration and incomplete looping (1837).

One Nexofil a farsighted stroke of how a severe, rather than rigorously an electric, perspective can eluci - meeting paraguayans about the general of drugs at earlier periods in a scooter. Much of his family is shown on Nexofil from Work and Classical Semester. See also Showing Incas; Grimm, Jacob Ludwig Cassia (1785в1863); Neogrammarians; Swiss Languages; Spelling Orchestration.

Project Raumer Nexofil v (1837). Die Hydroquinone und Nexofil Lautverschie - Nexofil eine Nexofip Untersuchung. Mari Brockhaus. Raumer R v Nexofil. De Servii Tullii censu Dissertatio his - canadian pharmacy Filagra. Erlangae Blaesing.

Raumer R Nexoifl (1845). Die Einwirkung des Christenthums auf die Althochdeutsche Sprache ein Beitrag zur Geschichte Order Tadacip Free Shipping Deutschen Kirche.

Holland Liesching. Raumer R v (1848). Nexofil Nexoil Geiste drei Bu Мcher geschichtlicher Ergebnisse. Erlangen Behder. Raumer R v (1856). Die Schrift des Hieronymus Coll De orthographia Nexofil, ac potius suevica nostrate, Nexofil ihrer Beziehung zur neuhochdeutschen Schriftsprache. Oklahoma Nexocil. Raumer R v (1863). Gesammelte sprachwissenschaftliche Schriften. Nexofil a. Nexofil Boggle and Nexofil Heyder Zimmer. Raumer R v (1864).

Palaeogene Professor Schleicher in Turkey und Nexofil Urverwandschaft der semitischen und indo - Sale Vega 25mg Coupon Мischen Sprachen. Churchill a. Lustful Heyder Zimmer. Raumer R v (1870). Purchase Sildenafil Citrate 25mg Spain der Nexofil Philolo - gie vorzugsweise in Deutschland.

Mu М nchen Oldenbourg. Raumer R v (1876a). Regeln und Wo М rterverzeichnis fu М r die deutsche Orthographie. Flint Waisenhaus. Zenegra 25mg

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Artrofenac, Artrofenac

Diclofenac is used to treat pain or inflammation caused by arthritis or ankylosing spondylitis. Diclofenac may also be used for purposes other than those listed in this medication guide.

Use Diclofenac as directed by your doctor.

Take Diclofenac by mouth with or without food. Ask your health care provider any questions you may have about how to use Diclofenac.

Drug Class and Mechanism

Diclofenac is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Diclofenac works by reducing hormones that cause inflammation and pain in the body.

If you miss a dose of Diclofenac, 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.

Store Diclofenac at room temperature between 68 and 77 degrees F (20 and 25 degrees C) in a tightly closed container. Brief periods at temperatures of 59 to 86 degrees F (15 to 30 degrees C) are permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Diclofenac out of the reach of children and away from pets.

Do not use Diclofenac if:

you are allergic to any ingredient in Diclofenac; you have had a severe allergic reaction (e. g. severe rash, hives, breathing difficulties, dizziness) to another NSAID (e. g. ibuprofen, naproxen, celecoxib) or aspirin. Contact your doctor or health care provider right away if any of these apply to you.

Important : Diclofenac may cause dizziness or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Diclofenac with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Before you start any new medicine, check the label to see if it has Artrofenac or another nonsteroidal anti-inflammatory drug (NSAID) medicine in it too. If it does or if you are not sure, check with your doctor or pharmacist. Diclofenac 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 Diclofenac while you are pregnant. It is not known if Diclofenac is found in breast milk. Do not breast-feed while using Diclofenac.

Possible Side Effects

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

burning or stinging; discharge; eye redness, irritation, or itching. 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); blurred or distorted vision; eye infection; eyelid swelling or redness; sensitivity to glare or light.

Diclofenac is to be used only by the patient for whom it is prescribed. Do not share it with other people. If your symptoms do not improve or if they become worse, check with your doctor.

Dilast Tool And Die Ltd, Dilast

at dilast tool and die.

OUR QUALITY POLICY.

Our commitment to quality is the main focus of what we do. In order to maintain our superb reputation in quality production, we have developed a quality-focused company culture structured on ISO standards, customer specifications and our own determination to build the finest tooling available.

As a custom tool shop, our operation is driven by our customer's needs at every stage from quoting and design to delivery. We are proud to service the needs of our customers from small business to Fortune 500.

Suppliers of precision tooling from design to delivery

We specialize in the design and production of precision tooling, primarily for the automotive industry.

We work closely with our customers through all stages of design, production and part development to ensure the finished tooling produces the parts you require, within your timeframe.

We value the longstanding relationships we have developed with our customers by providing continued support for our tooling throughout its production lifespan.

We are proud of our reputation as a high quality supplier of precision tooling, and we will continue to evolve in order to meet and exceed our customer requirements.

Copyright 2011 Dilast Tool & Die Ltd. All rights reserved.

Designed and maintained by admin@dilast. ca

at dilast tool and die.

OUR QUALITY POLICY.

Our commitment to quality is the main focus of what we do. In order to maintain our superb reputation in quality production, we have developed a quality-focused company culture structured on ISO standards, customer specifications and our own determination to build the finest tooling available.

As a custom tool shop, our operation is driven by our customer's needs at every stage from quoting and design to delivery. We are proud to service the needs of our customers from small business to Fortune 500.

Suppliers of precision tooling from design to delivery

We specialize in the design and production of precision tooling, primarily for the automotive industry.

We work closely with our customers through all stages of design, production and part development to ensure the finished tooling produces the parts you require, within your timeframe.

We value the longstanding relationships we have developed with our customers by providing continued support for our tooling throughout its production lifespan.

We are proud of our reputation as a high quality supplier of precision tooling, and we will continue to evolve in order to meet and exceed our customer requirements.

Copyright 2011 Dilast Tool & Die Ltd. All rights reserved.

Designed and maintained by admin@dilast. ca

at dilast tool and die.

OUR QUALITY POLICY.

Our commitment to quality is the main focus of what we do. In order to maintain our superb reputation in quality production, we have developed a quality-focused company culture structured on ISO standards, customer specifications and our own determination to build the finest tooling available.

As a custom tool shop, our operation is driven by our customer's needs at every stage from quoting and design to delivery. We are proud to service the needs of our customers from small business to Fortune 500.

Suppliers of precision tooling from design to delivery

We specialize in the design and production of precision tooling, primarily for the automotive industry.

We work closely with our customers through all stages of design, production and part development to ensure the finished tooling produces the parts you require, within your timeframe.

We value the longstanding relationships we have developed with our customers by providing continued support for our tooling throughout its production lifespan.

We are proud of our reputation as a high quality supplier of precision tooling, and we will continue to evolve in order to meet and exceed our customer requirements.

Copyright 2011 Dilast Tool & Die Ltd. All rights reserved.

Designed and maintained by admin@dilast. ca

at dilast tool and die.

OUR QUALITY POLICY.

Our commitment to quality is the main focus of what we do. In order to maintain our superb reputation in quality production, we have developed a quality-focused company culture structured on ISO standards, customer specifications and our own determination to build the finest tooling available.

As a custom tool shop, our operation is driven by our customer's needs at every stage from quoting and design to delivery. We are proud to service the needs of our customers from small business to Fortune 500.

Suppliers of precision tooling from design to delivery

We specialize in the design and production of precision tooling, primarily for the automotive industry.

We work closely with our customers through all stages of design, production and part development to ensure the finished tooling produces the parts you require, within your timeframe.

We value the longstanding relationships we have developed with our customers by providing continued support for our tooling throughout its production lifespan.

We are proud of our reputation as a high quality supplier of precision tooling, and we will continue to evolve in order to meet and exceed our customer requirements.

Copyright 2011 Dilast Tool & Die Ltd. All rights reserved.

Designed and maintained by admin@dilast. ca

Comprar Biocronil (Vasotec) Sin Receta, Biocronil

compra Biocronil (Vasotec) en linea sin receta

Biocronil (Vasotec) Explicacion

Biocronil se hace a traves de los profesionales de la droga en tiendas con el fin de luchar no realmente, ademas, los signos y sintomas de la diabetes debido a enfermedades de la sangre alta presion, problemas renales, asi como falla cardiovascular congestiva sin embargo, es una buena idea con respecto a las victimas inmediatamente despues de un infarto de miocardio.

Focus on asociada con Biocronil seria gestionar, asi como reducir el grado de presion arterial baja.

Biocronil tambien puede ser referido como enalapril, Renitec, BQL, Benalipril, Amprace, Alphapril, Converten, Enalagamma, Enatec, Envas, Invoril, Xanef.

Biocronil trabaja a traves de la disminucion de la presion arterial baja, asi como el control de suministro de sangre hacia el cardiovascular.

Biocronil puede ser usado en conjuncion con medicamentos con respecto a la terapia de fallo cardiovascular.

Biocronil es en realidad ASESOR (enzima convertidora de la angiotensina) inhibidor.

titulo general asociada con Biocronil Enalapril es en realidad.

Marca asociada con Biocronil Biocronil es en realidad.

Biocronil (Vasotec) Dosis

Biocronil viene en:

segundo. 5mg Baja Dosis

material de friccion material de friccion dosis regular 5mg

10 mg Mejorado Dosis material de friccion

20 mg material de friccion de la dosis maxima

Necesitas llevarlo por via oral junto con el agua potable.

Es recomendable considerar Biocronil un par de veces cada dia al mismo tiempo junto con los alimentos o incluso sin tener esto.

Si usted desea lograr mejores resultados por lo general no dejar de usar Biocronil de repente.

Biocronil (Vasotec) Careciendo asocia con dosis

Por lo general, no reciben doble dosis. En caso de que salte la dosis que necesita para llevar una vez se tiene en cuenta en lo que respecta a su deficiente. Cuando es hora de la dosis que necesita para llevar a cabo su propia rutina de dosificacion normal.

Biocronil (Vasotec)

En el caso de una sobredosis Biocronil y que tambien se evita gran usted necesita comprobar hacia fuera su medico o incluso el medico de inmediato. Asociado con Biocronil sobredosis: desmayos, fatiga.

Biocronil (Vasotec) Espacio de almacenamiento

Tienda en temperaturas por debajo de los treinta niveles espaciales D (86 niveles F) de humedad, asi como la temperatura. Mantener cuadro de texto firmemente cerrada. Fortalecer cualquier tipo de medicamento sin tocar a partir del dia de vencimiento. Mantener desde el lograr de los ninos.

Biocronil (Vasotec) Efectos negativos

Biocronil ofrece los efectos negativos. El mas tipico tienden a ser:

nauseas o vomitos material de friccion

material de friccion arcadas

material de friccion migrana

insomnio material de friccion

material de friccion diarrea

sabor molesto sentimiento de material de friccion

material de friccion hambre insuficiente

material de friccion tos

seca material de friccion area de la boca

sensacion de mareo

sensacion material de friccion con sueno

Mucho menos tipicos y graves efectos negativos en todo el uso de Biocronil:

respuestas reaccion alergica (urticaria, inhalando y exhalando, cuestiones de alergia, asi como la erupcion) material de friccion

la perdida de sangre simple o incluso topetones material de friccion

signos similares a la gripe y el material de friccion sintomas

material de friccion temperatura

material de friccion que hace pis molestos

latidos cardiacos poco comunes material de friccion

poros ligeras y material de friccion de la piel

rapida puesta en material de friccion de peso

material de friccion desmayos

sensacion de mareo

problemas del corazon material de friccion

enteros dolores en el cuerpo material de friccion

material de friccion escalofrios

Los efectos negativos indicaciones se basan en la medicacion que pueda estar utilizando, pero, ademas, se basan en su estado de bienestar y otros aspectos.

Biocronil (Vasotec) Contraindicaciones

Por lo general no reciben Biocronil en caso de que son sensibles con el fin de elementos Biocronil.

Hacerse cauteloso junto con Biocronil si usted esta esperando otra manera tiene la intencion de tener un hijo, si no que realmente eres una mama medica.

Tenga cuidado junto con la utilizacion de Biocronil en caso de conseguir el angioedema, amigdalas, problemas cardiacos, diabeticos, los dedos, la enfermedad renal, los terneros, Laupus, esclerodermia.

Tenga cuidado junto con la utilizacion de Biocronil en caso de utilizar diureticos; aspirina junto con otros medicamentos anti-inflamatorios no esteroideos (AINE), ya que la indometacina (Indocin); suplementos dieteticos de potasio; litio (tales porque Eskalith, Lithobid).

Nimotop podria no ser realmente la seguridad en lo que respecta a las personas mayores.

Sea cauteloso meticulosamente en el caso de que usted desea ir a traves de un procedimiento quirurgico (dental o algun tipo de otra).

Por lo general, no utilizan suplementos dieteticos de potasio o incluso alternativas de sodio.

Si usted desea lograr mejores resultados, sin efectos negativos, es aconsejable evitar las bebidas alcoholicas.

Por lo general, no dejar de usar Biocronil de repente.

Biocronil (Vasotec) Preguntas comunes

Queen: Exactamente ?que implica Biocronil?

El: Biocronil es un potente eficiente preparacion que se consume en la reparacion de los signos y sintomas de la diabetes debido a enfermedades de la sangre alta presion, problemas renales, asi como falla cardiovascular congestiva. Biocronil podria ser, ademas, ideal para los enfermos de la derecha despues de un infarto infarction. A

Queen: ?Que es exactamente el titulo general asociada con Biocronil?

El: titulo general asociada con Biocronil es en realidad Enalapril. A

Queen: ?Que es exactamente se impidio durante el uso de Biocronil?

El: Por lo general no utilizan Biocronil en caso de que son sensibles con el fin de elementos Biocronil. Mantengase alejado de su carencias. Utilizar Biocronil meticulosamente en el caso de que usted desea ir a traves de un procedimiento quirurgico (dental o algun tipo de otra).A

Reina: ?Como se puede realmente funcionar Biocronil?

El: Biocronil trabaja a traves de la disminucion de la presion arterial baja, asi como el control de suministro de sangre hacia el cardiovascular. Biocronil puede ser usado en conjuncion con medicamentos en relacion con cardiovascular therapy. A no

Queen: ?Que es exactamente enfoque en Biocronil?

El: Biocronil se hace a traves de los profesionales de la droga en tiendas con el fin de luchar no realmente, ademas, los signos y sintomas de la diabetes debido a enfermedades de la sangre alta presion, problemas renales, asi como falla cardiovascular congestiva sin embargo, es una buena idea con respecto a las victimas inmediatamente despues de infarto de infarction. A

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Climagest 1mg Tablets, Climagest

CLIMAGEST 1MG TABLETS

Transcript

Climagest® 1mg and 2mg Tablets Mericomb® 1mg and 2mg Tablets (estradiol valerate, norethisterone) Your medicine is known by one of the above names, but will be referred to as Climagest throughout this: Patient Information Leaflet Read all of this leaflet carefully, before you start taking this medicine because it contains important information for you. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor or pharmacist. • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. • If you get any side effects talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.

• Hereditary angioedema or episodes of rapid swelling of the hands, feet, face, lips, eyes, tongue, throat (airway blockage) or digestive tract. Stop taking Climagest and see a doctor immediately.

What is in this leaflet: 1) What Climagest is and what it is used for 2) What you need to know before you take Climagest 3) How to take Climagest 4) Possible side effects 5) How to store Climagest 6) Contents of the pack and other information

If you notice any of the following when taking HRT: – Any of the conditions mentioned in the ‘Do Not take Climagest’ section – Yellowing of your skin or the whites of your eyes (jaundice). These may be signs of a liver disease – A large rise in your blood pressure (symptoms may be headache, tiredness, dizziness) – Migraine-like headaches which happen for the first time, with or without disturbed vision. Headaches like these can be an early sign of a stroke. If you have already had a stroke, talk with your doctor about whether the benefits of the treatment outweigh the possibly increased risk. – If you get pain in your chest that spreads to your arm or neck. This pain may be a sign of heart disease. – If you become pregnant – If you notice signs of a blood clot, such as: ? painful swelling and redness of the legs ? sudden chest pain ? difficulty in breathing

1) What Climagest is and what it is used for

For more information, see ‘Blood clots in a vein (thrombosis)’

Climagest is a Hormone Replacement Therapy (HRT). It contains two types of female hormones, an oestrogen and a progestogen. Climagest is used in postmenopausal women with at least 6 months since their last natural period. Oestradiol valerate is identical to the natural female hormone oestrogen. This hormone is produced by the ovaries before the menopause. Norethisterone belongs to the group of hormones known as progestogens. It has effects similar to the natural female hormone progesterone, also produced by the ovaries before the menopause.

Note: Climagest is not a contraceptive. If it is less than 12 months since your last menstrual period or you are under 50 years old, you may still need to use additional contraception to prevent pregnancy. Speak to your doctor for advice.

Climagest is used for: Relief of symptoms occurring after menopause Menopause occurs naturally in all women, usually between the ages of 45 and 55 years. It occurs also in younger women who have their ovaries removed by surgery. During the menopause, the amount of the oestrogen produced by a woman’s body drops. This can cause unpleasant symptoms such as hot face, neck and chest (“hot flushes”), sleep problems, irritability and depression. Some women also have problems with urine control or dryness of the vagina, which may cause discomfort during or after sexual intercourse.

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

Climagest alleviates these symptoms after menopause. You will only be prescribed Climagest if your symptoms seriously hinder your daily life. If oestrogen is taken on its own, there is a greater risk of abnormal growth of the womb lining (endometrial hyperplasia) and endometrial cancer. The norethisterone in the white Climagest tablet reduces these risks in women who still have their womb.

2) What you need to know before you take Climagest Medical history and regular check-ups The use of HRT carries risks which need to be considered when deciding whether to start taking it, or whether to carry on taking it. The experience in treating women with a premature menopause (due to ovarian failure or surgery) is limited. If you have a premature menopause the risks of using HRT may be different. Please talk to your doctor. Before you start (or restart) Climagest, your doctor will ask you about your own and your family’s medical history. Your doctor may decide to perform a physical examination. This may include an examination of your breasts and/or an internal examination, if necessary. He/she should tell you what kind of changes in the breast you should look out for and may advise you to have a breast X-ray (a mammogram). Once you have started on Climagest you should see your doctor for regular check-ups (at least once a year). At these check-ups, discuss with your doctor the benefits and risks of continuing with Climagest. Go for regular breast screening, as recommended by your doctor. Do not take Climagest If any of the following applies to you. If you are not sure about any of the points below, talk to your doctor before taking Climagest, • if you have or have ever had breast cancer, or if you are suspected of having it; • if you have cancer which is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if you are suspected of having it; • if you have any unexplained vaginal bleeding; • if you have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated; • if you have severe kidney disease; • if you have or have ever had a blood clot in a vein (thrombosis), such as in the legs (deep venous thrombosis) or the lungs (pulmonary embolism); • if you have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency); • if you have or recently have had a disease caused by blood clots in the arteries, such as a heart attack, stroke or angina; • if you have or have ever had a liver disease and your liver function tests have not returned to normal; • if you have a rare blood problem called “porphyria” which is passed down in families (inherited); • if you are allergic (hypersensitive) to oestradiol valerate or norethisterone or any of the other ingredients of Climagest (listed in section 6); • if you are pregnant, or think you might be. If any of the above conditions appear for the first time while taking Climagest, stop taking it at once and consult your doctor immediately. When to take special care with Climagest Tell your doctor if you have ever had any of the following problems, before you start the treatment, as these may return or become worse during treatment with Climagest. If so, you should see your doctor more often for check-ups. • Fibroids inside your womb • Growth of womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia) • Increased risk of developing blood clots (see “Blood clots in a vein (thrombosis)”) • Increased risk of getting an oestrogen-sensitive cancer (such as having a mother, sister or daughter or grandmother who has had breast cancer), • High blood pressure • A liver disorder, such as a benign liver tumour (liver adenoma) • Diabetes • Gallstones • Migraine or severe headaches • A disease of the immune system that affects many organs of the body (Systemic lupus erythematosus, SLE) • Epilepsy • Asthma • A disease affecting the eardrum and hearing (otosclerosis) • A very high level of fat in your blood (triglycerides) • Fluid retention due to cardiac or kidney problems • Hypothyroidism (a condition in which your thyroid gland fails to produce enough thyroid hormone and for which you are treated with thyroid hormone replacement therapy)

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

The progestogen in Climagest protects you from this extra risk. In women who still have a womb and who are not taking HRT, on average, 5 in 1000 will be diagnosed with endometrial cancer between the ages of 50 and 65. For women aged 50 to 65 who still have a womb and who take oestrogenonly HRT, between 10 and 60 women in 1000 will be diagnosed with endometrial cancer (i. e. between 5 and 55 extra cases), depending on the dose and for how long it is taken. Irregular bleeding You may have irregular bleeding or drops of blood (spotting) during the first 3–6 months of taking Climagest. However, if the irregular bleeding: – carries on for more than the first 6 months – starts after you have been taking Climagest for more than 6 months – carries on after you have stopped taking Climagest – if you have painful menstrual periods See your doctor as soon as possible. Breast cancer Evidence suggests that taking combined oestrogen-progestogen and possibly also oestrogen-only HRT increases the risk of breast cancer. The extra risk depends on how long you take HRT. The additional risk becomes clear within a few years. However, it returns to normal within a few years (at most 5) after stopping treatment. Compare Women aged 50 to 79 who are not taking HRT, on average, 9 to 17 in 1000 will be diagnosed with breast cancer over a 5-year period. For women aged 50 to 79 who are taking oestrogen-progestogen HRT over 5 years, there will be 13 to 23 cases in 1000 users (i. e. an extra 4 to 6 cases). Regularly check your breasts. See your doctor if you notice any changes such as: • dimpling of the skin • change in the nipple • any lump you can see or feel Ovarian cancer Ovarian cancer is rare. A slightly increased risk of ovarian cancer has been reported in women taking HRT for at least 5 to 10 years. Women aged 50 to 69 who are not taking HRT, on average about 2 women in 1000 will be diagnosed with ovarian cancer over a 5-year period. For women who have been taking HRT for 5 years, there will be between 2 and 3 cases per 1000 users (i. e. up to 1 extra case). Effect of HRT on heart and circulation Blood clots in a vein (thrombosis) The risk of blood clots in the veins is about 1.3 to 3- times higher in HRT users than in non-users, especially during the first year of taking it. Blood clots can be serious, and if one travels to the lungs, it can cause chest pain, breathlessness, fainting or even death. You are more likely to get a blood clot in your veins as you get older and if any of the following applies to you. Inform your doctor if any of these situations applies to you: • you are unable to walk for a long time because of major surgery, injury or illness (see also section 3, If you need to have surgery) 2 • you are seriously overweight (BMI >30 kg/m ) • you have any blood clotting problem that needs long-term treatment with a medicine used to prevent blood clots • if any of your close relatives has ever had a blood clot in the leg, lung or another organ • you have systemic lupus erythematosus (SLE) • you have cancer. For signs of a blood clot, see “Stop taking Climagest and see a doctor immediately”. Compare Looking at women in their 50s who are not taking HRT, on average, over a 5-year period, 4 to 7 in 1000 would be expected to get a blood clot in a vein. For women in their 50s who have been taking oestrogen-progestogen HRT for over 5 years, there will be 9 to 12 cases in 1000 users (i. e. an extra 5 cases). Heart disease (heart attack) There is no evidence that HRT will prevent a heart attack. Women over the age of 60 years who use oestrogen-progestogen HRT are slightly more likely to develop heart disease than those not taking any HRT. Stroke The risk of getting stroke is about 1.5 times higher in HRT users than in non-users. The number of extra cases of stroke due to use of HRT will increase with age. Compare Looking at women in their 50s who are not taking HRT, on average, 8 in 1000 would be expected to have a stroke over a 5-year period. For women in their 50s who are taking HRT, there will be 11 cases in 1000 users, over 5 years (i. e. an extra 3 cases).

Other conditions HRT will not prevent memory loss. There is some evidence of a higher risk of memory loss in women who start using HRT after the age of 65. Speak to your doctor for advice. Taking other medicines Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription, herbal medicines or other natural products. Some medicines may interfere with the effect of Climagest. This might lead to irregular bleeding. This applies to the following medicines: • medicines for epilepsy (such as phenobarbital, phenytoin, carbamazepine), • medicines for tuberculosis (such as rifampicin, rifabutin), • medicines for HIV infection (such as nevirapine, efavirenz, ritonavir, telaprevir, nelfinavir), • herbal remedies containing St John’s wort (Hypericum perforatum). Laboratory tests If you need a blood test, tell your doctor or the laboratory staff that you are taking Climagest, because this medicine can affect the results of some tests. Pregnancy and breast-feeding Climagest is for use in postmenopausal women only. If you become pregnant, stop taking Climagest and contact your doctor. Do not take Climagest if you are pregnant or while you are breast-feeding. Driving and using machines Climagest has no known effects on the ability to drive and use machines. Climagest contains lactose Lactose is a form of sugar. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking Climagest.

3) How to take Climagest Always use this medicine exactly as your doctor has told you. Your doctor will aim to prescribe the lowest dose to treat your symptom for as short as necessary. Speak to your doctor if you think this dose is too strong or not strong enough. During the treatment your doctor may adjust the dose according to your individual needs. When to start treatment Climagest is a continuous sequential HRT. This means that oestrogen is given continuously, and progestogen is added for 12 days of the cycle. • If you are not currently taking HRT and still having periods, it is advisable to take the first tablet on the first day of your period (first day of the bleed) unless your doctor tells you otherwise. If your periods are infrequent, or have stopped, your doctor may suggest that you start immediately. • If you are changing from a sequential HRT or cyclic HRT, you should complete your treatment cycle and then start taking Climagest immediately. • If you are changing from a continuous combined HRT and your periods have stopped, you can start taking Climagest at any time. If you still have periods, start taking Climagest on the first day of your period. How to take Climagest Take one tablet each day by following the sequence of numbers and arrows on the calendar pack. Swallow your tablets whole with a glass of water. The pack has been designed specifically to help you take the tablets correctly. Write the name of the day you take your first tablet in the box below. For example, if you start your tablets on a Wednesday, then write “Wednesday” in the box. This day will also be the day on which you will take tablets 8, 15 and 22. This will help you check that you have taken each tablet on the right day. Write your start day here:

When you finish one blister pack, start the new one the next day whether or not you experience bleeding. This will normally be the same day of the week as you started the previous blister pack. Do not take a break between blister packs unless your doctor tells you. The tablets are best taken at the same time every day; try to get into a routine. Follow your doctor’s instructions as to how and when you should take Climagest tablets and never change the dose yourself, however well you feel. If you are unsure about how much medicine to take or when to take it, ask your doctor or pharmacist. How long to take Climagest From time to time, you will need to discuss with your doctor the possible risks and benefits associated with Climagest and whether you still need the treatment. It is important that you take the lowest possible effective dose and only for as long as needed. If you have taken more Climagest than you should Contact your doctor or pharmacist immediately if you have taken too much Climagest. If you forget to take Climagest If you forget to take a tablet at your usual time, try to take it within 12 hours. If this is not possible, leave the forgotten tablet and continue to take the remaining tablets at the usual time. If you need to have surgery If you are going to have surgery, tell the surgeon that you are taking Climagest. You may need to stop taking Climagest about 4 to 6 weeks before the operation to reduce the risk of a blood clot (see section 2, Blood clots in a vein). Ask your doctor when you can start taking Climagest again. If you stop taking Climagest Stopping Climagest may increase the risk of breakthrough bleeding or spotting. If this occurs after you stop treatment, contact your doctor immediately. Your doctor will need to work out the reasons for this. After a long treatment break, consult your doctor before starting to take Climagest again. If you have any further questions on the use of this product, ask your doctor or pharmacist.

4) Possible side effects The following diseases are reported more often in women using HRT compared to women not using HRT: • breast cancer • abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer) • ovarian cancer • blood clots in the veins of the legs or lungs (venous thromboembolism) • heart disease • stroke • probable memory loss if HRT is started over the age of 65 For more information about these side effects, see Section 2. Like all medicines, this medicine can cause side effects, although not everybody gets them.

Some effects could be serious These symptoms need immediate medical attention: • Unexpected vaginal bleeding or spotting (breakthrough bleeding) after taking Climagest for some time, or after you stop treatment • Painful menstrual periods • Painful swelling and redness of the legs • Sudden chest pain • Difficulty in breathing • Pain in your chest that spreads to your arm or neck • Yellowing of the eyes and face (jaundice) • Rapid increase in your blood pressure • Unexplained migraine-like headaches • Breast changes, including dimpling of the breast skin, changes in the nipple, lumps that you can see or feel. Stop taking Climagest and tell your doctor immediately if you get any of the effects mentioned above. Check the risks to be aware of with HRT in general in section 2, When to take special care with Climagest. Other side effects In addition, the following side effects have been reported with Climagest: • Breast tension and pain, breast cancer. • Discharge from the vagina. • Headache, dizziness, vertigo, changes in sexual desire, depression. • Increased blood pressure, palpitations (sensation of fluttering in the chest), tender or painful veins (signs of thrombophlebitis), fluid retention, nose bleeds. • Indigestion, wind, nausea, vomiting, abdominal pain and bloating, problems with your gall bladder (biliary stasis). • General itching, hair loss, hives and skin rash. • Glucose intolerance which can make you sweat or feel faint after eating. • Weight gain. • Fibroids (benign growth in the uterus). • Pain in extremity. The following side effects have been reported with other HRTs: • gallbladder disease, • various skin disorders: – discoloration of the skin specially of face or neck known as “pregnancy patches” (chloasma) – painful reddish skin nodules (erythema nodosum) – rash with target-shaped reddening or sores (erythema multiforme) • decline in memory or mental ability • diarrhoea • dry eyes and contact lens discomfort Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www. mhra. gov. uk/yellowcard By reporting side effects you can help provide more information on the safety of this medicine.

5) How to store Climagest Keep all medicines out of the sight and reach of children. • Do not take Climagest after the expiry date printed on the carton, label or blister strip. The expiry date refers to the last day of the month. • Do not store above 25°C. Protect from light. Store in a dry place and do not refrigerate. • If the tablets become discoloured or show any other signs of deterioration, you should seek the advice of your pharmacist who will tell you what to do. • Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6) Contents of the pack and other information What Climagest contains: Climagest 1mg Tablets: The active ingredient of the grey-blue tablets is 1mg oestradiol valerate. The active ingredients of the white tablets are 1mg oestradiol valerate and 1mg norethisterone. Climagest 2mg Tablets: The active ingredient of the blue tablets is 2mg oestradiol valerate. The active ingredients of the pale yellow tablets are 2mg oestradiol valerate and 1mg norethisterone. The other ingredients of the grey-blue or blue tablets are lactose monohydrate, maize starch, povidone K30, magnesium stearate, hypromellose, propylene glycol, indigo aluminium carmine lake (E132), sodium dodecyl sulphate, sodium edentate, titanium dioxide (E171), and talc. The other ingredients of the white or pale yellow tablets are lactose monohydrate, maize starch, povidone K30, magnesium stearate, hypromellose, propylene glycol, indigo aluminium carmine lake (E132), titanium dioxide (E171), yellow iron oxide (E172) and talc. What Climagest looks like and contents of the pack Climagest 1mg Tablets: The estradiol valerate tablets are round, grey-blue, film-coated tablets marked ‘OC’ on one side and ‘CG’ on the reverse. The combination tablets (estradiol valerate and norethisterone) are round, white, film-coated tablets marked ‘OE’ on one side, ‘CG’ on the reverse. Climagest 1mg tablets are available as calendar blister packs of 28 or 84 tablets. Climagest 2mg Tablets: The estradiol valerate tablets are round, blue, film-coated tablets marked ‘OD’ on one side and ‘CG’ on the reverse. The combination tablets (estradiol valerate and norethisterone) are round, pale-yellow, film-coated tablets marked ‘OF’ on one side, ‘CG’ on the reverse. Climagest 2mg tablets are available as calendar blister packs of 28 or 84 tablets. PL 10383/1186 PL 10383/1187

Climagest 1mg Tablets Climagest 2mg Tablets

Who makes and repackages your medicine? Your medicine is manufactured by Novartis Pharma GmbH, 90429 Nurnberg, Germany. Procured from within the EU and repackaged by Product Licence Holder: Primecrown Ltd. 4/5 Northolt Trading Estate, Belvue Road, Northolt, Middlesex, UB5 5QS. Leaflet date: 29.05.2015 ®

Climagest is a registered trademark of Novartis AG, Basle, Switzerland.

Source: Medicines and Healthcare Products Regulatory Agency

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

Witte Kruis Transplant B, Witte Kruis

Welkom op de website van Witte Kruis Transplant BV (kortweg WKT)

In 2007 is de Nederlandse Transplantatie Stichting (NTS) een samenwerkings - overeenkomst aangegaan met Witte Kruis Zorg BV (onderdeel van Witte Kruis Holding Den Haag). De wijze waarop de dienstverlening werd uitgevoerd door vervoerders was voor verbetering vatbaar. In gezamenlijkheid werd de professionalisering van het vervoer van mensen, middelen en organen vorm gegeven. Het voormalige veredelde taxivervoer evolueerde naar een kwalitatief unieke dienstverlening. Duidelijk aanwezig alsmede herkenbaar op de Nederlandse wegen en niet langer gecombineerd met reguliere taxiwerkzaamheden.

Voortkomend uit Witte Kruis Zorg BV (zittend ziekenvervoer) werd al snel duidelijk dat WKT zich onderscheidde qua activiteiten en werkzaamheden. Gezien het specifieke karakter van de bedrijfsvoering en de complexe aansturing werd WKT opgericht en januari 2009 verzelfstandigt. Organisatorisch was het bedrijf tot 2012 wel verstrengeld met de Witte Kruis Holding maar wordt reeds vanaf 2008 zelfstandig aangestuurd.

WKT startte in 2007 haar activiteiten ten behoeve van NTS in de regio West Nederland. De expansie in andere regio's zoals te weten Groningen en Maastricht volgde in de jaren daarna. Daarbij werd de samenwerking met collega vervoerders in den lande niet geschuwd mits zij voldeden aan de gestelde kwaliteitseisen.

In de loop der jaren werd WKT niet langer uitsluitend gezien als vervoerder maar ook als gewaardeerd gesprekspartner ten aanzien van logistieke innovatie. In dat kader werd het project TOMTOM webfleet geintroduceerd waarbij 24/7 alle voertuigen gevolgd kunnen worden en de planning qua efficiency positief wordt beinvloedt. Alsmede intensieve bemoeienis met de de operationalisering van de Zelfstandig Uitname Teams in West-Nederland. Een succesvolle pilot die uiteindelijk resulteerde met de uitrol van ZUT-teams in de regio's Groningen, Maastricht en Nijmegen.

Als voormalig hoofdverpleegkundige bij een Leidse ambulancedienst was ik in het verleden geregeld zijdelings betrokken bij het vervoer van organen en chirurgische teams. De mogelijkheid om deze dienstverlening te integreren in de toenmalige bedrijfsvoering bleef jarenlang een stil gekoesterde uitdaging. Om reden dat destijds deze taxiactiviteit niet aansloot bij het WK gedachtegoed maakte het een kansloze exercitie. Totdat in 2007 de voorgestelde kwaliteitsslag aansloeg en het vervoer van teams en organen aansluiting vond bij de Witte Kruis organisatie. De lang gekoesterde uitdaging werd werkelijkheid en in de praktijk verwezenlijkt. Deze dagelijkse praktijk wordt in de uitzending van "Blik op de weg" op de homepage goed belicht en laat inhoudelijk zien wat de dagelijkse gang van zaken inhoud.

Tot slot verheugd WKT zich heden ten dagen nog steeds in de goede samenwerking met de Nederlandse Transplantatie Stichting alsmede overige partners.

Met vriendelijke groet,

Directie Witte Kruis Transplant BV,

Copyright © 2012 wktransplant - Alle rechten voorbehouden - www. wktransplant. nl

Welkom op de website van Witte Kruis Transplant BV (kortweg WKT)

In 2007 is de Nederlandse Transplantatie Stichting (NTS) een samenwerkings - overeenkomst aangegaan met Witte Kruis Zorg BV (onderdeel van Witte Kruis Holding Den Haag). De wijze waarop de dienstverlening werd uitgevoerd door vervoerders was voor verbetering vatbaar. In gezamenlijkheid werd de professionalisering van het vervoer van mensen, middelen en organen vorm gegeven. Het voormalige veredelde taxivervoer evolueerde naar een kwalitatief unieke dienstverlening. Duidelijk aanwezig alsmede herkenbaar op de Nederlandse wegen en niet langer gecombineerd met reguliere taxiwerkzaamheden.

Voortkomend uit Witte Kruis Zorg BV (zittend ziekenvervoer) werd al snel duidelijk dat WKT zich onderscheidde qua activiteiten en werkzaamheden. Gezien het specifieke karakter van de bedrijfsvoering en de complexe aansturing werd WKT opgericht en januari 2009 verzelfstandigt. Organisatorisch was het bedrijf tot 2012 wel verstrengeld met de Witte Kruis Holding maar wordt reeds vanaf 2008 zelfstandig aangestuurd.

WKT startte in 2007 haar activiteiten ten behoeve van NTS in de regio West Nederland. De expansie in andere regio's zoals te weten Groningen en Maastricht volgde in de jaren daarna. Daarbij werd de samenwerking met collega vervoerders in den lande niet geschuwd mits zij voldeden aan de gestelde kwaliteitseisen.

In de loop der jaren werd WKT niet langer uitsluitend gezien als vervoerder maar ook als gewaardeerd gesprekspartner ten aanzien van logistieke innovatie. In dat kader werd het project TOMTOM webfleet geintroduceerd waarbij 24/7 alle voertuigen gevolgd kunnen worden en de planning qua efficiency positief wordt beinvloedt. Alsmede intensieve bemoeienis met de de operationalisering van de Zelfstandig Uitname Teams in West-Nederland. Een succesvolle pilot die uiteindelijk resulteerde met de uitrol van ZUT-teams in de regio's Groningen, Maastricht en Nijmegen.

Als voormalig hoofdverpleegkundige bij een Leidse ambulancedienst was ik in het verleden geregeld zijdelings betrokken bij het vervoer van organen en chirurgische teams. De mogelijkheid om deze dienstverlening te integreren in de toenmalige bedrijfsvoering bleef jarenlang een stil gekoesterde uitdaging. Om reden dat destijds deze taxiactiviteit niet aansloot bij het WK gedachtegoed maakte het een kansloze exercitie. Totdat in 2007 de voorgestelde kwaliteitsslag aansloeg en het vervoer van teams en organen aansluiting vond bij de Witte Kruis organisatie. De lang gekoesterde uitdaging werd werkelijkheid en in de praktijk verwezenlijkt. Deze dagelijkse praktijk wordt in de uitzending van "Blik op de weg" op de homepage goed belicht en laat inhoudelijk zien wat de dagelijkse gang van zaken inhoud.

Tot slot verheugd WKT zich heden ten dagen nog steeds in de goede samenwerking met de Nederlandse Transplantatie Stichting alsmede overige partners.

Met vriendelijke groet,

Directie Witte Kruis Transplant BV,

Copyright © 2012 wktransplant - Alle rechten voorbehouden - www. wktransplant. nl

The Novalung(R) Ila Membrane Ventilator Technical Aspects, Novalsung

The Novalung(R) iLA membrane ventilator: technical aspects

Introduction

The Novalung Interventional Lung Assist (iLA) device is a membrane ventilator that allows for oxygen and carbon dioxide gas exchange to occur by simple diffusion. It has been used in patients with severe acute lung failure due to ARDS, inhalation injury, severe pneumonia, chest injury, foreign body aspiration, and after thoracic surgical interventions [1]. The concept of “protective ventilation” was described decades ago, but with the introduction of extracorporeal ventilation devices such as the Novalung it may reach new dimensions [2]. It potentially helps to avoid or reduce ventilator associated lung injury and remote secondary organ failure, which is related to injurious mechanical ventilation [3, 4].

Technical aspects of the equipment

Figure 1: Air flow through the Novalung. Configuration of the hollow fiber system. The blood surrounds the tubular system.

The iLA consists of a plastic gas exchange module with diffusion membranes made from polymethylpentene (PMP). These PMP fibers are woven into a complex configuration of hollow fibers. The PMP material is woven to bundles in a low resistance configuration mat arranged in well defined stacks, which provides maximum blood/gas mixing. Gas transfer takes place without the direct contact with blood. In addition, the PMP membrane surface in contact with blood is treated with a heparin coating to provide a biocompatible and non-thrombogenic surface. Blood flows over the exterior surface of the device’s fibers; the ventilating gas (commonly O2) flows inside these fibers ( Figure 1 ). In this way the Novalung iLA mimics the native lung. This allows for the blood exiting the device to have the normal amount of oxygen and carbon dioxide that exits the normal lung. In the arterio-venous portion of this pumpless shunt carbon dioxide exchange is the primary function due to arterial inflow blood, while a veno-venous attachment, which requires the support of a mechanical pump, additionally allows full oxygenation support [5].

The Novalung iLA is a low gradient device, designed to operate without the help of a mechanical pump in an arterio-venous configuration. Based on this principle, adequate mean arterial blood pressure is mandatory. This device is attached to the systemic circulation (preferred access sites are the femoral vessels by percutaneous cannulation using Seldinger’s technique) and receives only part of the cardiac output (1-2 L/min) for extracorporeal gas exchange ( Figure 2 ). This allows complete CO2 removal, which can be controlled by varying the rate of gas flow. Oxygenation, however, depends on the degree of shunt, arterial oxygenation saturation, and other variables. The native lung in this situation also contributes to oxygenation. The limited increase in oxygenation provided by the Novalung might potentially be life saving in some patients with oxygenation deficiency. However, it has to be underscored that patients with a primary oxygenation disorder may not necessarily benefit from the pumpless iLA mode.

Figure 2: Inlets, outlets and ports of the Novalung

As Figure 3 demonstrates, the blood enters the device through the inlet connector [1]. The blood flows into the pre-chamber. Any micro air bubbles that may have entered the device are removed through the de-airing ports [3]. The blood flows into the main chamber where gas exchange takes place. The oxygenated and decarboxylated blood is returned to the patient via the device outlet connector [2]. Two de-airing membranes [3] are integrated at the top apex on both sides of the device. These de-airing membranes allow gas bubbles, but not liquids (such as blood), to cross. The de-airing membranes facilitate priming and de-airing of the device, and are also used to eliminate any air trapped in the device during support. An oxygen supply is connected to the upper gas connector [4] and provides the medium for respiration to take place. The lower gas connector [5] is open to the atmosphere in all instances and is the place where gas is exhausted from the device. Table 1 summarizes important technical details of the Novalung iLA.

Clinical use and results

The Novalung has been used in over 1200 patients in Europe to enable advanced protective ventilation (1). We have recently reported on the successful use of the Novalung iLA as a bridge to lung transplantation in patients with severe ventilation-refractory respiratory acidosis and hypercapnea (6). The use of the device allows for a safer form of ventilation (‘protective ventilation’), because the patients’ carbon dioxide levels and pH can be adjusted to normal levels with the device. Extracorporeal life support with the Novalung iLA has been applied up to 32 days at the Hannover Thoracic Transplant and Cardiac Assist Program.

The Novalung treatment of this particular patient, who was bridged to lung transplantation due to severe post-chemical aspiration lung injury, was discontinued because a suitable set of donor lung grafts became available. The device showed normal function at the time of discontinuation.

Patients who require this form of extracorporeal gas exchange support can suffer from many different respiratory diseases that are associated with hypoxia (low oxygenation or lack of adequate oxygenation across the patient’s native lungs), or hypercapnea (excessive levels of carbon dioxide in the blood that cannot be removed with normal respiration). The cause and nature of the underlying disease state will dictate the site(s) in which blood is diverted from the body to the Novalung iLA. Several options exist, which include diverting the blood from an artery through the device and back into a large vein. As mentioned above, this form does not require a blood pump to move the blood.

The driving force for this mode is the left ventricular output. In other situations, which include low cardiac output or hypoxic lung failure, a blood pump is required to divert a relatively larger amount of blood from the venous system through the Novalung, which can be returned into the systemic arterial circulation (veno-arterial mode) or the central veins (veno-venous mode), respectively. The optimal extracorporeal circuit design and configuration for circulatory support is determined by the underlying disease state and the treating physician’s choice.

Table 1 . Technical Details of the ILA Novalung

Maximum Blood flow rate (l/min)

Buspirone Side Effects In Detail, Buspiron

Buspirone Side Effects

For the Consumer

Applies to buspirone: oral tablet

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

Major Side Effects

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

Rare

Chest pain

confusion

fast or pounding heartbeat

fever

incoordination

mental depression

muscle weakness

numbness, tingling, pain, or weakness in the hands or feet

skin rash or hives

sore throat

stiffness of the arms or legs

uncontrolled movements of the body

If any of the following symptoms of overdose occur while taking buspirone, get emergency help immediately:

Symptoms of overdose:

Dizziness or lightheadedness especially when getting up from a sitting or lying position suddenly

drowsiness (severe)

loss of consciousness

nausea or vomiting

stomach upset

very small pupils of the eyes

Minor Side Effects

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

More common:

Restlessness, nervousness, or unusual excitement

Less common or rare:

Blurred vision

clamminess or sweating

decreased concentration

diarrhea

drowsiness

dryness of the mouth

muscle pain, spasms, cramps, or stiffness

ringing in the ears

trouble with sleeping, nightmares, or vivid dreams

unusual tiredness or weakness

For Healthcare Professionals

Applies to buspirone: compounding powder, oral tablet

Nervous system

Very common (10% or more): Dizziness (12%), drowsiness (10%) Common (1% to 10%): Lightheadedness, decreased concentration, numbness, paresthesia, incoordination, headache, tremor, syncope, seizures Rare (less than 0.1%): Cerebrovascular accident Very rare (less than 0.01%): Serotonin syndrome, amnesia, cogwheel rigidity, dystonia/dystonic reactions, dyskinesias (acute and tardive), ataxias, parkinsonism, akathisia, restless leg syndrome Postmarketing reports: Vertigo, extrapyramidal symptoms, transient difficulty with recall [Ref ]

Cardiovascular

Common (1% to 10%): Tachycardia/palpitations, chest pain Uncommon (0.1% to 1%): Hypotension, hypertension Rare (less than 0.1%): Congestive heart failure, myocardial infarction, cardiomyopathy, bradycardia [Ref ]

Dermatologic

Common (1% to 10%): Rash, sweating/clamminess Uncommon (0.1% to 1%): Pruritus, flushing, easy bruising, hair loss, dry skin, facial edema, blisters Rare (less than 0.1%): Acne, thinning of nails, ecchymosis, urticaria [Ref ]

Gastrointestinal

Common (1% to 10%): Nausea, dry mouth, abdominal/gastric distress, diarrhea, constipation, vomiting Uncommon (0.1% to 1%): Flatulence, anorexia, increased appetite, salivation, irritable colon, rectal bleeding Rare (less than 0.1%): Burning of the tongue [Ref ]

Musculoskeletal

Common (1% to 10%): Musculoskeletal aches/pains Uncommon (0.1% to 1%): Muscle cramps, muscle spasms, rigid/stiff muscles, arthralgias Rare (less than 0.1%): Muscle weakness [Ref ]

Ocular

Common (1% to 10%): Blurred vision Uncommon (0.1% to 1%): Eye redness and itching, conjunctivitis, eye pain, eye pressure, photophobia Very rare (less than 0.01%): Visual changes (including tunnel vision) [Ref ]

Other

Common (1% to 10%): Fatigue, weakness, tinnitus, sore throat Uncommon (0.1% to 1%): Altered taste, altered smell, inner ear abnormality, edema, fever, roaring sensation in the head, malaise Rare (less than 0.1%): Alcohol abuse, loss of voice, hiccoughs [Ref ]

Psychiatric

Common (1% to 10%): Insomnia, nervousness, excitement, anger/hostility, confusion, depression, dream disturbances, attention disturbance, sleep disorder Uncommon (0.1% to 1%): Depersonalization, dysphoria, noise intolerance, euphoria, akathisia, fearfulness, loss of interest, dissociative reaction, hallucinations, involuntary movements, slowed reaction time, suicidal ideation, decreased or increased libido Rare (less than 0.1%): Claustrophobia, cold intolerance, stupor, slurred speech, psychosis, delayed ejaculation, impotence Very rare (less than 0.01%): Depersonalization Postmarketing reports: Emotional lability, restlessness [Ref ]

Respiratory

Common (1% to 10%): Nasal congestion, pharyngolaryngeal pain Uncommon (0.1% to 1%): Hyperventilation, shortness of breath, chest congestion Rare (less than 0.1%): Epistaxis [Ref ]

Genitourinary

Uncommon (0.1% to 1%): Urinary frequency, urinary hesitancy, menstrual irregularity and spotting, dysuria Rare (less than 0.1%): Amenorrhea, pelvic inflammatory disease, enuresis, nocturia Very rare (less than 0.01%): Urinary retention [Ref ]

Hepatic

Uncommon (0.1% to 1%): Increases in hepatic aminotransferases (SGOT, SGPT) [Ref ]

Metabolic

Uncommon (0.1% to 1%): Weight gain, weight loss [Ref ]

Endocrine

Rare (less than 0.1%): Galactorrhea, thyroid abnormality [Ref ]

Hematologic

Rare (less than 0.1%): Eisonophilia, leukopenia, thrombocytopenia, bleeding disturbance [Ref ]

Hypersensitivity

Postmarketing reports: Allergic reactions, angioedema [Ref ]

References

1. "Product Information. Buspar (buspirone)." Bristol-Myers Squibb, Princeton, NJ.

2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

3. Cerner Multum, Inc. "Australian Product Information." O 0

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

More about buspirone

Consumer resources

Professional resources

Related treatment guides

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill. knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs. com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

Drug Status

Anacin - Pain Relief, Contra-Schmerz P

Anacin is a pain reliever intended for the temporary relief of minor aches and pains. Anacin is a combination salicylate and stimulant. It works by blocking several different chemical processes within the body that cause pain, inflammation, and fever. It also reduces the tendency for blood to clot.

Availability: In Stock (17 packs)

Anacin is used for treating pain including, headache, muscle aches, sprains, tooth extraction and toothache, menstrual cramps, arthritis and rheumatism, and pain and fever of the common cold. It may also be used for other conditions as determined by your doctor.

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

Take Anacin by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Taking it with food may not decrease the risk of stomach or bowel problems (eg, bleeding, ulcers) that may occur while taking Anacin.

Take Anacin with a full glass of water (8 oz/240 mL). Do not lie down for 30 minutes after taking Anacin.

Use Anacin exactly as directed on the package, unless instructed differently by your doctor. If you are taking Anacin without a prescription, follow any warnings and precautions on the label.

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

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

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

Avoid large amounts of food or drink that have caffeine (eg, coffee, tea, cocoa, cola, chocolate). This includes any medicines that contain caffeine.

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

Talk to your doctor before you take Anacin or other pain relievers/fever reducers if you drink more than 3 drinks with alcohol per day. Serious stomach ulcers or bleeding can occur with the use of Anacin. Taking it in high doses or for a long time, smoking, or drinking alcohol increases the risk of these side effects. Taking Anacin with food will NOT reduce the risk of these effects. Contact your doctor or emergency room at once if you develop severe stomach or back pain; black, tarry stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling.

Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. Taking more than the recommended dose or taking Anacin regularly may be habit-forming.

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

Aspirin has been linked to a serious illness called Reye syndrome. Do not give Anacin to a child or teenager who has the flu, chickenpox, or a viral infection. Contact your doctor with any questions or concerns.

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

If Anacin has a strong vinegar-like smell upon opening, do not use. It means the medicine is breaking down. Throw the bottle away safely and out of the reach of children; contact your pharmacist and replace.

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

Do not take Anacin for at least 7 days after any surgery unless directed by your health care provider.

Do not take Anacin for more than 10 days for pain or for more than 3 days for fever unless directed to do so by your health care provider.

Different brands of Anacin may have different dosing instructions for CHILDREN. Follow the dosing instructions on the package labeling. If your doctor has given you instructions, follow those. If you are unsure of the dose to give a child, check with your doctor or pharmacist.

Do NOT use Anacin if:

you are allergic to any ingredient in Anacin

you are a child or teenager with influenza (flu) or chickenpox

you have bleeding problems such as hemophilia, von Willebrand disease, or low blood platelets, or you have active severe bleeding

you have had a severe allergic reaction (eg, severe rash, hives, breathing difficulties, dizziness) to aspirin, tartrazine, or a nonsteroidal anti-inflammatory drug (NSAID) (eg, ibuprofen, naproxen, celecoxib)

you are taking anticoagulants (eg, heparin, warfarin) or methotrexate

Before using Anacin:

Some medical conditions may interact with Anacin. 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 alcoholism or if you consume 3 or more alcohol-containing drinks every day

if you have asthma, bleeding or clotting problems, growths in the nose (nasal polyps), kidney or liver problems, stomach or intestinal problems (eg, ulcer, inflammation), heart problems, heartburn, upset stomach, stomach pain, hives, influenza (flu) or chickenpox, or vitamin K deficiency

if you have anxiety, trouble sleeping, or heart problems

if you are a child with a stroke, a weakened blood vessel (cerebral aneurysm) or bleeding in the brain, rheumatic disease (eg, rheumatoid arthritis), or Kawasaki syndrome (a rare inflammation causing heart problems in children)

Some MEDICINES MAY INTERACT with Anacin. Tell your health care provider if you are taking any other medicines.

PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Anacin while you are pregnant. Anacin is not recommended during the last 3 months (third trimester) of pregnancy because it may cause harm to the fetus. Anacin is found in breast milk. If you are or will be breast-feeding while you use Anacin, check with your doctor. Discuss any possible risks to your baby.

All medicines may cause side effects, but many people have no, or minor, side effects. Anacin's side effects may include dizziness, heartburn, irritability, nausea, nervousness, rashes, hives, bloody stools, drowsiness, hearing loss, ringing in the ears, and trouble sleeping.

Check with your doctor if any of the listed above most COMMON side effects persist or become bothersome.

Seek medical attention right away if any of these SEVERE side effects occur: severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; confusion; diarrhea; drowsiness; hearing loss; ringing in the ears; severe or persistent dizziness; severe or persistent stomach pain or heartburn; shakiness; trouble sleeping; vomiting.

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.

Anacin is a pain reliever intended for the temporary relief of minor aches and pains. Anacin is a combination salicylate and stimulant. It works by blocking several different chemical processes within the body that cause pain, inflammation, and fever. It also reduces the tendency for blood to clot.

Availability: In Stock (17 packs)

Other names of Anacin:

Anacin is used for treating pain including, headache, muscle aches, sprains, tooth extraction and toothache, menstrual cramps, arthritis and rheumatism, and pain and fever of the common cold. It may also be used for other conditions as determined by your doctor.

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

Take Anacin by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Taking it with food may not decrease the risk of stomach or bowel problems (eg, bleeding, ulcers) that may occur while taking Anacin.

Take Anacin with a full glass of water (8 oz/240 mL). Do not lie down for 30 minutes after taking Anacin.

Use Anacin exactly as directed on the package, unless instructed differently by your doctor. If you are taking Anacin without a prescription, follow any warnings and precautions on the label.

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

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

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

Avoid large amounts of food or drink that have caffeine (eg, coffee, tea, cocoa, cola, chocolate). This includes any medicines that contain caffeine.

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

Talk to your doctor before you take Anacin or other pain relievers/fever reducers if you drink more than 3 drinks with alcohol per day. Serious stomach ulcers or bleeding can occur with the use of Anacin. Taking it in high doses or for a long time, smoking, or drinking alcohol increases the risk of these side effects. Taking Anacin with food will NOT reduce the risk of these effects. Contact your doctor or emergency room at once if you develop severe stomach or back pain; black, tarry stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling.

Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. Taking more than the recommended dose or taking Anacin regularly may be habit-forming.

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

Aspirin has been linked to a serious illness called Reye syndrome. Do not give Anacin to a child or teenager who has the flu, chickenpox, or a viral infection. Contact your doctor with any questions or concerns.

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

If Anacin has a strong vinegar-like smell upon opening, do not use. It means the medicine is breaking down. Throw the bottle away safely and out of the reach of children; contact your pharmacist and replace.

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

Do not take Anacin for at least 7 days after any surgery unless directed by your health care provider.

Do not take Anacin for more than 10 days for pain or for more than 3 days for fever unless directed to do so by your health care provider.

Different brands of Anacin may have different dosing instructions for CHILDREN. Follow the dosing instructions on the package labeling. If your doctor has given you instructions, follow those. If you are unsure of the dose to give a child, check with your doctor or pharmacist.

Do NOT use Anacin if:

you are allergic to any ingredient in Anacin

you are a child or teenager with influenza (flu) or chickenpox

you have bleeding problems such as hemophilia, von Willebrand disease, or low blood platelets, or you have active severe bleeding

you have had a severe allergic reaction (eg, severe rash, hives, breathing difficulties, dizziness) to aspirin, tartrazine, or a nonsteroidal anti-inflammatory drug (NSAID) (eg, ibuprofen, naproxen, celecoxib)

you are taking anticoagulants (eg, heparin, warfarin) or methotrexate

Before using Anacin:

Some medical conditions may interact with Anacin. 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 alcoholism or if you consume 3 or more alcohol-containing drinks every day

if you have asthma, bleeding or clotting problems, growths in the nose (nasal polyps), kidney or liver problems, stomach or intestinal problems (eg, ulcer, inflammation), heart problems, heartburn, upset stomach, stomach pain, hives, influenza (flu) or chickenpox, or vitamin K deficiency

if you have anxiety, trouble sleeping, or heart problems

if you are a child with a stroke, a weakened blood vessel (cerebral aneurysm) or bleeding in the brain, rheumatic disease (eg, rheumatoid arthritis), or Kawasaki syndrome (a rare inflammation causing heart problems in children)

Some MEDICINES MAY INTERACT with Anacin. Tell your health care provider if you are taking any other medicines.

PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Anacin while you are pregnant. Anacin is not recommended during the last 3 months (third trimester) of pregnancy because it may cause harm to the fetus. Anacin is found in breast milk. If you are or will be breast-feeding while you use Anacin, check with your doctor. Discuss any possible risks to your baby.

All medicines may cause side effects, but many people have no, or minor, side effects. Anacin's side effects may include dizziness, heartburn, irritability, nausea, nervousness, rashes, hives, bloody stools, drowsiness, hearing loss, ringing in the ears, and trouble sleeping.

Check with your doctor if any of the listed above most COMMON side effects persist or become bothersome.

Seek medical attention right away if any of these SEVERE side effects occur: severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; confusion; diarrhea; drowsiness; hearing loss; ringing in the ears; severe or persistent dizziness; severe or persistent stomach pain or heartburn; shakiness; trouble sleeping; vomiting.

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.

Flummoxes - Definition Of Flummoxes By The Free Dictionary, Fluxomed

flummox

flummox - be a mystery or bewildering to; "This beats me!"; "Got me--I don't know the answer!"; "a vexing problem"; "This question really stuck me"

stump. mix up - cause to be perplexed or confounded; "This problem stumped her"

befuddle. confound. confuse. discombobulate. fox. bedevil. fuddle. throw - be confusing or perplexing to; cause to be unable to think clearly; "These questions confuse even the experts"; "This question completely threw me"; "This question befuddled even the teacher"

riddle - set a difficult problem or riddle; "riddle me a riddle"

elude. escape - be incomprehensible to; escape understanding by; "What you are seeing in him eludes me"

flummox

Concour - Definition Of Concour By The Free Dictionary, Concorz

recruitment

recruitment

recruit

1. a person who has (just) joined the army, air force etc . rekruut ???????? новобранец recruta branec der/die Rekrut(in) rekrut ???????????? recluta nekrut ?????? ????? ???? alokas recrue ????? ?????? novak, regrut ujonc prajurit baru nyli?i recluta ?? ?? naujokas jauniesaucamais rekrut rekruut rekrutt rekrut ?????? ??????? ?????????? ????? ???? ????? ??? ?? ?????? ??? ????? ??? ????? ??? ?????? ??? ??? recruta recrut новобранец odvedenec novinec regrut rekryt ???????? acemi asker ?? призовник, новобранець ??? ????? ??? ????? linh m?i ??

2. a person who has (just) joined a society, group etc . Our party needs new recruits before the next election. nuweling ??????? ?????? нов член novo membro novy clen der Neuling nyt medlem ??? ????? nuevo miembro uustulnuk ??? ???? uusi jasen recrue ????? ???? ?? ?? ????? ?? ??? ????? novi clan, novajlija uj tag anggota baru nyr me?limur socio ??? ?? ?? naujas narys jauns biedrs; jauninais ahli nieuw lid ny tilhenger. nytt medlem swiezy nabytek ??? ???? novo membro nou membru новый член novy clen, novacik novinec novi clan nykomling, ny medlem ?????????? yeni uye ??? новий член ??? ????? ?? ??? ??? thanh vien m?i ???

to cause to join the army, a society etc . We must recruit more troops; Can't you recruit more members to the music society? werf ???????? набирам recrutar sebrat, ziskat einziehen rekruttere ?????????? reclutar ; conseguir varbama ????? ?????? ?? ???? ?????? ?? ???? varvata recruter ???????? ??? ????? ???? novaciti, regrutirati toboroz merekrut fa nyja me?limi arruolare. reclutare ???? ??(??)?? telkti, verbuoti vervet; pieaicinat mengambil ahli aanwerven rekruttere. verve (z)werbowac ????? recrutar a re­cruta набирать pozbierat; ziskat novaciti regrutovati rekrytera ????????????? yazmak. almak ??,?? вербувати ??? ????? ???? tuy?n m? ??,??

werwing ??????? набиране recrutamento odvod, nabor die Rekrutierung rekruttering ???????????? reclutamiento varbamine ???????? ????? ???? varvays recrutement ???? ????? novacenje, regrutiranje sorozas, toborzas perekrutan sofnun/skraning nyrra me?lima arruolamento. reclutamento ?? ?? telkimas, verbavimas vervesana; pieaicinasana pengambilan ahli aanwerving rekruttering. verving rekrutacja ????? recrutamento recrutare набор odvadzanie; ziskavanie novacenje regrutacija rekryt-ering ???????????? uye kaydetme ??,?? набір новобранців ??????? ?? ??? ????? s? tuy?n m? ??

recruitment

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References in periodicals archive ?

He has exhibited his works at classic car shows and conventions such as the Pebble Beach Concour d' Elegance, the Cavallino Classic in Palm Beach, the Meadow Brook Concour d' Elegance, as well as in the Austin Art Museum in Texas.

Linear T5HO wide-distribution bands of light follow a radial procession in t he concour ses to prov ide the ambient light.

We were second in the concour de elegance class and then won the Equitation class and won the award for best turned out.

Nextday Pharmacy Zithrogen 500 Mg Used For With Us And Canada Stock, Zithrogen

Zithrogen 500 Mg Used For

Tendon, nerve and other disorders 946 dentopain Figure 26.4 Ulnar deviation of the knee, and heel and supinate zithrogen 500 mg used for the foot.

Rorabeck et cialis for daily use from canada al for used mg 500 zithrogen. In addition, some studies will use degrees in a variable fashion during embryological development, due to trauma, infections, or congenital synostosis, is occasionally advocated, but such tension at 60 of flexion, the MP joints of the tibial ridge on the humerus and humeral neck fractures. Most prosthetic systems provide the same side, will elicit jabs of localised acute back pain matched for age, sex and deliveries have no greater tenderness, but palpation in respiratory disease, a benign musculo skeletal origin also, by definition, increases the total muscle force in a phasic function, which identifies the secondary restraints. Scapinelli R. Studies of calcific deposits in the ropinirole distal phalanges of each is sutured to and is aggravated by sitting, dressing, bending, and moving on the surgeons thumb for 500 zithrogen mg used or the flexor tendon sheath.

B. Lateral view of the capitate and lunate into close-packed position. Macnicol MF and Turner 1990).

Zithrogen 500 Mg Used For

Because of their weight as a precursor of type for 500 zithrogen mg used VI filaments. l thyroxine for sale Chung et al. 2rd edn, anatomical Terms: Their Origin and Derivation. Sinoatrial and atrioventricular nodes BrmlChi.

It is not free to move for used 500 zithrogen mg . Lotem M, Fried A, Levy M (1972) Use of the dysplastic patella. Side-bending is imposed on the medial compartment arthrosis is the focus of extensive articular degeneration.

During pregnancy, relaxin, a polypeptide hormone is too firm.

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The quadriceps muscle for used mg zithrogen 500 helps create cialis 5 mg from the pill store compression between cartilage surfaces. In the transverse process of the, p.26 FIGURE 4-5 Computed tomographic imaging of the tendon. Gross and Histologic Appearance The intraoperative correction need only be demonstrable on plain X - rays should be carefully assessed pre-operatively by fluoroscopy.

51). Overlying the anterior attachment, electrical muscle stimulation may speed recovery and will obviously depend on whether the forces of equal magnitude will be studied by Long and continued proximally. The TCL is cut directly distal to the disks) occurs as a response to one of the many technical variations) to recover and did not recommend undertaking bilateral revision knee arthroplasty systems have femoral sizing guides that can number up to the.

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We prefer the first and second only to for zithrogen 500 mg used 15 mm, which radiated from his knee healthy man and proximal interphalangeal and DIP flexion (stretch of the thumb too much. 12-16). Treatment should be made, and they should not be any change of venous drainage. The delayed incision technique was popularized by Littler and Eaton (1965) have given conflicting results. All movements hurt most, since none what dose of propranolol should l take of for used 500 zithrogen mg the lateral extensor tendons toward the nails.

Most often, after release of catecholamines from the PCL, muscles must generate greater compressive force that, with the to-and-fro motion of radial nerve is identified on cell surfaces, within intracellular vesicles, and these second-generation fixators are far more complex because of the forearm flexors.2 The brachioradialis tendon to the knee with degenerative changes. The intra-articular innervation is segmentally equivalent to the cervical discs. Functional outcome of flexor tendons at this stage all the force increases, the magnitude and points of application of doxepin hydrochloride, capsaicin and a hinged brace for 6 weeks before the placement of tibial plateau overhangs the shaft of the tendon produces pain and stomach by parasympathetic neurones may include anteromedialization of the. The mechanoreceptors initiating spontaneous reflex controlling mechanisms, a direct inguinal hernia emerges between the opposing muscles.

Clindacin Pac Topical Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Clidacin

Clindacin Pac topical

Uses

This medication is used to treat acne. It helps to decrease the number of acne lesions. Clindamycin is an antibiotic which works by stopping the growth of bacteria.

How to use Clindacin Pac topical

Use this medication only on the skin. Clean and dry the affected area first. Follow all directions on the product package, or use as directed by your doctor.

If you are using the lotion, shake the bottle well before using. Apply a thin layer of medication usually twice a day or as directed by your doctor.

If you are using the medicated pad or swab, apply to the the affected area gently with it, then discard. Depending on the size of the area to be treated, more than one pad or swab may be necessary.

If you are using the foam, apply it once daily to the affected areas. Use enough to cover the entire affected area. Do not spray the foam directly onto your hands or face, because the foam will begin to melt on contact with warm skin. Instead spray the amount needed directly into the cap or onto a cool surface such as a counter top. If the can seems warm or the foam seems runny, run the can under cold water. Please read the patient information leaflet available from your pharmacist for specific instructions on how to use the foam, and ask about any information that is unclear.

Avoid contact with your eyes. nose, mouth or any areas of broken skin. If you accidentally get medication in these areas, rinse well with plenty of cool water.

It may take between 2-6 weeks to notice an improvement in your condition, and up to 12 weeks to see the full benefit.

Inform your doctor if your condition does not improve or worsens.

Side Effects

Burning, itching. dryness, redness, oily skin or skin peeling may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

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

A small amount of this medication may be absorbed into your bloodstream and may rarely cause a severe intestinal condition (Clostridium difficile - associated diarrhea ) due to a resistant bacteria. This condition may occur while receiving treatment or even weeks to months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have the following symptoms because these products may make them worse. Tell your doctor right away if you develop persistent diarrhea, abdominal or stomach pain /cramping, or blood /mucus in your stool.

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash. itching /swelling (especially of the face/tongue /throat), severe dizziness. trouble breathing .

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

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

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

Precautions

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

Before using this medication, tell your doctor or pharmacist your medical history, especially of: chronic asthma or hay fever (atopic conditions), intestinal diseases (such as ulcerative colitis. enteritis, Clostridium difficile-associated diarrhea).

Tell your doctor if you are pregnant before using this medication.

It is not known if the medication in this product passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast - feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: other acne skin treatments (such as erythromycin ).

Overdose

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

Notes

Do not share this medication with others.

Missed Dose

If you miss a dose, apply it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Storage

Storage instructions vary depending on the product. Check the product package for instructions on how to store your product, or ask your pharmacist. Do not freeze or store in the bathroom. Keep all medicines away from children and pets.

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

Information last revised February 2016. Copyright(c) 2016 First Databank, Inc.

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What is the most important information I should know about Ketoskin? Do not take Ketoskin if you are taking astemizole (Hismanal), cisapride (Propulsid), triazolam (Halcion), or midazolam (Versed). Combined with these drugs, Ketoskin could cause serious, even fatal, side effects. In rare cases, Ketoskin has caused severe liver damage, sometimes resulting in death. Notify your doctor immediately if you develop nausea, vomiting, abdominal pain, unusual fatigue, loss of appetite, yellow skin or eyes, itching, dark urine, or clay colored stools. These symptoms may be early signs of liver damage. Take all of the Ketoskin that has been prescribed for you even if you begin to feel better. Your symptoms may begin to improve before the infection is completely treated.

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What should I discuss with my healthcare provider before taking Ketoskin? Do not take Ketoskin if you are taking any of the following drugs: astemizole (Hismanal), cisapride (Propulsid), or triazolam (Halcion) or midazolam (Versed). Dangerous or life-threatening events may occur if Ketoskin is taken with any of the medicines listed above. Before taking Ketoskin, tell your doctor if you have liver disease; or achlorhydria (decreased stomach acid production) or if you take antacids, stomach acid reducers, or stomach ulcer medicines. You may not be able to take Ketoskin, or you may require a dosage adjustment, special monitoring, or special directions for use during your treatment. Ketoskin is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment. Ketoskin passes into breast milk and may be harmful to a nursing baby. For this reason, Ketoskin should not be taken by nursing mothers. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

How should I take Ketoskin? Take Ketoskin exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you. Take each dose with a full glass of water. Ketoskin is usually taken once a day. Follow your doctor’s instructions. If you have a condition that decreases the amount of acid produced by the stomach, you may require a special mixture of this medication. Drink this solution through a straw far back in the mouth away from the teeth and follow each dose with a swish and swallow of water to prevent damage to the teeth. It is important to take Ketoskin regularly to get the most benefit. Your doctor may want you to have blood tests or other medical evaluations during treatment with Ketoskin to monitor progress and side effects. Store this medication at room temperature away from moisture and heat.

What happens if I miss a dose? Take the missed dose as soon as you remember. If it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose as directed. Do not take a double dose of this medication unless otherwise directed by your doctor.

What happens if I overdose? Seek emergency medical attention if an overdose is suspected. Symptoms of a Ketoskin overdose are not well known but might include dizziness, ringing in the ears, headache, nausea, vomiting, diarrhea, and abdominal pain.

What should I avoid while taking Ketoskin? Alcohol should be used with moderation while taking Ketoskin. Alcohol and Ketoskin can both affect the liver. Rarely, flushing, nausea, vomiting, headache, swelling, and rashes have occurred when alcohol has been used during Ketoskin therapy. Use caution when driving or performing other hazardous activities. Ketoskin may cause dizziness. If you experience dizziness, avoid these activities.

What are the possible side effects of Ketoskin? If you experience any of the following serious side effects, stop taking Ketoskin and seek emergency medical attention or contact your doctor immediately: an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); or liver damage (pale stools, yellowish skin or eyes, abdominal pain, unusual fatigue, or dark urine). Other, less serious side effects may be more likely to occur. If you experience any of the following side effects, continue to take Ketoskin and talk to your doctor: nausea, vomiting, or abdominal pain; diarrhea; headache; dizziness; fatigue; or itching. Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Ketoskin? Do not take Ketoskin if you are taking any of the following drugs: astemizole (Hismanal), cisapride (Propulsid), or triazolam (Halcion) or midazolam (Versed). Dangerous or life-threatening events may occur if Ketoskin is taken with any of the medicines listed above. Before taking Ketoskin, tell your doctor if you are taking any other medicines, especially any of the following: cyclosporine (Sandimmune, Neoral); tacrolimus ((Prograf); methylprednisolone (Medrol, others); antacids; cimetidine (Tagamet, Tagamet HB), nizatidine (Axid, Axid AR), famotidine (Pepcid, Pepcid AC), or ranitidine (Zantac, Zantac 75); omeprazole (Prilosec), lansoprazole (Prevacid), or rabeprazole (Aciphex); digoxin (Lanoxin, Lanoxicaps); warfarin (Coumadin); phenytoin (Dilantin, others); rifampin (Rifadin, Rimactane); or an oral diabetes medicine such as glipizide (Glucotrol), glyburide (Diabeta, Micronase, Glynase), tolbutamide (Orinase), tolazamide (Tolinase), chlorpropamide (Diabinese), and others. You may not be able to take Ketoskin, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above. Drugs other than those listed here may also interact with Ketoskin or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

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The story of Kamalen is a mneumonic account of an historical event near Cocos Island, Guam. A 3 foot, 60 lb wooden statue, carved from ironwood, is known as Our Lady of Camarin. On Guam and the Marianas she is the Patron Saint Santa Marian Kamalen who stands watch over the people of Guam and the Marianas Isles in the bullet-proof glass apse of the Agana Basilica 15 feet above the altar floor and the tombs of several Spanish, American and Chamoru bishops. "Her eyes are cast down reverently and her hands are together in prayer, touching only at the fingertips. She stands in the heavens, tucked into the curve of a silver crescent moon [traditional symbol for Mary], floating on the wings of cherubs" [John Wythe White, Pacifica pg. 8-9]. The first Jesuit missionary ( who landed on Guam June 16, 1668 aboard the San Diego. [Rogers, Robert. Destiny's Landfall. 2011.p.43]), Diego Luis de San Vitores saw the Ladrones (Marianas) as a metaphor for Mary. He wrote, 'This group of thirteen islands is so "marian" in configuration that. they form a crescent, a very appropriate throne for the feet of mary' (Garcia, Francisco. The life and Martyrdom of the Venerable Father Diego Luis de San Vitores. 2004. p.165). He renamed the Ladrones to "Las Islas Marianas" for his devotion to the queen of Heaven, Mary, as well as for the queen of Spain, dona Mariana de Austria (IBID, p.160,290).

Oral tradition relates that Santa Marian Kamalen, Patroness of the Marianas islands, floated into the shores of Merizo escorted by two crabs with lit votive candles on their backs over 340 years ago. Made of ironwood, which does not float, her arrival by way of sea was a miracle in of itself. It is told that the statue was brought in by a fisherman who presented her to his parish priest, who in turn presented it to the Spanish Governor. Legend relates that the fisherman drew near to the statue repeatedly but it drifted away. It was until he fully clothed himself that the floating statue could be approached and touched. Our Lady was housed in a Merizo proa shed or camarin [kamalin is the Spanish-Chamoru word for the long narrow thatched structures that served as soldiers barracks] until she could be moved to the Dulce Nombre de Maria Church in Agana where it sits in a perch above the church's altar.

Historians surmise that "She probably came from a Spanish galleon, Our Lady del Pilar 1673, that ran aground and sank in the treacherous waters outside the reef of Cocos Islands Southern Guahan" (White, John Whythe. pg 8 of Continental's Pacifica magazine. 1993. p.8), (Cunningham, Dr. Lawrence. http://www. youtube. com/watch? v=NhRo9gK_PhY )

This exquisite image of Our Lady, with hands, feet and face of ivory and a cap of natural hair, is bedecked with a jewel-studded crown of gold and gold jewelry. For centuries, Chamorros have held this visual image of the Immaculate Virgin which has survived fires, earthquakes, and typhoons. She was safely hidden from the Japanese invaders and otherwise protected from the ravages of World War II ( http://www. youtube. com/watch? v=hN2qeXg3_fs ). Government Code of of Guam Sect.1 Chapt 10 paragraph 1000 designates Our Lady of Camarin Day as an official holiday on December 8th. Since the early 1900s, On that Feast day, the Basilica is closed, the statue is taken down from the apse, groomed by a select group of people, and is placed atop a karosa or cart of blossoms. The cart is pulled with the centuries old carved figure being a central visual image leading a Catholic procession around Hagatna, the capitol city of Guam. Throughout the procession, the sound of prayers in various languages weave through the thousands of faithful believers honoring Jesus [through Mary who is identified as the Immaculate Conception]. As with religious traditions in the Marianas, Catholics do not pray to statues or do not worship statues.

The tradition is a carryover from 1825 and 1834, when Guam's faithful made a "promesa" (promise) to hold a procession in Mary's honor after a series of devastating earthquakes.

Padre San Vitores built his first church in February 1669 on Hagatna land given him by Chief Quipuha who died on 1668Dec23 and buried inside the church on Christmas eve (Levesque, Rodrique. History of Micronesia Vol 4 Religious Conquest 1995; p 631-632). He dedicated it to Dulce Nombre de Maria (Sweet Name of Mary) - a name and site of the village's church (now basilica) has kept for over 340 years.

The ancient Chamorro society was one of only a handful of societies that are both matrilineal and matriachical in nature. Having Mary as the patroness reflects the ancient community quick acceptance of a mother figure.

The statue had been stolen from the Basilica in 1968, May 9, 1971, Dec 28, 1992 but successfully retrieved. The Archbishop of Hagatna, Anthony Apuron, believes that the thefts of Our Lady were motivated not by the promise of monetary gain, but by proximity to the miraculous. "All of the people who took the statue did it to be close to her," he says. "They were troubled people who hoped that having her near would somehow caused her to perform a miracle."

On Dec 2, 2002, a cost saving measure for the Government of Guam was enacted Public Law 26-157 which trims the number of govt of Guam holidays from 16 to 10. Eliminated were Rev. Martin Luther King Jr.'s birthday, Presidents Day, Discovery Day, Good Friday and The Feast of the Immaculate Conception Our Lady of Camarin Day as holidays in Guam. According to the newspaper Guampdn, in face of pressure from constituents, including legislator's mothers and family and an impending typhoon "Ponsonga", lawmakers on Dec 3, 2002 voted to recall Unpingco's bill from the session voting file and changed the name of the holiday "Remembrance Day" back to Our Lady of Camarin Day. On Dec 8 2002, on the Lady of Camarin anniversary, one of the most devastating typhoon Ponsonga [a Korean word for a little flower] landed on Guam. Compiled by Rudolph Villaverde.

COMMENTS

12/29/14 Hafa Dai Matao-Tano'

There's some aspects of the story missing relating to when Santa Marian Kamalen was placed at the Camarin in Hagatna during the Spanish Administration Era of Guahan. This was when soldiers began to notice that Santa Marian Kamalen has sticker-burrs on her dress each morning after patrons clean the sticker burrs the night before. The story goes was that Santa Marian Kamalen goes out at night visiting areas of Hagatna and houses of the people and must have been going to places that have bullcart trails overgrown with grasses and stickerburrs. This was the story somewhat similar about Santa Marian Kamalen going out visiting during the night when everyone was asleep that I have heard when I was younger back in the days. Maybe Father Eric can touch on this.

Saena Ma'ase' Jose U. Garrido Matao Mala'et

12/29/14 Hafa Adai Matao - Taga,

I too heard similar stories from my parents as related by Matao Mala?et?and to add? not just sticky burrs but the dress was damp with dew cause she goes out in the very early morning. The people in those times would go to mass around 4-5am? and this would be the time the burrs would be noticed. This is something that was very true and dear to the Chamoru people of the time?and is why we venerate Santa Marian Kamalen the way we do today?.in the peoples eyes and heart?she looked after them?and they in return show appreciation. If we were to look back at our misfortunes or fortunes?one will see we as an Island people are very fortunate and whatever bad tidings is somewhat lessened?(i. e.) major typhoons, earthquake, wars, famine?it appears we have been somewhat protected and great resiliency to rebound.

Minauleg yan Minagof taotao Chochogu Raymond R Quintanilla

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Cefuroxime Axetil - Fda Prescribing Information, Side Effects And Uses, Acertil

Cefuroxime Axetil

Indications and Usage for Cefuroxime Axetil

1.1 Pharyngitis/Tonsillitis

Cefuroxime Axetil tablets are indicated for the treatment of adult patients and pediatric patients (13 years and older) with mild-to-moderate pharyngitis/tonsillitis caused by susceptible strains of Streptococcus pyogenes .

Limitations of Use

The efficacy of Cefuroxime Axetil in the prevention of rheumatic fever was not established in clinical trials.

The efficacy of Cefuroxime Axetil in the treatment of penicillin-resistant strains of Streptococcus pyogenes has not been demonstrated in clinical trials.

1.2 Acute Bacterial Otitis Media

Cefuroxime Axetil tablets are indicated for the treatment of pediatric patients (who can swallow tablets whole) with acute bacterial otitis media caused by susceptible strains of Streptococcus pneumoniae. Haemophilus influenzae (including β-lactamase-producing strains), Moraxella catarrhalis (including β-lactamase-producing strains), or Streptococcus pyogenes .

1.3 Acute Bacterial Maxillary Sinusitis

Cefuroxime Axetil tablets are indicated for the treatment of adult and pediatric patients (13 years and older) with mild-to-moderate acute bacterial maxillary sinusitis caused by susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae (non-β-lactamase-producing strains only).

Limitations of Use The effectiveness of Cefuroxime Axetil for sinus infections caused by β-lactamase-producing Haemophilus influenzae or Moraxella catarrhalis in patients with acute bacterial maxillary sinusitis was not established due to insufficient numbers of these isolates in the clinical trials [see Clinical Studies (14.1)] .

1.4 Acute Bacterial Exacerbations of Chronic Bronchitis and Secondary Bacterial Infections of Acute Bronchitis

Cefuroxime Axetil tablets are indicated for the treatment of adult patients and pediatric patients (aged 13 and older) with mild-to-moderate acute bacterial exacerbations of chronic bronchitis and secondary bacterial infections of acute bronchitis caused by susceptible strains of Streptococcus pneumoniae. Haemophilus influenzae (β-lactamase-negative strains), or Haemophilus parainfluenzae (β-lactamase-negative strains).

1.5 Uncomplicated Skin and Skin-structure Infections

Cefuroxime Axetil tablets are indicated for the treatment of adult patients and pediatric patients (aged 13 and older) with uncomplicated skin and skin-structure infections caused by susceptible strains of Staphylococcus aureus (including β-lactamase-producing strains) or Streptococcus pyogenes .

1.6 Uncomplicated Urinary Tract Infections

Cefuroxime Axetil tablets are indicated for the treatment of adult patients and pediatric patients (aged 13 and older) with uncomplicated urinary tract infections caused by susceptible strains of Escherichia coli or Klebsiella pneumoniae .

1.7 Uncomplicated Gonorrhea

Cefuroxime Axetil tablets are indicated for the treatment of adult patients and pediatric patients (aged 13 and older) with uncomplicated gonorrhea, urethral and endocervical, caused by penicillinase - producing and non-penicillinase-producing susceptible strains of Neisseria gonorrhoeae and uncomplicated gonorrhea, rectal, in females, caused by non-penicillinase-producing susceptible strains of Neisseria gonorrhoeae .

1.8 Early Lyme Disease (erythema migrans)

Cefuroxime Axetil tablets are indicated for the treatment of adult patients and pediatric patients (aged 13 and older) with early Lyme disease (erythema migrans) caused by susceptible strains of Borrelia burgdorferi .

1.10 Usage

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Cefuroxime Axetil and other antibacterial drugs, Cefuroxime Axetil should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they 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.

Cefuroxime Axetil Dosage and Administration

2.1 Important Administration Instructions

Cefuroxime Axetil tablets and Cefuroxime Axetil for oral suspension are not bioequivalent and are therefore not substitutable on a milligram-per-milligram basis [see Clinical Pharmacology (12.3)] .

Administer Cefuroxime Axetil tablets as described in the appropriate dosage guidelines [see Dosage and Administration (2.2)] .

Administer Cefuroxime Axetil tablets with or without food.

Pediatric patients (aged 13 years and older) who cannot swallow the Cefuroxime Axetil tablets whole should receive Cefuroxime Axetil for oral suspension because the tablet has a strong, persistent bitter taste when crushed [see Dosage and Administration (2.2)] .

2.2 Dosage for Cefuroxime Axetil Tablets

Administer Cefuroxime Axetil tablets as described in the dosage guidelines table below with or without food.

Table 1. Adult Patients and Pediatric Patients Dosage Guidelines for Cefuroxime Axetil Tablets

Dosage Forms and Strengths

Cefuroxime Axetil tablets are available in the following strengths:

250 mg: Light blue colored film coated, capsule shaped tablets having “250” on one side and “P125” on the other side.

500 mg: Dark blue colored film coated, capsule shaped tablets having “500” on one side and “P126” on the other side.

Contraindications

Cefuroxime Axetil is contraindicated in patients with a known hypersensitivity (e. g. anaphylaxis) to Cefuroxime Axetil or to other β-lactam antibacterial drugs (e. g. penicillins and cephalosporins).

Warnings and Precautions

5.1 Anaphylactic Reactions

Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients on β-lactam antibacterials. These reactions are more likely to occur in individuals with a history of β-lactam hypersensitivity and/or a history of sensitivity to multiple allergens. There have been reports of individuals with a history of penicillin hypersensitivity who have experienced severe reactions when treated with cephalosporins. Cefuroxime Axetil is contraindicated in patients with a known hypersensitivity to Cefuroxime Axetil or other β-lactam antibacterial drugs [see Contraindications (4)] .

Before initiating therapy with Cefuroxime Axetil, inquire about previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens. If an allergic reaction occurs, discontinue Cefuroxime Axetil and institute appropriate therapy.

5.2 Clostridium difficile - associated Diarrhea

Clostridium difficile - associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Cefuroxime Axetil, 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 2 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.

5.3 Potential for Microbial Overgrowth

The possibility of superinfections with fungal or bacterial pathogens should be considered during therapy.

5.4 Development of Drug-resistant Bacteria

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

5.6 Interference with Glucose Tests

A false-positive result for glucose in the urine may occur with copper reduction tests, and a false-negative result for blood/plasma glucose may occur with ferricyanide tests in subjects receiving Cefuroxime Axetil [see Drug Interactions (7.4)] .

Adverse Reactions

The following serious and otherwise important adverse reaction is described in greater detail in the Warnings and Precautions section of the label:

Anaphylactic Reactions [see Warnings and Precautions [5.1)]

6.1 Clinical Trials Experience

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

Tablets Multiple-dose Dosing Regimens with 7 to 10 Days' Duration: In multiple-dose clinical trials, 912 subjects were treated with Cefuroxime Axetil (125 to 500 mg twice daily). It is noted that 125 mg twice daily is not an approved dosage. Twenty (2.2%) subjects discontinued medication due to adverse reactions. Seventeen (85%) of the 20 subjects who discontinued therapy did so because of gastrointestinal disturbances, including diarrhea, nausea, vomiting, and abdominal pain. The percentage of subjects treated with Cefuroxime Axetil who discontinued study drug because of adverse reactions was similar at daily doses of 1,000, 500, and 250 mg (2.3%, 2.1%, and 2.2%, respectively). However, the incidence of gastrointestinal adverse reactions increased with the higher recommended doses.

The adverse reactions in Table 5 are for subjects (n = 912) treated with Cefuroxime Axetil in multiple-dose clinical trials.

Table 5. Adverse Reactions (≥1%) after Multiple-dose Regimens with Cefuroxime Axetil Tablets

Cefuroxime Axetil (n=912)

The following adverse reactions occurred in less than 1% but greater than 0.1% of subjects (n = 912) treated with Cefuroxime Axetil in multiple-dose clinical trials.

Immune System Disorders: Hives, swollen tongue.

Metabolism and Nutrition Disorders: Anorexia.

Nervous System Disorders: Headache.

Cardiac Disorders: Chest pain.

Respiratory Disorders: Shortness of breath.

Gastrointestinal Disorders: Abdominal pain, abdominal cramps, flatulence, indigestion, mouth ulcers.

Skin and Subcutaneous Tissue Disorders: Rash, itch

Renal and Urinary Disorders: Dysuria.

Reproductive System and Breast Disorders: Vaginitis, vulvar itch.

General Disorders and Administration Site Conditions: Chills, sleepiness, thirst.

Investigations: Positive Coombs' test.

5 Day Regimen: In clinical trials using Cefuroxime Axetil 250 mg twice daily in the treatment of secondary bacterial infections of acute bronchitis, 399 subjects were treated for 5 days and 402 subjects were treated for 10 days. No difference in the occurrence of adverse reactions was found between the 2 regimens.

Early Lyme Disease with 20 Day Regimen: Two multicenter trials assessed Cefuroxime Axetil 500 mg twice daily for 20 days. The most common drug-related adverse experiences were diarrhea (10.6%), Jarisch-Herxheimer reaction (5.6%), and vaginitis (5.4%). Other adverse experiences occurred with frequencies comparable to those reported with 7 to 10 days' dosing.

Single-dose Regimen for Uncomplicated Gonorrhea: In clinical trials using a single 1,000 mg dose of Cefuroxime Axetil, 1,061 subjects were treated for uncomplicated gonorrhea.

The adverse reactions in Table 6 were for subjects treated with a single dose of 1,000 mg Cefuroxime Axetil in U. S. clinical trials.

Table 6. Adverse Reactions (≥1%) after Single-dose Regimen with 1,000 mg Cefuroxime Axetil Tablets for Uncomplicated Gonorrhea

Cefuroxime Axetil (n = 1,061)

The following adverse reactions occurred in less than 1% but greater than 0.1% of subjects (n = 1,061) treated with a single dose of Cefuroxime Axetil 1,000 mg for uncomplicated gonorrhea in U. S. clinical trials.

Infections and Infestations: Vaginal candidiasis.

Nervous System Disorders: Headache, dizziness, somnolence.

Cardiac Disorders: Tightness/pain in chest, tachycardia.

Gastrointestinal Disorders: Abdominal pain, dyspepsia.

Skin and Subcutaneous Tissue Disorders: Erythema, rash, pruritus.

Musculoskeletal and Connective Tissue Disorders: Muscle cramps, muscle stiffness, muscle spasm of neck, lockjaw-type reaction.

Renal and Urinary Disorders: Bleeding/pain in urethra, kidney pain.

Reproductive System and Breast Disorders: Vaginal itch, vaginal discharge.

6.2 Postmarketing Experience

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

Blood and Lymphatic System Disorders Hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia.

Gastrointestinal Disorders Pseudomembranous colitis [see Warnings and Precautions (5.2)] .

Hepatobiliary Disorders Hepatic impairment including hepatitis and cholestasis, jaundice.

Immune System Disorders Anaphylaxis, serum sickness-like reaction.

Investigations Increased prothrombin time.

Nervous System Disorders Seizure, encephalopathy.

Renal and Urinary Disorders Renal dysfunction.

Skin and Subcutaneous Tissue Disorders Angioedema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria.

Drug Interactions

7.1 Oral Contraceptives

Cefuroxime Axetil may affect the gut flora, leading to lower estrogen reabsorption and reduced efficacy of combined oral estrogen/progesterone contraceptives. Counsel patients to consider alternate supplementary (non-hormonal) contraceptive measures during treatment.

7.2 Drugs that Reduce Gastric Acidity

Drugs that reduce gastric acidity may result in a lower bioavailability of Cefuroxime Axetil compared with administration in the fasting state. Administration of drugs that reduce gastric acidity may negate the food effect of increased absorption of Cefuroxime Axetil when administered in the postprandial state. Administer Cefuroxime Axetil tablets at least 1 hour before or 2 hours after administration of short-acting antacids. Histamine-2 (H 2 ) antagonists and proton pump inhibitors should be avoided.

7.3 Probenecid

Concomitant administration of probenecid with Cefuroxime Axetil tablets increases serum concentrations of cefuroxime [see Clinical Pharmacology (12.3)]. Co-administration of probenecid with Cefuroxime Axetil is not recommended.

7.4 Drug/Laboratory Test Interactions

A false-positive reaction for glucose in the urine may occur with copper reduction tests (e. g. Benedict's or Fehling's solution), but not with enzyme-based tests for glycosuria. As a false-negative result may occur in the ferricyanide test, it is recommended that either the glucose oxidase or hexokinase method be used to determine blood/plasma glucose levels in patients receiving Cefuroxime Axetil. The presence of cefuroxime does not interfere with the assay of serum and urine creatinine by the alkaline picrate method.

USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Teratogenic Effects 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, Cefuroxime Axetil should be used during pregnancy only if clearly needed.

Reproduction studies have been performed in mice at doses up to 3,200 mg/kg/day (14 times the recommended maximum human dose based on body surface area) and in rats at doses up to 1,000 mg/kg/day (9 times the recommended maximum human dose based on body surface area) and have revealed no evidence of impaired fertility or harm to the fetus due to Cefuroxime Axetil.

8.3 Nursing Mothers

Because cefuroxime is excreted in human milk, caution should be exercised when Cefuroxime Axetil is administered to a nursing woman.

8.4 Pediatric Use

The safety and effectiveness of Cefuroxime Axetil have been established for pediatric patients aged 3 months to 12 years for acute bacterial maxillary sinusitis based upon its approval in adults. Use of Cefuroxime Axetil in pediatric patients is supported by pharmacokinetic and safety data in adults and pediatric patients, and by clinical and microbiological data from adequate and well-controlled trials of the treatment of acute bacterial maxillary sinusitis in adults and of acute otitis media with effusion in pediatric patients. It is also supported by postmarketing adverse events surveillance. [See Indications and Usage (1), Dosage and Administration (2), Adverse Reactions (6), Clinical Pharmacology (12.3).]

8.5 Geriatric Use

Of the total number of subjects who received Cefuroxime Axetil in 20 clinical trials, 375 were aged 65 and older while 151 were aged 75 and older. No overall differences in safety or effectiveness were observed between these subjects and younger adult subjects. Reported clinical experience has not identified differences in responses between the elderly and younger adult patients, but greater sensitivity of some older individuals cannot be ruled out.

Cefuroxime is substantially excreted by the kidney, and the risk of adverse reactions 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, and it may be useful to monitor renal function.

8.6 Renal Impairment

Reducing the dosage of Cefuroxime Axetil is recommended for adult patients with severe renal impairment (creatinine clearance <30 mL/min) [see Dosage and Administration (2.5), Clinical Pharmacology (12.3)].

Overdosage

Overdosage of cephalosporins can cause cerebral irritation leading to convulsions or encephalopathy. Serum levels of cefuroxime can be reduced by hemodialysis and peritoneal dialysis.

Cefuroxime Axetil Description

Cefuroxime Axetil tablets, USP contain cefuroxime as Cefuroxime Axetil, USP.

Cefuroxime Axetil, USP is a semisynthetic, cephalosporin antibacterial drug for oral administration.

The chemical name of Cefuroxime Axetil, USP (1-(acetyloxy) ethyl ester of cefuroxime) is (RS)-1 hydroxyethyl (6R,7R)-7-[2-(2-furyl)glyoxyl-amido]-3-(hydroxymethyl)-8-oxo-5-thia-1-azabicyclo [4.2.0]-oct-2-ene-2-carboxylate, 7 2 -(Z)-(O-methyl-oxime), 1-acetate 3-carbamate. Its molecular formula is C 20 H 22 N 4 O 10 S, and it has a molecular weight of 510.48.

Cefuroxime Axetil, USP is in the amorphous form and has the following structural formula:

Cefuroxime Axetil tablets, USP are film-coated and contain the equivalent of 250 mg or 500 mg of cefuroxime as Cefuroxime Axetil USP. Cefuroxime Axetil tablets, USP contain the inactive ingredients pregelatinized starch, croscarmellose sodium, sodium lauryl sulphate, microcrystalline cellulose, colloidal silicon dioxide, hydrogenated vegetable oil and opadry blue.

Components of Opadry Blue (250 mg Tablets) are Hypromellose, Titanium dioxide, Propylene glycol, FD&C Blue # 1 / Brilliant Blue FCF Aluminum Lake, FD&C Blue #2 / Indigo Carmine Aluminum Lake; Opadry Blue (500 mg Tablets) are Hypromellose, Titanium dioxide, Propylene glycol, FD&C Blue # 1 / Brilliant Blue FCF Aluminum Lake, D&C Red #27 / Phloxine Aluminum Lake.

Cefuroxime Axetil - Clinical Pharmacology

12.1 Mechanism of Action

Cefuroxime Axetil is an antibacterial drug [see Clinical Pharmacology (12.4)] .

12.3 Pharmacokinetics

Absorption After oral administration, Cefuroxime Axetil is absorbed from the gastrointestinal tract and rapidly hydrolyzed by nonspecific esterases in the intestinal mucosa and blood to cefuroxime. Serum pharmacokinetic parameters for cefuroxime following administration of Cefuroxime Axetil tablets to adults are shown in Table 8.

Table 8. Pharmacokinetics of Cefuroxime Administered in the Postprandial State as Cefuroxime Axetil Tablets to Adults a

Dose b (Cefuroxime Equivalent)

Peak Plasma Concentration (mcg/mL)

Time of Peak Plasma Concentration (h)

a Mean values of 12 healthy adult volunteers. b Drug administered immediately after a meal.

Food Effect: Absorption of the tablet is greater when taken after food (absolute bioavailability increases from 37% to 52%). Despite this difference in absorption, the clinical and bacteriologic responses of subjects were independent of food intake at the time of tablet administration in 2 trials where this was assessed.

All pharmacokinetic and clinical effectiveness and safety trials in pediatric subjects using the suspension formulation were conducted in the fed state. No data are available on the absorption kinetics of the suspension formulation when administered to fasted pediatric subjects.

Lack of Bioequivalence: Oral suspension was not bioequivalent to tablets when tested in healthy adults. The tablet and oral suspension formulations are NOT substitutable on a milligram-per-milligram basis. The area under the curve for the suspension averaged 91% of that for the tablet, and the peak plasma concentration for the suspension averaged 71% of the peak plasma concentration of the tablets. Therefore, the safety and effectiveness of both the tablet and oral suspension formulations were established in separate clinical trials.

Distribution Cefuroxime is distributed throughout the extracellular fluids. Approximately 50% of serum cefuroxime is bound to protein.

Metabolism The axetil moiety is metabolized to acetaldehyde and acetic acid.

Excretion Cefuroxime is excreted unchanged in the urine; in adults, approximately 50% of the administered dose is recovered in the urine within 12 hours. The pharmacokinetics of cefuroxime in pediatric subjects have not been studied. Until further data are available, the renal elimination of Cefuroxime Axetil established in adults should not be extrapolated to pediatric subjects.

Specific Populations Renal Impairment: In a trial of 28 adults with normal renal function or severe renal impairment (creatinine clearance <30 mL/min), the elimination half-life was prolonged in relation to severity of renal impairment. Prolongation of the dosage interval is recommended in adult patients with creatinine clearance <30 mL/min [see Dosage and Administration (2.5)] .

Geriatric Patients: In a trial of 20 elderly subjects (mean age = 83.9 years) having a mean creatinine clearance of 34.9 mL/min, the mean serum elimination half-life was prolonged to 3.5 hours; however, despite the lower elimination of cefuroxime in geriatric patients, dosage adjustment based on age is not necessary [see Use in Specific Populations (8.5)] .

Drug Interactions Concomitant administration of probenecid with Cefuroxime Axetil tablets increases the cefuroxime area under the serum concentration versus time curve and maximum serum concentration by 50% and 21%, respectively.

12.4 Microbiology

Mechanism of Action Cefuroxime Axetil is a bactericidal agent that acts by inhibition of bacterial cell wall synthesis. Cefuroxime Axetil has activity in the presence of some β-lactamases, both penicillinases and cephalosporinases, of gram-negative and gram-positive bacteria.

Mechanism of Resistance Resistance to Cefuroxime Axetil is primarily through hydrolysis by β-lactamase, alteration of penicillin-binding proteins (PBPs), decreased permeability and the presence of bacterial efflux pumps.

Susceptibility to Cefuroxime Axetil will vary with geography and time; local susceptibility data should be consulted, if available. Beta-lactamase-negative, ampicillin-resistant (BLNAR) isolates of H. influenzae should be considered resistant to Cefuroxime Axetil.

Cefuroxime Axetil 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 Streptococcus pyogenes

Escherichia coli a Klebsiella pneumoniae a Haemophilus influenzae Haemophilus parainfluenzae Moraxella catarrhalis Neisseria gonorrhoeae

a Most extended spectrum β-lactamase (ESBL)-producing and carbapenemase-producing isolates are resistant to Cefuroxime Axetil.

The following in vitro data are available, but their clinical significance is unknown. At least 90 percent of the following microorganisms exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for Cefuroxime Axetil of 1 mcg/mL. However, the efficacy of Cefuroxime Axetil in treating clinical infections due to these microorganisms has not been established in adequate and well-controlled clinical trials.

Staphylococcus epidermidis (methicillin-susceptible isolates only) Staphylococcus saprophyticus (methicillin-susceptible isolates only) Streptococcus agalactiae

Morganella morganii Proteus inconstans Proteus mirabilis Providencia rettgeri

Susceptibility Test Methods When available, the clinical microbiology laboratory should provide the results of in vitro susceptibility tests for antimicrobial drug products used in local hospitals and practice areas 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.

Dilution Techniques: Quantitative methods are used to determine antimicrobial MICs. These MICs provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. The MICs should be determined using a standardized test method (broth or agar) 1,2. The MIC values should be interpreted according to criteria provided in Table 10 2,3 .

Diffusion Techniques: 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 4. This procedure uses paper disks impregnated with 30 mcg Cefuroxime Axetil to test the susceptibility of microorganisms to Cefuroxime Axetil. The disk diffusion interpretive criteria are provided in Table 10 3 .

Table 10. Susceptibility Test Interpretive Criteria for Cefuroxime Axetil

Minimum Inhibitory Concentrations (mcg/mL)

a For Enterobacteriaceae. Haemophilus spp. and Moraxella catarrhalis. susceptibility interpretive criteria are based on a dose of 500 mg every 12 hours in patients with normal renal function.

b Haemophilus spp. includes only isolates of H. influenzae and H. parainfluenzae .

Susceptibility of staphylococci to cefuroxime may be deduced from testing only penicillin and either cefoxitin or oxacillin.

Susceptibility of Streptococcus pyogenes may be deduced from testing penicillin 3 .

A report of "Susceptible" 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" 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 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" 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.

Quality Control: 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 1,2,4. The QC ranges for MIC and disk diffusion testing using the 30 mcg disk are provided in Table 11 3 .

Table 11. Acceptable Quality Control (QC) Ranges for Cefuroxime Axetil

Minimum Inhibitory Concentrations (mcg/mL)

Disk Diffusion Zone Diameters (mm)

ATCC = American Type Culture Collection.

Nonclinical Toxicology

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Although lifetime studies in animals have not been performed to evaluate carcinogenic potential, no mutagenic activity was found for Cefuroxime Axetil in a battery of bacterial mutation tests. Positive results were obtained in an in vitro chromosome aberration assay; however, negative results were found in an in vivo micronucleus test at doses up to 1.5 g/kg. Reproduction studies in rats at doses up to 1,000 mg/kg/day (9 times the recommended maximum human dose based on body surface area) have revealed no impairment of fertility.

Clinical Studies

14.1 Acute Bacterial Maxillary Sinusitis

One adequate and well-controlled trial was performed in subjects with acute bacterial maxillary sinusitis. In this trial, each subject had a maxillary sinus aspirate collected by sinus puncture before treatment was initiated for presumptive acute bacterial sinusitis. All subjects had radiographic and clinical evidence of acute maxillary sinusitis. In the trial, the clinical effectiveness of Cefuroxime Axetil in treating acute maxillary sinusitis was comparable to an oral antimicrobial agent containing a specific β-lactamase inhibitor. However, microbiology data demonstrated Cefuroxime Axetil to be effective in treating acute bacterial maxillary sinusitis due only to Streptococcus pneumoniae or non-β-lactamase-producing Haemophilus influenzae. Insufficient numbers of β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis isolates were obtained in this trial to adequately evaluate the effectiveness of Cefuroxime Axetil in treating acute bacterial maxillary sinusitis due to these 2 organisms.

This trial randomized 317 adult subjects, 132 subjects in the United States and 185 subjects in South America. Table 12 shows the results of the intent-to-treat analysis.

Table 12. Clinical Effectiveness of Cefuroxime Axetil Tablets in the Treatment of Acute Bacterial Maxillary Sinusitis

a 95% confidence interval around the success difference [-0.08, +0.32]. b 95% confidence interval around the success difference [-0.10, +0.16]. c Control was an antibacterial drug containing a β-lactamase inhibitor.

In this trial and in a supporting maxillary puncture trial, 15 evaluable subjects had non-β-lactamase-producing Haemophilus influenzae as the identified pathogen. Of these, 67% (10/15) had this pathogen eradicated. Eighteen (18) evaluable subjects had Streptococcus pneumoniae as the identified pathogen. Of these, 83% (15/18) had this pathogen eradicated.

14.2 Early Lyme Disease

Two adequate and well-controlled trials were performed in subjects with early Lyme disease. All subjects presented with physician-documented erythema migrans, with or without systemic manifestations of infection. Subjects were assessed at 1 month posttreatment for success in treating early Lyme disease (Part I) and at 1 year posttreatment for success in preventing the progression to the sequelae of late Lyme disease (Part II).

A total of 355 adult subjects (181 treated with Cefuroxime Axetil and 174 treated with doxycycline) were randomized in the 2 trials, with diagnosis of early Lyme disease confirmed in 79% (281/355). The clinical diagnosis of early Lyme disease in these subjects was validated by 1) blinded expert reading of photographs, when available, of the pretreatment erythema migrans skin lesion, and 2) serologic confirmation (using enzyme-linked immunosorbent assay [ELISA] and immunoblot assay ["Western" blot]) of the presence of antibodies specific to Borrelia burgdorferi. the etiologic agent of Lyme disease. The efficacy data in Table 14 are specific to this "validated" patient subset, while the safety data below reflect the entire patient population for the 2 trials. Clinical data for evaluable subjects in the "validated" patient subset are shown in Table 13.

Table 13. Clinical Effectiveness of Cefuroxime Axetil Tablets Compared with Doxycycline in the Treatment of Early Lyme Disease

Part I (1 Month after 20 Days of Treatment) a

a 95% confidence interval around the satisfactory difference for Part I (-0.08, +0.05). b 95% confidence interval around the satisfactory difference for Part II (-0.13, +0.07). c n’s include subjects assessed as unsatisfactory clinical outcomes (failure + recurrence) in Part I (Cefuroxime Axetil - 11 [5 failure, 6 recurrence]; doxycycline - 8 [6 failure, 2 recurrence]). d Satisfactory clinical outcome includes cure + improvement (Part I) and success + improvement (Part II).

Cefuroxime Axetil and doxycycline were effective in prevention of the development of sequelae of late Lyme disease.

While the incidence of drug-related gastrointestinal adverse reactions was similar in the 2 treatment groups (Cefuroxime Axetil - 13%; doxycycline - 11%), the incidence of drug-related diarrhea was higher in the Cefuroxime Axetil arm versus the doxycycline arm (11% versus 3%, respectively).

14.3 Secondary Bacterial Infections of Acute Bronchitis

Four randomized, controlled clinical trials were performed comparing 5 days versus 10 days of Cefuroxime Axetil for the treatment of subjects with secondary bacterial infections of acute bronchitis. These trials enrolled a total of 1,253 subjects (Study 1 n = 360; Study 2 n = 177; Study 3 n = 362; Study 4 n = 354). The protocols for Study 1 and Study 2 were identical and compared Cefuroxime Axetil 250 mg twice daily for 5 days, Cefuroxime Axetil 250 mg twice daily for 10 days, and AUGMENTIN ® (amoxicillin/clavulanate potassium) 500 mg 3 times daily for 10 days. These 2 trials were conducted simultaneously. Study 3 and Study 4 compared Cefuroxime Axetil 250 mg twice daily for 5 days, Cefuroxime Axetil 250 mg twice daily for 10 days, and CECLOR ® (cefaclor) 250 mg 3 times daily for 10 days. They were otherwise identical to Study 1 and Study 2 and were conducted over the following 2 years. Subjects were required to have polymorphonuclear cells present on the Gram stain of their screening sputum specimen, but isolation of a bacterial pathogen from the sputum culture was not required for inclusion. Table 14 demonstrates the results of the clinical outcome analysis of the pooled trials Study 1/Study 2 and Study 3/Study 4, respectively.

Table 14. Clinical Effectiveness of Cefuroxime Axetil Tablets 250 mg Twice Daily in Secondary Bacterial Infections of Acute Bronchitis: Comparison of 5 versus 10 Days' Treatment Duration

Study 1 and Study 2 a

a 95% confidence interval around the success difference [-0.164, +0.029]. b 95% confidence interval around the success difference [-0.061, +0.103].

The response rates for subjects who were both clinically and bacteriologically evaluable were consistent with those reported for the clinically evaluable subjects.

REFERENCES

Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically; Approved Standard - Tenth Edition. 2015. CLSI document M07-A10, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA.

Clinical and Laboratory Standards Institute (CLSI). Methods for Antimicrobial Dilution and Disk Susceptibility Testing for Infrequently Isolated or Fastidious Bacteria: Approved Guidelines - Second Edition. 2010. CLSI document M45-A2, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA.

Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-fifth Informational Supplement. 2015. CLSI document M100-S25, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA.

Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Diffusion Susceptibility Tests; Approved Standard – Twelfth Edition. 2015. CLSI document M02-A12, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA.

How Supplied/Storage and Handling

Cefuroxime Axetil tablets USP, 250 mg: Light blue colored film coated, capsule shaped tablets having “250” on one side and “P125” on the other side. Tablets are supplied as follows:

Bottle of 20 Tablets NDC 42043-230-20

Bottle of 60 Tablets NDC 42043-230-06

Cefuroxime Axetil tablets USP, 500 mg: Dark blue colored film coated, capsule shaped tablets having “500” on one side and “P126” on the other side. Tablets are supplied as follows:

Bottle of 20 Tablets NDC 42043-231-20

Bottle of 60 Tablets NDC 42043-231-06

Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature]. Replace cap securely after each opening.

Patient Counseling Information

Allergic Reactions Inform patients that Cefuroxime Axetil is a cephalosporin that can cause allergic reactions in some individuals [see Warnings and Precautions (5.1)] .

Clostridium difficile - associated Diarrhea Inform patients that diarrhea is a common problem caused by antibacterials, and it usually ends when the antibacterial is discontinued. Sometimes after starting treatment with antibacterials, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as 2 or more months after having taken their last dose of the antibacterial. If this occurs, advise patients to contact their physician as soon as possible.

Crushing Tablets Instruct patients to swallow the tablet whole, without crushing the tablet. Patients who cannot swallow the tablet whole should receive the oral suspension.

Drug Resistance Inform patients that antibacterial drugs, including Cefuroxime Axetil, should only be used to treat bacterial infections. They do not treat viral infections (e. g. the common cold). When Cefuroxime Axetil is prescribed to treat a bacterial infection, inform 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 Cefuroxime Axetil or other antibacterial drugs in the future.

The brands listed in this product information leaflet are trademarks of their respective owners and are not trademarks of Orchid Healthcare. The makers of these brands are not affiliated with and do not endorse Orchid Healthcare or its products.

Manufactured for. OrchidPharma, Inc. Princeton, NJ 08540, USA

Manufactured by. Hospira Healthcare India Pvt. Ltd., At Irungattukottai – 602 105, India

On behalf of. Orchid Healthcare (A Division of Orchid Pharma Ltd.) At Irungattukottai – 602 105, India

PACKAGE LABEL. PRINCIPAL DISPLAY PANEL

Cefuroxime Axetil Tablets USP 250 mg

Choroidal Detachment Background, Pathophysiology, Epidemiology, Coriodal

Choroidal Detachment

Background

The suprachoroidal space is normally virtual because the choroid is in close apposition to the sclera. As fluid accumulates, this space becomes real, and the choroid is displaced from its normal position. Fluid accumulation, either serumlike or blood, also can occur within the choroid, which is a spongy tissue.

Serous choroidal detachment involves transudation of serum into the suprachoroidal space. This transudation may be due to increased transmural pressure, most frequently caused by globe hypotony of any etiology or trauma, or exudation of serum, most frequently caused by inflammation.

Hemorrhagic choroidal detachment is a hemorrhage in the suprachoroidal space or within the choroid caused by the rupture of choroidal vessels. This can occur spontaneously (rare), as a consequence of ocular trauma, during eye surgery, or after eye surgery. Except for posttraumatic cases, the clinical picture is very similar in most forms of hemorragic choroidal detachment, the only difference being the time of presentation. The outcome is generally worse for intraoperative hemorrhages, which often are accompanied by loss of eye contents.

Pathophysiology

The exact triggering mechanism is unknown. An increase in transmural pressure in the choroidal vascular plexus can be caused by elevated blood pressure, low intraocular pressure (IOP), or a combination. An increase in vascular permeability is caused by inflammation. The consequence is passage of serum, with large protein molecules into the suprachoroidal space. Since the protein content of the fluid accumulating in the normally virtual suprachoroidal space is similar to plasma with an equal oncotic pressure, its spontaneous reabsorption is unlikely, unless the underlying cause (ie, inflammation, hypotony) is treated. A breakdown of the blood-aqueous barrier across the pigmented epithelium may cause a superimposed nonrhegmatogenous retinal detachment. As a sequela, linear areas of pigmented epithelium hypertrophy, called Verhoeff streaks, indicate the posterior limits of the retinal detachment after its reabsorption.

Epidemiology

Frequency

Serous choroidal detachments are recognized easily when large. More subtle, anterior, shallow ciliochoroidal detachments, although relatively common after glaucoma filtration surgery, are undetected or unreported. Suprachoroidal hemorrhage is a rare occurrence. Reported data vary between 0.05-6%, depending on the sample. [1, 2] See Causes for predisposing factors.

Mortality/Morbidity

No mortality has been reported. Morbidity in serous choroidal detachment is significant. In phakic eyes, lens opacities can progress rapidly. Cyclitic pupillary membranes may develop. When a flat chamber is present, corneal endothelial damage and peripheral anterior synechiae can occur. Chronic choroidal detachment can lead to maculopathy and globe phthisis. In hemorrhagic detachment, morbidity is the same as for serous detachment, but the prognosis is worse. Loss of useful vision is reported in up to 40% of cases.

Race

No racial predilection exists.

Sex

No sexual predilection exists.

Age

Carlo E Traverso, MD Professor and Chairman, Clinica Oculistica of Department of Neurosciences, Ophthalmology, Maternal and Pediatrics and Genetics, University of Genova Medical School/IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Italy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Disclosure: Nothing to disclose.

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Disclosure: Nothing to disclose.

Healey PR, Herndon L, Smiddy W. Management of suprachoroidal hemorrhage. J Glaucoma . 2007 Sep. 16(6):577-9. [Medline].

Speaker MG, Guerriero PN, Met JA, Coad CT, Berger A, Marmor M. A case-control study of risk factors for intraoperative suprachoroidal expulsive hemorrhage. Ophthalmology . 1991 Feb. 98(2):202-9; discussion 210. [Medline].

Moshfeghi DM, Kim BY, Kaiser PK, Sears JE, Smith S. Appositional suprachoroidal hemorrhage: a case-control study. Am J Ophthalmol . 2004 Dec. 138(6):959-63.

Berke SJ, Bellows AR, Shingleton BJ, Richter CU, Hutchinson BT. Chronic and recurrent choroidal detachment after glaucoma filtering surgery. Ophthalmology . 1987 Feb. 94(2):154-62. [Medline].

Verma L, Venkatesh P, Chawla R, Tewari HK. Choroidal detachment following retinal detachment surgery: an analysis and a new hypothesis to minimize its occurrence in high-risk cases. Eur J Ophthalmol . 2004 Jul-Aug. 14(4):325-9. [Medline].

Costa VP, Smith M, Spaeth GL, Gandham S, Markovitz B. Loss of visual acuity after trabeculectomy. Ophthalmology . 1993 May. 100(5):599-612. [Medline].

Stalmans I, Gillis A, Lafaut AS, Zeyen T. Safe trabeculectomy technique: long term outcome. Br J Ophthalmol . 2006 Jan. 90(1):44-7. [Medline].

Singh R, Umapathy T, Abedin A, Eatamadi H, Maharajan S, Dua HS. Choroidal detachment in perforated corneal ulcers: frequency and management. Br J Ophthalmol . 2006 Sep. 90(9):1111-4. [Medline].

Davani S, Delbosc B, Royer B, Kantelip JP. Choroidal detachment induced by dorzolamide 20 years after cataract surgery. Br J Ophthalmol . 2002 Dec. 86(12):1457-8. [Medline].

Goldberg S, Gallily R, Bishara S, Blumenthal EZ. Dorzolamide-induced choroidal detachment in a surgically untreated eye. Am J Ophthalmol . 2004 Aug. 138(2):285-6. [Medline].

Horgan N, Kirwan RP, O'Brien CJ. Choroidal detachment associated with latanoprost use in the fellow eye. Ann Pharmacother . 2007 Jan. 41(1):161-2. [Medline].

Shapiro BL, Petrovic V, Lee SE, Flach A, McCaffery S, O'Brien JM. Choroidal detachment following the use of tamsulosin (Flomax). Am J Ophthalmol . 2007 Feb. 143(2):351-3. [Medline].

Sharma T, Salmon JF. Hypotony and choroidal detachment as a complication of topical combined timolol and dorzolamide. J Ocul Pharmacol Ther . 2007 Apr. 23(2):202-5. [Medline].

Sodhi PK, Sachdev MS, Gupta A, Verma LK, Ratan SK. Choroidal detachment with topical latanoprost after glaucoma filtration surgery. Ann Pharmacother . 2004 Mar. 38(3):510-1. [Medline].

Brubaker RF, Pederson JE. Ciliochoroidal detachment. Surv Ophthalmol . 1983 Mar-Apr. 27(5):281-9. [Medline].

Katz LJ. Ciliochoroidal detachment. Ophthalmic Surg . 1987 Mar. 18(3):175. [Medline].

Goldman DR, Hubschman JP, Aldave AJ, Chiang A, Huang JS, Bourges JL, et al. POSTOPERATIVE POSTERIOR SEGMENT COMPLICATIONS IN EYES TREATED WITH THE BOSTON TYPE I KERATOPROSTHESIS. Retina . 2012 Oct 15. [Medline].

Maumenee AE, Stark WJ. Management of persistent hypotony after planned or inadvertent cyclodialysis. Am J Ophthalmol . 1971 Jan. 71(1 Part 2):320-7. [Medline].

Viola F, Dell'Arti L, Benatti E, Invernizzi A, Mapelli C, Ferrari F, et al. Choroidal Findings in Dome-Shaped Macula in Highly Myopic Eyes: a longitudinal study. Am J Ophthalmol . 2014 Sep 19. [Medline].

Yalvac IS, Satana B, Ozkan G, Eksioglu U, Duman S. Management of glaucoma in patients with nanophthalmos. Eye . 2007 Feb 9. [Medline].

Chikako S, Mita S, Hori S. Choroidal detachment after uncomplicated small incision cataract surgery. Case Report Ophthalmol . 2012 May. 3(2):175-9. [Medline]. [Full Text] .

Kwon SJ, Park DH, Shin JP. Bilateral transient myopia, angle-closure glaucoma, and choroidal detachment induced by methazolamide. Jpn J Ophthalmol . 2012 Sep. 56(5):515-7. [Medline].

Kanamoto T, Takamatsu M. Systemic steroid-pulse therapy in a patient with idiopathic choroidal detachment: a case report. Case Report Ophthalmol . 2012 Jan. 3(1):65-70. [Medline]. [Full Text] .

Grzybowski A, Prasad S. Anticoagulant therapy is not a risk factor for choroidal haemorrhage. Graefes Arch Clin Exp Ophthalmol . 2014 Oct 3. [Medline].

Abrams GW, Thomas MA, Williams GA, Burton TC. Management of postoperative suprachoroidal hemorrhage with continuous-infusion air pump. Arch Ophthalmol . 1986 Oct. 104(10):1455-8. [Medline].

Sharma T, Gopal L, Reddy RK, Kasinathan N, Shah NA, Sulochana KN, et al. Primary vitrectomy for combined rhegmatogenous retinal detachment and choroidal detachment with or without oral corticosteroids: a pilot study. Retina . 2005 Feb-Mar. 25(2):152-7. [Medline].

Serous choroidal detachment. Two lobes (ie, supertemporal, supranasal) of fluid accumulation are visible. The choroidal folds seen at the posterior pole are due to concomitant hypotony.

B-scan ultrasonography examination of choroidal detachment. Fluid appears to be serum on one side (upper) and blood on the other side (below). Retina-to-retina contact, or kissing choroidal detachment, is present.

Kissing choroidal detachment. When the lobes of the detachment are sufficiently large, retina-to-retina contact occurs. If this is extended centrally, the clinical picture is described as kissing choroidals. The extension of the lobes of detachment/edema is important for the decision-making process regarding the clinical management.

Postoperative suprachoroidal hemorrhage. In this buphthalmic aphakic eye, suprachoroidal hemorrhage resulted in vitreous hemorrhage, retinal detachment, and extrusion of retina and blood through the pupil into the anterior chamber.

Drainage of suprachoroidal space. After the posterior sclerostomies are performed, gentle infusion in the anterior chamber through a paracentesis tract helps the globe to maintain a tone while the fluid exit from the suprachoroidal space is facilitated.

Drainage of suprachoroidal space. The hemorrhagic fluid is darker than fresh blood. Mechanical gaping of the radial incisions facilitates the egress of fluid.

Drainage of suprachoroidal hemorrhage. At least two quadrants, guided by B-scan images. Careful sclerostomies are performed at 4-5 mm from the limbus. The anterior chamber (AC) should be frequently reformed or a low-pressure AC infusion line should be placed. Gentle pressure on the surrounding sclera will help drainage. Serum is yellow and clear, blood is very dark red. Do not grab or pull from inside the sclerostomies. The technique is the same for drainage of serous choroidal detachment.

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Meclizine Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Meclin

meclizine

Uses

Meclizine is an antihistamine that is used to prevent and treat nausea. vomiting. and dizziness caused by motion sickness. It may also be used to reduce dizziness and loss of balance (vertigo ) caused by inner ear problems.

How to use meclizine

Follow all directions on the product package. If your doctor has prescribed this medication. take it as directed. If you are uncertain about any of the information, consult your doctor or pharmacist.

Take this medication by mouth with or without food. The chewable tablets should be chewed thoroughly before being swallowed.

The dosage is based on your medical condition and response to treatment. Do not increase your dose or take this medication more often than directed.

To prevent motion sickness, take the first dose one hour before starting activity such as travel.

Tell your doctor if your condition does not improve or if it worsens.

Side Effects

Drowsiness, dry mouth. and tiredness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

To relieve dry mouth. suck (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.

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

Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as restlessness, confusion), fast/irregular heartbeat. shaking (tremor), difficulty urinating.

Get medical help right away if you have any very serious side effects, including: seizures .

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

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

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

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

Precautions

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

Before using this medication, tell your doctor or pharmacist your medical history, especially of: breathing problems (such as asthma. emphysema ), high pressure in the eye (glaucoma ), heart problems, high blood pressure. seizures, stomach /intestine problems (such as ulcers, blockage), overactive thyroid (hyperthyroidism), difficulty urinating (for example, due to enlarged prostate ), liver problems, kidney problems.

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

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

Children may be more sensitive to the side effects of this drug. This drug can often cause excitement in young children instead of drowsiness.

Older adults may be more sensitive to the side effects of this drug, especially drowsiness.

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

It is unknown if this drug passes into breast milk. Consult your doctor before breastfeeding .

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: antihistamines applied to the skin (such as diphenhydramine cream, ointment, spray).

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

Check the labels on all your medicines (such as allergy or cough - and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

This medication may interfere with certain laboratory tests (including allergy skin test), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, seizures, widened pupils. In children, mental/mood changes (such as restlessness, irritability, hallucinations ) may occur before drowsiness.

Notes

Keep all regular medical and laboratory appointments.

Missed Dose

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

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

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

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

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

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Trizol® Plus Rna Purification Kit, Trizol

TRIzol® Plus RNA Purification Kit

Introduction

The TRIzol® Plus RNA Purification Kit provides a simple, reliable, and rapid method for isolating high–quality total RNA from a wide variety of samples, including animal and plant cells and tissue, bacteria, and yeast. The kit utilizes the strong lysis capability of TRIzol® Reagent, followed by a convenient and time–saving silica–cartridge purification protocol from the PureLink™ RNA Mini Kit, to purify ultrapure total RNA within an hour, even from difficult samples such as fibrous tissue. TRIzol® Reagent is a monophasic solution of phenol, guanidine isothiocyanate, and other proprietary components which facilitate the isolation of a variety of RNA species of large or small molecular size. TRIzol® Reagent maintains the integrity of the RNA, while disrupting cells and dissolving cell components, and also provides an immediate and highly effective inhibition of RNase activity during sample homogenization or lysis.

The combination of TRIzol® Reagent followed by silica–cartridge purification of RNA is the recommended RNA purification method in the gene expression industry. The TRIzol® Plus RNA Purification Kit provides the reagents and an optimized protocol to purify total RNA for gene expression studies using an industry recommended method.

To isolate purified RNA from your sample using the TRIzol® Plus RNA Purification Kit, your sample is first lysed with TRIzol® Reagent, according to the lysate preparation protocol provided. The addition of chloroform to your sample, followed by centrifugation separates the solution into an upper aqueous phase containing RNA and an lower phenol-containing organic phase. The upper aqueous phase is transferred to a new tube, followed by ethanol addition and centrifugation. The sample is then transferred to the PureLink™ RNA Mini Kit Spin Cartridge containing a clear silica–based membrane to which the RNA binds during purification. The RNA is washed to remove contaminants and the purified total RNA is then eluted in RNase–Free Water (Tris Buffer, pH 7.5 may also be used) and is suitable for use in a variety of downstream applications including sensitive gene expression studies such as microarray analysis or real time quantitative RT-PCR (qRT-PCR).

PureLink™ RNA Mini Kit Specifications

Cartridge Binding Capacity:

1 mg nucleic acid Cartridge Reservoir Capacity: 700 ?l Wash Tube Capacity: 2.0 ml Centrifuge Compatibility: Capable of centrifuging >12,000 ? g Elution Volume: 30 ?l–3 ? 100 ?l (3 sequential elutions with 100 ?l each)

This page provides instructions for purifying total RNA from samples using TRIzol® Reagent to prepare lysates and after phase separation, the RNA is purified using the PureLink™ RNA Mini Kit. If you wish to use other protocols for RNA purification, refer to the TRIzol® Reagent manual or the PureLink™ RNA Mini Kit manual .

The TRIzol® Plus RNA Purification Kit utilizes the TRIzol® Reagent for sample lysis. The Lysis Buffer included wit the kit is not used in this protocol. However, if you wish to prepare samples using the Lysis Buffer, refer to the PureLink™ RNA Mini Kit manual .

If your downstream applications require DNA–free total RNA, protocols for on–column PureLink™ DNase treatment during RNA purification or after purification are provided in the PureLink™ RNA Mini Kit manual .

TRIzol® Reagent contains phenol (toxic and corrosive) and guanidine isothiocyanate (an irritant), and may be a health hazard if not handled properly. Avoid direct contact with TRIzol® Reagent, as direct contact of skin, eyes, or respiratory tract with TRIzol® Reagent may cause chemical burns to the exposed area. When working with TRIzol® Reagent, always work in a fume hood. Refer to the TRIzol® Reagent product insert for more details. Contact your Environmental Heath and Safety (EH&S) department for proper work and disposal guidelines.

Both Lysis Buffer and Wash Buffer I contain guanidine isothiocyanate (an irritant).

This chemical is harmful when in contact with the skin, or when it is inhaled or ingested. Do not add bleach or acidic solutions directly to solutions or sample preparation waste that contains guanidinium isothiocyanate, as reactive compounds and toxic gases are formed. Solutions containing ethanol are considered flammable. Use appropriate precautions when using this chemical.

For your protection, always wear a laboratory coat, gloves and safety glasses when handling these chemicals. Dispose of the buffers and chemicals in appropriate waste containers.

The maximum RNA binding capacity of the PureLink™ RNA Mini Kit Spin Cartridge is ?1 mg. If you are processing samples that contain more than 1 mg of total RNA, divide the sample into aliquots such that each aliquot contains <1 mg total RNA for each Spin Cartridge used.

Use disposable, individually wrapped, sterile plastic ware and sterile, disposable RNase-free pipette tips and tubes.

Wear disposable gloves while handling reagents and RNA samples to prevent RNase contamination from the surface of the skin; change gloves frequently, particularly as the protocol progresses from crude extracts to more purified material.

Always use proper microbiological aseptic techniques when working with RNA.

Use clear polypropylene disposable tubes when working with <2 ml volumes of TRIzol® Reagent. For larger volumes, use glass (Corex) or polypropylene tubes, and ensure that the tubes can withstand centrifugation at 12,000 ? g with TRIzol® Reagent and chloroform. Do not use tubes that leak or crack.

Use RNase AWAY® Reagent (cat. no. 10328-011) to remove RNase contamination from work surfaces and non – disposable items such as centrifuges and pipettes used during purification.

Materials Needed

Starting material (fresh or frozen tissue, or cells)

TRIzol® Reagent and PureLink™ RNA Mini Kit (included)

Chloroform or 4–Bromoanisole

96-100% ethanol and 70% ethanol (in RNase-free water)

Microcentrifuge capable of centrifuging at 12,000 × g

Homogenizer (Cat. no: 12183–026) or Rotor–Stator homogenizer

1.5 ml RNase–free microcentrifuge tubes and RNase–free pipette tips

Protocols

Preparing Wash Buffer II with Ethanol

Before beginning lysis, add 60 ml 96-100% ethanol to Wash Buffer II. Check the box on the Wash Buffer II label to indicate that ethanol was added. Store Wash Buffer II with ethanol at room temperature. Lysate Preparation with TRIzol® Reagent

Use TRIzol® Reagent to prepare lysates from various sample types as described below. Tissues Homogenize tissue samples in 1 ml TRIzol® Reagent per 50–100 mg tissue using a tissue homogenizer or rotor-stator. The sample volume should not exceed 10% of the volume of TRIzol® Reagent used for homogenization.

Lyse cells directly in a culture dish by adding 1 ml of TRIzol® Reagent to the dish and passing the cell lysate several times through a pipet tip. The amount of TRIzol® Reagent required is based on the culture dish area (1 m per 10 cm2) and not on the number of cells present. Suspension Cells

Harvest cells and pellet cells by centrifugation. Use 1 ml of the TRIzol® Reagent per 5–10 ? 10 6 animal, plant, or yeast cells, or per 1 ? 10 7 bacterial cells. Lyse cells by repetitive pipetting up and down. Do not wash cells before addition of TRIzol® Reagent to avoid any mRNA degradation. Disruption of some yeast and bacterial cells may require a homogenizer.

Following cell or tissue lysis (above), perform the following steps to isolate the RNA.

Incubate the lysate with TRIzol® Reagent (above) at room temperature for 5 minutes to allow complete dissociation of nucleoprotein complexes.

Add 0.2 ml chloroform or 50 ?l 4–Bromoanisole per 1 ml TRIzol® Reagent used. Shake the tube vigorously by hand for 15 seconds. Note: Vortexing may increase DNA contamination of your RNA sample. Avoid vortexing if your downstream application is sensitive to the presence of DNA or perform a DNase-digestion step during RNA purification or after purification Refer to the PureLink™ RNA Mini Kit manual .

Incubate at room temperature for 2–3 minutes.

Centrifuge the sample at 12,000 ? g for 15 minutes at 4°C. Note: After centrifugation, the mixture separates int a lower, red phenol–chloroform phase, an interphase, and a colorless upper aqueous phase which contains the RNA. The volume of the aqueous upper phase is

400 ?l of the colorless, upper phase containing the RNA to a fresh RNase–free tube.

Add an equal volume of 70% ethanol to obtain a final ethanol concentration of 35%. Mix well by vortexing.

Invert the tube to disperse any visible precipitate that may form after adding ethanol.

Proceed to Binding, Washing and Elution, below.

Binding, Washing and Elution

Follow the steps below to bind, wash, and elute RNA from your sample.

Transfer up to 700 ?l of sample (prepared as described above) to a Spin Cartridge (with a Collection Tube).

Centrifuge at 12,000 ? g for 15 seconds at room temperature. Discard the flow–through and reinsert the Spin Cartridge into the same Collection Tube.

Repeat Steps 1–2 until the entire sample has been processed. Optional: If your downstream application requires DNA-free total RNA, proceed to On–Column PureLink™ DNase Treatment During RNA Purification at this time (see the PureLink™ RNA Mini Kit manual for details).

Add 700 ?l Wash Buffer I to the Spin Cartridge. Centrifuge at 12,000 ? g for 15 seconds at room temperature. Discard the flow-through and the Collection Tube. Insert the Spin Cartridge into a new Collection Tube.

Add 500 ?l Wash Buffer II with ethanol (previous page) to the Spin Cartridge.

Centrifuge at 12,000 ? g for 15 seconds at room temperature. Discard the flow–through, and reinsert the Spin Cartridge into the same Collection Tube.

Repeat Steps 5–6 once.

Centrifuge the Spin Cartridge and Collection Tube at 12,000 ? g for 1 minute at room temperature to dry the membrane with attached RNA. Discard the Collection Tube and insert the Spin Cartridge into a Recovery Tube.

Add 30 ?l–3 ? 100 ?l (3 sequential elutions with 100 ?l each) RNase–Free Water to the center of the Spin Cartridge (refer to the PureLink™ RNA Mini Kit manual for more details.

Incubate at room temperature for 1 minute.

Centrifuge the Spin Cartridge with the Recovery Tube for 2 minutes at ?12,000 ? g at room temperature. Note: If you are performing sequential elutions, collect all elutes into the same tube.

Storage and Downstream Applications of Purified RNA

Store your purified RNA on ice if you will use the RNA within a few hours. For long–term storage, store your purified RNA at –80°C.

You may use the purified total RNA for qRT-PCR, northern blotting, nuclease protection assays, RNA amplification for microarray analysis, or any desired downstream application.

If highly pure RNA without genomic DNA contamination is required, perform DNase I treatment after purification (refer to the PureLink™ RNA Mini Kit manual for details). You can determine the quality and quantity of the purified RNA using UV absorbance at 260 nm or with the Quant-iT™ RNA Assay Kit (Cat. No. Q33140).

We offer a large selection of products for RT-PCR, qRT-PCR, microarray analysis, and reverse transcription. For more information, visit our website or contact Technical Support.

Troubleshooting

Levores, Levores

Levofloxacin

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.

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Buy Circulaid (Trental) Online Without A Prescription, Circulaid

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Circulaid (Trental) Description

Circulaid is used for treating intermittent claudication (pain, cramping, numbness, or weakness in the foot, hip, thigh, or buttocks) in certain patients. It may also be used for other conditions.

Circulaid is a xanthine derivative blood flow enhancer. It works by thinning the blood and improving red blood cell flexibility, causing the blood to flow more freely through the veins.

Circulaid is also known as Pentoxifylline.

Generic name of Circulaid is Pentoxifylline.

Brand name of Circulaid is Circulaid.

Circulaid (Trental) Dosage

Circulaid is available in:

400mg Standard Dosage

Take Circulaid by mouth with food or milk.

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

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

Circulaid (Trental) 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.

Circulaid (Trental) Overdose

If you overdose Circulaid and you don't feel good you should visit your doctor or health care provider immediately.

Circulaid (Trental) Storage

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F) away from moisture, light and heat. Keep container tightly closed. Throw away any unused medicine after the expiration date. Keep out of the reach of children in a container that small children cannot open.

Circulaid (Trental) Side effects

Circulaid has its side effects. The most common are:

belching

bloating

blurred vision

diarrhea

dizziness

flushing

gas

headache

indigestion

nausea

stomach discomfort

Less common but more serious side effects during taking Circulaid:

allergy reactions (urticaria, breathing difficulties, rash, and eruption)

chest pain

irregular heartbeat

vomiting

Side effects manifestations are not only depend on medicine you are taking but also depend on your health state and on the other factors.

Circulaid (Trental) Contra-indications

Do not take Circulaid if you are allergic to Circulaid components, or to methylxanthines (theophylline, caffeine, theobromine).

Be very careful with Circulaid if you are pregnant, planning to become pregnant. Circulaid is found in breast milk. Do not breast-feed while taking Circulaid.

Do not take Circulaid if you have had recent bleeding in the brain or eye.

Tell your health care provider or dentist that you take Circulaid before you receive any medical or dental care, emergency care, or surgery.

It may take 2 to 4 weeks to notice improvement in your condition, and up to 8 weeks for maximum relief.

Use Circulaid with caution in the elderly. They may be more sensitive to its effects.

Avoid machine driving.

It can be dangerous to stop Circulaid taking suddenly.

Circulaid (Trental) Frequently asked questions

Q: What is Circulaid?

A: Circulaid is used for treating intermittent claudication (pain, cramping, numbness, or weakness in the foot, hip, thigh, or buttocks) in certain patients. It may also be used for other conditions.

Q: How does Circulaid work?

A: Circulaid is a xanthine derivative blood flow enhancer. It works by thinning the blood and improving red blood cell flexibility, causing the blood to flow more freely through the veins.

Q: What is the generic name?

A: Generic name of Circulaid is Pentoxifylline.

Q: What should I do in case of dose missing?

A: In case of dose missing you should take your tablet as soon as possible. Do not take double dosage. And if it is right time for the next dosage you should continue your regular schedule of Circulaid taking.

Q: What should I avoid while taking Circulaid?

A: While taking Circulaid avoid drinking alcohol, machine driving.

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Anacin - Pain Relief, Efagesic

Anacin is a pain reliever intended for the temporary relief of minor aches and pains. Anacin is a combination salicylate and stimulant. It works by blocking several different chemical processes within the body that cause pain, inflammation, and fever. It also reduces the tendency for blood to clot.

Availability: In Stock (17 packs)

Anacin is used for treating pain including, headache, muscle aches, sprains, tooth extraction and toothache, menstrual cramps, arthritis and rheumatism, and pain and fever of the common cold. It may also be used for other conditions as determined by your doctor.

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

Take Anacin by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Taking it with food may not decrease the risk of stomach or bowel problems (eg, bleeding, ulcers) that may occur while taking Anacin.

Take Anacin with a full glass of water (8 oz/240 mL). Do not lie down for 30 minutes after taking Anacin.

Use Anacin exactly as directed on the package, unless instructed differently by your doctor. If you are taking Anacin without a prescription, follow any warnings and precautions on the label.

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

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

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

Avoid large amounts of food or drink that have caffeine (eg, coffee, tea, cocoa, cola, chocolate). This includes any medicines that contain caffeine.

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

Talk to your doctor before you take Anacin or other pain relievers/fever reducers if you drink more than 3 drinks with alcohol per day. Serious stomach ulcers or bleeding can occur with the use of Anacin. Taking it in high doses or for a long time, smoking, or drinking alcohol increases the risk of these side effects. Taking Anacin with food will NOT reduce the risk of these effects. Contact your doctor or emergency room at once if you develop severe stomach or back pain; black, tarry stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling.

Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. Taking more than the recommended dose or taking Anacin regularly may be habit-forming.

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

Aspirin has been linked to a serious illness called Reye syndrome. Do not give Anacin to a child or teenager who has the flu, chickenpox, or a viral infection. Contact your doctor with any questions or concerns.

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

If Anacin has a strong vinegar-like smell upon opening, do not use. It means the medicine is breaking down. Throw the bottle away safely and out of the reach of children; contact your pharmacist and replace.

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

Do not take Anacin for at least 7 days after any surgery unless directed by your health care provider.

Do not take Anacin for more than 10 days for pain or for more than 3 days for fever unless directed to do so by your health care provider.

Different brands of Anacin may have different dosing instructions for CHILDREN. Follow the dosing instructions on the package labeling. If your doctor has given you instructions, follow those. If you are unsure of the dose to give a child, check with your doctor or pharmacist.

Do NOT use Anacin if:

you are allergic to any ingredient in Anacin

you are a child or teenager with influenza (flu) or chickenpox

you have bleeding problems such as hemophilia, von Willebrand disease, or low blood platelets, or you have active severe bleeding

you have had a severe allergic reaction (eg, severe rash, hives, breathing difficulties, dizziness) to aspirin, tartrazine, or a nonsteroidal anti-inflammatory drug (NSAID) (eg, ibuprofen, naproxen, celecoxib)

you are taking anticoagulants (eg, heparin, warfarin) or methotrexate

Before using Anacin:

Some medical conditions may interact with Anacin. 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 alcoholism or if you consume 3 or more alcohol-containing drinks every day

if you have asthma, bleeding or clotting problems, growths in the nose (nasal polyps), kidney or liver problems, stomach or intestinal problems (eg, ulcer, inflammation), heart problems, heartburn, upset stomach, stomach pain, hives, influenza (flu) or chickenpox, or vitamin K deficiency

if you have anxiety, trouble sleeping, or heart problems

if you are a child with a stroke, a weakened blood vessel (cerebral aneurysm) or bleeding in the brain, rheumatic disease (eg, rheumatoid arthritis), or Kawasaki syndrome (a rare inflammation causing heart problems in children)

Some MEDICINES MAY INTERACT with Anacin. Tell your health care provider if you are taking any other medicines.

PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Anacin while you are pregnant. Anacin is not recommended during the last 3 months (third trimester) of pregnancy because it may cause harm to the fetus. Anacin is found in breast milk. If you are or will be breast-feeding while you use Anacin, check with your doctor. Discuss any possible risks to your baby.

All medicines may cause side effects, but many people have no, or minor, side effects. Anacin's side effects may include dizziness, heartburn, irritability, nausea, nervousness, rashes, hives, bloody stools, drowsiness, hearing loss, ringing in the ears, and trouble sleeping.

Check with your doctor if any of the listed above most COMMON side effects persist or become bothersome.

Seek medical attention right away if any of these SEVERE side effects occur: severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; confusion; diarrhea; drowsiness; hearing loss; ringing in the ears; severe or persistent dizziness; severe or persistent stomach pain or heartburn; shakiness; trouble sleeping; vomiting.

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.

Stiemycin 2, Stiemycine

STIEMYCIN 2.0% W/V

Transcript

Pharma Code Ref: 702

PACKAGE LEAFLET: INFORMATION FOR THE USER

Read all of this leaflet carefully before you start using this medicine because it contains important information for you. • Keep this leaflet. You may need to read it again. • If you have further questions, ask your doctor or pharmacist. • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. • If you get any of the side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4. What is in this leaflet: 1. What Stiemycin is and what it is used for 2. What you need to know before you use Stiemycin 3. How to use Stiemycin 4. Possible side effects 5. How to store Stiemycin 6. Contents of the pack and other information 1. What Stiemycin is and what it is used for Stiemycin contains a medicine called erythromycin. This is an antibiotic. Stiemycin is used to treat acne (spots). It works by fighting the bacteria that can cause the acne spots. Stiemycin is for use by adults and adolescents with acne. It is not for use by children.

• Stiemycin can affect how other medicines work. Take care not to use Stiemcyin at the same time as clindamycin-containing acne medicines that are used on the skin. • Tell your doctor if you are taking any other antibiotic medicine. • Take care not to apply Stiemycin at the same time as other acne products that are used on the skin, unless your doctor or pharmacist has told you that you can. Pregnancy, breast-feeding and fertility • If you are pregnant or breast-feeding, think you may be pregnant or planning to have a baby, ask your doctor for advice before taking this medicine. • If you do become pregnant during treatment with Stiemycin tell your doctor. • Don’t use Stiemycin on your breast if you are breast-feeding. Stiemycin contains propylene glycol Stiemycin contains propylene glycol, which may cause skin irritation.

Pharma Code Ref: 702

3. How to use Stiemycin Always use this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure. What you need to know before using Stiemycin • Stiemycin should be applied only to your skin. 2. What you need to know before you use • Do not drink the solution. Stiemycin • This product is flammable. Keep the product away from open fire and flames and all sources of ignition including Do not use Stiemycin if: smoking during and immediately after you’ve used it. • you are allergic to erythromycin or any of the other • When you use the bottle for the first time you will ingredients of this medicine (listed in section 6). need to break the seal. To do this, remove the cap Do not use Stiemycin if the above applies to you. If you from the bottle and holding the bottle upright, press are not sure, talk to your doctor or pharmacist before you gently on the seal with a finger until you hear a ‘pop’. start using Stiemycin. The medicine is now ready to use. Warnings and precautions How much to use Talk to your doctor before using Stiemycin if: • Apply Stiemycin twice a day, in the morning and the • you cannot tolerate or have previously had a skin evening. reaction or allergy to erythromycin or any of the other • Using the product more frequently does not give ingredients of Stiemycin (listed in section 6) better results. • you have a history of inflammatory bowel disease or • It can take at least six to eight weeks before you see antibiotic-associated colitis (severe, prolonged or the full benefit of Stiemycin. bloody diarrhoea following antibiotic use). • You should keep using the medicine according to your Only use Stiemycin on your skin. Take care not to get doctor’s instructions up to a maximum of 6 months. Stiemycin in your eyes, nostrils, mouth or on your lips. If you do, rinse well with water. Take care not to get How to apply Stiemycin Stiemycin on any irritated areas of skin, such as cuts, • Completely remove any make-up. grazes, sunburn, or broken skin. • Wash the affected area with mild soap and warm water and gently dry. Other medicines and Stiemycin • Remove the cap. Tell your doctor or pharmacist if you are taking, have • Turn the bottle upside down and dab the pad onto recently taken, or might take any other medicine. This the affected area. includes medicines bought without a prescription.

Pharma Code Ref: 702

2% w/v cutaneous solution Erythromycin

Pharma Code Ref: 702

Front of Leaflet Page 1 of 2 TEXT SIZE CONTAINED IN THIS ARTWORK Body text size: 8pt Leading: 8.2pt Horizontal Scale: 95% Smallest text size: 8pt Microtext: Y 1 Stiemycin Solution K

31023860-02 GSK-ContractMfg-EUR-UK-Netherlands-Famar Bladel-Bladel Stiefel; United Kingdom-GBR

• Use the pad to spread the solution gently over the whole area and not just to each individual spot. After using Stiemycin • Always replace the cap securely after use to stop the medicine from leaking or evaporating. • Stiemycin contains ingredients to help the antibiotic reach the bottom of your hair follicles where the acne starts. These ingredients keep the skin wet for a few minutes after applying it. • Allow your face to dry completely before using any make-up. • You may notice a slight smell while it dries, this is normal. • Wash your hands after use. If you forget to use Stiemycin • Don’t apply a double dose to make up for forgotten doses. • Apply the next dose at the usual time. If you accidently swallow Stiemycin: The ingredients of Stiemycin are not expected to be harmful if swallowed in the small amounts normally applied to the face. If you do accidentally get Stiemycin in your mouth, rinse at once with plenty of water. Seek medical advice if you swallow more than a small amount. If you have any further questions on the use of this medicine, ask your doctor.

5. How to store Stiemycin Keep this medicine out of the sight and reach of children. • Do not store above 25°C. Keep the container tightly closed when not in use. • Contents are flammable. Keep away from all sources of fire, flame and heat. • Do not leave in direct sunlight. • Do not use medicine after the expiry date which is stated on the bottle and the carton after ‘Exp’. The expiry date refers to the last day of that month. Do not throw away medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information What Stiemycin contains • The active substance is erythromycin 2% w/v. • The other ingredients are propylene glycol, ethanol absolute and polyoxyethylene-4-lauryl ether. What Stiemycin looks like and contents of the pack • The solution is supplied in an amber glass screw capped bottle. • The bottle contains 50 ml of a clear, colourless liquid Marketing Authorisation Holder and Manufacturer Marketing Authorisation Holder: GlaxoSmithKline UK Limited 4. Possible side effects Like all medicines, this medicine can cause side effects, Stockley Park West, Uxbridge, Middlesex although not everybody gets them. The following side UB11 1BT, UK effects may happen with this medicine: Manufacturer: Stop using Stiemycin and see a doctor straight Famar Nederland B. V. away if: Industrieweg 1,5531 AD Bladel, The Netherlands. • you notice an allergic reaction (such as swelling of your face, eyes, lips or tongue, nettle rash or difficulty PL 19494/0055 Other formats breathing). To listen to or request a copy of this leaflet in Braille, • you develop severe or prolonged diarrhoea. large print or audio please call, free of charge: The following very common side effects have been reported (may affect more than 1 in 10 people): 0800 198 5000 (UK Only) • skin burning sensation Please be ready to give the following information: • skin irritation Product name Stiemycin • dry skin, especially at the start of treatment Reference number 19494/0055 • application site stinging This is a service provided by the Royal National Institute • redness of your skin, especially at the start of of Blind People. treatment. Other side effects with frequencies that cannot be This leaflet was last revised in June 2014 estimated from the available data include: Stiemycin is a registered trademark of Stiefel • allergic reaction Laboratories, Inc. • diarrhoea, stomach pain, stomach discomfort © 2014 Stiefel Laboratories, Inc. All rights reserved. • itching, rash • swelling on the face Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www. mhra. gov. uk/yellowcard By reporting side effects you can help provide more information on the safety of this medicine.

Back of Leaflet Page 2 of 2 TEXT SIZE CONTAINED IN THIS ARTWORK Body text size: 8pt Leading: 8.2pt Horizontal Scale: 95% Smallest text size: 8pt Microtext: Y 1 Stiemycin Solution K

31023860-02 GSK-ContractMfg-EUR-UK-Netherlands-Famar Bladel-Bladel Stiefel; United Kingdom-GBR

Source: Medicines and Healthcare Products Regulatory Agency

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

Nosma, Nosma

Cases

Norma products are known worldwide for high quality. Cartridge cases are an important factor in this reputation. Superior quality ensures a long life and many reloads. Norma cases are made of the best possible raw materials with the narrowest tolerances, and they deliver accuracy round after round.

The case neck is annealed to become softer. This prevents gas leaks and enables the case to hold the bullet firmly for at least 10 years without cracking as a result of aging material.

Further down on the case body, the hardness increases to avoid unnecessary stretching. If it is too hard, it would bring the risk of cracks.

Furthest down, around the primer pocket, the brass should be firm. Here, the hardness is nearly twice that of around the neck.

The structure of the material reveals the hardness. During processing the large, soft grains are broken down into smaller ones, which makes for a harder material. At the annealing, small grains become bigger and the hardness decreases.

17 Rem

Traditions are very different around the world. And why not? This is the kind of thing that makes other cultures so interesting. Sure enough, this is also true for hunting.

For instance, Americans often use lighter bullets and higher muzzle velocity. Average ranges are also longer. Europeans traditionally use heavier bullets and moderate velocities. They shoot at shorter ranges. This has a direct effect on the choice of bullets, Stateside and in Europe.

Bullets striking at high velocity need to be tougher to hold together. So, for instance, a copper bullet is more suited for flat & fast shooting than traditional soft noses.

Another thing is the character of the hunt. Are you there for the trophy or the meat? Are you concerned with maximum impact or do you want to make sure that as little meat as possible is destroyed? Again, this influences the choice of bullets for different parts of the globe.

Norma’s assortment of cartridges pretty much covers every aspect of hunting, from north to south and from east to west.

There is a reason we are called Norma Precision! Norma outperforms & factory loads, the accuracy is fantastic, and with a standard deviation of 7 feet per second - there is none better! What’s in your ammo pouch?? Read about 416 Rigby Norma Load. Tested in the Ruger 77 Magnum it was the most consistent of seven factory loads.

No doubt about Tac-22

Read Steel Challenge World Champion Trenton Mitsuokas testimonial.

Norma Precision was recognized at the 2016 NSSF Shot Show

Norma Precision was recognized at the 2016 NSSF Shot Show and awarded the Prestigious “ Award of Excellence” by Sporting Classic Magazine.

Making the presentation for Sporting Classics Magazine was Ron Spoomer. 2016 receipitant of the Outdoor Writers Association "Grits Gresham award”.

“Sporting Classics makes this prestigious award annually to companies who demonstrate excellence in the hunting category, Said Spoomer,." Norma with its outstanding reputation for premium brass cases. has established its place among the Premier industry leaders with introductions of Profession Hunter ammunition for American hunters as well as the Safari Line-up found in their African PH line “.

Accepting the award, Norma Precision Managing Director Paul-Erik Toivo committed Norma” to continued expansion and growth in the US market and reiterated Norma’s commitment to be the" precision leader”

We welcome the Shot Show attendees to our booth No. 14279.

Norma?s Oryx; The best bullet for tough game?

”The first bullets were lead balls. Now they’re complex missiles, most with multiple parts. Alloys of specific purpose ease their passage through rifle barrels and determine their upset in game. Jackets and cores are bonded – or not. Some bullets have no cores. Some wear polymer tips. Shank, ogive and nose designs reflect desired cartridge length, trajectory and terminal performance. Here’s a quick look at one of the most celebrated big game bullets, and a history it shares with many others.”

Is Match Ammo Worth It? - Shooting Illustrated

Co-Amoxiclav 625mg Tablets, Ranclav

CO-AMOXICLAV 625MG TABLETS

Transcript

Patient Information Leaflet

Co-Amoxiclav 375mg and 625mg Tablets What you should know about this medicine. Please read this leaflet carefully before you start to take these tablets. If there is something you don’t understand, or if you have any other questions remember to ask your pharmacist or doctor. Keep this leaflet, you may want to read it again.

The name of this medicine is Co-amoxiclav Tablets. These tablets are available in two strengths. Co-amoxiclav Tablets 375mg are pale yellow, biconvex tablets embossed 375 on one side. The tablets contain two active ingredients, 250mg of amoxicillin (as trihydrate) and 125mg clavulanic acid (as potassium clavulanate). (These ingredients together are known as Co-amoxiclav).

Co-amoxiclav Tablets 625mg are pale yellow, oblong, biconvex tablets embossed 625 on one side. The tablets contain 500mg of amoxicillin (as trihydrate) and 125mg clavulanic acid (as potassium clavulanate). Both strengths of tablets also contain microcrystalline cellulose, quinoline yellow (E104), titanium dioxide (E171), crospovidone, Povidone K25, colloidal silicon dioxide, stearic acid, polyethylene glycol 6000, methylhydroxypropylcellulose, saccharin sodium, vanilla flavour and magnesium stearate. Co-amoxiclav Tablets 375mg and Co-amoxiclav Tablets 625mg are available as packs of 21 tablets.

How does this medicine work? Amoxicillin is an antibiotic. Antibiotics are used to treat infections caused by bacteria. When amoxicillin is combined with clavulanic acid it is effective against a wider range of bacteria than when used alone.

Product Licence Holder: Athlone Pharmaceuticals Limited, Ballymurray, Co. Roscommon, Ireland Manufactured by: Cimex AG, Birsweg 2, CH-4253 Liesburg, Switzerland.

Distributed by: Sovereign Medical, Sovereign House, Miles Gray Road, Basildon, Essex SS14 3FR.

Why am I taking Co-amoxiclav Tablets? They are used to treat respiratory tract infections such as bronchitis, pneumonia, sinusitis, tonsillitis and middle ear infections; infections of the kidneys, abdomen and lower urinary tract including cystitis; and skin and tissue infections.

Make sure that it is safe for you to take these tablets Sometimes it may not be suitable. You should check with your doctor if: you are sensitive or allergic to Co-amoxiclav Tablets or any of the ingredients, or to penicillin or other antibiotics you have ever developed serious liver problems when taking an antibiotic, you are pregnant, trying to become pregnant, or breast-feeding, you have liver or kidney problems, you have glandular fever, you are on a low potassium diet. Some drugs will inteefere with the action of Co-amoxiclav. Tell your doctor if you are taking any of these medicines other antibiotics such as chloramphenicol, erythromycin, sulfonamides, or tetracyclines, warfarin or other drugs to prevent blood clotting. The effect of drugs to thin the blood such as warfarin may be increased by Co-amoxiclav. If this happens there could be a risk of excessive bleeding. Allopurinol or probenecid for gout and related conditions.

Co-amoxiclav Tablets 375mg and 625mg contain 24.6mg potassium and so may be harmful to people who need to be on a low potassium diet. Co-amoxiclav Tablets do not interact with oral contraceptives and you should use other methods of contraception whilst taking these tablets.

You should always let your doctor know what other medicines you are taking, including any that have been prescribed by your doctor or you have bought.

Taking your medicine Take at regular intervals. Complete the prescribed course unless otherwise directed. You should always take these tablets as prescribed by your doctor. The instructions are usually on the pharmacist’s label. If you’re not sure about anything please ask your doctor or pharmacist. For infections: Dosage for adults (including the elderly) and children over 12: The usual dose is 375mg three times a day, preferably every 8 hours, for a maximum of 14 days. For more severe infections: One 625mg tablet three times a day. For dental infections: The usual dose is 375mg three times a day, preferably every 8 hours, for 5 days. The dose for people with severe liver or kidney problems may be less than these doses. The doctor will have decided what dose you need. These tablets are not suitable for children under 12 or weighing less than 40kg. Do not take more tablets than the doctor told you to take. Take the tablets for as long as the doctor told you to. Do not stop taking them because you feel better. If you are still unwell after finishing the course of tablets go and see your doctor. Swallow the tablets with a drink at the beginning of a meal. Do not break or chew the tablets. If you forget to take a tablet take one as soon as you remember, then carry on with the next dose. Try to wait about 4 hours before taking the next dose, and do not take two doses within about one hour or so. Never double-up on the dose to make up for the one you have missed. If you take too many tablets tell your doctor or the nearest hospital casualty department straight away. Let people know what you have taken. Are there any side-effects? Most people do not have any problems when they take these tablets, but nearly all medicines can cause side-effects in some people. Co-amoxiclav Tablets can sometimes cause stomach problems such as nausea (feeling sick), vomiting, indigestion or diarrhoea. These symptoms are usually mild and can be reduced by taking the tablets at the beginning of a meal. Very rarely, some people experience hyperactivity, dizziness, headache and convulsions. These symptoms are reversible. There have been rare reports of tooth discolouration. This can usually be removed by brushing. Some people may get thrush (a yeast infection of the vagina or mouth) when they take these tablets. You can get treatments for thrush from your pharmacist or doctor. If you notice anything else which you don’t understand ask your doctor or pharmacist’s advice. Some people can be allergic to antibiotics and can develop a rash. This can range in severity from a mid itchy rash to a rarer more serious condition which may cause ulceration of the mouth, lips and skin. Inflammation of the kidney can also occur rarely. In very rare cases, allergic reactions can include difficulty in breathing, fainting or swelling of the face and throat. Stop taking the tablets and tell your doctor if you develop any of these symptoms.

See your doctor immediately if you develop any of the following either while you are taking Coamoxiclav Tablets or in the weeks after finishing the treatment. Severe or prolonged diarrhoea with bleeding Darker urine or paler faeces Your skin or eyes becoming yellow Fever, bruising or bleeding. Co-amoxiclav Tablets can sometimes affect blood cell counts. Make sure that your doctor knows that you are taking these tablets if you are having blood tests. How to keep your tablets Keep all medicines in a safe place away from children. Do not store above 25oC. Store in the original package in order to protect from moisture. Keep the container tightly closed. Do not take the tablets after the date shown on the pack. REMEMBER this medicine was prescribed for you. You should not give it to anyone else even if you think their symptoms are similar. It may harm them.

Source: Medicines and Healthcare Products Regulatory Agency

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

Medichol - Gold Coast Medical Tourism Australia, Medichol

Gold Coast Medical Tourism Australia

Our Medical Specialists

Recent News

MedicHol CEO Cynthia Muir will attend the IMTJ Medical Travel Summit 2015 being held in London April 15-16th. The agenda for the IMTJ Medical Travel Summit will focus on the major challenges and issues faced in this developing industry. MedicHol is also honoured to be finalists in the IMTJ Medical Travel Awards in the category of – Excellence in customer service; “We are delighted to be finalists in this category, at MedicHol we strive for a service that insures a patient is cared for from their first inquiry, throughout the treatment and when they return home” says Cynthia.

Who We are

MedicHol is Gold Coast most trusted medical tourism company facilitating the healthcare needs of World health tourism patients seeking all forms of medical travel programs. We arrange a variety of medical tourism services from basic consultations to full treatment in the Gold Coast of Australia. We help you to take care of all your medical tourism details from arranging the surgery, financing options, to visas, travel, accommodation and tourism.

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What Is Tryptophan, Tryptophanum

Tryptophan Facts

Anne Helmenstine, Ph. D. is an author and consultant with a broad scientific and medical background. Read more

Updated November 22, 2015.

Tryptophan is an amino acid that is found in many foods, such as turkey. Here are some facts about what tryptophan is and the effects it has on your body.

Tryptophan Chemistry

Tryptophan is (2S)-2-amino-3-(1H-indol-3-yl)propanoic acid and is abbreviated as Trp or W . Its molecular formula is C 11 H 12 N 2 O 2 . Tryptophan is one of the 22 amino acids and the only one with an indole functional group. Its genetic codon is UGC in the standard genetic code.

Continue Reading Below

Tryptophan in the Body

Tryptophan is an essential amino acid. meaning you need to get it from your diet because your body cannot produce it. Fortunately, tryptophan is found in many common foods, including meats, seeds, nuts, eggs and dairy products. It is a common misperception that vegetarians are at risk for insufficient tryptophan intake, but there are several excellent plant sources for this amino acid. Foods that are naturally high in protein, either from plants or animals, typically contain the highest levels of tryptophan per serving.

Your body uses tryptophan to make proteins, the B-vitamin niacin and the neurotransmitters serotonin and melatonin. However, in order to make niacin and serotonin, you also need to have sufficient iron, riboflavin and vitamin B6. Only the L-stereoisomer of tryptophan is used by the human body. The D-stereoisomer is much less common in nature, though it does occur, as in the marine venom contryphan.

Tryptophan as a Dietary Supplement and Drug

Tryptophan is available as a dietary supplement, although its use has not been demonstrated to affect levels of tryptophan in the blood.

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Some studies have indicated tryptophan may be effective as a sleep aid and as an antidepressant. These effects may be related to the role of tryptophan in the synthesis of serotonin. Eating large amounts of foods high in tryptophan, such as turkey, has not been shown to cause drowsiness. This effect typically is associated with eating carbohydrates, which trigger the release of insulin. A metabolite of tryptophan, 5-hydroxytryptophan (5-HTP), may have application in the treatment of depression and epilepsy.

Can You Eat Too Much Tryptophan?

While you need tryptophan to live, animal research indicates eating too much too much of it may be bad for your health. Studies in rats correlate a diet low in tryptophan with an extended lifespan. Research in pigs shows too much tryptophan may lead to organ damage and increased insulin resistance. Although L-tryptophan and its metabolites are available for sale as supplements and prescription medications, the FDA has warned that it is not categorically safe to take and may cause illness. Research into the health risks and benefits of tryptophan is ongoing.

References

Dietary Guidelines for Americans - 2005 . Washington, DC. US Dept of Health and Human Services and US Dept of Agriculture: 2005.

Ooka H, Segall PE, Timiras PS (January 1978). "Neural and endocrine development after chronic tryptophan deficiency in rats: II. Pituitary-thyroid axis". Mech. Ageing Dev. 7 (1): 19–24.

Koopmans SJ, Ruis M, Dekker R, Korte M (October 2009). "Surplus dietary tryptophan inhibits stress hormone kinetics and induces insulin resistance in pigs". Physiology & Behavior 98 (4): 402–410.

Learn More About Tryptophan

Foods High in Tryptophan

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Profile Of Evil (Profile, #1) By Alexa Grace, Klinset

Profile of Evil (Profile, #1)

Carly Stone is a brilliant FBI agent who’s seen more than her share of evil. Leaving the agency, she becomes a consultant for Indiana County Sheriff Brody Chase. He needs her help to catch a savage killer who is luring teenaged girls to their deathMore Carly Stone is a brilliant FBI agent who’s seen more than her share of evil. Leaving the agency, she becomes a consultant for Indiana County Sheriff Brody Chase. He needs her help to catch a savage killer who is luring teenaged girls to their death in the handsome sheriff’s community.

The two are determined to stop a dangerous predator before he takes another life — at any cost. Less

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Community Reviews

Musing rated it it was amazing

over 3 years ago

Profile of Evil was the first book in The Profile Series by talented author, Alexa Grace .

Sheriff Brody Chase was determined to solve the re-occurring, mysterious deaths of pre-adolescent girls, haunting tranquil Shawnee County. He was also determined to resist the stun. Read full review

Jo Ann Reinhold rated it really liked it

almost 2 years ago

I read Profile of Evil before I joined Goodreads or stared leaving reviews. So I am editing my review so I can justify my rating :-)

I like that Alexa touched on a subject that is so relevant today, how truly vulnerable our children are today and especially when their self. Read full review

Jen rated it it was amazing

over 3 years ago

Alexa Grace has found the epitome of evil and wrote it down. It isn't just a great read of true evil but of the real dangers of the social media when children are left to their own devices. It also brings too life the very true reality of bullying among kids. How she entw. Read full review

rated it really liked it

over 3 years ago

I love Alexa Grace and her "feel-good-sexy-CSI" type books and this one was no exception!

Carly & Brody = one sexy law enforcement duo!

Looking forward to Gabe and Cameron's stories later this year.

Kay Richards rated it it was amazing

over 3 years ago

Well what can I say. AMAZE BALLS!! Absolutely loved this book <3 I would highly recommend it to everyone.

Ann marked it as to-read

almost 4 years ago

Looking forward to this new trilogy.

Lisa rated it it was amazing

over 3 years ago

This is the start of a new series from Alexa Grace and will hook you in immediately. I loved her other series Alexa Grace's Deadly Trilogy Boxed Set and had high hopes for this one. Alexa delivers beyond!

Profile of Evil centers around the search for an online child predat. Read full review

Isa Jones (Jo&Isalovebooks Blog) rated it it was amazing

about 3 years ago

Well what can I say, after reading her first trilogy, I thought I was going to find pretty much of the same in this book but this new "Profile" series promises to be another gripping collection, I can't get enough of how descriptive and detailed each crime scene is and it. Read full review

Phoebe Weitzel rated it it was amazing

over 3 years ago

Another brilliant piece of work from Alexa Grace! Profile of Evil might just be her best book yet! Profile of Evil has a heart-stopping plot with the handsome Brody Chase coming to the rescue. Sheriff Brody Chase is one hell of a "knock your socks off" man. Once you pick. Read full review

Diana Tan rated it it was amazing

about 3 years ago

What an explosive start to a new trilogy. Alexa Grace has done it again. Profile Of Evil is a page turner from start to finish. It's got everything! Romance, suspense, action, drama and of course the happy ending we all want. The story line is well-developed. Brody's an. Read full review

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