Crash Victim - Fesses Up, Provides Lessons - Ride Ct - Ride New England, Ridect

Crash Victim ‘Fesses Up, Provides Lessons

Thomas Magnavice was out riding his just-acquired Kawasaki Z1000 last Friday evening when he “went down.” His spectacular crash on Route 72 in Harwinton, CT was captured on video by a driver who was following behind him. State police were immediately called to the scene as were an ambulance and local volunteer firefighters.

As luck would have it, as deputy chief of the Harwinton Fire Police, I responded to help direct traffic on the two-lane state highway – arriving to see Magnavice seated on the pavement and his shoulder already bandaged. I ended up talking with his riding companion, Steve Chouinard, who provided a few details about the crash. We agreed that the fact that Magnavice had just “traded up” to a more powerful machine, and one with throttle by wire, may have contributed to the crash.

It only took a few days for the video to be posted on the CT Motorcycle Riders page on Facebook. And the person posting it was Magnavice himself, who – in his initial post as well as in follow-up comments – candidly admitted his own in role the crash. In introducing the video, he stated, “So this was me passing 3 cars on a bumpy ass road last Friday on I bike that I owned for 1 week.”

Here’s the video:

Magnavice explained that in one week’s time he had managed to put 600 miles on the Z1000 “and was starting to get a little too comfortable on it.” What he didn’t say initially, but which is clearly evident in the video, was that he was attempting to pass illegally on a double yellow line.

Fortunately for him, Magnavice only sustained a dislocated shoulder and a partially collapsed lung. Had he not been wearing an armored jacket and a full-face helmet, his injuries would have been more severe; perhaps even fatal. “If I had cuff gloves and (riding) pants that zipped into my jacket, I would have no road rash,” he wrote.

In subsequent comments in the Facebook thread, Magnavice said, “I know I’m lucky as hell, but it was still a bad decision to pass on a shitty road.” He added that state police only gave him a warning. “I happened so fast I just remember the bars shaking and thinking no big deal.”

Give him credit for taking ownership of the crash. “The reason I posted this is so people can learn from my bad decisions and hopefully save someone’s life. I take full responsibility for my irresponsible actions. I’m just lucky I didn’t hurt anyone else.”

In a message to RIDE-CT & RIDE-NewEngland, Magnavice added regarding the crash, “I learned a lot from it. Not to let riding with someone new make you feel like you need to impress them. Buy better gloves and riding pants. And most importantly don’t go full throttle on a bumpy road.”

Magnavice had been riding about two years and had 20,000 miles experience when he crashed, making him another example of how any rider can get into an accident at any time. His candor is admirable. Here’s hoping that the lessons he learned stick with other riders.

Comments

Dizinal, Dizinal

Dramamine is used for preventing and treating nausea, vomiting, and dizziness caused by motion sickness.

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

Dramamine may be taken with or without food. Use Dramamine exactly as directed on the package, unless instructed differently by your doctor. If you are taking Dramamine without a prescription, follow any warnings and precautions on the label. Take the first dose at least 30 minutes before activity or travel. If you miss a dose of Dramamine 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 Dramamine.

Use Dramamine exactly as directed by your Health Provider.

Store Dramamine at room temperature, between 68 and 77 degrees F (20 and 25 degrees C), or according to directions on the package label. Store in the original package or container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Dramamine out of the reach of children and away from pets.

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

if you are pregnant or planning to become pregnant

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 asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, lung disease, shortness of breath, or sleep apnea

if you have a blockage of the stomach, intestine, or urinary tract; difficulty urinating; diabetes; ulcers; enlargement of the prostate; glaucoma; heart disease; irregular heartbeat; high blood pressure; porphyria; or thyroid disease

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

Sodium oxybate (GHB) because an increase in sleep duration and a decrease in the ability to breathe are likely to occur

MAO inhibitors (eg, phenelzine) because serious side effects, such as high blood pressure or seizure, may occur

Antibiotics that may cause hearing problems (eg, gentamicin, vancomycin) because Dramamine may mask symptoms of hearing problems

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

Do NOT use Dramamine if:

you are allergic to any ingredient in Dramamine or other similar medicines

you are taking sodium oxybate (GHB)

you are currently taking or have taken a monoamine oxidase (MAO) inhibitor (eg, phenelzine) in the past 14 days

you are breast-feeding

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

Dramamine may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Dramamine. Using Dramamine alone, with certain other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Avoid drinking alcohol or taking other medications that cause drowsiness (eg, sedatives, tranquilizers) while taking Dramamine. Dramamine will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants. Dramamine may cause dizziness. Alcohol, hot weather, exercise, and fever can increase this effect. To prevent it, sit up or stand slowly, especially in the morning. Also, sit or lie down at the first sign of dizziness. Do not exceed the recommended dose or use Dramamine more frequently or for longer than prescribed without first checking with your doctor. Do not become overheated in hot weather or during exercise or other activities since heatstroke may occur. Dramamine may cause increased sensitivity to the sun. Avoid exposure to the sun, sunlamps, or tanning booths until you know how you react to Dramamine. Use a sunscreen or protective clothing if you must be outside for a prolonged period. Do not use Dramamine with any medicine that contains diphenhydramine. Before you begin taking any new prescription or nonprescription medicine, including one used on the skin, read the ingredients to see if it also contains diphenhydramine or another similar medicine (eg, antihistamine). If it does, or if you are uncertain if it does, contact your doctor or pharmacist. Use Dramamine with caution in the ELDERLY because they may be more sensitive to its effects, especially dizziness, sedation, and lightheadedness upon standing. Safe use and instructions for use in CHILDREN differs according to the brand used. Talk to your doctor or pharmacist if you have any questions about the brand you are using. Use of Dramamine is not recommended in CHILDREN younger than 2 years of age without first talking with the child's doctor. Safety and effectiveness in this age group have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Dramamine during pregnancy. Dramamine is excreted in breast milk. Do not breast-feed while taking Dramamine.

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:

Dizziness; drowsiness; dry mouth, throat, and nose; thickening of mucus in nose or throat.

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

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; convulsions; decreased alertness; difficulty urinating; excessive excitability; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; mental or mood changes; pounding in the chest; seizures; tremor; unusual bruising or bleeding; wheezing; yellowing of the eyes or skin.

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

Dramamine is used for preventing and treating nausea, vomiting, and dizziness caused by motion sickness.

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

Dramamine may be taken with or without food. Use Dramamine exactly as directed on the package, unless instructed differently by your doctor. If you are taking Dramamine without a prescription, follow any warnings and precautions on the label. Take the first dose at least 30 minutes before activity or travel. If you miss a dose of Dramamine 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 Dramamine.

Use Dramamine exactly as directed by your Health Provider.

Store Dramamine at room temperature, between 68 and 77 degrees F (20 and 25 degrees C), or according to directions on the package label. Store in the original package or container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Dramamine out of the reach of children and away from pets.

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

if you are pregnant or planning to become pregnant

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 asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, lung disease, shortness of breath, or sleep apnea

if you have a blockage of the stomach, intestine, or urinary tract; difficulty urinating; diabetes; ulcers; enlargement of the prostate; glaucoma; heart disease; irregular heartbeat; high blood pressure; porphyria; or thyroid disease

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

Sodium oxybate (GHB) because an increase in sleep duration and a decrease in the ability to breathe are likely to occur

MAO inhibitors (eg, phenelzine) because serious side effects, such as high blood pressure or seizure, may occur

Antibiotics that may cause hearing problems (eg, gentamicin, vancomycin) because Dramamine may mask symptoms of hearing problems

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

Do NOT use Dramamine if:

you are allergic to any ingredient in Dramamine or other similar medicines

you are taking sodium oxybate (GHB)

you are currently taking or have taken a monoamine oxidase (MAO) inhibitor (eg, phenelzine) in the past 14 days

you are breast-feeding

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

Dramamine may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Dramamine. Using Dramamine alone, with certain other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Avoid drinking alcohol or taking other medications that cause drowsiness (eg, sedatives, tranquilizers) while taking Dramamine. Dramamine will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants. Dramamine may cause dizziness. Alcohol, hot weather, exercise, and fever can increase this effect. To prevent it, sit up or stand slowly, especially in the morning. Also, sit or lie down at the first sign of dizziness. Do not exceed the recommended dose or use Dramamine more frequently or for longer than prescribed without first checking with your doctor. Do not become overheated in hot weather or during exercise or other activities since heatstroke may occur. Dramamine may cause increased sensitivity to the sun. Avoid exposure to the sun, sunlamps, or tanning booths until you know how you react to Dramamine. Use a sunscreen or protective clothing if you must be outside for a prolonged period. Do not use Dramamine with any medicine that contains diphenhydramine. Before you begin taking any new prescription or nonprescription medicine, including one used on the skin, read the ingredients to see if it also contains diphenhydramine or another similar medicine (eg, antihistamine). If it does, or if you are uncertain if it does, contact your doctor or pharmacist. Use Dramamine with caution in the ELDERLY because they may be more sensitive to its effects, especially dizziness, sedation, and lightheadedness upon standing. Safe use and instructions for use in CHILDREN differs according to the brand used. Talk to your doctor or pharmacist if you have any questions about the brand you are using. Use of Dramamine is not recommended in CHILDREN younger than 2 years of age without first talking with the child's doctor. Safety and effectiveness in this age group have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Dramamine during pregnancy. Dramamine is excreted in breast milk. Do not breast-feed while taking Dramamine.

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:

Dizziness; drowsiness; dry mouth, throat, and nose; thickening of mucus in nose or throat.

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

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; convulsions; decreased alertness; difficulty urinating; excessive excitability; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; mental or mood changes; pounding in the chest; seizures; tremor; unusual bruising or bleeding; wheezing; yellowing of the eyes or skin.

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

Dramamine is used for preventing and treating nausea, vomiting, and dizziness caused by motion sickness.

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

Dramamine may be taken with or without food. Use Dramamine exactly as directed on the package, unless instructed differently by your doctor. If you are taking Dramamine without a prescription, follow any warnings and precautions on the label. Take the first dose at least 30 minutes before activity or travel. If you miss a dose of Dramamine 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 Dramamine.

Use Dramamine exactly as directed by your Health Provider.

Store Dramamine at room temperature, between 68 and 77 degrees F (20 and 25 degrees C), or according to directions on the package label. Store in the original package or container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Dramamine out of the reach of children and away from pets.

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

if you are pregnant or planning to become pregnant

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 asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, lung disease, shortness of breath, or sleep apnea

if you have a blockage of the stomach, intestine, or urinary tract; difficulty urinating; diabetes; ulcers; enlargement of the prostate; glaucoma; heart disease; irregular heartbeat; high blood pressure; porphyria; or thyroid disease

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

Sodium oxybate (GHB) because an increase in sleep duration and a decrease in the ability to breathe are likely to occur

MAO inhibitors (eg, phenelzine) because serious side effects, such as high blood pressure or seizure, may occur

Antibiotics that may cause hearing problems (eg, gentamicin, vancomycin) because Dramamine may mask symptoms of hearing problems

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

Do NOT use Dramamine if:

you are allergic to any ingredient in Dramamine or other similar medicines

you are taking sodium oxybate (GHB)

you are currently taking or have taken a monoamine oxidase (MAO) inhibitor (eg, phenelzine) in the past 14 days

you are breast-feeding

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

Dramamine may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Dramamine. Using Dramamine alone, with certain other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Avoid drinking alcohol or taking other medications that cause drowsiness (eg, sedatives, tranquilizers) while taking Dramamine. Dramamine will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants. Dramamine may cause dizziness. Alcohol, hot weather, exercise, and fever can increase this effect. To prevent it, sit up or stand slowly, especially in the morning. Also, sit or lie down at the first sign of dizziness. Do not exceed the recommended dose or use Dramamine more frequently or for longer than prescribed without first checking with your doctor. Do not become overheated in hot weather or during exercise or other activities since heatstroke may occur. Dramamine may cause increased sensitivity to the sun. Avoid exposure to the sun, sunlamps, or tanning booths until you know how you react to Dramamine. Use a sunscreen or protective clothing if you must be outside for a prolonged period. Do not use Dramamine with any medicine that contains diphenhydramine. Before you begin taking any new prescription or nonprescription medicine, including one used on the skin, read the ingredients to see if it also contains diphenhydramine or another similar medicine (eg, antihistamine). If it does, or if you are uncertain if it does, contact your doctor or pharmacist. Use Dramamine with caution in the ELDERLY because they may be more sensitive to its effects, especially dizziness, sedation, and lightheadedness upon standing. Safe use and instructions for use in CHILDREN differs according to the brand used. Talk to your doctor or pharmacist if you have any questions about the brand you are using. Use of Dramamine is not recommended in CHILDREN younger than 2 years of age without first talking with the child's doctor. Safety and effectiveness in this age group have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Dramamine during pregnancy. Dramamine is excreted in breast milk. Do not breast-feed while taking Dramamine.

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:

Dizziness; drowsiness; dry mouth, throat, and nose; thickening of mucus in nose or throat.

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

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; convulsions; decreased alertness; difficulty urinating; excessive excitability; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; mental or mood changes; pounding in the chest; seizures; tremor; unusual bruising or bleeding; wheezing; yellowing of the eyes or skin.

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

Danoclav, Danoclav

Antibiotics - Danoclav (Brand name: augmentin)

Common use It is is a broad-spectrum antibiotic which destroys bacteria. It is active against many aerobic (those developing in presence of oxygen) and anaerobic (those developing in absence of oxygen) gram positive and aerobic gram negative microorganisms including strains which produce beta-lactamase (the enzyme which destroys penicillin). Clavulanate potassium comprised in the content of this medication provides resistance of Augmentin to activity of bacterial beta-lactamases. This medication is used to treat pneumonia and other infectious diseases of respiratory, gastrointestinal systems, urogenital systems, infections which appear after surgery and others.

Dosage and directions Doses are administered individually depending on your condition, localization of infection and susceptibility of the pathogen. Do not take it in larger amounts or longer than recommended. Swallow the whole tablet. If it is the Augmentin Chewable tablet then chew it before swallowing. Augmentin should be taken at evenly spaced interval.

Precautions Do not use it if you are allergic to any other penicillin antibiotic, if you have liver or kidney failure or mononucleosis.

Contraindications Do not use the medicine if you have allergy to its components or another penicillin antibiotics, if you have infectious mononucleosis, a history of liver problems or yellowing of the eyes or skin caused by Augmentin.

Possible side effect Dyspepsia, abdominal discomfort, bloating, gas nausea, vomiting, liver function disorders, hepatitis, jaundice caused by stagnation of bile, vaginal itching and also symptoms of allergy (hives, rash, swelling). Cautiousness should be exercised in patients with liver failure. The medication is not recommended for pregnant (especially third trimester) and breastfeeding women.

Treatment with Augmentin and other antibiotics can change the normal bacteria flora of the colon and permit overgrowth of C. difficile, a bacteria which causes pseudomembranous colitis. Probenecid which is used to treat gout may slow excretion of Augmentin by kidneys and result in increase of its toxicity.

Missed dose If you missed a dose take it as soon as you remember, but not if it is almost time of the next intake by your schedule. If so skip the missed dose. Do not try to compensate a missed dose by taking an extra one.

Overdose If you suppose that took too much of Augmentin and experience such symptoms as nausea, vomiting, stomach pain, diarrhea, skin rash, drowsiness, and hyperactivity, seek immediate medical help.

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

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

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CO Amoxiclav

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amoxicillin/clavulanic acid 500 mg/125 mg - oral, Augmentin

The display and use of drug information on this site is subject to express terms of use. By continuing to view the drug information, you agree to abide by such terms of use.

GENERIC NAME: AMOXICILLIN/CLAVULANIC ACID 500 MG/125 MG - ORAL (a-MOX-i-SIL-in/KLAV-you-lan-ik)

BRAND NAME(S): Augmentin

USES: Amoxicillin /clavulanic acid is a penicillin-type antibiotic used to treat a wide variety of bacterial infections. It works by stopping the growth of bacteria. This antibiotic only treats bacterial infections. It will not work for viral infections (e. g. common cold. flu ). Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness.

HOW TO USE: Take this medication by mouth with a meal or snack, usually every 8 or 12 hours, or as directed by your doctor. Antibiotics work best when the amount of medicine in your body is kept at a constant level. Therefore, take this drug at evenly spaced intervals. Continue to take this medication until the full prescribed amount is finished even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a relapse of the infection. Inform your doctor if your condition persists or worsens.

SIDE EFFECTS: Diarrhea. nausea. or vomiting may occur during the first few days as your body adjusts to the medication. Take with food to minimize stomach upset. If any of these effects persist or worsen, contact the doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: easy bruising or bleeding, persistent sore throat or fever. dark urine. persistent nausea or vomiting. severe stomach/abdominal pain. yellowing eyes or skin. This medication may rarely cause a severe intestinal condition (Clostridium difficile - associated diarrhea ) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Tell your doctor immediately if you develop: persistent diarrhea, abdominal or stomach pain /cramping, or blood/mucus in your stool. Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection (oral or vaginal fungal infection). Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge or other new symptoms. 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. The amoxicillin in this combination medication can commonly cause a mild rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe allergic reaction. Therefore, seek immediate medical attention if you develop any rash. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Quick Guide Infectious Mononucleosis (Mono): Symptoms and Treatment

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Comprar Abutiroi (Synthroid) Sin Receta, Abutiroi

compra Abutiroi (Synthroid) en linea sin receta

Abutiroi (Synthroid) Explicacion

Abutiroi es realmente un tratamiento ideal dentro de la batalla hacia problemas de la glandula tiroides, por ejemplo, el bocio, la tiroiditis, la glandula tiroides malignidad, asi como n? Ud. Ademas, extras deficiencia de la glandula tiroides, asi como sus signos y sintomas.

Abutiroi utilidad esta dentro de sustitucion con respecto a las victimas, en cuyo grado de glandula tiroides basura que se crea por glandular de la glandula tiroides no es muy regular.

Abutiroi tambien puede ser referido como levotiroxina, Lethyrox, Eltroxin, Evotrox, Thyrax, Euthyrox, Levaxin, L-tiroxina, Thyrox, Eutirox, Levoxyl.

titulo general asociada con Abutiroi es en realidad levotiroxina.

Marcas asociadas con Abutiroi tienden a ser Unithroid, Levoxyl, Abutiroi, Levothroid.

Abutiroi (Synthroid) Dosis

Abutiroi viene en:

25mcg Baja material de friccion Dosis

50 mcg material de friccion dosis regular

material de friccion 200 mcg Dosis Maxima

Obtener pastillas Abutiroi por via oral antes de la cena.

Por lo general, no moler o incluso masticar esto.

Get Abutiroi diaria al mismo tiempo, cada manana junto con el agua potable.

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

Abutiroi (Synthroid) 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.

Abutiroi (Synthroid)

En el caso de que la sobredosis de Abutiroi y que tambien se evita gran usted necesita comprobar hacia fuera su medico o incluso el medico de inmediato. Asociado con Abutiroi sobredosis: nauseas o vomitos, calidos, problemas del corazon, latido del corazon rapido, cada vez mas asociado con el hambre, la respiracion breve, insomnio, sudoracion, cefalea, diarrea, malestar infrecuente.

Abutiroi (Synthroid) Espacio de almacenamiento

Tienda en temperaturas de espacio entre 10 y 30 niveles de D (59, asi como ochenta y seis niveles F) de la humedad, la iluminacion, 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.

Abutiroi (Synthroid) Efectos negativos

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

vomitando material de friccion

nauseas o vomitos material de friccion

insuficiente considerar material de friccion

material de friccion temblores

material de friccion migrana

ansiedad

modificaciones, junto con material de friccion hambre

material de friccion insomnio

material de friccion caliente

dentro de material de friccion menstruacion

sensibilidad hacia el material de friccion temperatura

material de friccion calvicie

inferior de la pierna calambres material de friccion

material de friccion diarrea

material de friccion exudacion

Mucho menos tipicos y graves efectos negativos en toda utilizando Abutiroi:

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

cardiaco anormal vencio

problemas cardiacos friccion de material

Los efectos negativos indicaciones se basan en medicamentos que podrian estar utilizando pero, ademas, se basan en su condicion de bienestar y otros aspectos

Abutiroi (Synthroid) Contraindicaciones

Por lo general no lo hacen Abutiroi utilizar en caso de que usted es sensible a fin de elementos Abutiroi.

Abutiroi se podria utilizar si usted esta esperando otra manera tiene la intencion de tener un hijo, si no que realmente eres una mama medica. No dana al nino.

Por lo general, no tome ventaja de este medicamento junto con pildoras de perdida de peso dentro de la subsanacion de tener sobrepeso o incluso para perder peso.

Tenga cuidado junto con Abutiroi en caso de que usted esta tomando medicamentos para reducir el colesterol (por ejemplo colestipol (tales porque Colestid), colestiramina (Questran)); salicilatos de dosificacion mas altos (por ejemplo, porque la aspirina); rifamicinas (por ejemplo, debido a la rifampicina); sulfato ferroso; yoduro; glucocorticoides (por ejemplo, debido a la prednisona, dexametasona); teofilina; El fenobarbital; digoxina; citoquinas (por ejemplo, debido a la interleuquina-2, interferon-alfa); amiodarona; antiacidos que tienen aluminio de peso ligero; medicamentos para la diabetes (por ejemplo, debido a la rosiglitazona, la insulina, glipizida); antidepresivos (por ejemplo, debido a la sertralina, amitriptilina, maprotilina); medicamentos anti-tiroideos (por ejemplo, porque el propiltiouracilo, metimazol); warfarina; ketamina; sucralfato medicamento ulcera (tales Carafate); HGH; bloqueadores beta (propranolol), porque tales articulos, hormonas femeninas, de litio.

Get Abutiroi con cuidado en caso de que se ven afectados por infarto de miocardio; deficiencia suprarrenal, problemas de la glandula tiroides (enfermedad nodular de la glandula tiroides, no toxico disipa bocio); diabetica; enfermedades cardiovasculares (enfermedad de las arterias coronarias, presion arterial alta, fallo cardiovascular, arritmias, o incluso angina); huesos fragiles; problemas de basura (por ejemplo, porque los sintomas poliglandulares autoinmunes, deficiencias basura hipotalamicas); esterilidad femenina o masculina, tirotoxicosis; coagulacion torrente sanguineo, los problemas que hielan.

Tenga cuidado junto con Abutiroi si quieres tener un tratamiento quirurgico.

Puede ser danino para evitar el uso de Abutiroi, de repente.

Abutiroi (Synthroid) Preguntas comunes

Queen: ?Que es exactamente Abutiroi?

El: Abutiroi es realmente un tratamiento ideal dentro de la batalla hacia problemas de la glandula tiroides, por ejemplo, el bocio, la tiroiditis, la glandula tiroides malignidad, asi como n ud. Ademas, extras deficiencia de la glandula tiroides, asi como sus signos y sintomas. Es

Reina: ?Como puede realmente hace carrera Abutiroi?

El: Abutiroi utilidad esta dentro de sustitucion con respecto a las victimas en cuyo grado de glandula tiroides basura que se crea por glandular de la glandula tiroides no es realmente regular. A

Queen: ?Cuales son exactamente efectos negativos Abutiroi?

El: Abutiroi ofrece los tipicos efectos negativos, por ejemplo, vomitos, nauseas o vomitos, el peso corporal insuficiente, temblores, migrana, ansiedad, modificaciones, junto con el hambre, la falta de sueno, caliente, dentro de la menstruacion, la sensibilidad hacia la temperatura, calvicie, calambres en las piernas inferiores, la diarrea, la exudacion. Sin embargo en la situacion que se asocia con el rechazo asociado con elementos Abutiroi que son capaces de encontrar efectos negativos mas graves: ritmo cardiaco anormal, problemas cardiacos, asociados con la respuesta de reaccion alergica (urticaria, problemas con la inhalacion y la exhalacion, la alergia, la inflamacion, el cierre). La probabilidad de efectos negativos a aparecer depende de la posicion de bienestar, asi como, naturalmente, en la receta Abutiroi posterior correcta medications. A

Queen: ?Cuales son exactamente general, asi como las marcas asociadas con Abutiroi?

El: titulo general asociada con Abutiroi es en realidad levotiroxina. Marcas asociadas con Abutiroi tienden a ser Unithroid, Levoxyl, Abutiroi, Levothroid. A

comprar Abutiroi (Synthroid) en linea, Abutiroi (Synthroid) comprar en linea sin receta, Abutiroi (Synthroid) comprar sin receta, comprar barato Abutiroi (Synthroid), Abutiroi (Synthroid) comprar sin receta, comprar Abutiroi (Synthroid) de Canada, comprar Abutiroi (Synthroid) Canada, Para Abutiroi (Synthroid) en linea, Para Abutiroi (Synthroid) Generico Sin Receta Medica, Abutiroi (Synthroid) orden sin receta, Pildora por via oral Abutiroi (Synthroid)

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Reumacide Generic Name Indomethacin Online, Reumacide

Reumacide General Information

Reumacide - Pharmacology:

Antiinflammatory effects of Reumacide are believed to be due to inhibition of cylooxygenase in platelets which leads to the blockage of prostaglandin synthesis. Antipyretic effects may be due to action on the hypothalamus, resulting in an increased peripheral blood flow, vasodilation, and subsequent heat dissipation.

Reumacide for patients

Reumacide, like other drugs of its class, is not free of side effects. The side effects of these drugs can cause discomfort and rarely, there are more serious side effects, such as gastrointestinal bleeding, which may result in hospitalization and even fatal outcomes. NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are often essential agents in the management of arthritis, but they also may be commonly employed for conditions which are less serious. Physicians may wish to discuss with their patients the potential risks and likely benefits of NSAID treatment, particularly when the drugs are used for less serious conditions where treatment without NSAIDs may represent an acceptable alternative to both the patient and physician.

This description is suitable for active ingredient Indomethacin

Reumacide Interactions

In normal volunteers receiving indomethacin, the administration of diflunisal decreased the renal clearance and significantly increased the plasma levels of indomethacin. In some patients, combined use of INDOCIN and diflunisal has been associated with fatal gastrointestinal hemorrhage. Therefore, diflunisal and INDOCIN should not be used concomitantly.

In a study in normal volunteers, it was found that chronic concurrent administration of 3.6 g of aspirin per day decreases indomethacin blood levels approximately 20%.

The concomitant use of INDOCIN with other NSAIDs is not recommended due to the increased possibility of gastrointestinal toxicity, with little or no increase in efficacy.

Clinical studies have shown that INDOCIN does not influence the hypoprothrombinemia produced by anticoagulants. However, when any additional drug, including INDOCIN, is added to the treatment of patients on anticoagulant therapy, the patients should be observed for alterations of the prothrombin time. In post-marketing experience, bleeding has been reported in patients on concomitant treatment with anticoagulants and INDOCIN. Caution should be exercised when INDOCIN and anticoagulants are administered concomitantly.

When INDOCIN is given to patients receiving probenecid, the plasma levels of indomethacin are likely to be increased. Therefore, a lower total daily dosage of INDOCIN may produce a satisfactory therapeutic effect. When increases in the dose of INDOCIN are made, they should be made carefully and in small increments.

Caution should be used if INDOCIN is administered simultaneously with methotrexate. INDOCIN has been reported to decrease the tubular secretion of methotrexate and to potentiate its toxicity.

Administration of non-steroidal anti-inflammatory drugs concomitantly with cyclosporine has been associated with an increase in cyclosporine-induced toxicity, possibly due to decreased synthesis of renal prostacyclin. NSAIDs should be used with caution in patients taking cyclosporine, and renal function should be carefully monitored.

Capsules INDOCIN 50 mg t. i.d. produced a clinically relevant elevation of plasma lithium and reduction in renal lithium clearance in psychiatric patients and normal subjects with steady state plasma lithium concentrations. This effect has been attributed to inhibition of prostaglandin synthesis. As a consequence, when INDOCIN and lithium are given concomitantly, the patient should be carefully observed for signs of lithium toxicity. (Read circulars for lithium preparations before use of such concomitant therapy.) In addition, the frequency of monitoring serum lithium concentration should be increased at the outset of such combination drug treatment.

INDOCIN given concomitantly with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin. Therefore, when INDOCIN and digoxin are used concomitantly, serum digoxin levels should be closely monitored.

In some patients, the administration of INDOCIN can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing, and thiazide diuretics. Therefore, when INDOCIN and INDOCIN. (Reumacide) diuretics are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained.

INDOCIN reduces basal plasma renin activity (PRA), as well as those elevations of PRA induced by furosemide administration, or salt or volume depletion. These facts should be considered when evaluating plasma renin activity in hypertensive patients.

It has been reported that the addition of triamterene to a maintenance schedule of INDOCIN resulted in reversible acute renal failure in two of four healthy volunteers. INDOCIN and triamterene should not be administered together.

INDOCIN and potassium-sparing diuretics each may be associated with increased serum potassium levels. The potential effects of INDOCIN and potassium-sparing diuretics on potassium kinetics and renal function should be considered when these agents are administered concurrently.

Most of the above effects concerning diuretics have been attributed, at least in part, to mechanisms involving inhibition of prostaglandin synthesis by INDOCIN.

Blunting of the antihypertensive effect of beta-adrenoceptor blocking agents by non-steroidal antiinflammatory drugs including INDOCIN has been reported. Therefore, when using these blocking agents to treat hypertension, patients should be observed carefully in order to confirm that the desired therapeutic effect has been obtained. INDOCIN can reduce the antihypertensive effects of captopril and losartan.

False-negative results in the dexamethasone suppression test (DST) in patients being treated with INDOCIN have been reported. Thus, results of the DST should be interpreted with caution in these patients.

Reumacide Contraindications

Reumacide should not be used in:

Patients who are hypersensitive to this product.

Patients in whom acute asthmatic attacks, urticaria, or rhinitis are precipitated by aspirin or other nonsteroidal anti - inflammatory agents.

Suppositories INDOCIN are contraindicated in patients with a history of proctitis or recent rectal bleeding.

This description is suitable for active ingredient Indomethacin

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

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Allergy Symptoms, Testing, And Shots, Lergy

Allergy (Allergies)

Allison Ramsey, MD

Dr. Allison Ramsey earned her undergraduate degree at Colgate University and her medical degree at the University of Rochester School of Medicine and Dentistry. She completed her internal medicine training at the University of Rochester School of Medicine and Dentistry and remained at the university to complete her fellowship training in allergy and clinical immunology. Dr. Ramsey is board certified in internal medicine and allergy and immunology. Her professional interests include the treatment of drug allergy and eosinophilic disorders. She also enjoys teaching medical trainees. She is a member of the American Academy of Allergy, Asthma, and Immunology, the American College of Allergy, Asthma, and Immunology, the New York State Allergy Society, and the Finger Lakes Allergy Society. In her personal life, her interests include exercise, especially running and horseback riding; and spending time with her husband and two children.

Syed Shahzad Mustafa, MD

After growing up in the Rochester area, Dr. Mustafa pursued his undergraduate studies at the Johns Hopkins University in Baltimore and attended medical school at SUNY Buffalo. He then completed his internal medicine training at the University of Colorado and stayed in Denver to complete his fellowship training in allergy and clinical immunology at the University of Colorado, National Jewish Health, and Children's Hospital of Denver.

William C. Shiel Jr. MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick Guide Allergy: What Happens in a Nasal Allergy Attack

Allergy facts

Allergy involves an exaggerated response of the immune system, often to common substances such as foods or pollen .

The immune system is a complex system that normally defends the body against foreign invaders, such as bacteria and viruses. while also surveying for abnormal tissue changes, such as cancer .

Allergens are substances that are foreign to the body and that cause an allergic reaction .

IgE is the allergic antibody.

Although many individuals outgrow allergies over time, allergies can also develop at any age, including during adulthood.

While the environment plays a role in the development of allergy. there is a greater risk of developing allergic conditions if a person has a family history of allergy, especially in parents or siblings.

Allergy overview

This is a review regarding how the allergic response of the immune system occurs and why certain people become allergic. The most common allergic diseases are described, including allergic rhinitis (nasal allergies), allergic conjunctivitis (eye allergies ), allergic asthma. urticaria (hives), and food allergies.

Reviewed on 4/18/2016

Fiocchi A, Assa'ad A, Bahna S; Adverse Reactions to Foods Committee; American College of Allergy, Asthma and Immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse Reactions to Foods Committee, American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 2006 Jul;97(1):10-20; quiz 21, 77.

Price D, Bond C, Bouchard J, Costa R, Keenan J, Levy ML, Orru M, Ryan D, Walker S, Watson M. International Primary Care Respiratory Group (IPCRG) Guidelines: management of allergic rhinitis. Prim Care Respir J. 2006 Feb;15(1):58-70. Epub 2005 Dec 27.

American College of Allergy, Asthma, & Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol. 2006 Mar;96(3 Suppl 2):S1-68. No abstract available.

Flinterman AE, Pasmans SG, Hoekstra MO, Meijer Y, van Hoffen E, Knol EF, Hefle SL, Bruijnzeel-Koomen CA, Knulst AC. Determination of no-observed-adverse-effect levels and eliciting doses in a representative group of peanut-sensitized children. J Allergy Clin Immunol. 2006 Feb;117(2):448-54.

Scibilia J, Pastorello EA, Zisa G, Ottolenghi A, Bindslev-Jensen C, Pravettoni V, Scovena E, Robino A, Ortolani C. Wheat allergy: a double-blind, placebo-controlled study in adults. J Allergy Clin Immunol. 2006 Feb;117(2):433-9.

Medically Reviewed By: Ellen Reich, MD, Board Certified in Allergy and Immunology, Board Certified in Pediatrics and Michael Manning, MD, of the American Board of Allergy and Immunology.

6.iStock, Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.

7.Charles Daghlian, Getty Images/ScienceFoto, iStock

11.Dartmouth Electron Microscope Facility, Dartmouth College

Cafinitrina - Spanish - English Translation And Examples, Cafinitrina

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Parlodel

Parlodel is used for:

Treating Parkinson disease. It is used to treat certain conditions (eg, excessive or abnormal breast milk production, certain menstrual problems) caused by too much prolactin in the blood (hyperprolactinemia). It may also be used to treat certain tumors that make too much prolactin. It is also used to treat a condition where your body makes too much growth hormone (acromegaly). It may also be used for other conditions as determined by your doctor.

Parlodel is a dopamine agonist. It works by blocking the release of prolactin from the pituitary gland. It also works by lowering growth hormone levels in patients with acromegaly. In Parkinson disease, Parlodel works by stimulating dopamine receptors in certain parts of the brain.

Do NOT use Parlodel if:

you are allergic to any ingredient in Parlodel or to ergot alkaloids

you are breast-feeding

you have uncontrolled high blood pressure

you are taking Parlodel only to treat hyperprolactinemia and you become pregnant

you have a rare hereditary problem of galactose intolerance, severe lactase deficiency, or glucose-galactose malabsorption

you are taking an azole antifungal (eg, ketoconazole, miconazole), certain medicines used for migraines ("triptans," such as eletriptan or sumatriptan), efavirenz, an ergot alkaloid (eg, ergotamine), a macrolide antibiotic (eg, erythromycin), a protease inhibitor (eg, boceprevir, ritonavir), or telithromycin

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

Before using Parlodel:

Some medical conditions may interact with Parlodel. 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 breastfeeding

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 or you are at risk for developing high blood pressure associated with pregnancy

if you have recently given birth and you also have a history of heart blood vessel problems or other severe heart or blood vessel problems (eg, stroke)

if you have a history of heart problems (eg, heart attack, irregular or slow heartbeat); blood vessel problems; high or low blood pressure; stroke; kidney or liver problems; lung or breathing problems (eg, asthma); stomach ulcers; or stomach or bowel bleeding

if you have a history of mental or mood problems, dementia, neuroleptic malignant syndrome (NMS), seizures, skin cancer (melanoma), sleep problems (eg, falling asleep without warning), or vision problems

if you drink alcohol or have a history of addiction or compulsive behavior (eg, eating, gambling, shopping)

if you are taking medicine that lowers your blood pressure

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

Certain medicines used for migraines ("triptans," such as eletriptan or sumatriptan) because excessive increases in blood pressure may occur

Azole antifungals (eg, ketoconazole, itraconazole), beta-blockers (eg, propranolol), efavirenz, ergot alkaloids (eg, ergotamine), macrolide antibiotics (eg, erythromycin), medicine for high blood pressure, protease inhibitors (eg, boceprevir, ritonavir), sympathomimetics (eg, albuterol, amphetamine, pseudoephedrine), or telithromycin because they may increase the risk of Parlodel's side effects

Haloperidol, metoclopramide, phenothiazines (eg, chlorpromazine), or pimozide because they may decrease Parlodel's effectiveness

Methyldopa because side effects, including dizziness upon standing, may be increased by Parlodel

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

How to use Parlodel:

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

Take Parlodel with food.

If you miss a dose of Parlodel, 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 Parlodel.

Important safety information:

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

Do not drink alcohol while you are using Parlodel.

Check with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Parlodel; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.

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

Some people who use Parlodel may experience sudden onset of severe drowsiness or may even fall asleep during normal daily activities (eg, driving, eating, talking). This could occur without warning. If this happens, do not drive, operate machinery, or perform other possibly unsafe tasks while you use Parlodel. Tell your doctor right away.

Do not suddenly stop taking Parlodel. Some conditions may become worse when Parlodel is suddenly stopped. Your dose may need to be slowly lowered by your doctor to avoid side effects (eg, fever, stiff muscles, confusion, abnormal thinking, fast or irregular heartbeat, sweating).

If you are taking Parlodel for a brain tumor, stopping Parlodel can lead to rapid regrowth of the tumor. Do not stop taking Parlodel without talking with your doctor.

Patients with Parkinson disease may have an increased risk of developing a certain type of skin cancer (melanoma). It is not known if Parlodel also increases the risk of melanoma. You may need to have skin exams while you are using Parlodel. Tell your doctor if you notice any unusual skin growths or a change in the appearance of a mole. Discuss any questions or concerns with your doctor.

Some people have experienced new, unusual, or increased urges (eg, gambling, sexual urges) while taking Parlodel. Tell your doctor right away if you notice such effects.

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

Parlodel may decrease the effectiveness of your birth control pill. To prevent pregnancy, be sure to use an additional form of birth control (eg, condoms) while using Parlodel.

Lab tests, including blood pressure, liver and kidney function, heart function, and blood cell counts, may be performed to monitor your progress. Be sure to keep all doctor and lab appointments.

Parlodel should be used with extreme caution in CHILDREN younger than 11 years old; safety and effectiveness in these children have not been confirmed.

PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Parlodel while you are pregnant. It is not known if this medicine is found in breast milk. Do not breast-feed while taking Parlodel.

Possible side effects of Parlodel:

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:

Cold sensitivity in fingers and toes; constipation; diarrhea; dizziness; drowsiness; dry mouth; fatigue; headache; indigestion; light-headedness; loss of appetite; nausea; stomach cramps; stuffy nose; 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); abnormal involuntary movements; back pain; bloody or black, tarry stools; changes in sexual ability or desire; chest pain; confusion; decreased urine; depression; fainting; hallucinations; one-sided weakness; persistent, watery nasal discharge; ringing in the ears; seizures; severe or persistent headache or dizziness; shortness of breath; slurred speech or trouble speaking; stomach pain; sudden daytime sleepiness; sudden loss of coordination; swelling of the legs, ankles, or feet; unusual skin growths or change in the appearance of a mole; vision changes (eg, blurred vision, vision loss); vomit that looks like coffee grounds.

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

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center. or emergency room immediately. Symptoms may include confusion; constipation; delusions; dizziness; drowsiness; fainting; hallucinations; increased sweating; nausea; pale skin; repetitive yawning; vomiting.

Proper storage of Parlodel:

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

General information:

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

Parlodel is to be used only by the patient for whom it is prescribed. Do not share it with other people.

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

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

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

Review Date: August 8, 2016

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

More about Parlodel (bromocriptine)

Procion Cold Water Mx Fiber Reactive Dyes, Priocin

Welcome to Prociondye. com. We are a division of Aljo Dyes, and the premier manufacturer and distributor of MX Cold Process, Fiber Reactive, Cold Water Dyes in North America. We carry upwards of 50 different MX Cold Process, Fiber Reactive, Cold Water Dye colors, available in sizes rangeing from 1 oz. to 100 Lbs and over. Both retail customers and wholesale distributors are welcome to purchase our professional grade, very competitively priced Dyes. We have a retail store in Lower Manhattan, NYC, and ship our dyes worldwide.

Fiber Reactive, Cold Water Dyes exhibit brilliant color, have good fastness to washing, and are ideal for painting directly onto silk, cotton, rayon, and wool, or for screen printing with gum thickener. They are also excellent for use in the batik process. These dyes requires the addition of Common Salt and Washing Soda when immersing in the dye bath, and Baking Soda and Urea when painting or printing. Our "gum thickener #3056" is a neutral ph powder that dissolves in water and is an ideal gel thickener for these dyes. Please note: washing soda, or sal soda, is best purchased here, since the commercial brand now contains additives which reduce color intensity. Available in 19 inter-mixable colors. (we also have urea).

An Example

All of our Fiber Reactive, Cold Process Dyes are sold in powder form. To determine how much dye is needed for a garment, take into account the weight of the garment and the depth of color desired. Our colorcharts show the cold process dyes in two strengths - 5% OWG and 1% OWG (On Weight of Goods.) If you were to dye a shirt weighing 10 Oz. for example, you would use 5% of 10 Oz of dye - a single half ounce packet. In addition, you would add 200% of 10oz. of common salt - 1 Lb. 4 oz

Recipe for Dyebath:

1 lb. Cloth (cotton, rayon, silk or wool)

2 lbs. Common salt

1 oz. Washing soda (soda ash) 3.5 tablespoons.

2.5 gallons water (just enough to cover the fabric)

5 - 1 oz. Aljo cold process dye (Apprx. 5& dye to dry weight of fabric.)

Directions for Immersion Dyeing

Add pre-dissolved dye & salt to water. Temperature of water should be 70 to 105 F. Higher temperatures within this range result in somewhat deeper color.

Enter clean, wet, cloth into the above dye-bath. Continue dyeing for 40 minutes, stirring often.

Remove cloth from bath and add soda, which has been dissolved in small amount of warm water. Re-enter cloth into dye-bath and continue dyeing for about 50-60 minutes. Stir as often as necessary to insure even dyeing.

Remove cloth from bath and rinse in very warm water until all excess dye is removed. Use soap or Aljo wa-6 surfactant to assist extraction of excess un-fixed color. Do not use bleach.

NOTE: Brilliant Turquoise cw#20 and Black cw#1684 should be dyed at 140 F. After the soda has been added, to assure full depth of shade and even color. Use twice the normal amount of soda for cw#20 and for mixtures which contain cw #20.

Directions for Direct Application (Printing, Painting or Direct Tie-Dye) on Cotton, Rayon, Silk & Wool:

Dissolve 2 to 4 Teaspoons Gum Thickner #3056 into one quart of cold water. allow to dissolve and swell to gel consistency. (Use of Gum Thickner is optional-it enables one to control the flow of paint on fabric, making a more specific image.)

Dissolve 2 - 4 Tablespoons of Urea Crystals into one quart of water, or one quart of the gel. If you have "hard" water add Calgon, purchased at supermarket.

Keep the above stock solution, using as needed.

Prepare "Paint" solution by adding as much Dye as needed into the above mixture. Usually about 1 to 3 teaspoons of dye per cup of liquid will be used, depending on the depth of color desired.

When ready to apply add BAKING SODA to the above mixture - 1 Teaspoon per cup. Apply to cloth with brush, squeeze bottle, sponge, or any desired method.

Keep the piece covered with plastic in order to prevent and retard drying. The piece should be kept damp for at least 24 hours in order to allow the Dye to react and bond to the fibre. Then remove cover-allow to air dry completely.

When dry, proceed to heat set the piece. This is done by ironing, steaming, baking in oven at 285 F for 5 minutes or in a hot clothes dryer for 1 hour.

Wash the fabric in cold water. Then wash in very hot water using soap or detergent. Follow by a third and final rinsing. All of the excess dye should be removed. The material is machine washable. Do not use Chlorine Bleach with the ALJO COLD PROCESS DYE.

Alternative Method for Tye-Dye & Painting:

Pre-Soak material to be dyed in a solution of 1 cup of Soda Ash in 2.5 gallons of warm water for 20 minutes.

Dissolve Dye in warm water to desired concentration (omitting Urea and Baking Soda). Gel made with Gum Thickner #3056 may be used to control spreading.

Apply this concentrated "Paint" to cloth by any desired method.

Retard drying for at least 12 hours by covering with plastic. Then air dry. When completely dry, rinse in cold water. Then wash with soap in the hottest water available, 200 F is ideal.

Alfuzosin Medical Facts From, Alfuzosini

alfuzosin

What is alfuzosin?

Alfuzosin is an alpha-adrenergic (AL-fa ad-ren-ER-jik) blocker. Alfuzosin helps relax the muscles in the prostate and bladder neck, making it easier to urinate.

Alfuzosin is used to improve urination in men with benign prostatic hyperplasia (enlarged prostate).

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

What is the most important information I should know about alfuzosin?

You should not take alfuzosin if you have moderate to severe liver disease.

There are many other drugs that can interact with alfuzosin. Tell your doctor about all medications you use.

What should I discuss with my healthcare provider before taking alfuzosin?

You should not take alfuzosin if you are allergic to it, or if you have:

moderate to severe liver disease.

Some medicines can interact with alfuzosin and should not be used at the same time. Your doctor may need to change your treatment plan if you use any of the following drugs:

an antibiotic--clarithromycin, telithromycin;

antifungal medicine--itraconazole, ketoconazole, posaconazole, voriconazole;

heart medication--nicardipine, quinidine;

antiviral medicine to treat hepatitis C or HIV/AIDS--atazanavir, boceprevir, cobicistat, delavirdine, fosamprenavir, indinavir, nelfinavir, ritonavir, saquinavir, telaprevir; or

medicines similar to alfuzosin--doxazosin, prazosin, silodosin, tamsulosin, or terazosin.

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

low blood pressure, or a history of low blood pressure caused by taking medications;

a personal or family history of long QT syndrome;

heart disease, angina (chest pain), high blood pressure;

coronary artery disease (hardened arteries);

a history of prostate cancer; or

a condition for which you take a nitrate medication (such as nitroglycerin).

Alfuzosin can affect your pupils during cataract surgery. Tell your eye surgeon ahead of time that you are using this medicine.

Although alfuzosin is not for use in women, this medicine is not expected to harm an unborn baby or a nursing baby. If you are a woman and you take alfuzosin, tell your doctor if you are pregnant or breast-feeding.

Alfuzosin is not approved for use by anyone younger than 18 years old.

How should I take alfuzosin?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Alfuzosin is usually taken once daily just after a meal. Do not take alfuzosin on an empty stomach. Take the medicine at the same time each day.

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

Alfuzosin lowers blood pressure and may cause dizziness or fainting, especially when you first start taking it. You may feel very dizzy when you first wake up. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

While using alfuzosin, your blood pressure and prostate will need to be checked often.

Some things can cause your blood pressure to get too low. This includes vomiting, diarrhea, or heavy sweating. Call your doctor if you have a prolonged illness that causes diarrhea or vomiting.

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

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

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

What should I avoid while taking alfuzosin?

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Drinking alcohol with this medicine can cause side effects.

Alfuzosin side effects

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

Call your doctor at once if you have:

a light-headed feeling, like you might pass out;

new or worsening chest pain;

upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

penis erection that is painful or lasts 4 hours or longer.

Common side effects may include:

feeling tired; or

cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Alfuzosin dosing information

Usual Adult Dose for Benign Prostatic Hyperplasia:

Extended-release tablet: 10 mg orally once a day immediately after the same meal each day

What other drugs will affect alfuzosin?

Many drugs can interact with alfuzosin, and some drugs should not be used together. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with alfuzosin. Give a list of all your medicines to any healthcare provider who treats you.

More about alfuzosin

Consumer resources

Professional resources

Related treatment guides

Where can I get more information?

Your pharmacist can provide more information about alfuzosin.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. 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 drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 8.02. Revision Date: 2016-01-29, 11:29:42 AM.

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Neotetranase, Neotetranase

Common use It is is a broad-spectrum antibiotic which destroys bacteria. It is active against many aerobic (those developing in presence of oxygen) and anaerobic (those developing in absence of oxygen) gram positive and aerobic gram negative microorganisms including strains which produce beta-lactamase (the enzyme which destroys penicillin). Clavulanate potassium comprised in the content of this medication provides resistance of Augmentin to activity of bacterial beta-lactamases. This medication is used to treat pneumonia and other infectious diseases of respiratory, gastrointestinal systems, urogenital systems, infections which appear after surgery and others.

Dosage and directions Doses are administered individually depending on your condition, localization of infection and susceptibility of the pathogen. Do not take it in larger amounts or longer than recommended. Swallow the whole tablet. If it is the Augmentin Chewable tablet then chew it before swallowing. Augmentin should be taken at evenly spaced interval.

Precautions Do not use it if you are allergic to any other penicillin antibiotic, if you have liver or kidney failure or mononucleosis.

Contraindications Do not use the medicine if you have allergy to its components or another penicillin antibiotics, if you have infectious mononucleosis, a history of liver problems or yellowing of the eyes or skin caused by Augmentin.

Possible side effect Dyspepsia, abdominal discomfort, bloating, gas nausea, vomiting, liver function disorders, hepatitis, jaundice caused by stagnation of bile, vaginal itching and also symptoms of allergy (hives, rash, swelling). Cautiousness should be exercised in patients with liver failure. The medication is not recommended for pregnant (especially third trimester) and breastfeeding women.

Treatment with Augmentin and other antibiotics can change the normal bacteria flora of the colon and permit overgrowth of C. difficile, a bacteria which causes pseudomembranous colitis. Probenecid which is used to treat gout may slow excretion of Augmentin by kidneys and result in increase of its toxicity.

Missed dose If you missed a dose take it as soon as you remember, but not if it is almost time of the next intake by your schedule. If so skip the missed dose. Do not try to compensate a missed dose by taking an extra one.

Overdose If you suppose that took too much of Augmentin and experience such symptoms as nausea, vomiting, stomach pain, diarrhea, skin rash, drowsiness, and hyperactivity, seek immediate medical help.

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

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

Common use It is is a broad-spectrum antibiotic which destroys bacteria. It is active against many aerobic (those developing in presence of oxygen) and anaerobic (those developing in absence of oxygen) gram positive and aerobic gram negative microorganisms including strains which produce beta-lactamase (the enzyme which destroys penicillin). Clavulanate potassium comprised in the content of this medication provides resistance of Augmentin to activity of bacterial beta-lactamases. This medication is used to treat pneumonia and other infectious diseases of respiratory, gastrointestinal systems, urogenital systems, infections which appear after surgery and others.

Dosage and directions Doses are administered individually depending on your condition, localization of infection and susceptibility of the pathogen. Do not take it in larger amounts or longer than recommended. Swallow the whole tablet. If it is the Augmentin Chewable tablet then chew it before swallowing. Augmentin should be taken at evenly spaced interval.

Precautions Do not use it if you are allergic to any other penicillin antibiotic, if you have liver or kidney failure or mononucleosis.

Contraindications Do not use the medicine if you have allergy to its components or another penicillin antibiotics, if you have infectious mononucleosis, a history of liver problems or yellowing of the eyes or skin caused by Augmentin.

Possible side effect Dyspepsia, abdominal discomfort, bloating, gas nausea, vomiting, liver function disorders, hepatitis, jaundice caused by stagnation of bile, vaginal itching and also symptoms of allergy (hives, rash, swelling). Cautiousness should be exercised in patients with liver failure. The medication is not recommended for pregnant (especially third trimester) and breastfeeding women.

Treatment with Augmentin and other antibiotics can change the normal bacteria flora of the colon and permit overgrowth of C. difficile, a bacteria which causes pseudomembranous colitis. Probenecid which is used to treat gout may slow excretion of Augmentin by kidneys and result in increase of its toxicity.

Missed dose If you missed a dose take it as soon as you remember, but not if it is almost time of the next intake by your schedule. If so skip the missed dose. Do not try to compensate a missed dose by taking an extra one.

Overdose If you suppose that took too much of Augmentin and experience such symptoms as nausea, vomiting, stomach pain, diarrhea, skin rash, drowsiness, and hyperactivity, seek immediate medical help.

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

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

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Amoxicillin (Amoxicillin)

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DISCLAIMER: MediGuard is not intended to be a substitute for professional medical advice. MediGuard cannot and does not take into consideration every possible interaction or account for individual responses to medicine. Different individuals may respond to medication in different ways. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective, or appropriate for any given patient. Always seek the advice of a qualified health provider with any questions you may have before making any changes to your treatment. The use of the MediGuard site and its content is at your own risk. The MediGuard site and the information contained in it is intended for users in the United States and information in other countries may be different.

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This Game Is Too Hard - Chapter 1 - Octosan - Undertale (Video Game) Archive Of Our Own, Octosan

Summary:

Freak encounters and otherworldly relationships follow Frisk and her companion Flowey back into the completion of her run. Seeing what could be, all the child wants is the ending that she saw in another world, an ending where she could have friends and someone who cares. But the game she plays wasn't really designed to end happily. Was Sans right after all?

Happy or sad, she'll come to understand the purpose of all the side characters. Even the villainous ones.

A continuation of "The Many Worlds Theory Sucks". Features Underfell AU.

Notes:

(See the end of the work for notes .)

Chapter 1. They Taste Like Dust, Obviously

Chapter Text

It was quiet in the forest, since everything was muffled by the snow. The trees did their best to stifle the razorlike wind that always seemed to be blowing through Snowdin and its surrounding areas, and by the entrance to the ruins they were so thick that you might not feel it at all. Hence it was very easy to hear things from behind the door, even though it was thick stone. There was a knock, and another knock.

Inside the door it was easy to hear anything, because she was always listening for something. He usually did knock twice, anxious to make sure that she was actually there. The way it always went, she would ask who was there and get another joke. This time, she said, "You are back already?"

Because this was their second meeting in the same day.

His gruff, wheezy and city-accented voice never failed to delight her with its company, as on he talked. His voice, and an accidentally slipped up name, was really the only thing that she knew about him. She wasn't listening to all of his words, of course, and she never did, but she faded back in when it counted--when she could pick up what he said by context. ". the kid hasn't been wasting any time," he was murmuring, and she chewed the end of her pencil. "if the river-person actually takes them where they need to go, might even be less than an hour before they make it to the core."

She had never been given updates on their progress before. She had never asked him. She wondered what made this so different. Her furry lips--if they could actually be called that--parted "Are you going to keep watching them?"

He coughed, and he said, "figure that's what i should do. dunno, though."

"I see." Perhaps it was simply beginning to be too much for him. She understood that feeling. That was why she thought that he should have sent the human home, to the home that they wanted, right from the start. Why did she expect him to succeed where she had failed? "Mmm. mmm. mmmm. " Little noises that started coming from her tightly closed mouth, before she even noticed.

She chewed on the end of her pencil until there was no end. She pictured the human going through the Core, all sweaty from the heat and assaulted by monsters on all sides, as they had surely been assaulted through their entire journey. She pictured them going past the Core, right up into her husband's castle. Her eyes wide, staring without a hope of blinking, she pressed a hand over her face so that she wouldn't have to see. She hoped that they still had the pie she packed them. Did that nice young other Sans ever try some? He never did tell her what his favorite flavor was.

". What. " What did he want? What could he want?

"wanna hear a joke?" She didn't say anything, so he went on regardless, "how d'you get baby dip?"

A joke? Her eyes were still unblinking, but she mechanically answered, "I do not know. How do you get baby dip?"

From the other side of the door he snickered and said, "put a baby in a blender."

Her eyes squeezed shut when she started to laugh, pressing her hands over her mouth to try and quell it. Her laugh was embarrassingly loud, uncontrollable, more of a cackling really, and after a moment she let it go on unimpeded. She could have sworn that she heard that joke before, but she didn't know where or when and it didn't really matter. "Oh no, oh, oh no," were the only things that she said, she heard him laughing too. Put a baby in a blender.

Come to think of it, where did one get baby carrots? Baby corn? So much food was named after babies, you might think that people had an obsession with eating them. What did babies even taste like?

With her giggles subsided, though, she was better but not great. She pressed her hand the cold door. "Oh, Sans. " she found herself warbling, and his laughter stopped too. "That child is not going to make it. And yet I am not ready to see the surface again."

"th-they might make it," he stammered, but he didn't sound convinced. "n-nothin's stopped 'em so far."

"Mm. mmmmm. " Came the noises again.

This time he had no joke for her, but that was all right. He had told more than enough without her saying any back. It wouldn't be fair. But after several minutes of silence, silence except for the noises she made, he did end up saying something. "i-i-it might not be my business. b-but. "

"Yes?" She whispered, shocked by how quiet her voice was.

"w-well. you always seem so down. y-you might feel better if you left those stuffy. d-dark ruins once in a while, y'know?"

That wasn't even enough to get her polite, confused laughter. Her hand, as it dragged down the door, left pale lines from her claws and smudge marks as her palms wiped away a stream of soot. "I am sorry. I do not get it."

"i-it wasn't a joke. uh, more like-. uh, friendly advice?"

The lady stopped speaking entirely, her voice lost. Her body felt heavy and her lungs heavier, unable to breathe or see. Her staring eyes took over again, and she left that voice hanging there, out in the cold of Snowdin Forest. "Oh," she mouthed at last, but as that implied it was inaudible. Had she had this conversation before? Or was that simply how it felt to her, at this very moment? Life was full of little moments like that. Humans had a lovely phrase for it. " Deja vu ." Was that France? France was a country that ate snails. She had always wanted to go.

His voice prodded in, as it always did, with words that entered her dark world. "lady. are you still there?"

She said nothing.

". d. did you want me t'give ya more information about the kid?"

Again, nothing. She lifted her blackened hand to her face, her pure white fur blemished. She slowly began wiping her hands together, but all that achieved was getting her other giant paw smudged.

"l-listen," he said. His voice got louder, and her eyes moved back to the door. "i gotta head home. th' boss is gonna be looking for me, and he's kind of pissed at me as it is. i'll come back later. okay?"

She nodded, not remembering he couldn't see.

". uhhh. yeah. so. uh. 'bye."

Sighing, she rested her head against the door to the ruins long after he left, smoke exiting out from past her lips as she played with her own magic. It was still beyond the door now, without any soul in sight, human or monster. Lots of monsters were at home, watching their television screens in anticipation. The finale of Mettaton's TV series, the long awaited conclusion, was airing tonight.

The Ruins door to Snowdin.

Cracked open a little.

Next Chapter: Bright Lights

Notes:

Hello! Welcome all to my next fanfiction in the Bunny Fell-Fell series, which I may or may not be hastily posting the first chapter of. This time around I can't promise to stay strictly to my deadlines, since as I said before I'll be pretty busy over the next few months, but I have quite the urge to keep going. If possible, I will be updating each Saturday.

If anyone's joining in who hasn't read the first fic, you probably should go read The Many Worlds Theory Sucks, although I suppose it may not be completely necessary to. This is essentially a fanfiction about a pacifist Underfell run, but because of the events of the last fic, quite a few things will be different.

Series this work belongs to:

What Is Paradox Definition From, Paranox

paradox

A paradox is a statement or concept that contains conflicting ideas. In logic, a paradox is a statement that contradicts itself; for example, the statement "I never tell the truth" is a paradox because if the statement is true (T), it must be false (F) and if it is false (F), it must be true (T). In everyday language, a paradox is a concept that seems absurd or contradictory, yet is true. In a Windows environment, for instance, it is a paradox that when a user wants to shut down their computer, it is necessary to first click "start".

This was last updated in November 2009

Contributor(s): Robert Barrena

Related Terms

Definitions

- A T-shaped employee, in the context of human resources, is an individual that has a depth of knowledge and skills in a particular area of specialization, along with a breadth of knowledge in relate. (WhatIs. com )

- Risk management is a company's process for identifying and controlling threats to its assets, including proprietary corporate data, customers' PII and intellectual property. (SearchCompliance. com )

- Rebranding is an update of the materials and presentation used to represent a business. A company may rebrand to appear more modern or to distance itself from past issues, among other possibilities. (WhatIs. com )

Glossaries

- Terms related to business, including definitions about project management and words and phrases about human resources, finance and vertical industries.

- This WhatIs. com glossary contains terms related to Internet applications, including definitions about Software as a Service (SaaS) delivery models and words and phrases about web sites, e-commerce.

Dig Deeper

Posterior Reversible Encephalopathy Syndrome, Pres

Posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state that occurs secondary to the inability of posterior circulation to autoregulate in response to acute changes in blood pressure. Hyperperfusion with resultant disruption of the blood brain barrier results in vasogenic oedema, but not infarction, most commonly in the parieto-occipital regions.

On this page:

Terminology

PRES is also known as hypertensive encephalopathy or reversible posterior leukoencephalopathy .

The term PRES can be a misnomer as the syndrome can involve or extend beyond the posterior cerebrum. Furthermore, although most cases involve a resolution of changes with the treatment of the precipitating cause and clinical recovery some patients can progress to develop permanent cerebral injury and be left with residual neurological defects.

It should not be confused with chronic hypertensive encephalopathy. also known as hypertensive microangiopathy, which results in microhemorrhages in the basal ganglia, pons and cerebellum.

Clinical presentation

Patients present with a headache, seizures, encephalopathy and/or visual disturbance.

Pathology

Various clinical settings can precipitate the syndrome. The mechanism is not well understood but is thought to be related to the altered integrity of the blood brain barrier. Two main theories have been proposed:

high blood pressure: leads to loss of self-regulation, hyperperfusion with endothelial damage and vasogenic oedema

endothelial dysfunction: leads to vasoconstriction and hypoperfusion resulting in cerebral ischaemia and subsequent vasogenic oedema

Hypertension is not present or does not reach the upper limits to self-regulation (150-160 mmHg) in 25% of patients.

Aetiology

Radiographic features

Most commonly there is vasogenic oedema within the occipital and parietal regions (

95% of cases), perhaps relating to the posterior cerebral artery supply. The oedema is usually symmetrical. Despite being termed posterior, PRES can be found in a non-posterior distribution, mainly in watershed areas, including within the frontal, inferior temporal, cerebellar and brainstem regions 2. Both cortical and subcortical locations are affected.

There are three main imaging patterns:

holohemispheric at watershed zones

superior frontal sulcus

parieto-occipital dominance

Other uncommon patterns of PRES in <5% include: purely unilateral, or "central" (brainstem or basal ganglia lacking cortical or subcortical white matter involvement).

Parenchymal infarctions and haemorrhage are associated with PRES in respectively 10-25% and 15% of cases.

The presence of contrast enhancement, no matters the pattern or how avid, does not portend the clinical outcome.

CT

The affected regions, as outlined above, are hypoattenuating.

MRI

Signal characteristics of affected areas include:

T1: hypointense in affected regions

T1 C+ (Gd): patchy variable enhancement. It can be seen in

35% of patients, whether leptomeningeal or cortical pattern.

T2: hyperintense in affected regions

DWI: usually normal

ADC: signal increased in affected regions due to increased diffusion

GRE: may show hypointense signal in cases of haemorrhage

SWI: may show microhemorrhages in up to 50%

Differential diagnosis

General imaging differential considerations include:

References

1. Foocharoen C, Tiamkao S, Srinakarin J et-al. Reversible posterior leukoencephalopathy caused by azathioprine in systemic lupus erythematosus. J Med Assoc Thai. 2006;89 (7): 1029-32. Pubmed citation

2. Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol. 2007;28 (7): 1320-7. doi:10.3174/ajnr. A0549 - Pubmed citation

3. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008;29 (6): 1036-42. doi:10.3174/ajnr. A0928 - Pubmed citation

4. Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 2008;29 (6): 1043-9. doi:10.3174/ajnr. A0929 - Pubmed citation

5. Bartynski WS, Tan HP, Boardman JF et-al. Posterior reversible encephalopathy syndrome after solid organ transplantation. AJNR Am J Neuroradiol. 2008;29 (5): 924-30. doi:10.3174/ajnr. A0960 - Pubmed citation

6. Fugate JE, Claassen DO, Cloft HJ et-al. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin. Proc. 2010;85 (5): 427-32. doi:10.4065/mcp.2009.0590 - Free text at pubmed - Pubmed citation

7. McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, Teksam M. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007 Oct;189(4):904-12. www. ncbi. nlm. nih. gov/pubmed/17885064

8. McKinney AM, Sarikaya B, Gustafson C, Truwit CL. Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility-weighted imaging. AJNR Am J Neuroradiol. 2012 May;33(5):896-903. http://www. ncbi. nlm. nih. gov/pubmed/22241378

9. McKinney AM, Jagadeesan BD, Truwit CL. Central-variant posterior reversible encephalopathy syndrome: brainstem or basal ganglia involvement lacking cortical or subcortical cerebral edema. AJR Am J Roentgenol. 2013 Sep;201(3):631-8. http://www. ncbi. nlm. nih. gov/pubmed/23971457

10. Karia SJ, Rykken JB, McKinney ZJ, Zhang L, McKinney AM. Utility and Significance of Gadolinium-Based Contrast Enhancement in Posterior Reversible Encephalopathy Syndrome. AJNR Am J Neuroradiol. 2015 Nov 12. http://www. ncbi. nlm. nih. gov/pubmed/26564441

Article Information

Synonyms or Alternate Spellings:

Posterior reversible encephalopathy syndrome (PRES)

PRES

Hypertensive encephalopathy

RPLS

Reversible posterior leukoencephalopathy syndrome

Reversible posterior cerebral edema syndrome

Hyperperfusion encephalopathy

Occipito-parietal encephalopathy

Reversible leukoencephalopathy

Acute hypertensive encephalopathy

Reversible posterior cerebral oedema syndrome

Cases and Figures

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Imaging Differential Diagnosis

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Wysong Uretic Dry Cat Food, Uretic

Wysong Uretic Dry Cat Food

What is Wysong Uretic Dry Cat Food?

Cat owners know how difficult it can be to control urologic conditions in cats. Wysong Uretic cat food is specially formulated to be the base for a maintenance diet for cats who are prone to urologic conditions, like Urolithiasis, struvite crystals, bladder stones, feline lower urinary tract disease (FLUTD), and other similar problems. Wysong foods, including Uretic, are made in the USA at their own facilities with USDA - and FDA-approved domestically sourced ingredients, so you can feel good about what your cat is eating.

Ideal for cats who are prone to urinary tract problems, but can also be used as a maintenance diet

Helps keep urine pH balanced, which encourages a healthy urinary tract

Features food made from fresh ingredients

Prepared with healthy fats chosen to protect against free radical/oxidation degradation

Includes phytonutrients from fresh plant sources

Made in the USA from USDA and FDA-approved domestic sources

Prebiotics and probiotics for digestive health

Wysong Uretic is formulated to keep your cat's urinary tract healthy. Uretic doesn't have any excess minerals that can lead to the formation of crystals. The formula also helps maintain an acidic urine. When a cat's urine acidity (or pH) is in the correct range, crystals are less likely to form. Uretic cat food helps keep urine pH-balanced, which works against many of bladder and urinary tract problems that some cats are prone to.

Any sudden change in diet may result in digestive disturbances. Wysong Uretic is a unique formulation, and should be gradually introduced. Over a period of 15 days, mix Uretic with the present diet beginning at about 10% and then gradually increase proportions. If difficulties arise, return to a smaller percentage and try again.

Always keep fresh, pure water available. This is especially important for cats who are prone to urinary tract problems.

If you feed your cat twice per day, cut the feeding amount in half at each meal. The amount fed should be adjusted to maintain an ideal body weight. Do not overfeed, regardless of the pet's eagerness. Over consumption leading to digestive upset is the most common difficulty pets have adjusting to this highly concentrated, unique nutritional formulation.

The following amounts suggested should be decreased in proportion to the amount of supplementation with fresh whole foods, or other foods provided in addition to Wysong dry food. Additionally, factors such as stress and amount of activity may make it necessary to adjust the amount of feeding. If fed singularly on any given day, the following general instructions apply below.

Factors such as stress and amount of activity may make it necessary to adjust the amount of feeding. Most adult cats should be fed twice a day.

Wysong Uretic Dry Cat Food

Store in a cool dry place and protect from moisture.

Wysong Uretic Dry Cat Food:

Ingredients: Chicken, Chicken Meal, Fish Meal, Turkey Meal, Peas, Brown Rice, Chicken Fat (preserved with Mixed Tocopherols), Flaxseeds, Beet Pulp, Sesame Seeds, Eggs, Montmorillonite Clay, Crab Meal, Natural Chicken and Fish Flavor, Whey, Salt, Calcium Carbonate, Tomato Pomace, Calcium Propionate, Taurine, Organic Barley Grass Powder, Blueberry, Kelp, Yogurt, Citric Acid, Apple Pectin, Fish Oil, Yeast Extract, Mixed Tocopherols, Rosemary Extract, Chicory Root, Hemicellulose Extract, Yeast Culture, Carrots, Celery, Beets, Parsley, Lettuce, Watercress, Spinach, Minerals (Ferrous Sulfate, Iron Proteinate, Zinc Proteinate, Zinc Sulfate, Manganese Sulfate, Manganese Proteinate, Copper Sulfate, Copper Proteinate, Sodium Selenite, Calcium Iodate), Vitamins (Ascorbic Acid [source of Vitamin C], Niacin Supplement, Vitamin E Supplement, Vitamin A Supplement, Thiamine Mononitrate, Pyridoxine Hydrochloride [source of Vitamin B6], Calcium Pantothenate, Riboflavin Supplement, Biotin, Vitamin B12 Supplement, Vitamin D3 Supplement, Folic Acid, Menadione Sodium Bisulfite Complex [source of Vitamin K activity]), Dried Bacillus licheniformis Fermentation Product, Dried Aspergillus oryzae Fermentation Product, Dried Aspergillus niger Fermentation Product, Dried Enterococcus faecium Fermentation Product, Dried Lactobacillus casei Fermentation Product, Dried Lactobacillus acidophilus Fermentation Product, Dried Bacillus subtilis Fermentation Product, Dried Lactobacillus plantarum Fermentation Product, Dried Lactobacillus lactis Fermentation Product, Pepper.

How does this food compare to Hills Urinary and Royal Canin SO?

What are ingredients and levels?

Asked by: giselle

Wyson Uretic is formulated to keep your cat's urinary tract healthy. Uretic doesn't have any excess minerals that can lead to the formation of crystals. The formula also helps maintain an acidic urine. When a cat's urine acidity (or Ph) is in the correct range, crystals are less likely to form. Uretic cat food helps keep urine Ph-balanced, which works against many of bladder and urinary tract problems that some cats are prone to. Ingredients Chicken, Chicken Giblets, Ground Oat Groats, Fish Oil, Salt, Dried Whey, DL-Methionine, Taurine, L-Lysine, Eggs, Plums, Poultry Fat (preserved with mixed Tocopherols as a source of vitamin E), Ground Wheat, Dried Wheat Grass Powder, Dried Barley Grass Powder, Whey, Dried Yogurt, Lecithin, Citric Acid, Sage Extract, Rosemary Extract, Dried Kelp, Garlic, Black Pepper, Artichoke, Dried Bacillus subtilis Fermentation Product, Dried Enterococcus faecium Fermentation Product, Dried Lactobacillus acidophilus Fermentation Product, Dried Lactobacillus acidophilus Fermentation Product, Dried Lactobacillus lactis Fermentation Product, Yeast Culture, Dried Aspergillus oryzae Fermentation Product, Dried Aspergillus oryzae Fermentation Product, Ascorbic Acid, Zinc Protcinatc, Iron Protcinatc, Vitamin E Supplement, Niacin Supplement, Manganese Proteinate, Calcium Pantothenate, Thiamine Mononitrate, Copper Protein-ate, Pyridoxine Hydrochloride, Riboflavin Supplement, Vitamin A Acetate, Folic Acid, Biotin, Vitamin B12 Supplement, Vitamin D3 Supplement. Guaranteed Analysis Amount Crude Protein 32.00% (Min) Crude Fat 15.50% (Min) Crude Fiber 4.00% (Max) Moisture 12.00% (Max) Taurine 0.20% (Min)

Answered by: Jason/PetMed Pro

Date published: 2012-04-22

2016-09-19T06:02CST

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Valproic Acid Medlineplus Drug Information, Valproic Acid

Valproic Acid

IMPORTANT WARNING:

Valproic acid may cause serious or life threatening damage to the liver and is most likely to occur within the first 6 months of therapy. The risk of developing liver damage is greater in children who are younger than 2 years of age and are also taking more than one medication to prevent seizures, have certain inherited diseases that may prevent the body from changing food to energy normally, or any condition that affects the ability to think, learn, and understand.; Tell your doctor if you have a a certain inherited condition that affects the brain, muscles, nerves, and liver (Alpers Huttenlocher Syndrome), urea cycle disorder (an inherited condition that affects the ability to metabolize protein), or liver disease. Your doctor will probably tell you not to take valproic acid. If you notice that your seizures are more severe or happen more often or if you experience any of the following symptoms, call your doctor immediately: excessive tiredness, lack of energy, weakness, pain on the right side of your stomach, loss of appetite, nausea, vomiting. dark urine, yellowing of your skin or the whites of your eyes, or swelling of the face.

Tell your doctor if you are pregnant or plan to become pregnant. Women who are pregnant or could become pregnant should not take valproic acid to prevent migraine headaches. Pregnant women should only take valproic acid to treat seizures or bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods) if other medications have not not control their symptoms. If you can become pregnant, you should use effective birth control while taking valproic acid. Talk to your doctor about birth control methods that will work for you. If you become pregnant while taking valproic acid, call your doctor immediately. Vaproic acid can harm the fetus.

Valproic acid may cause serious or life-threatening damage to the pancreas. This may occur at any time during your treatment. If you experience any of the following symptoms, call your doctor immediately: ongoing pain that begins in the stomach area, but may spread to the back nausea, vomiting, or loss of appetite.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to valproic acid.

Talk to your doctor about the risks of taking valproic acid or of giving valproic acid to your child.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with valproic acid and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www. fda. gov/Drugs/DrugSafety/ucm085729.htm ) or the manufacturer's website to obtain the Medication Guide.

Why is this medication prescribed?

Valproic acid is used alone or with other medications to treat certain types of seizures. Valproic acid is also used to treat mania (episodes of frenzied, abnormally excited mood) in people with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). It is also used to prevent migraine headaches, but not to relieve headaches that have already begun. Valproic acid is in a class of medications called anticonvulsants. It works by increasing the amount of a certain natural substance in the brain.

How should this medicine be used?

Valproic acid comes as a capsule, an extended-release (long-acting) tablet, a delayed-release ( releases the medication in the intestine to prevent damage to the stomach) tablet, a sprinkle capsule (capsule that contains small beads of medication that can be sprinkled on food), and a syrup (liquid) to take by mouth. The syrup, capsules, delayed-release tablets, and sprinkle capsules are usually taken two or more times daily. The extended-release tablets are usually taken once a day. Take valproic acid at around the same time(s) every day. Take valproic acid with food to help prevent the medication from upsetting your stomach. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take valproic acid exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the regular capsules, delayed-release capsule, and extended-release tablets whole; do not split, chew, or crush them.

You can swallow the sprinkle capsules whole, or you can open the capsules and sprinkle the beads they contain on a teaspoonful of soft food, such as applesauce or pudding. Swallow the mixture of food and medication beads right after you prepare it. Be careful not to chew the beads. Do not store unused mixtures of food and medication.

Do not mix the syrup into any carbonated drink.

Your doctor may start you on a low dose of valproic acid and gradually increase your dose.

Valproic acid may help to control your condition but will not cure it. Continue to take valproic acid even if you feel well. Do not stop taking valproic acid without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood. If you suddenly stop taking valproic acid, you may experience a severe, long-lasting and possibly life-threatening seizure. Your doctor will probably decrease your dose gradually.

Other uses for this medicine

Valproic acid is also sometimes used to treat outbursts of aggression in children with attention deficit hyperactivity disorder (ADHD; more difficulty focusing or remaining still or quiet than other people who are the same age). Talk to your doctor about the possible risks of using this medication for your condition.

This medication is sometimes prescribed for other uses. Ask your doctor or pharmacist for more information.

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

drowsiness

dizziness

headache

diarrhea

constipation

changes in appetite

weight changes

back pain

agitation

mood swings

abnormal thinking

uncontrollable shaking of a part of the body

loss of coordination

uncontrollable movements of the eyes

blurred or double vision

ringing in the ears

hair loss

Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS section, call your doctor immediately:

unusual bruising or bleeding

tiny purple or red spots on the skin

fever

blisters or rash

bruising

hives

difficulty breathing or swallowing

confusion

tiredness

vomiting

drop in body temperature

weakness in the joints

Valproic acid may cause other side effects. Call your doctor if you have any unusual problems while 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, 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:

sleepiness

irregular heartbeat

coma (loss of consciousness for a period of time)

What other information should I know?

If you are taking the sprinkle capsules, you may notice the medication beads in your stool. This is normal and does not mean that you did not get the full dose of medication.

If you have diabetes and your doctor has told you to test your urine for ketones, tell the doctor that you are taking valproic acid. Valproic acid can cause false results on urine tests for ketones.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking valproic acid.

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

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Modani Furniture New York - 47 Photos & 93 Reviews - Home Decor - 40 E 19th St, Flatiron, New York,

Modani Furniture New York

The furniture here is nice, and in the end I'm satisfied with the floor lamp I bought here (even though I had to lug it home myself or incur… Read More

The furniture here is nice, and in the end I'm satisfied with the floor lamp I bought here (even though I had to lug it home myself or incur a $99 delivery fee).

However, the employees here are incredibly rude, dismissive and unhelpful. When you walk in, they sit like bumps on a log in front of the computer doing. Well I'm not exactly sure what. A pity that a nice store has to make such poor hires and have such bad customer service and gratitude.

I was very happy with my visit to Modani today. Very nice beds, and Gilbert was very knowledgable and helpful. He explained to me the… Read More

I was very happy with my visit to Modani today. Very nice beds, and Gilbert was very knowledgable and helpful. He explained to me the differences between the various beds and the assembly options. Great store, I will come back!

I wish if there was less than one star option. The workers are very rude and disrespectful. don't know the value of customer treatment.… Read More

I wish if there was less than one star option. The workers are very rude and disrespectful. don't know the value of customer treatment. We walked around the show room and they didn't even bother to walk with us. Stuck to their chairs and their smart phones are a bunch of grownups in their look but teenagers in their attitudes.

We were told the delivery will take place in 3 weeks and now we entering the 5th week and the sofa is still not here. What is worse, is that they don't call you in advance to let you know about the delay so that you don't have to take the day off from work. And they even get agitated when you call them asking about the delivery.

I wish if I can return everything now. Made a major mistake by choosing my furniture from Modani and hope people will find a better place to buy furniture.

Comment by Emilie P. of Modani Furniture New York:

Dear Firas, Thank you for your feedback. After receiving your comment, the store manager was immediately contacted in order to discuss the… Read More

Dear Firas, Thank you for your feedback. After receiving your comment, the store manager was immediately contacted in order to discuss the issue with the sales staff and the delivery team. As we thrive to offer our customers the best possible experience, we are terribly sorry we were not able to fulfill our goal, and remain available to make it up to you! Regards The Modani Management Team

Jessica helped me choose Bellagio dining chairs really fast as I was nervous because the parking outside is commercial only. The chairs were… Read More

Jessica helped me choose Bellagio dining chairs really fast as I was nervous because the parking outside is commercial only. The chairs were ready for pick up in two days which was faster than other furniture stores. Thank you staff at Modani for helping me!

This is an update on my initial review. After I reached out several times to their upper management team, they agreed to switch our my old… Read More

This is an update on my initial review. After I reached out several times to their upper management team, they agreed to switch our my old lumpy couch for a new one even though it was out of production. They offered to make a new couch for me. Thanks Modani

Comment by Emilie P. of Modani Furniture New York:

Good Afternoon Ashley, Thank you for letting us know about your recent experience with Modani. I apologize if our service did not meet your… Read More

Good Afternoon Ashley, Thank you for letting us know about your recent experience with Modani. I apologize if our service did not meet your expectations and appreciate taking time to share your concerns via Yelp. We have every desire to address your needs and provide the best solution available to resolve your issue. Our goal is to provide a consistently high quality products and an exemplary level of customer service. Based on the events you described, we did not meet this goal. To encourage you to shop with us again and as a tangible means of acknowledging your disappointment, despite our strict policy we would like to offer you to exchange your sofa for a brand new one in the same price range. We would greatly appreciate if you can update the review and work with us, if you allow us we will make sure your next experience with Modani will be nothing but pleasant and enjoyable. Please accept our sincere apology for any trouble or inconvenience we have caused you. We highly appreciate your feedback as it will assist us in becoming better at what we do. It's our goal to retain you as a satisfied customer and will hope to serve you again in the future. If you have any questions please do not hesitate to contact me. -- Best Regards, Gleb Gerasimovich Customer Service Manager Modani Furniture (305)438-4390 Ext 119 Gleb@modani. com

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Kishore E.

The furniture here is nice, and in the end I'm satisfied with the floor lamp I bought here (even though I had to lug it home myself or incur a $99 delivery fee).

However, the employees here are incredibly rude, dismissive and unhelpful. When you walk in, they sit like bumps on a log in front of the computer doing. Well I'm not exactly sure what. A pity that a nice store has to make such poor hires and have such bad customer service and gratitude.

Daniel G.

Antoine and Silvana were very knowledgeable about the products ans design sense. Prices are great!

Sebastian H.

I was very happy with my visit to Modani today. Very nice beds, and Gilbert was very knowledgable and helpful. He explained to me the differences between the various beds and the assembly options. Great store, I will come back!

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Accuzide ~ Pribalovy Letak, Skupina, Ucinky, Acuzide

Accuzide

Priloha c. 1 k rozhodnuti o zmene registrace sp. zn. sukls192480/2011 Pribalova informace Prectete si prosim pozorne nasledujici text pribalove informace. Obsahuje informace o tom, jak byste meli uzivat tento lek. Budete-li mit nejake dotazy, zeptejte se, prosim, sveho lekare nebo lekarnika. Informace pro pouziti, ctete pozorne! Accuzide potahovane tablety Drzitel rozhodnuti o registraci Pfizer spol. s r. o. Praha, Ceska republika Vyrobce Pfizer Manufacturing Deutchland GmbH Betriebsstatte Freiburg, Freiburg, Nemecko Slozeni leku Lecive latky: quinaprili hydrochloridum (chinapril-hydrochlorid) 10,832 mg odpovida quinaprilum (chinapril) 10 mg, hydrochlorothiazidum (hydrochlorothiazid) 12,50 mg Pomocne latky: kandelilovy vosk, kopovidon, hypromelosa, monohydrat laktosy, makrogol 400, tezky zasadity uhlicitan horecnaty, magnesium-stearat, hyprolosa, povidon 25, oxid titanicity, zluty oxid zelezity, cerveny oxid zelezity Indikacni skupina Kombinace ACE inhibitoru a diuretika, lek na snizeni vysokeho krevniho tlaku Charakteristika Pripravek Accuzide se pouziva k lecbe vysokeho krevniho tlaku. Obsahuje kombinaci dvou lecivych latek, chinaprilu a hydrochlorothiazidu. Chinapril patri do skupiny ACE inhibitoru a jeho ucinek je zalozeny na potlaceni tvorby latek podilejicich se na zvysovani krevniho tlaku v tele. Hydrochlorothiazid pusobi mocopudne a odvadi z tela prebytecnou vodu. Indikace Pripravek se uziva k lecbe vysokeho krevniho tlaku u pacientu, jejichz krevni tlak nemohl byt dostatecne snizen samotnym chinaprilem. Pripravek je urcen k lecbe dospelych pacientu. Kontraindikace Kdy nesmite uzivat pripravek Accuzide? Pripravek Accuzide nesmi uzivat pacienti s precitlivelosti na kteroukoliv slozku pripravku a pacienti s anamnezou angioedemu (nahle vznikajici ohraniceny otok kuze, sliznice a podkoznich tkani) v souvislosti s drivejsi lecbou ACE inhibitory. Pokud jste tehotna dele nez 3 mesice. (Je vsak lepe pripravek neuzivat ani na pocatku tehotenstvi – viz bod Tehotenstvi a kojeni).

Vzhledem ke slozce hydrochlorthiazidu nesmi tento pripravek uzivat pacienti se zastavou moceni nebo precitlivelosti na jine leky odvozene od sulfonamidu. Pokud se stavy uvedene v tomto odstavci u Vas vyskytnou teprve behem uzivani pripravku, informujte o tom sveho osetrujiciho lekare Na co byste meli upozornit lekare pred zahajenim lecby pripravkem Accuzide? V nasledujicim oddilu se uvadi, kdy byste meli uzivat pripravek Accuzide jenom za urcitych podminek a za zvlast pecliveho lekarskeho dohledu. Poradte se prosim se svym lekarem. Plati to i tehdy, pokud se u vas tyto okolnosti jiz nekdy v minulosti vyskytly. Zvysena opatrnost je nutna u pacientu:

s omezenou funkci ledvin nebo s vylucovanim bilkoviny v moci s poruchou obranyschopnosti organismu se dnou se sklerozou mozkovych nebo vencitych tepen cukrovkou s mirnou poruchou jaternich funkci s jakoukoliv znamkou infekce (napr. bolesti v krku, horecka) v tehotenstvi, neuzivejte pripravek Accuzide pokud jste tehotna dele nez 3 mesice. Informujte

sveho lekare, pokud se domnivate, ze jste tehotna, nebo byste mohla otehotnet. Uzivani pripravku Accuzide neni vhodne na pocatku tehotenstvi. Ve druhe a treti tretine tehotenstvi se pripravek Accuzide nesmi uzivat, protoze by mohl zpusobit zavazne poskozeni plodu – viz bod Tehotenstvi a kojeni

pri kojeni, informujte sveho lekare, pokud kojite. Pri kojeni novorozence (v prvnich tydnech po

porodu) a obzvlaste nedonoseneho ditete neni lecba pripravkem Accuzide 20 vhodna. Pokud kojite starsi dite, musi vas lekar zvazit prinos lecby a jeji mozna rizika ve srovnani s lecbou jinymi pripravky.

Na co musite dbat v tehotenstvi a v obdobi kojeni? Tehotenstvi Informujte sveho lekare, pokud se domnivate, ze jste tehotna, nebo byste mohla otehotnet. Lekar vam doporuci vysazeni pripravku Accuzide jeste drive, nez otehotnite, nebo jakmile zjistite, ze jste tehotna, a prevede vas na jinou lecbu. Uzivani pripravku Accuzide neni vhodne na pocatku tehotenstvi. Od tretiho mesice tehotenstvi se pripravek Accuzide nesmi uzivat, protoze behem druhe a treti tretiny tehotenstvi by mohl zpusobit zavazne poskozeni plodu. Kojeni Informujte sveho lekare, pokud kojite. Pri kojeni novorozence (v prvnich tydnech po porodu) a obzvlaste nedonoseneho ditete neni lecba pripravkem Accuzide vhodna. Pokud kojite starsi dite, musi vas lekar zvazit prinos lecby a jeji mozna rizika ve srovnani s lecbou jinymi pripravky. Co se musi vzit v uvahu u deti a starsich osob? Vzhledem k nedostatecnym zkusenostem s lecbou pripravkem Accuzide u deti, se jim tento lek nesmi podavat. Pacientum starsim 65 let by mela byt pred zacatkem lecby zkontrolovana funkce ledvin a pripadne snizena davka pripravku Accuzide (viz tez oddil Upozorneni). Nezadouci ucinky Jake nezadouci ucinky se mohou vyskytnout behem lecby pripravkem Accuzide?

Nejcastejsimi nezadoucimi ucinky jsou

v oblasti obehoveho systemu zavrate, pocit slabosti, rozmazane videni vznikajici v dusledku

vyrazneho poklesu krevniho tlaku. Priznaky zvysene nebo i snizene koncentrace drasliku v krvi byvaji pocit sucha v ustech, zvysena zizen, nepravidelny tep, zmeny nalady, svalove krece nebo svalove bolesti, brneni rukou, nohou nebo rtu

dychaci system: suchy drazdivy kasel, zanet prudusek, zridka dusnost nebo ryma zazivaci system: nekdy se muze vyskytnout nevolnost, bolesti v nadbrisku, zridka zvraceni,

kuze: obcas se mohou vyskytnout kozni reakce z precitlivelosti jako vyrazka, vzacne koprivka,

svedeni nebo puchyrky

nervovy system: obcas se mohou objevit bolesti hlavy, unava, ospalost, nespavost, poruchy

vrozene, familialni a geneticke vady: malformace kardiovaskularniho a centralniho nervoveho

Tyto mozne nezadouci ucinky mohou behem pokracujici lecby odeznit. Pokud pretrvavaji nebo vas obtezuji, poradte se se svym lekarem. U nekterych pacientu muze dojit i k dalsim vzacnym nezadoucim ucinkum. Pripadny vyskyt vyse uvedenych nezadoucich ucinku nebo jinych neobvyklych reakci oznamte svemu lekari. V pripade nahle snizeni ostrosti videni nebo bolesti oci je nutne ihned navstivit lekare. Neleceny stav by mohl zpusobit ztratu zraku. Interakce Jake jine leky ovlivnuji ucinek pripravku Accuzide anebo je jejich ucinek ovlivnen pripravkem Accuzide? Ucinky pripravku Accuzide a ucinky jinych soucasne uzivanych leku se mohou navzajem ovlivnovat. Vas lekar by mel byt proto informovan o vsech lecich, ktere v soucasne dobe uzivate, nebo ktere zacnete uzivat, a to na lekarsky predpis i bez nej. Nez zacnete soucasne s uzivanim pripravku Accuzide uzivat nejaky volne prodejny lek, poradte se se svym osetrujicim lekarem. Soucasne uzivani nekterych leku proti horecce a bolesti (napr. kyselina acetylsalicylova, indometacin) vede ke snizeni ucinnosti pripravku Accuzide. Soucasne uzivani pripravku Accuzide a lithia (lek uzivany v lecbe nekterych dusevnich onemocneni) muze vest k prohloubeni nezadoucich ucinku lithia. Pri soucasnem uzivani pripravku Accuzide a leku potlacujicich obranyschopnost organismu (napr. cytostatika, kortikoidy) muze dojit ke snizeni poctu bilych krvinek. Uzivani pripravku Accuzide muze ovlivnit ucinek leku proti cukrovce. Soucasne uzivani pripravku s obsahem drasliku nebo draslik setricich leku (spironolakton, amilorid, triamteren) muze vest ke zvyseni hladin drasliku v krvi. Ktere potraviny a napoje byste nemeli konzumovat? Sul snizuje ucinek pripravku Accuzide, naopak alkohol jeho ucinek prohlubuje. Dodrzujte zivotospravu doporucenou Vasim lekarem. Davkovani a zpusob podani Davka pripravku Accuzide zavisi na vasem zdravotnim stavu. Presne davkovani vzdy urci lekar. Obvykla davka pripravku je 1 potahovana tableta denne. Pri nedostatecnem ucinku muze lekar doporucit zvyseni davky az na 2 tablety denne.

Jak a kdy byste meli uzivat pripravek Accuzide? Pripravek Accuzide lze uzivat nezavisle na jidle. Tableta se uziva cela, nerozkousana rano a zapiji se primerenym mnozstvim vody. Jak dlouho byste meli uzivat pripravek Accuzide? Delku lecby urci Vas osetrujici lekar. Upozorneni pro pripad predavkovani V zavislosti na rozsahu predavkovani se mohou objevit nasledujici priznaky: zavazne snizeni krevniho tlaku, zpomalena srdecni cinnost, obehovy sok, porucha vedomi (az koma). Pri predavkovani nebo nahodnem uziti pripravku ditetem vyhledejte okamzite lekare. Co byste meli udelat zapomenete-li si vzit jednu davku? Pokracujte v uzivani pripravku Accuzide podle doporuceneho davkovaciho schematu. Co se stane, jestlize prerusite lecbu pripravkem Accuzide nebo ukoncite lecbu prilis brzy? Vas krevni tlak se muze opet zvysit. Upozorneni

Pri lecbe pripravkem Accuzide muze dojit k otoku obliceje, vicek, rtu nebo jazyka a hrdla,

coz muze vest k zavaznym dechovym obtizim. Tyto obtize se mohou vyskytnout i po podani prvni davky. Objevi-li se tyto priznaky, lek vysadte a ihned vyhledejte lekare.

pripravek Accuzide muze zpusobit nahly pokles krevniho tlaku projevujici se zavratemi a

v nekterych pripadech az mdlobou. K tomuto stavu muze dojit zejmena v prvnich nekolika dnech lecby. Objevi-li se zavrate, lehnete si na zada, dokud obtize nezmizi. O dalsim postupu se poradte se svym lekarem.

Pri lecbe pripravkem Accuzide muzete rovnez pozorovat zvysene a castejsi moceni. Tento lek muze zpusobit zvysene ztraty drasliku z vaseho organismu. Vas lekar vam proto muze

doporucit, abyste jedli a pili potraviny a napoje obsahujici draslik. Nemente svuj dietni rezim bez predchozi porady s lekarem.

Jestlize onemocnite chorobou spojenou se zvracenim, prujmem nebo horecnatym onemocnenim se

zvysenym pocenim behem lecby pripravkem Accuzide. poradte se se svym lekarem predtim nez si vezmete dalsi davku pripravku Accuzide. Zvraceni, prujem, zvysene ztraty tekutin z organismu (dehydratace) a nadmerne poceni mohou rovnez snizit vas krevni tlak.

Poradte se rovnez s lekarem, mate-li priznaky infekce (napr. bolesti v krku nebo horecku). Zpozorujete-li jakekoliv znamky neobvykleho krvaceni, ihned vyhledejte lekare. Trpite-li onemocnenim ledvin, vas lekar vam bude v prubehu lecby provadet laboratorni kontroly

Informujte sveho lekare, pokud se domnivate, ze jste tehotna, nebo byste mohla otehotnet. Uzivani

pripravku Accuzide neni vhodne na pocatku tehotenstvi. Ve druhe a treti tretine tehotenstvi se pripravek Accuzide nesmi uzivat, protoze by mohl zpusobit zavazne poskozeni plodu – viz bod Tehotenstvi a kojeni.

Informujte sveho lekare, pokud kojite. Pri kojeni novorozence (v prvnich tydnech po porodu) a

obzvlaste nedonoseneho ditete neni lecba pripravkem Accuzide vhodna. Pokud kojite starsi dite, musi vas lekar zvazit prinos lecby a jeji mozna rizika ve srovnani s lecbou jinymi pripravky.

Pacienti ve vyssim veku mohou byt zvysene citlivi na nektery z nezadoucich ucinku

vyjmenovanych vyse. Objevi-li se tyto nezadouci ucinky, je zapotrebi se ihned poradit s lekarem.

Pripravek Accuzide obsahuje monohydrat laktosy. Pokud Vam Vas lekar rekl, ze nesnasite nektere cukry, poradte se se svym lekarem, nez zacnete tento lecivy pripravek uzivat.

Na co byste meli dbat pri rizeni motorovych vozidel, praci se stroji nebo praci ve vyskach apod.? Pripravek muze zejmena na pocatku lecby, pri zvysene unave a zavrati nepriznive ovlivnit cinnost vyzadujici zvysenou pozornost, koordinaci pohybu a rychle rozhodovani (napr. rizeni motorovych vozidel, obsluha stroju, prace ve vyskach apod.). Tuto cinnost byste mel(a) vykonavat pouze na zaklade vyslovneho souhlasu vaseho lekare. Uchovavani Uchovavejte pri teplote do 25°C. Varovani Pripravek se nesmi pouzivat po uplynuti doby pouzitelnosti vyznacene na obalu! Pripravek musi byt uchovavan mimo dosah a dohled deti! Baleni 10, 30, 50 a 100 potahovanych tablet Datum posledni revize textu 22.8.2012

KVALITATIVNI A KVANTITATIVNI SLOZENI

Jedna tableta obsahuje quinaprilum 10 mg a hydrochlorothiazidum 12,5 mg. Pomocne latky: monohydrat laktosy. Uplny seznam pomocnych latek viz bod 6.1. 3.

Potahovana tableta. Popis pripravku: ruzove, elipticke, bikonvexni film. potahovane tablety s delici ryhou na obou stranach. Pulici ryha pouze usnadnuje deleni tablety pro snazsi polykani, neni urcena k deleni davky. 4.

Chinapril/HCHTZ je indikovan k lecbe hypertenze u pacientu, u nichz je vhodna kombinacni terapie chinaprilem a diuretikem. 4.2

Davkovani a zpusob podani

U pacientu, kteri v soucasne dobe nejsou leceni diuretikem, bez ohledu na to, zda byli leceni chinaprilem v monoterapii, je doporucena uvodni davka chinaprilu/HCHTZ 10/12,5 mg. Po uvodni lecbe muze byt davka zvysena na 20/12,5 mg nebo 20/25 mg. Ucinne kontroly krevniho tlaku je obvykle dosazeno davkou 10/12,5 mg az 20/12,5 mg. Davkovaci rozmezi tohoto kombinovaneho pripravku (chinapril/HCHTZ) umoznuje flexibilitu titrace jednotlivych slozek podle klinicke indikace. U pacientu, kteri jsou v soucasne dobe leceni diuretikem, je doporucena uvodni davka chinaprilu 5 mg, aby byl minimalizovan potencial pro nadmerne snizeni krevniho tlaku. Davka ma byt titrovana tak, aby bylo dosazeno pozadovane snizeni krevniho tlaku. Pokud titrace vede k davkam obdobnym jako jsou u kombinovaneho pripravku, muze byt provedena nahrada chinaprilem/HCHTZ. Uprava davkovani pri zhorsene funkci ledvin: U pacientu se zhorsenou funkci ledvin (clearance kreatininu < 60 ml/min) se nema chinapril/HCHTZ pouzivat jako uvodni lecba. U pacientu s mirnou insuficienci ledvin (clearance kreatininu 30-60 ml/min) se zahaji lecba 5 mg chinaprilu a odpovidajicim zpusobem se titruje. Pacienti, u kterych je potrebne pridani diuretika, se muze jeho davka titrovat pomoci kombinace chinapril/HCHTZ. Uvodni zahajovci davka je 10/12,5. Kontrola krevniho tlaku muze byt udrzovana obvyklymi davkami chinaprilu/HCHTZ.

Pokud je nutna soubezna lecba diuretikem u pacientu se zavaznym zhorsenim funkce ledvin (<30 ml/min), pak se pri uzivani s chinaprilem dava prednost klickovym diuretikum pred thiazidovymi. Proto chinapril/HCHTZ neni doporucovan pro pacienty se zavaznym zhorsenim funkce ledvin. Pouziti u starsich osob: Terapeuticke ucinky jsou zrejme stejne u starsich osob (?65 let) a u mladsich pacientu, kterym byly podavany stejne denni davky. U starsich pacientu nebyl pozorovan zadny vzestup nezadoucich ucinku. Pouziti u deti: Bezpecnost a ucinnost u deti nebyla stanovena. 4.3

Chinapril/HCHTZ je kontraindikovan u pacientu s precitlivelosti na kteroukoliv slozku pripravku a u pacientu s anamnezou angioedemu v souvislosti s drivejsi lecbou inhibitory ACE. Druhy a treti trimestr tehotenstvi (viz bod 4.4 a 4.6) 4.4

Zvlastni upozorneni a zvlastni opatreni pro pouziti

Angioedem hlavy a krku: Angioedem byl popsan u pacientu lecenych inhibitory angiotensin konvertujiciho enzymu, a to i u 0,1 % pacientu uzivajicich chinapril. Pokud vznikne laryngealni stridor nebo angioedem obliceje, jazyka nebo glottis, lecba chinaprilem musi byt ihned prerusena a pacient musi byt nalezite lecen v souladu s prijatymi zasadami lecebne pece a peclive sledovan do vymizeni otoku. Pokud se objevi otoky, musi byt pacient peclive pozorovan. V pripadech, kdy je otok omezen na oblicej a rty, stav obvykle odezni bez lecby a k uleve od symptomu mohou pomoci antihistaminika. Angioedem s postizenim laryngu muze byt fatalni. V pripade postizeni jazyka, glottis nebo laryngu muze dojit k obstrukci dychacich cest, a proto musi byt neprodlene zahajena akutni lecba vcetne subkutanniho podani roztoku adrenalinu 1:1000 (0,3-0,5 ml). U cernochu lecenych inhibitory ACE byl popsan vyssi vyskyt angioedemu v porovnani s pacienty jine barvy pleti. Je potrebne rovnez zminit, ze v kontrolovanych klinickych studiich mely inhibitory ACE u cernochu mensi efekt na krevni tlak nez tomu bylo u pacientu jine barvy pleti. Ve dvou velkych otevrenych klinickych studiich hodnoticich ucinnost chinaprilu v lecbe hypertenze byla vypocitana incidence angioedemu u cernochu a pacientu jine barvy pleti pri lecbe chinaprilem. V jedne studii, kde bylo hodnoceno 1656 cernosskych pacientu a 10 583 pacientu jine barvy pleti, byla incidence angioedemu bez ohledu na souvislost s lecbou chinaprilem u cernochu 0,3 % a u pacientu jine barvy pleti 0,39 %. V dalsi studii (1443 cernochu a 9300 pacientu jine barvy pleti) byla incidence angioedemu u cernochu 0,55 % a 0,17 % u pacientu jine barvy pleti. Strevni angioedem: U pacientu lecenych inhibitory ACE byl popsan strevni angioedem. Projevoval se jako bolesti bricha (s nauseou nebo bez ni ci se zvracenim). U nekterych pacientu nebyla predchozi anamneza angioedemu obliceje a hladiny C-1 esterazy byly normalni. Angioedem byl diagnostikovan pri vysetreni CT bricha nebo ultrazvukem, pripadne pri operaci a po vysazeni inhibitoru ACE symptomy odeznely. U pacientu lecenych inhibitory ACE, kteri udavaji bolesti bricha, je zapotrebi v ramci diferencialni diagnozy uvazovat i o strevnim angioedemu. Pacienti s anamnezou angioedemu, ktery nema vztah k lecbe inhibitorem ACE, mohou mit pri lecbe inhibitorem ACE vyssi riziko angioedemu. Anafylaktoidni reakce: Desenzibilizace: U pacientu uzivajicich inhibitory ACE behem desenzibilizacni terapie jedem blanokridlych se vyskytly prolongovane zivot ohrozujici anafylaktoidni reakce. U stejnych pacientu se

zabranilo vzniku techto reakci, pokud byly inhibitory ACE prechodne vysazeny, avsak opet se objevily po jejich neumyslnem nasazeni. LDL afereza: U pacientu, kteri se podrobili afereze lipoproteinu o nizke hustote pomoci absorpce dextransulfatem pri soucasne lecbe inhibitorem ACE, byly hlaseny pripady anafylaktoidni reakce. Hemodialyza: Klinicke dukazy ukazuji na to, ze pacienti na hemodialyze s pouzitim membran s vysokym prutokem (jako jsou polyakrylonitritove membrany) maji pri soucasne lecbe inhibitorem ACE s vetsi pravdepodobnosti anafylaktoidni reakce. Teto kombinace je nutne se vystrihat, a to bud pouzivanim jinych antihypertenziv nebo jine hemodialyzacni membrany. Hypotenze: Chinapril/HCHTZ muze zpusobovat symptomatickou hypotenzi, obvykle to nebyva casteji nez pri monoterapii jednotlivymi leky pripravku. U nekomplikovanych pacientu s hypertenzi lecenych chinaprilem byla vzacne pozorovana symptomaticka hypotenze. Jedna se vsak pravdepodobne o dusledek inhibice ACE u pacientu s depleci soli ci objemovou depleci, jako jsou pacienti predtim leceni diuretiky, kteri meli dietu s omezenim soli nebo pacienti na dialyze. (viz bod 4.4 Zvlastni upozorneni a zvlastni opatreni pro pouziti.) Chinapril/HCHTZ se musi pouzivat s opatrnosti u pacientu lecenych soucasne i jinymi antihypertenzivy. Thiazidova slozka pripravku s obsahem chinaprilu/HCHTZ muze potencovat ucinek jinych antihypertenziv, zejmena ganglioplegik nebo latek, ktere blokuji periferni adrenergni system. Antihypertenzni ucinky thiazidove slozky mohou byt rovnez zesileny u pacientu po sympatektomii. U pacientu s mestnavym srdecnim selhanim s pridruzenou insuficienci ledvin nebo bez ni, muze terapie hypertenze inhibitorem ACE zpusobit vyrazny pokles krevniho tlaku, ktery se muze projevovat oligurii, azotemii a ve vzacnych pripadech i akutnim selhanim ledvin a smrti. Terapie chinaprilem/HCHTZ musi byt zahajena za peclive lekarske kontroly. Tito pacienti musi byt peclive sledovani prvni dva tydny lecby a vzdy pri zvyseni davky leku. Pokud dojde k symptomaticke hypotenzi, pacient se musi polozit a v pripade nutnosti se mu poda intravenozni infuze fyziologickeho roztoku. Prechodna hypotenzni odpoved neni kontraindikaci podani dalsich davek. Pokud k takove prihode dojde, je zapotrebi zvazit podavani nizsich davek leku. Neutropenie/agranulocytoza: V souvislosti s lecbou inhibitory ACE se u pacientu s nekomplikovanou hypertenzi vzacne vyskytla agranulocytoza a deprese kostni drene, casteji vsak u pacientu se zhorsenou cinnosti ledvin, zejmena, pokud trpeli soucasne vaskularni kolagenozou. Behem lecby chinaprilem byla vzacne hlasena agranulocytoza. Tak jako u ostatnich inhibitoru ACE, ma se u pacientu s vaskularni kolagenozou a/anebo onemocnenim ledvin zvazit monitorovani bileho krevniho obrazu. Systemovy lupus erythematosus: Bylo popsano, ze thiazidova diuretika zpusobuji exacerbaci nebo aktivaci systemoveho lupus erythematosus. Fetalni/neonatalni morbidita a mortalita: (viz bod 4.6 Tehotenstvi a kojeni). Zhorsena funkce ledvin: U pacientu s tezkym onemocnenim ledvin se musi chinapril/HCHTZ pouzivat s opatrnosti. Thiazidy mohou u techto pacientu vyvolat azotemii a ucinky opakovanych davek se mohou kumulovat. Jako dusledek inhibice systemu renin-angiotensin-aldosteron lze ocekavat u citlivych osob zmeny funkce ledvin. U pacientu s tezkym srdecnim selhanim, u kterych muze funkce ledvin zaviset na aktivite systemu renin-angiotensin-aldosteron, muze lecba inhibitory ACE vcetne chinaprilu, vest k oligurii a/anebo progredujici azotemii a vzacne k akutnimu selhani ledvin a/anebo smrti (viz bod 4.8 Nezadouci ucinky).

Pri poklesu clearance kreatininu je prodlouzen polocas chinaprilatu. U pacientu s clearanci kreatininu <60 ml/min je nutna nizsi uvodni davka chinaprilu (viz bod 4.2 Davkovani a zpusob podani). Davka leku se zvysuje podle odpovedi na lecbu a musi se peclive monitorovat funkce ledvin, i kdyz uvodni studie neukazuji na to, ze by lek vedl k dalsimu zhorseni funkce ledvin. U nekterych chinaprilem lecenych pacientu s hypertenzi nebo srdecnim selhanim bez zjevneho vaskularniho onemocneni ledvin doslo zejmena pri soucasnem podavani chinaprilu s diuretikem k vzestupu dusiku mocoviny v krvi a kreatininu v seru, ktere bylo obvykle mene vyznamne a prechodne. Tyto nalezy se s vetsi pravdepodobnosti objevuji u pacientu s jiz existujicim postizenim ledvin. Muze byt zapotrebi snizeni davky leku. Vysetreni pacienta s hypertenzi musi vzdy obsahovat i vyhodnoceni funkce ledvin (viz bod 4.2 Davkovani a pusob podani). V klinickych studiich u pacientu s hypertenzi a s jednostrannou nebo oboustrannou stenozou a. renalis doslo po lecbe inhibitorem ACE u nekterych pacientu k vzestupu dusiku mocoviny v krvi a kreatininu v seru. Tento vzestup byl po vysazeni inhibitoru ACE a/anebo diuretika temer vzdy reverzibilni. U techto pacientu musi byt v prvnich nekolika tydnech lecby monitorovana funkce ledvin (viz bod 4.8 Nezadouci ucinky). Zhorsena funkce jater: U pacientu s poruchou funkce jater nebo progredujicim jaternim onemocnenim se ma chinapril/HCHTZ uzivat s opatrnosti, protoze jiz mene vyrazne alterace rovnovahy tekutin a mineralu mohou vyvolat jaterni koma. Metabolismus chinaprilu na chinaprilat je za normalnich okolnosti zavisly na jaterni esteraze. Koncentrace chinaprilatu jsou u pacientu s alkoholickou cirhozou snizeny vzhledem ke zhorsene deesterifikaci chinaprilu. Poruchy elektrolytu v seru: Vysetreni elektrolytu v seru se musi provadet v primerenych intervalech, aby byla detekovana mozna porucha elektrolytove rovnovahy. Tak jako i u ostatnich inhibitoru ACE, mohou byt u pacientu lecenych chinaprilem v monoterapii zvysene hladiny kalia v seru. V klinickych studiich se hyperkalemie (kalium v seru ?5,8 mmol/l) vyskytovala priblizne u 2 % pacientu lecenych chinaprilem. Ve vetsine pripadu byly zvysene hladiny kalia v seru izolovanymi hodnotami, ktere se upravily i pri pokracovani v lecbe. Mene nez 0,1 % pacientu ukoncila lecbu z duvodu hyperkalemie. Rizikove faktory pro rozvoj hyperkalemie jsou insuficience ledvin, diabetes mellitus a soubezne pouzivani kalium setricich diuretik, potravinovych doplnku drasliku a/anebo nahrazky soli s obsahem drasliku. Pridani kalium setriciho diuretika ke chinaprilu/HCHTZ, ktere jiz obsahuje diuretikum, se nedoporucuje. Naopak, lecba thiazidovymi diuretiky vedla k hypokalemii, hyponatremii a hypochloremicke alkaloze. Tyto poruchy se nekdy manifestuji jako jeden nebo i vice z nasledujicich priznaku: sucho v ustech, zizen, slabost, apatie, ospalost, neklid, bolesti svalu nebo svalove krece, svalova unava, hypotenze, oligurie, tachykardie, nausea, zmatenost, zachvaty a zvraceni. Hypokalemie muze rovnez zvysit citlivost nebo zvyraznit odpoved srdce na toxicke ucinky digitalisu. Riziko hypokalemie je nejvyssi u pacientu s jaterni cirhozou, u pacientu s rychlou diurezou, u pacientu s neprimerenym peroralnim prijmem elektrolytu a u pacientu se soubeznou lecbou kortikosteroidy nebo adrenokortikotropnim hormonem (ACTH). Protichudne ucinky chinaprilu a hydrochlorothiazidu na kalium v seru se u mnohych pacientu zhruba vyrovnavaji, takze se nepozoruje zadny celkovy efekt na kalium v seru. U jinych pacientu tak muze byt jeden nebo druhy efekt dominantni. Uvodni vysetreni elektrolytu v seru a jeho pravidelne opakovani s cilem urcit pripadnou poruchu elektrolytove rovnovahy musi byt provadeno ve vhodnych intervalech. Deficit chloridu, ktery je sekundarni pri terapii thiazidy, je obvykle mirny a specifickou lecbu vyzaduje pouze za mimoradnych okolnosti (napr. pri onemocneni jater nebo ledvin). V horkem pocasi se muze u pacientu s otoky rozvinout dilucni hyponatremie. Vhodnou lecbou u techto pacientu je spise omezeni vody nez podavani soli, s vyjimkou vzacnych situaci, kdy je hyponatremie zivot ohrozujici. Pri skutecne depleci soli je jeji radna nahrada lecbou volby.

Thiazidy snizuji vylucovani kalcia. U maleho poctu pacientu, kteri byli dlouhou dobu leceni thiazidy, byly pozorovany patologicke zmeny pristitnych telisek s hyperkalcemii a hypofosfatemii. Zavaznejsi komplikace hyperparathyreozy (nefrolitiaza, kostni resorpce a pepticke vredy) nebyly pozorovany. Pred vysetrenim funkce pristitnych telisek maji byt thiazidy vysazeny. Thiazidy zvysuji vylucovani magnesia moci a muze tak dojit k hypomagnesinemii (viz bod 4.4 Zvlastni upozorneni a zvlastni opatreni pro pouziti a bod 4.5 Interakce s jinymi lecivy a jine formy interakce). Dalsi metabolicke poruchy: Thiazidova diuretika maji sklon snizovat glukozovou toleranci a zvysovat serove hladiny cholesterolu, triglyceridu a kyseliny mocove. Tyto ucinky jsou obvykle mene vyznamne, avsak u vnimavych pacientu se muze objevit klinicky manifestni dna nebo zjevny diabetes. Hypoglykemie a diabetes: U pacientu s diabetem na inzulinu nebo peroralnich antidiabeticich mohou inhibitory ACE vest k hypoglykemii. U diabetiku proto muze byt potrebne peclivejsi sledovani. Kasel: Kasel byl hlasen pri uzivani inhibitoru ACE vcetne chinaprilu. Typicky je neproduktivni, pretrvavajici kasel, ktery ustoupi po vysazeni lecby. Kasel vyvolany inhibitorem ACE se ma povazovat za soucast diferencialni diagnostiky kasle. Operace/anestezie: U pacientu, kteri se podrobi vetsimu chirurgickemu vykonu nebo anestezii je zapotrebi opatrnost, protoze bylo prokazano, ze inhibitory angiotensin konvertujiciho enzymu blokuji tvorbu angiotensinu II sekundarne ke kompenzacnimu uvolnovani reninu. To muze vest k hypotenzi, kterou lze upravit zvetsenim objemu expanzi. Akutni kratkozrakost (myopie) a sekundarni glaukom s uzavrenym uhlem: Hydrochlorothiazid, patrici do skupiny sulfonamidu, muze zpusobovat idiosynkratickou reakci, vyustujici v prechodnou akutni myopii a akutni glaukom s uzavrenym uhlem. Symptomy zahrnuji akutni snizeni vizualni ostrosti nebo bolest oci a typicky se objevuji v prubehu hodin ci tydnu od nasazeni leciveho pripravku. Neleceny akutni glaukom s uzavrenym uhlem muze vest k permanentni ztrate zraku. Primarni lecbou je vysazeni hydrochlorothiazidu nejrychlejsim moznym zpusobem. Rychlou lecbu ci operativni zakrok je treba zvazit, pokud nitroocni tlak zustava zvyseny. Rizikove faktory pro rozvoj akutniho glaukomu s uzavrenym uhlem zahrnuji v minulosti prodelanou alergii na sulfonamidy ci penicilin. Informace pro pacienty Tehotenstvi: Podavani ACE inhibitoru by nemelo byt zahajeno behem tehotenstvi. S vyjimkou pacientek, pro ktere je dlohodoba lecba ACE inhibitory nezbytna, by vsechny ostatni pacientky mely byt v pripade planovaneho tehotenstvi prevedeny na jinou antihypertenzni lecbu s lepe overenou bezpecnosti pro tehotenstvi a plod. Pokud doslo k otehotneni, je treba ihned ukoncit podavani ACE inhibitoru a v pripade nutnosti dalsi lecby zahajit jinou lecbu (viz bod 4.3, 4.6). Angioedem: Angioedem, vcetne edemu laryngu, se muze vyskytnout zejmena po prvni davce chinaprilu. Pacienti maji byt pouceni, aby v pripade jakehokoliv priznaku nebo projevu pripominajiciho angioedem (tj. otok obliceje, koncetin, oci, rtu, jazyka, polykacich nebo dychacich obtizi) ihned prestali uzivat chinapril/HCHTZ a obratili se na sveho lekare. Hypotenze: Pacienti maji byt upozorneni, aby hlasili zavrate, zejmena v prvnich nekolika dnech lecby chinaprilem/HCHTZ. Pacientum ma byt vysvetleno, ze pokud se vyskytne synkopa, tak maji prestat uzivat lek do doby nez stav zkonzultuji se svym lekarem. Vsichni pacienti maji byt varovani, ze neprimereny prijem tekutin, nadmerne poceni nebo dehydratace mohou vest k vyraznemu poklesu krevniho tlaku zpusobeneho snizenim objemu tekutin. K poklesu

krevniho tlaku mohou vest i jine priciny objemove deplece, jako je zvraceni nebo prujem. Pacienti maji byt pouceni, aby tyto stavy konzultovali se svym lekarem. Operace/anestezie: Pacienti, u kterych je planovana operace a/anebo anestezie, maji byt pouceni, aby informovali lekare, ze uzivaji inhibitor ACE. Hyperkalemie: Pacienti maji byt pouceni, aby bez konzultace s lekarem neuzivali potravinove doplnky s obsahem drasliku nebo nahrady soli obsahujici draslik. Neutropenie: Pacienti maji byt pouceni, aby ihned hlasili jakoukoliv znamku infekce (napr. bolesti v krku, horecku), protoze se muze jednat o znamku neutropenie. Tento pripravek obsahuje monohydrat laktosy. Pacienti se vzacnymi dedicnymi problemy s intoleranci galaktosy, nedostatkem Lapp laktasy nebo malabsorpci glukosy a galaktosy by tento pripravek nemeli uzivat. POZN. Tak jako u mnohych jinych leku je opravnene urcite pouceni pacientu lecenych chinaprilem/HCHTZ. Informace jsou urceny k tomu, aby byl tento lek pouzivan bezpecne a ucinne. Nejedna se o uvedeni vsech moznych nezadoucich nebo zamyslenych ucinku. 4.5

Interakce s jinymi lecivymi pripravky a jine formy interakce

Tetracyklin a jine leky s interakci s magneziem: Podani tetracyklinu s chinaprilem snizilo absorpci tetracyklinu priblizne o 28 – 37 %. Snizena absorpce je zpusobena pritomnosti hydratu zasaditeho uhlicitanu horecnateho, coz je pomocna latka ve formulaci chinaprilu. K teto interakci je nutne prihlizet pri preskripci chinaprilu/HCHTZ a tetracyklinu a dalsich leku, u kterych existuje interakce s magnesiem. Lithium: Lithium obecne nema byt podavan s diuretiky. Diuretika snizuji renalni clearanci lithia a prispivaji k vysokemu riziku lithiove toxicity U pacientu uzivajicich soucasne lithium a inhibitor ACE byly hlaseny pripady zvysene hladiny lithia v seru a projevy lithiove toxicity, ktere jsou dany ztratou soli zpusobenou temito leky. Pri pouzivani chinaprilu/HCHTZ muze byt zvyseno riziko lithiove toxicity. Chinapril/HCHTZ se musi podavat s opatrnosti a doporucuje se caste monitorovani hladin lithia v seru. Jine latky: Pri pouzivani chinaprilu soucasne s propranololem, hydrochlorothiazidem, digoxinem nebo cimetidinem se nevyskytly zadne klinicky vyznamne farmakokineticke interakce. Antikoagulacni ucinek jednorazove davky warfarinu (meren pomoci protrombinoveho casu) nebyl vyznamne zmenen pri soucasnem podavani s chinaprilem 2x denne. Pri soubeznem podavani nize uvedenych leku muze dojit k jejich interakci s thiazidovymi diuretiky: Alkohol, barbituraty nebo narkotika: Muze dojit k potenciaci ortostaticke hypotenze. Antidiabetika (peroralni antidiabetika a inzulin): Muze byt potrebna uprava davkovani antidiabetik. Jina antihypertenziva: Aditivni ucinek nebo potenciace. Kortikosteroidy, ACTH: Vyraznejsi deplece elektrolytu, zejmena hypokalemie. Presoricke aminy (napr. noradrenalin): Moznost snizene odpovedi na presoricke aminy, neni vsak natolik silna, aby predem vyloucila jejich pouziti. Nedepolarizujici myorelaxancia (napr. tubokurarin): Mozna zvysena odpoved na myorelaxans.

Nesteroidni antirevmatika: U nekterych pacientu muze podavani nesteroidniho antirevmatika snizit diureticke, natriureticke a antihypertenzivni ucinky klickovych, kalium setricich a thiazidovych diuretik. Pokud se proto pouzivaji soucasne chinapril/HCHTZ a nesteroidni antirevmatika, pak musi byt pacient peclive sledovan, aby se zjistilo, zda byl dosazen pozadovany ucinek chinaprilu/HCHTZ. Latky zvysujici hladiny kalia v seru: Chinapril je inhibitor angiotensin konvertujiciho enzymu, ktery je schopen snizovat hladiny aldosteronu, coz na oplatku muze vest k retenci kalia. Proto soucasna lecba chinaprilem a potravinovymi doplnky drasliku nebo kalium setricimi diuretiky se ma pouzivat s opatrnosti a pri patricnem monitorovani hladin kalia v seru. (Viz bod 4.4 Zvlastni upozorneni a zvlastni opatreni pro pouziti.) Protoze chinapril/HCHTZ obsahuje diuretikum, pridani kalium setriciho diuretika se nedoporucuje. Iontomenicove pryskyrice: Absorpce hydrochlorothiazidu je zhorsena pri pritomnosti iontomenicovych pryskyric, jako je cholestyramin a kolestipol. Jednorazove davky pryskyric vazi hydrochlorothiazid az z 85 % a snizuji jeho absorpci z gastrointestinalniho traktu az o 43 %. 4.6

Tehotenstvi a kojeni

Tehotenstvi: ACE inhibitory: Podavani ACE inhibitoru behem prvniho trimestru tehotenstvi neni doporuceno (viz bod 4.4). Podavani ACE inhibitoru v druhem a tretim trimestru tehotenstvi je kontraindikovano (viz bod 4.3, 4.4). Epidemiologicke udaje o riziku teratogenity po podavani ACE inhibitoru behem prvniho trimestru tehotenstvi nejsou konzistetntni, a vsak mirne zvysene riziko nelze vyloucit. Pokud neni dalsi lecba ACE inhibitory pro pacientku nezbytna, mely by byt vsechny zeny, ktere planuji tehotenstvi, prevedeny na jinou antihypertenzivni lecbu s lepe overenou bezpecnosti pro tehotenstvi. Je-li zjisteno tehotenstvi, je nutno ihned ukoncit podavani ACE inhibitoru a v pripade potreby je nahradit jinou lecbou. Jsou-li ACE inhibitory podavany behem druheho a tretiho trimestru tehotenstvi, pusobi fetotoxicitu (snizeni renalnich funkci, oligohydramnion, opozdeni osifikace lebky) a nenatalni toxicitu (renalni selhani, hypotenzi, hyperkalemii). (Viz bod 5.3) Pokud doslo k expozici ACE inhibitorum po druhem trimestru tehotenstvi, doporucuje se ultrazvukove vysetreni ledvin a lebky. Deti matek, ktere uzivaly v tehotenstvi ACE inhibitory, musi byt sledovany pro moznou hypotenzi. Hydrochlorothiazid: Existuji omezene zkusenosti s podavanim hydrochlorothiazidu behem tehotenstvi, zejmena behem prvniho trimestru. Studie na zviratech neposkytuji dostatecna data. Hydrochlorothiazid prostupuje placentou. Na zaklade farmakologickeho mechanismu pusobeni hydrochlorothiazidu pri jeho uzivani behem druheho a tretiho trimestru, muze snizit fetoplacentalni perfuzi a muze zpusobit fetalni ci neonatalni nasledky jako ikterus, poruseni rovnovahy elektrolytu a trombocytopenii. Hydrochlorothiazid nesmi byt uzivan pri tehotenskych otocich, tehotenske hypertenzi nebo preeklampsii z duvodu rizika snizeneho plazmatickeho objemu a placentalni hypoperfuze, bez prospesneho ucinku na prubeh onemocneni. Hydrochorothiazid nesmi byt uzivan pri esencialni hypertenzi u tehotnych zen s vyjimkou vzacnych pripadu, kde nelze pouzit jinou lecbu. Kojeni: Chinapril: Podle omezenych farmakokinetickych udaju jsou koncentrace v materskem mlece velmi nizke (viz bod 5.2). I kdyz jsou tyto koncentrace pravdepodobne bez klinickeho vyznamu, podavani pripravku ACCUZIDE behem kojeni se nedoporucuje matkam nedonosenych deti a behem nekolika prvnich

tydnu po porodu pro nedostatek klinickych zkusenosti a pro hypoteticke riziko kardiovaskularnich a renalnich nezadoucich ucinku. U matek kojicich starsi dite lze podavani pripravku ACCUZIDE zvazovat, je-li lecba nezbytna a dite bude peclive sledovano. Hydrochlorothiazid: Hydrochlorothiazid je vylucovan v malem mnozstvi do materskeho mleka. Thiazidova diuretika ve velkych davkach, ktere vyznamne zvysuji diurezu, mohou pusobit snizeni tvorby materskeho mleka. Podavani pripravku ACCUZIDE behem kojeni se nedoporucuje. Pokud je pripravek ACCUZIDE podavan kojicim matkam, musi to byt v nejnizsich moznych davkach. 4.7

Ucinky na schopnost ridit a obsluhovat stroje

Schopnost, zabyvat se cinnostmi jako je obsluha stroju nebo rizeni motorovych vozidel, muze byt porusena, zejmena pri zahajeni lecby chinaprilem/HCHTZ. 4.8

Chinapril/HCHTZ byl hodnocen z hlediska bezpecnosti u 1571 pacientu v kontrolovanych a nekontrolovanych studiich. V klinickych studiich s chinaprilem/HCHTZ nebyly pozorovany zadne nezadouci ucinky specificke pro tuto kombinaci. Nezadouci ucinky, ktere se vyskytly, byly omezeny pouze na ty, ktere byly jiz drive hlaseny pri lecbe chinaprilem nebo hydrochlorothiazidem. V kontrolovanych studiich byly nejcastejsimi klinickymi nezadoucimi reakcemi hlasenymi u nejmene 1 % pacientu lecenych jakoukoliv kombinaci chinaprilu a hydrochlorothiazidu bolesti hlavy (6,7 %), zavrate (4,8 %) kasel (3,2 %) a unava (2,9 %) Je nutne poznamenat, ze kasel je typicky neproduktivni, pretrvavajici a odezni po vysazeni lecby. Obecne byly nezadouci ucinky z hlediska sve povahy mirne a prechodne a nebyl pozorovan zadny vztah mezi nezadoucimi ucinky a vekem, pohlavim, rasou nebo trvanim lecby (viz bod 4.4 Zvlastni upozorneni a zvlastni opatreni pro pouziti, Angioedem a Hypotenze). Ukonceni lecby pro nezadouci ucinky bylo nezbytne u priblizne 2 % pacientu. Nejcastejsim duvodem pro vysazeni byly bolesti hlavy (0,5 %), dale pak kasel a nausea a/anebo zvraceni (0,2 %). Nize jsou uvedeny nezadouci ucinky, ktere se vyskytly u ? 1 % pacientu lecenych chinaprilem/HCHTZ v kontrolovanych studiich (n = 943).

Procento pacientu v kontrolovanych studiich

Bolesti na hrudi

Nize jsou uvedeny klinicke nezadouci ucinky, ktere maji pravdepodobnou, moznou, urcitou nebo nejistou souvislost s lecbou a vyskytly se v kontrolovanych nebo nekontrolovanych klinickych studiich s chinaprilem a hydrochlorothiazidem ve frekvenci od 0,5 % do <1,0 % a mene caste prihody pozorovane v klinickych studiich a po uvedeni pripravku na trh (oznacene *) nebo pri podavani HCHTZ: Poruchy krve a lymfatickeho systemu: hemolyticka anemie*, trombocytopenie* Poruchy imunitniho systemu: anafylaktoidni reakce* Psychiatricke poruchy: nervozita Poruchy nervoveho systemu: parestesie Srdecni poruchy: palpitace, tachykardie Cevni poruchy: hypotenze, posturalni hypotenze*, synkopa* Respiracni, hrudni a mediastinalni poruchy: dyspnoe, sinusitis Gastrointestinalni poruchy: sucho v ustech nebo krku, flatulence, pancreatitis* Poruchy jater a zlucovych cest: hepatitida* Poruchy kuze a podkozi: alopecie*, erythema multiforme, exfoliativni dermatitis*, pemfigus*, reakce z fotosenzitivity*, pruritus, vyrazka (HCHTZ) Stevens Johnsonuv syndrom Poruchy pohyboveho systemu a pojivove tkane: artralgie Poruchy ledvin a mocovych cest: infekce mocoveho systemu (viz bod 4.4 Zvlastni upozorneni a opatreni pro pouziti) Poruchy reprodukcniho systemu a choroby prsu: impotence Vrozene, familialni a geneticke vady: viz bod 4.6 Tehotenstvi a kojeni Celkove a jinde nezarazene poruchy a lokalni reakce po podani: periferni otoky Chinapril byl hodnocen z hlediska bezpecnosti u 4960 osob a pacientu a byl dobre snasen. Z nich se 3203 pacientu, z toho 655 starsich osob zucastnilo kontrolovanych klinickych studii. Chinapril byl hodnocen z hlediska dlouhodobe bezpecnosti u vice nez 1400 pacientu lecenych 1 rok i dele. Klinicke laboratorni nalezy: Elektrolyty v seru: (iz bod 4.4 Zvlastni upozorneni a zvlastni opatreni pro pouziti

Kreatinin a dusik mocoviny v krvi: U pacientu lecenych chinaprilem/HCHTZ byl ve 3 % pozorovan vzestup (>1,25x nad horni hranici normalnich hodnot) hladiny kreatininu v seru a ve 4 % vzestup hladiny dusiku mocoviny v krvi (viz bod 4.4 Zvlastni upozorneni a opatreni pro pouziti). Kyselina mocova, glukoza, magnesium, cholesterol, triglyceridy, PBI, parathyreoidalni funkcni testy a kalcium (viz bod 4.4 Zvlastni upozorneni a opatreni pro pouziti). Hematologie: viz bod 4.4 Zvlastni upozorneni a opatreni pro pouziti. 4.9

Nejsou k dispozici udaje o predavkovani chinaprilem/HCHTZ u lidi. LD50 chinaprilu/HCHTZ

v kombinaci u mysi a potkanu kolisa od 1063/664 do 4640/2896 mg/kg. Nejpravdepodobnejsi klinicke manifestace by byly symptomy, ktere lze pricist predavkovani chinaprilem v monoterapii, jako je tezka hypotenze, ktera se normalne leci intravenozni infuzi fyziologickeho roztoku. Nejcastejsi priznaky a projevy pozorovane pri predavkovani HCHTZ v monoterapii jsou dany elektrolyovou depleci (hypokalemie, hypochloremie, hyponatremie) a dehydrataci zpusobene nadmernou diurezou. Pokud se podava rovnez digitalis, muze hypokalemie akcentovat srdecni arytmie. Nejsou k dispozici zadne specificke informace o lecbe predavkovanim chinaprilem/HCHTZ. Hemodialyza a peritonealni dialyza maji jen maly ucinek na eliminaci chinaprilu a chinaprilatu. Lecba je symptomaticka a podpurna v souladu se zavedenymi standardy lecebne pece. 5.

Farmakoterapeuticka skupina: antihypertenzivum ATC kod. C09B A06 Chinapril/hydrochlorothiazid je tableta s fixni kombinaci inhibitoru angiotensin konvertujiciho enzymu chinapril-hydrochloridu a diuretika hydrochlorothiazidu (HCHTZ). V klinickych studiich vedlo soucasne podavani chinaprilu a hydrochlorothiazidu k vetsimu snizeni krevniho tlaku nez jednotlive latky podavane samostatne. Soucasne podavani chinaprilu a hydrochlorothiazidu nema zadny efekt na farmakokinetiku jednotlivych leku. Vysledkem diuretickeho ucinku hydrochlorothiazidu je zvysena plazmaticka reninova aktivita (PRA), zvysena sekrece aldosteronu, snizeni hladiny kalia v seru a zvyseni ztrat kalia moci. Podani chinaprilu inhibuje osu renin-angiotrnsin-aldosteron a ma sklon ke zmirneni poklesu kalia zpusobene hydrochlorothiazidem. Mechanismus ucinku Chinapril se rychle deesterifikuje na chinaprilat (dvojkyselina chinaprilu, hlavni metabolit), ktery je ve studiich u lidi i zvirat silny inhibitor angiotensin konvertujiciho enzymu. ACE je peptidyl dipeptidaza, ktera katalyzuje premenu angiotensinu I na vasokonstrikcni angiotensin II, ktery se pomoci mnohych ruznych mechanismu zucastni vaskularni kontroly a funkce vcetne stimulace sekrece aldosteronu kurou nadledvin. Mechanismus ucinku chinaprilu u lidi i zvirat spociva v inhibici cirkulujici a tkanove

aktivity ACE, a tim snizeni vasopresoricke aktivity a sekrece aldosteronu. Odstraneni negativni zpetne vazby angiotensinu II na sekreci reninu vede ke zvysene plazmaticke reninove aktivite (PRA). I kdyz za hlavni mechanismus antihypertenzniho ucinku se povazuje ovlivneni systemu renin-angiotensin-aldosteron, chinapril vykazuje antihypertenzni ucinky i u pacientu s hypertenzi s nizkou hladinou reninu. Monoterapie chinaprilem mela antihypertenzni ucinky u pacientu vsech studovanych ras, i kdyz byla ponekud mene ucinna u cernochu (obvykle prevazne skupina s nizkou hladinou reninu) nez u pacientu s jinou barvou pleti. ACE je totozny s kininazou II, coz je enzym degradujici bradykinin, ktery ma silne vasodilatacni ucinky. Zda zvysene hladiny bradykininu hraji ulohu v terapeutickem ucinku chinaprilu, musi byt teprve objasneno. Ve studiich na zviratech antihypertenzni ucinek chinaprilu trva dele nez jeho inhibicni efekt na cirkulujici ACE, zatimco tkanova inhibice ACE koreluje tesneji s trvanim antihypertenznich ucinku. Chinapril hydrochlorid je sul chinaprilu, etylesteru nonsulfhydryloveho inhibitoru angiotensin konvertujiciho enzymu (ACE), quinalaprilatu. Podani 10-80 mg chinaprilu pacientum s mirnou az tezkou hypertenzi vede ke snizeni krevniho tlaku vsede i vestoje pri minimalnim ucinku na srdecni frekvenci. Antihypertenzni ucinnost zacina behem 1 hodiny a vrcholoveho ucinku je obvykle dosazeno za 2-4 hodiny po podani. K dosazeni maximalnich ucinku na snizeni krevniho tlaku muze byt u nekterych pacientu potrebna dvoutydenni lecba. V doporucenych davkach se u vetsiny pacientu udrzuji antihypertenzni ucinky po cely 24hodinovy davkovaci interval a pretrvava i pri dlouhodobe lecbe. Hemodynamicke vysetreni u pacientu s hypertenzi ukazalo, ze snizeni krevniho tlaku vyvolane chinaprilem je provazeno snizenim celkove periferni rezistence a renalni vaskularni rezistence pri malych nebo zadnych zmenach srdecni frekvence, srdecniho indexu, prutoku krve ledvinami, glomerularni filtrace anebo filtracni frakce. Mechanismus zakladniho antihypertenzniho ucinku diuretik neni znam. Pri chronickem podavani dochazi ke snizeni periferni vaskularni rezistence, tento jev vsak muze byt druhotny pri zmenach sodikove rovnovahy. Hydrochlorothiazid je diuretikum, ktere pusobi primo na ledviny, ktere zvysene vylucuji sodik a chloridy a s tim i prislusny objem vody. Hydrochlorothiazid rovnez zvysuje vylucovani kalia a bikarbonatu a snizuje vylucovani kalcia. Chronicka lecba hydrochlorothiazidem zvysuje PRA 2 - 6x. Po peroralnim podani hydrochlorothiazidu zacne diureza do dvou hodin, vrcholu dosahne asi za 4 hodiny a trva asi 6 – 12 hodin. Hydrochlorothiazid se vylucuje nezmenen ledvinami. Kdyz byly plazmaticke hladiny sledovany po dobu nejmene 24 hodin, bylo zjisteno, ze plazmaticky polocas kolisa mezi 4 – 15 hodinami. Nejmene 61 % peroralne podane davky se vylouci nezmeneno behem 24 hodin. Hydrochlorothiazid prostupuje placentarni barieru, avsak nikoliv hematoencefalickou barieru. Soubezna lecba thiazidovymi diuretiky ma ucinek na snizeni krevniho tlaku, ktery je vetsi nez pri podavani jednotlivych latek pripravku samostatne. 5.2

Po peroralnim podani jsou vrcholove koncentrace chinaprilu v plazme pozorovany behem 1 hodiny. Na zaklade izolace chinaprilu a jeho metabolitu v moci se rozsah jeho absorpce odhaduje na 60 %. Absorpce hydrochlorothiazidu je ponekud pomalejsi (1 – 2,5 hod.) a uplnejsi (50 - 80 %). 38 % peroralne podaneho chinaprilu je systemove dostupnych jako chinaprilat. Plazmaticky polocas chinaprilu je priblizne 1 hodina. Vrcholove plazmaticke koncentrace chinaprilatu se pozoruji priblizne za 2 hodiny po peroralni davce chinaprilu. Chinaprilat se vylucuje hlavne ledvinami a jeho efektivni

akumulacni polocas jsou priblizne 3 hodiny. Priblizne 97 % chinaprilu nebo chinaprilatu cirkulujiciho v plazme je vazano na bilkoviny. U pacientu s insuficienci ledvin se eliminacni polocas chinaprilatu zvysuje s poklesem clearance kreatininu. Farmakokineticke studie u pacientu v konecnem stadiu onemocneni ledvin, kteri jsou v chronickem dialyzacnim programu nebo na trvale ambulantni peritonealni dialyze ukazuji, ze dialyza ma jen maly ucinek na eliminaci chinaprilu a chinaprilatu. Eliminace chinaprilatu je rovnez snizena u starsich pacientu (?65 let) a dobre koreluje s jejich urovni funkce ledvin (viz bod 4.2 Davkovani a zpusob podani). Studie u potkanu ukazuji, ze chinapril a jeho metabolity neprostupuji hematoencefalickou barieru. Kojeni: U sesti kojicich zen byl po jednorazove davce 20 mg chinaprilu zjisten pomer M/P (mleko/plazma) 0,12. Za 4 hodiny po uziti davky nebyl chinapril v mlece detekovatelny. Hladiny chinaprilatu v mlece nebyly detekovatelne (<5 µg/l) po celou dobu. Plne kojene dite by v mlece prijimalo priblizne 1,6% davky chinaprilu uzite matkou v prepoctu na hmotnost ditete. Thiazidova diuretika ve velkych davkach. ktere vyznamne zvysuji diurezu, mohou pusobit snizeni tvorby materskeho mleka. Famakokinetika u starsich osob: Starsi pacienti maji zvysenou plochu pod krivkou plazmaticke koncentrace (AUC) a vrcholove hladiny chinaprilatu v porovnani s hodnotami u mladsich pacientu. To zrejme souvisi spise se snizenou funkci ledvin nez s vekem jako takovym. Z celkoveho poctu pacientu, kteri dostavali chinapril/HCHTZ v klinickych studiich, jich bylo 15 % ve veku 65 let nebo starsich a 1,5 % ve veku 75 let a vice. Nebyly pozorovany celkove rozdily v ucinnosti nebo bezpecnosti mezi temito a mladsimi pacienty. Vyssi citlivost u nekterych starsich osob vsak nelze vyloucit. 5.3

Predklinicke udaje vztahujici se k bezpecnosti

Studie na kancerogenitu, mutagenitu a studie sledujici fertilitu s chinaprilem/HCHTZ nebyly u zvirat provadeny. Ve studiich na mysich a potkanech s chinapril-hydrochloridem nebyly pri dennich davkach do 75, nebo 100 mg/kg (50-60x vyssi davky nez je maximalni denni davka u lidi) podavanych po dobu 104 tydnu pozorovany zadne kancerogenni ucinky. V Amesove testu s metabolickou aktivaci nebo bez ni neprokazal chinapril ani chinaprilat zadne mutagenni vlastnosti. Chinapril byl rovnez negativni v techto studiich geneticke toxicity: bodova mutace savcich bunek in vitro . vymena sesterskych chromatid v kulturach savcich bunek, mikronuklearni test u mysi, chromozomalni aberace s kulturou bunek plic V79 in vitro a cytogeneticka studie s kostni dreni potkanu in vivo. U potkanu nebyly zjisteny zadne nezadouci ucinky na fertilitu nebo reprodukci pri davkach az 100 mg/kg/den (60x vice nez je maximalni denni davka u lidi). U potkanu, kterym byly podavany davky chinaprilu az 300 mg/kg/den (180x vice nez je maximalni denni davka u lidi), nebyly pozorovany zadne fetotoxicke nebo teratogenni ucinky, pres toxicitu u matek pri davce 150 mg/kg/den. U potkanu lecenych v pozdnim obdobi gestace a behem laktace davkami 25 mg/kg/den nebo vyssimi bylo u potomku pozorovano snizeni telesne vahy. U kraliku nebyl chinapril teratogenni. Tak jak tomu bylo i u jinych inhibitoru ACE, u nekterych kraliku byla pozorovana toxicita u matek jiz pri davkach 0,5 mg/kg/den a embryotoxicita pri davkach 1 mg/kg/den. Hydrochlorothiazid nebyl mutagenni in vitro v Amesove mikrobialnim mutagennim testu pri maximalni koncentraci 5 mg/plotnu s pouzitim kmenu TA98 a TA100. Vzorky moce pacientu lecenych hydrochlorothiazidem nemely pri Amesove testu mutagenni aktivitu. Hydrochlorothiazid indukoval u ovarialnich bunek cinskeho krecka s metabolickou aktivaci nebo bez ni vymenu sesterskych chromatid, avsak nikoliv chromozomalni aberace. Hydrochlorothiazid ve vysokych

koncentracich indukoval mutace v bunkach mysich lymfomu. Schopnost rady leku indukovat nondisjunkci a vymenu genu mezi chromozomy byla merena s pouzitim Aspergillus nidulans . Nondisjunkci indukuje velky pocet leku, vcetne hydrochlorothiazidu. 6.

Seznam pomocnych latek

Kandelilovy vosk, kopovidon, hypromelosa, monohydrat laktosy, makrogol 400, tezky zasadity uhlicitan horecnaty, magnesium-stearat, hyprolosa, povidon 25, oxid titanicity, zluty oxid zelezity, cerveny oxid zelezity. 6.2

Neuplatnuje se. 6.3

Zvlastni opatreni pro uchovavani

Uchovavejte pri teplote do 25°C. 6.5

Druh obalu a velikost baleni

Al/Al blistr, krabicka. Velikost baleni: 10, 30, 50, 100 potahovanych tablet. 6.6

Zvlastni opatreni pro likvidaci pripravku a pro zachazeni s nim

Zadne zvlastni pozadavky 7.

DRZITEL ROZHODNUTI O REGISTRACI

Pfizer spol. s r. o. Praha, Ceska republika 8.

DATUM PRVNI REGISTRACE/ PRODLOUZENI REGISTRACE

DATUM REVIZE TEXTU

UDAJE UVADENE NA VNEJSIM OBALU Krabicka Accuzide 1.

NAZEV LECIVEHO PRIPRAVKU

Accuzide quinaprilum 10 mg / hydrochlorothiazidum 12,5 mg potahovane tablety 2.

OBSAH LECIVE LATKY/LECIVYCH LATEK

Jedna tableta obsahuje quinaprilum 10 mg a hydrochlorothiazidum 12,5 mg. 3.

SEZNAM POMOCNYCH LATEK

Pomocne latky: monohydrat laktosy. 4.

LEKOVA FORMA A OBSAH BALENI

Potahovane tablety 10, 30, 50, 100 potahovanych tablet 5.

ZPUSOB A CESTA/CESTY PODANI

Pred pouzitim si prectete pribalovou informaci. 6.

ZVLASTNI UPOZORNENI, ZE LECIVY PRIPRAVEK MUSI BYT UCHOVAVAN MIMO DOHLED A DOSAH DETI

Uchovavejte mimo dohled a dosah deti. 7.

DALSI ZVLASTNI UPOZORNENI, POKUD JE POTREBNE

Pouzitelne do: 9.

ZVLASTNI PODMINKY PRO UCHOVAVANI

Uchovavejte pri teplote do 25°C. 10. ZVLASTNI OPATRENI PRO LIKVIDACI NEPOUZITYCH LECIVYCH PRIPRAVKU

NEBO ODPADU Z NICH, POKUD JE TO VHODNE

Nepouzitelne lecivo vrate do lekarny. 11. NAZEV A ADRESA DRZITELE ROZHODNUTI O REGISTRACI Pfizer, spol. s r. o. Stroupeznickeho 17, Praha 5, Ceska republika 12. REGISTRACNI CISLO/CISLA Reg. c. 58/1079/94-C 13. CISLO SARZE C. sarze: 14. KLASIFIKACE PRO VYDEJ Vydej leciveho pripravku vazan na lekarsky predpis. 15. NAVOD K POUZITI 16. INFORMACE V BRAILLOVE PISMU Accuzide

MINIMALNI UDAJE UVADENE NA BLISTRECH NEBO STRIPECH blistr 1.

NAZEV LECIVEHO PRIPRAVKU

Accuzide quinaprilum 10 mg / hydrochlorothiazidum 12,5 mg potahovane tablety 2.

NAZEV DRZITELE ROZHODNUTI O REGISTRACI

Pouzitelne do: 4.

Loratadine 10 Mg Tablets, Zylohist

LORATADINE 10 MG TABLETS

Transcript

PACKAGE LEAFLET: INFORMATION FOR THE USER

Children under 2 years of age and/or under 30 kg of weight should not take this medicine.

Loratadine 10 mg Tablets

Take special care with Loratadine Tablets

Loratadine Read all of this leaflet carefully because it contains important information for you. This medicine is available without prescription. However, you still need to take Loratadine 10 mg tablets carefully to get the best results from it. - Keep this leaflet. You may need to read it again. - Ask your pharmacist if you need more information or advice. - You must contact a doctor if your symptoms worsen or do not improve. - If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

if you have severe liver problems

if you have been told that you have an intolerance to some sugars.

if you are due to have skin tests since Loratadine could affect the results.

If any of the above applies to you, please tell your doctor or pharmacist. 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. Laboratory tests: Antihistamines may prevent response to allergens in skin allergy testing, therefore this medicine should be stopped two days prior to such testing.

In this leaflet: 1. What Loratadine 10 mg Tablets are and what they are used for 2. Before you take Loratadine Tablets 3. How to take Loratadine Tablets

Taking Loratadine Tablets with food and drink

4. Possible side effects

This medicine may be taken with or without food.

5. How to store Loratadine Tablets Pregnancy and breast-feeding

6. Further information 1. WHAT LORATADINE 10 MG TABLETS ARE AND WHAT THEY ARE USED FOR The name of your medicine is Loratadine 10 mg Tablets. It will be referred to as Loratadine Tablets throughout this leaflet. Loratadine Tablets belong to a class of medicines known as antihistamines. Antihistamines help to reduce allergic symptoms by preventing the effects of a substance called histamine, which is produced in the body.

Ask your doctor or pharmacist for advice before taking any medicine. Pregnancy: the safe use of loratadine during pregnancy has not been established. The use of Loratadine during pregnancy is therefore not recommended. Breast feeding: loratadine, the active substance in this medicine is excreted in breast milk; therefore the use of loratadine is not recommended in breast-feeding women. Driving and using machines

Loratadine Tablets relieve symptoms associated with allergic rhinitis (for example, hay fever), such as sneezing, runny or itchy nose, and burning or itchy eyes. Loratadine tablets may also be used to help relieve symptoms of urticaria (itching, redness and number and size of hives). Relief of these symptoms lasts a full day and helps you to resume your normal daily activities and sleep.

2. BEFORE YOU TAKE LORATADINE TABLETS

At the recommended dose, Loratadine Tablets are not expected to cause you to be drowsy or less alert. However, very rarely some people experience drowsiness, which may affect their ability to drive or use machines. Please make sure you are not drowsy before performing these activities. Important information about some of the ingredients of Loratadine tablets Loratadine Tablets contain lactose (milk sugar). If you have been told by your doctor that you have intolerance to some sugars, contact your doctor before taking this medicinal product.

DO NOT TAKE Loratadine Tablets if you are allergic (hypersensitive) to Loratadine or any of the other ingredients of Loratadine Tablets. An allergic reaction can include skin rash, itching, swelling or breathing difficulties.

if you are pregnant or planning to become pregnant

if you are breast-feeding currently. Loratadine 10 mg Tablets Loratadine

Loratadine 10 mg Tablets Loratadine

PACKAGING DEVELOPMENT Product Name. Loratadine 10mg Tab. (PIL) Cordinator. P

Item Code. XXXXX Artist. A

Date. 01-11-12 (06-11-12) Software. Illustrator CS5

Fonts. Convert to curve Colours : BLUE WOOL TEST VALUE 5-8 (LIGHT FASTENING DATA)

Supersedes / Reference Tuck flap: __ mm

Side / Collar flap overlap: yes / no

Material. 54 GSM JK Maplitho Paper.

Actual Size. 160 x 310mm

Size after Folding. 40 x 20mm

Print repeat length : Grain Direction. Perpendicular to Crease / Perpendicular to Pasting Flap / Parallel to length Reference / Instructions / Remark / Braille Text Embossing: Path. F:a/P/STD Che/Selariz Loratadine Std Che Cipla (EU) Ltd/Loratadine 10mg Tab. P Std Che Cipla (EU) Ltd (PIL).ai Checked by

Pharma Code / 2D Code Barcode Code Artwork

3. HOW TO TAKE LORATADINE TABLETS Always take Loratadine exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure. Try to get into the habit of taking your medicine at the same time every day. This will make it easier for you to remember. The usual dose is Age

Adults and children over 12 years of age

10 mg once daily (swallow one tablet daily with water)

Children aged 2 to 12 years and weighing over 30 kg

10 mg once daily (swallow one tablet daily with water)

Children who are aged over 2 years old but do not weigh more than 30 kg

Should not take this medicine

Children under 2 years of age

Should not take this medicine

Patients with severe liver problems

Your doctor may prescribe a different dose for patients with severe liver problems

If you take more Loratadine Tablets than you should If you may have taken more Loratadine than you should, talk to your doctor or pharmacist immediately. Overdose may cause sleepiness or a faster heart beat. Immediate medical attention should be sought in the event of an overdose; take your tablets along to show to your doctor, if possible.

However, check with your doctor if they continue or are bothersome: - nausea (feeling sick) - fatigue - headache - nervousness - dryness of the mouth, nose and throat - hair loss In addition, other side effects that have been reported when taking Loratadine Tablets are: - dizziness - rapid heartbeat - palpitation (awareness of heartbeat/racing) - irritation of the stomach lining (gastritis) - increased appetite - insomnia - skin rashes - abnormal liver function. If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist. 5. HOW TO STORE LORATADINE TABLETS Keep your tablets out of the reach and sight of children. - Do not take Loratadine Tablets after the expiry date which is stated on the carton after “Exp”. The expiry date refers to the last day of that month. - Store in the original package. - 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. FURTHER INFORMATION

If you have forgotten to take your tablet, take it as soon as you remember and continue as usual. Do not take a double dose to make up for a forgotten dose. If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. POSSIBLE SIDE EFFECTS Like all medicines, Loratadine can cause side effects, although not everybody gets them. You must stop taking Loratadine Tablets immediately and consult your doctor if you develop any allergic reaction to this medicine. This can consist of - skin rash or eruptions (including inside the mouth) - itching - swelling of the face, tongue, lips, hands, feet - breathing difficulties Other side effects - The following side effects have been reported rarely with loratadine use. They are generally non serious and may go away on their own.

What Loratadine Tablets contain - The active substance is Loratadine 10 mg. - The other ingredients are lactose monohydrate, colloidal anhydrous silica, croscarmellose sodium, talc and magnesium stearate . What Loratadine Tablets look like and contents of the pack Loratadine Tablets are white coloured, circular, flat beveled uncoated tablets, with central breakline on one side and ‘L’ on other side. Loratadine Tablets are available in blister strips in pack size of 30 tablets. Marketing Authorisation Holder Cipla (EU) Limited, Hillbrow House, Hillbrow Road, Esher, Surrey, KT10 9NW. Manufacturer: APC Pharmaceuticals & Chemicals (Europe) Ltd., 9th floor, C. P. House, 97-107 Uxbridge Road, Ealing, London. W5 5TL Distributed By: APC Pharmaceuticals & Chemicals (Europe) Ltd., 9th floor, C. P. House, 97-107 Uxbridge Road, Ealing, London, W5 5TL This leaflet was last revised in 10/2012.

If you forget to take Loratadine Tablets

Source: Medicines and Healthcare Products Regulatory Agency

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

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Biortan (Cozaar) Description

Biortan is a perfect remedy, which helps to fight against the symptoms of high blood pressure and to reduce the risk of stroke in people with hypertension.

Its target is to treat kidney problems in people with type 2 diabetes.

Biortan is also known as Losartan potassium, Cosart, Los-Po.

Biortan acts by preventing the hormone angiotensin II from constricting the blood vessels, which tends to raise blood pressure. It is angiotensin II receptor antagonists.

Generic name of Biortan is Losartan Potassium.

Brand name of Biortan is Biortan.

Biortan (Cozaar) Dosage

Biortan is available in:

25mg Low Dosage

50mg Standard Dosage

100mg Increased Dosage

Take Biortan tablets orally with or without food.

Do not crush or chew it.

Take Biortan once or twice a day at the same time.

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

Biortan (Cozaar) 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.

Biortan (Cozaar) Overdose

If you overdose Biortan and you don't feel good you should visit your doctor or health care provider immediately. Symptoms of Biortan overdosage: fainting, feeling lightheaded, rapid heartbeat.

Biortan (Cozaar) 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.

Biortan (Cozaar) Side effects

Biortan has its side effects. The most common are:

Less common but more serious side effects during taking Biortan:

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

huskiness

fainting

difficulty with swallowing

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

Biortan (Cozaar) Contra-indications

Do not take Biortan if you are allergic to Biortan components.

Do not take Biortan if you're pregnant or you plan to have a baby, or you are a nursing mother. Biortan can harm your baby.

Do not use Biortan if you are taking salt substitutes or potassium supplements, other blood pressure medicine, diuretic (water pill).

It can be dangerous to use Biortan if you suffer from or have a history of liver disease, kidney disease, heart failure.

If you want to achieve most effective results without any side effects it is better to avoid alcohol.

Avoid machine driving.

Do not stop taking Biortan suddenly.

Biortan (Cozaar) Frequently asked questions

Q: What is the important Biortan information should I know?

A: Biortan is an effective medication which helps to fight with the symptoms of high blood pressure and to reduce the risk of stroke in people with hypertension. It is used in the treatment of kidney problems in people with type 2 diabetes. Do not use Biortan if you are taking salt substitutes or potassium supplements, other blood pressure medicine, diuretic (water pill). Do not stop taking it suddenly. Avoid alcohol and machine driving. Do not take Biortan in case of allergy to this medicine or to its components. Do not use Biortan while you are pregnant or have nurseling. It can be dangerous to use Biortan if you suffer from or have a history of liver disease, kidney disease, heart failure.

Q: What are Biortan side effects?

A: Biortan has its common side effects such as sore throat, lightheadedness, runny nose. But in case of rejection of Biortan ingredients you can experience more serious side effects: huskiness, fainting, allergic symptoms (difficulties with breathing, throat closing, swelling, rash, hives), difficulty with swallowing. Possibility of side effects appearing depends on health status and, of course, on your right following Biortan prescriptions.

Q: What are generic and brand names of Biortan?

A: Generic name of Biortan is Losartan Potassium. Brand name of Biortan is Biortan.

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Sinequan (Doxepin) Side Effects, Interactions, Warning, Dosage & Uses, Doxicin

Suicidality and Antidepressant Drugs

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

DRUG DESCRIPTION

SINEQUAN® (doxepin hydrochloride) is one of a class of psychotherapeutic agents known as dibenzoxepin tricyclic compounds. The molecular formula of the compound is C19H21NO•HCl having a molecular weight of 316. It is a white crystalline solid readily soluble in water, lower alcohols and chloroform .

Inert ingredients for the capsule formulations are: hard gelatin capsules (which may contain Blue 1, Red 3, Red 40, Yellow 10, and other inert ingredients); magnesium stearate; sodium lauryl sulfate; starch.

Inert ingredients for the oral concentrate formulation are: glycerin; methylparaben; peppermint oil; propylparaben; water.

Chemistry

SINEQUAN (doxepin HCl) is a dibenzoxepin derivative and is the first of a family of tricyclic psychotherapeutic agents. Specifically, it is an isomeric mixture of: 1-Propanamine, 3-dibenz[b, e]oxepin-11(6H)ylidene-N, N-dimethyl-, hydrochloride.

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North Carolina Folklife Institute

Scenes from the 1976 Statewide Folklife Festival

Fall 2015 marks a season of exciting new beginnings for NC Folk. We’ve been around for the past 41 years, from putting on North Carolina’s first statewide folk festival in 1974, to working behind the scenes to support folklife programs of the NC Arts Council, to working statewide from our Durham offices.

But much of our work has always been “in the field”: working in cooperation with members of communities all across the state to document their traditions, helping equip them with the tools and skills to carry out projects of their own, and partnering with people, organizations, and localities in North Carolina to tap into folklife’s great potential as a tool for community development.

To maximize our resources and energies, NC Folk has moved out of our Durham office.

For many years we managed the folklife archives for the North Carolina Arts Council, to ensure that the public (especially communities documented in the archives) could have easy access to these materials. We are delighted that, through a three-way collaboration, these archives now have a great new home at the State Archives in Raleigh. Over the last two years NC Folk staff and interns have worked hard to digitize much of our contributions to the archive, so we’ll continue to have ready access to the rich products of our four decades of documentation. And of course, now our documentation is native digital, and continues to be archived and catalogued, with the goal of making as much as possible available online.

Meanwhile, our work has kept us out of the office more and more of the time. In just the past month members of our staff have been to Clinton, Cullowhee, Lexington, and Pembroke! We find that most people connect with us online — through our enormously popular monthly newsletter, on Facebook or other social media, or via our website.

For these reasons, we’ve decided to convert to a largely virtual office. We’re excited about shifting money from rent and other overhead into more robust service options, more online access to archival materials, and more online publications that share our research.

To make this ambitious plan a reality, we have also reconfigured our staff team. Evan Hatch joins our team as Director of Programs and Development. A very accomplished folklorist, Evan served for more than a decade as Director of Folk and Traditional Arts Programming for the Arts Center of Cannon County in Woodbury, Tennessee. There he designed and implemented a progressive, award-winning folk arts program that provided a national model for similar organizations. But he is a North Carolina native, and we are delighted to have helped woo him home.

Joy Salyers continues as Executive Director. You’ll find that, while NC Folk’s physical footprint has become smaller, our staff and overall organizational capacity have grown, further increasing our ability to carry out great work across the state. We’ll now primarily be working remotely and from the field, offering even more community trainings, site visits and consultations, and documentary fieldwork, as well as boosting our web and social media presence. Keep an eye out for us online and on the road! We’re thrilled about the future.

The North Carolina Folklife Institute is a 501(c)3 nonprofit organization. Donations can be made online or by check: PO Box 61222, Durham, NC 27715.

North Carolina Folklife Institute

Scenes from the 1976 Statewide Folklife Festival

Fall 2015 marks a season of exciting new beginnings for NC Folk. We’ve been around for the past 41 years, from putting on North Carolina’s first statewide folk festival in 1974, to working behind the scenes to support folklife programs of the NC Arts Council, to working statewide from our Durham offices.

But much of our work has always been “in the field”: working in cooperation with members of communities all across the state to document their traditions, helping equip them with the tools and skills to carry out projects of their own, and partnering with people, organizations, and localities in North Carolina to tap into folklife’s great potential as a tool for community development.

To maximize our resources and energies, NC Folk has moved out of our Durham office.

For many years we managed the folklife archives for the North Carolina Arts Council, to ensure that the public (especially communities documented in the archives) could have easy access to these materials. We are delighted that, through a three-way collaboration, these archives now have a great new home at the State Archives in Raleigh. Over the last two years NC Folk staff and interns have worked hard to digitize much of our contributions to the archive, so we’ll continue to have ready access to the rich products of our four decades of documentation. And of course, now our documentation is native digital, and continues to be archived and catalogued, with the goal of making as much as possible available online.

Meanwhile, our work has kept us out of the office more and more of the time. In just the past month members of our staff have been to Clinton, Cullowhee, Lexington, and Pembroke! We find that most people connect with us online — through our enormously popular monthly newsletter, on Facebook or other social media, or via our website.

For these reasons, we’ve decided to convert to a largely virtual office. We’re excited about shifting money from rent and other overhead into more robust service options, more online access to archival materials, and more online publications that share our research.

To make this ambitious plan a reality, we have also reconfigured our staff team. Evan Hatch joins our team as Director of Programs and Development. A very accomplished folklorist, Evan served for more than a decade as Director of Folk and Traditional Arts Programming for the Arts Center of Cannon County in Woodbury, Tennessee. There he designed and implemented a progressive, award-winning folk arts program that provided a national model for similar organizations. But he is a North Carolina native, and we are delighted to have helped woo him home.

Joy Salyers continues as Executive Director. You’ll find that, while NC Folk’s physical footprint has become smaller, our staff and overall organizational capacity have grown, further increasing our ability to carry out great work across the state. We’ll now primarily be working remotely and from the field, offering even more community trainings, site visits and consultations, and documentary fieldwork, as well as boosting our web and social media presence. Keep an eye out for us online and on the road! We’re thrilled about the future.

The North Carolina Folklife Institute is a 501(c)3 nonprofit organization. Donations can be made online or by check: PO Box 61222, Durham, NC 27715.

Facetix, Facetix

What is this medicine?

ESCITALOPRAM is used to treat depression and certain types of anxiety.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions: bipolar disorder or a family history of bipolar disorder diabetes heart disease kidney or liver disease receiving electroconvulsive therapy seizures (convulsions) suicidal thoughts, plans, or attempt by you or a family member an unusual or allergic reaction to escitalopram, the related drug citalopram, other medicines, foods, dyes, or preservatives pregnant or trying to become pregnant breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. You can take it with or without food. If it upsets your stomach, take it with food. Take your medicine at regular intervals. Do not take it more often than directed. Do not stop taking except on your doctor's advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine, contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following: certain diet drugs like dexfenfluramine, fenfluramine, phentermine, sibutramine cisapride citalopram medicines called MAO Inhibitors like Nardil, Parnate, Marplan, Eldepryl nefazodone phenothiazines like chlorpromazine, mesoridazine, prochlorperazine, thioridazine procarbazine St. John's Wort venlafaxine

This medicine may also interact with the following: amphetamine or dextroamphetamine aspirin and aspirin-like drugs carbamazepine cimetidine ketoconazole linezolid medicines for depression, anxiety, or psychotic disturbances medicines that treat or prevent blood clots like warfarin, enoxaparin, and dalteparin medicines that treat HIV infection or AIDS medicines for migraine headache like almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan medicines used to treat tuberculosis like isoniazid, rifabutin, rifampin, rifapentine metoclopramide NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen pentazocine tryptophan

This list may not describe all possible interactions. Give your health care providers a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular checks on your progress. Continue taking your tablets even if you do not feel better right away. It can take 1 to 2 weeks or longer before you start to feel the effects of this medicine.

Patients and their families should watch out for worsening depression or thoughts of suicide. Also watch out for sudden or severe changes in feelings such as feeling anxious, agitated, panicky, irritable, hostile, aggressive, impulsive, severely restless, overly excited and hyperactive, or not being able to sleep. If this happens, especially at the beginning of treatment or after a change in dose, call your health care professional.

If you have been taking this medicine regularly for some time, do not stop taking it suddenly. You must gradually reduce the dose, or your symptoms may get worse. Ask your doctor or health care professional for advice.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medicine. Avoid alcoholic drinks.

Do not treat yourself for coughs, colds, or allergies without asking your doctor or health care professional for advice. Some ingredients can increase possible side effects.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water may help. Contact your doctor if the problem does not go away or is severe.

What side effects may I notice from this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible are: allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue confusion feeling faint or lightheaded, falls fast talking and excited feelings or actions that are out of control hallucination, loss of contact with reality seizures suicidal thoughts or other mood changes unusual bleeding or bruising

Side effects that do not require medical attention usually (report to your doctor or health care professional if they continue or are bothersome): blurred vision changes in appetite change in sex drive or performance headache increased sweating nausea

This list may not describe all possible side effects.

Where should I keep my medicine?

Keep out of reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

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FACETIX

AntiandrogпїЅnico para el tratamiento de las manifestaciones andrпїЅgenas de la mujer.

ComposiciпїЅn.

Cada gragea de FACETIX contiene acetato de ciproterona 2 mg y etinilestradiol 0.035 mg, excipientes, c. s.

Propiedades.

Mecanismo de acciпїЅn: El acetato de ciproterona (ACP) ejerce su mecanismo de acciпїЅn en aquellos пїЅrganos blancos de los andrпїЅgenos, especialmente antagonizando receptores androgпїЅnicos. El etinilestradiol es un derivado semisintпїЅtico del estrпїЅgeno natural estradiol que actпїЅa por vпїЅa oral por contener el grupo etinilo en el carbono 17, el cual le confiere la capacidad de resistir a la inactivaciпїЅn. El etinilestradiol actпїЅa inhibiendo la ovulaciпїЅn, la maduraciпїЅn folicular e inhibe el desarrollo y la actividad de las glпїЅndulas sebпїЅceas y del folпїЅculo piloso al bloquear la hormona luteinizante. Si el hirsutismo es de apariciпїЅn reciente o se ha intensificado considerablemente en los пїЅltimos tiempos, debe hacerse una valoraciпїЅn sobre las causas. Durante el tratamiento se inhibe la ovulaciпїЅn, impidiendo asпїЅ una posible concepciпїЅn. Por lo tanto, no es necesario el uso simultпїЅneo de anticonceptivos hormonales o de otro tipo.

Indicaciones.

FACETIX es un antiandrпїЅgeno para el tratamiento de algunas manifestaciones de androgenizaciпїЅn en la mujer como el acnпїЅ, en sus formas mпїЅs acentuadas y en la seborrea, inflamaciпїЅn o formaciпїЅn de nпїЅdulos (acnпїЅ papulopustulosa); alopecia androgпїЅnica y casos leves de hirsutismo. FACETIX no estпїЅ indicado en pacientes de sexo masculino.

DosificaciпїЅn.

El tratamiento con FACETIX debe iniciarse el primer dпїЅa de ciclo y tomarse 1 gragea durante 21 dпїЅas consecutivos, hasta acabar el envase, luego se intercala una pausa de 7 dпїЅas durante la cual se produce una hemorragia semejante a la menstrual. Si falta la regla es preciso excluir la existencia de un embarazo antes de comenzar con el envase siguiente. Luego de la semana de descanso se iniciarпїЅ un nuevo ciclo de tratamiento.

Contraindicaciones.

Embarazo, lactancia, trastornos graves de la funciпїЅn hepпїЅtica, sпїЅndrome de Dubin-Johnson, sпїЅndrome de Rotor, tromboembolia, trombosis, trastornos de coagulaciпїЅn, hipertensiпїЅn arterial, carcinoma de mama o del endometrio, diabetes, antecedentes de alteraciпїЅn del metabolismo de los lпїЅpidos, ictericia, herpes, tumores malignos. No estпїЅ indicado en pacientes del sexo masculino. Causas para suspender el tratamiento: El tratamiento con FACETIX debe suspenderse si la paciente reporta por primera vez cefaleas tipo jaqueca o cefaleas no habituales, trastornos repentinos de la visiпїЅn, audiciпїЅn, igualmente, signos iniciales de tromboflebitis o tromboembolias, sensaciпїЅn de dolor o de constricciпїЅn en el tпїЅrax, cirugпїЅas e inmovilidad forzosa.

Reacciones adversas.

FACETIX es bien tolerado. Ocasionalmente puede presentar cefaleas, molestias gпїЅstricas, nпїЅuseas, tensiпїЅn mamaria, hemorragias intermedias, variaciпїЅn del peso, modificaciones de la libido, estados depresivos, cloasma.

Interacciones.

La eficacia de FACETIX puede afectarse por la administraciпїЅn simultпїЅnea de otros medicamentos como barbitпїЅricos, hidantoпїЅnas, rifampicina, fenilbutazona, ampicilina.

PresentaciпїЅn.

FACETIX estпїЅ disponible en caja que contiene un estuche cosmпїЅtico con 21 unidades (Reg. San. INVIMA M-013288).

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2. vt ( technique, invention ) → essere l'ideatore/trice di

pioneer

1. a person who goes to a new, often uninhabited or uncivilized (part of a) country to live and work there. The American pioneers; ( also adjective ) a pioneer family. pionier ?????? ???????? ??????? ??????? пръв заселник pioneiro pionyr(sky) der/die Pionier(in), Pionier-. pioner; pioner - ????????? pionero asunik ????? ????? uudisasukas pionnier ???? ????????, ??-???????? pionir, krocitelj novih putova uttoro pionir landnemi pioniere ??? ??? pionierius pionieris, celmlauzis peneroka pionier pioner. nybygger pionier ???????????? ????????? ?????? ????????? pioneiro pio­nier первопроходец, пионер pionier; pioniersky pionir pionir pionjar ?????????? oncu ??? піонер; перший поселенець ????? ???????? ngu?i khai hoang ???

2. a person who is the first to study some new subject, or use or develop a new technique etc . Joseph Lister was one of the pioneers of modern medicine; The Wright brothers were the pioneers of aeroplane flight. pionier ??????? ?? ???????? пионер pioneiro prukopnik der/die Pionier(in) pioner; foregangsmand ?????????? pionero. precursor. iniciador teerajaja ?????? tienraivaaja pionnier. iere. precurseur ????? ??? ??? ?????? ?? ??? ???? ???? uvoditelj, predvodnik uttoro pelopor frumherji pioniere. precursore ??? ???, ??? pradininkas celmlauzis perintis pionier pioner. banebryter pionier ?????? pioneiro pionier, precursor новатор priekopnik zacetnik pionir pionjar, banbrytare, foregangsman ?????????? oncu ?? першовідкривач; новатор ???? ngu?i tien phong ??

to be the first to do or make. Who pioneered the use of vaccine for preventing polio? die weg baan ????? ????? ??? ????? ????????? проправям път за ser o pioneiro de probojovavat den Weg bahnen v?re pioner inden for ??????. ????????????????, ????????????? promover. echar los cimientos de, sentar las bases de teed rajama ??? ??? ???? olla uranuurtaja lancer. ouvrir la voie ??????? ????? ??????? ???? predvoditi, uvoditi uttoro munkat vegez memelopori vera brautry?jandi fare da pioniere ???? ???? ?? buti pradininku, skinti kelia but celmlauzim, but pirmajam mempelopori als eerste doen v?re banebrytende zapoczatkowac. torowac droge ????? ????? ????? ????????????????????? ser o pioneiro de a face/a folosi pentru prima oara быть первопроходцем, инициатором razit cestu (comu) utreti pot utrti put vara pionjar, bana vag [for] ??????? onculuk etmek ?? прокладати шлях, бути піонером ??? ?? ????? ????? di tien phong ??

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Our instructors were oddly assorted; wandering pioneer school-teachers, stranded ministers of the Gospel, a few enthusiastic young men just out of graduate schools.

Six hours later, when the shadow of Devil's Spur had crossed the river, and spread a slight coolness over the flat beyond, the Pioneer coach, leaving the summit, began also to bathe its heated bulk in the long shadows of the descent.

For many years past the whale-ship has been the pioneer in ferreting out the remotest and least known parts of the earth.

Therefore, though I am but ill qualified for a pioneer. in the application of these two semi-sciences to the whale, I will do my endeavor.

To the Anglo-Saxon race has been intrusted the destinies of the world, during its pioneer period of struggle and conflict.

He is the Great Western Pioneer whom the nations follow.

There was nothing in the books about that lovely region; it had been neglected by the tourist, it was virgin soil for the literary pioneer .

Thus relieved of a grievous load, I from that hour set to work afresh, resolved to pioneer my way through every difficulty: I toiled hard, and my success was proportionate to my efforts; my memory, not naturally tenacious, improved with practice; exercise sharpened my wits; in a few weeks I was promoted to a higher class; in less than two months I was allowed to commence French and drawing.

I longed to explore the country before me, and, like the pioneer stock from which I sprang, to view what the landscape beyond the encircling hills might disclose from the summits which shut out my view.

Straggling upon the outskirts were the thatched huts of natives, picturesque in their primeval savagery, harmonizing with the background of tropical jungle and accentuating the squalid hideousness of the white man's pioneer architecture.

What other hardier pioneer would come, hatchet in hand, to cut down the dark copses?

Durant, vice-president of the road, stopped at this point; cheers were given, the Sioux and Pawnees performed an imitation Indian battle, fireworks were let off, and the first number of the Railway Pioneer was printed by a press brought on the train.

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Lasilacton Capsules, Lasilactone

LASILACTON CAPSULES

Transcript

Lasilactone Capsules / Lasilacton Capsules Patient Information Leaflet In particular, tell your doctor if you are taking any of the following: Read all of this leaflet carefully before you start taking this medicine * Keep this leaflet. You may need to read it again * If you have any further questions, ask your doctor or pharmacist * This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours * If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist Your medicine is called Lasilactone Capsules / Lasilacton Capsules but will be called Lasilactone throughout this leaflet. In this leaflet: 1

What Lasilactone is and what they are used for

Before you take Lasilactone

How to take Lasilactone

Possible side effects

How to store Lasilactone

What Lasilactone is and what is it used for

Lasilactone contains two different medicines called: furosemide and spironolactone. Both belong to a group of medicines called diuretics (water tablets). Lasilactone can be used to stop the build up of extra water in your body. This extra water can cause swollen ankles, shortness of breath and feeling more tired than usual. Lasilactone works by helping you to pass more water (urine) than you usually do. If the extra water in your body is not removed, it can put extra strain on the heart, blood vessels, lungs, kidneys or liver.

Before you take Lasilactone

Do not take this medicine and tell your doctor if: * You are allergic (hypersensitive) to furosemide, spironolactone or any of the other ingredients of Lasilactone (listed in Section 6 below) Signs of an allergic reaction include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue * You are allergic to sulphonamides such as sulfadiazine or co-trimoxazole * You have severe problems with your kidneys * You have severe liver problems * Your doctor has told you that you have a low blood volume or are dehydrated. * You are not passing any water (urine) * You have too much or too little potassium or sodium in your blood (shown in blood tests) * You have an illness called ‘Addison's Disease’. This can make you feel tired and weak * You are breast-feeding (see “Pregnancy and breast-feeding” section below) Do not take Lasilactone if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking Lasilactone. Take special care with Lasilactone

The following medicines can affect the way Lasilactone work and increase the chance of you getting side effects: * Medicines which change the amount of potassium in your blood. These include potassium supplements such as potassium chloride or certain water tablets (diuretics) such as triamterene and amiloride * Medicines such as ramipril, enalapril, perindopril (called ‘ACE inhibitors’) or losartan, candesartan, irbesartan (called ‘angiotensin II receptor antagonists’). Your doctor may need to change the dose of your capsules or ask you to stop taking them * Medicines for high blood pressure or heart problems. Your doctor may need to change the dose of your medicine * Medicines used as a general anaesthetic for relaxing your muscles during surgery * Medicines for diabetes. These may not work as well when you are taking Lasilactone. * Theophylline - used for wheezing or difficulty in breathing * Phenytoin - used for epilepsy. This can lower the effect of Lasilactone. The following medicines can increase the chance of side effects when taken with Lasilactone: * Lithium - used for mental illnesses. To help stop side effects your doctor may need to change the dose of your lithium and check the amount of lithium in your blood * Cisplatin - used for some cancers * Digoxin - used for heart problems. Your doctor may need to change the dose of your medicine * Non-steroidal anti-inflammatory drugs (NSAIDs) - used for pain and inflammation such as aspirin, ibuprofen, ketoprofen or indometacin * Carbamazepine - used for epilepsy * Aminoglutethimide - used for breast cancer * Ciclosporin - used to stop the rejection of organs after a transplant * Methotrexate - used for cancers of the skin, joint or bowel diseases * Carbenoxolone - used for ulcers of the food-pipe (gullet) * Reboxetine - used for depression; if used for a long time * Amphotericin - used for fungal infections; if used for a long time * Corticosteroids used for inflammation such as prednisolone * Liquorice used in cough preparations; if taken in large amounts * Probenecid (used with another HIV medicine) * Medicines for infection such as gentamicin, amikacin, neomycin, netilmicin, tobramycin, vancomycin or high doses of cephalosporins * Medicines used as injections before X-ray examinations * Medicines used for constipation (laxatives) such as bisacodyl or senna; if used for a long time * Medicines for asthma when given in high doses (such as salbutamol, terbutaline sulphate, salmeterol, formoterol or bambuterol) * Other water tablets (diuretics) such as bendroflumethiazide. Your doctor may need to change the dose of your medicine. Taking Lasilactone with food and drink Lasilactone should be swallowed with a full glass of water. Pregnancy and breast-feeding Do not take Lasilactone if you are pregnant. Talk to your doctor before taking this medicine if you are pregnant, might become pregnant, or think you might be pregnant. Do not breast-feed if you are taking Lasilactone. This is because small amounts may pass into the mother’s milk. Talk to your doctor before taking this medicine if you are breast-feeding or planning to breast-feed.

Check with your doctor or pharmacist before taking your medicine if: * You have difficulty in passing water (urine) * You are 65 years of age or older * You have liver problems or kidney problems * You have diabetes * You are taking other medicines which change the amount of potassium in your blood (see “Taking other medicines” section below) * You are an elderly patient with dementia and are also taking risperidone * You have low blood pressure or feel dizzy when you stand up * You have prostate problems * You have gout * You feel dizzy or dehydrated. This can happen if you have lost a lot of water through being sick, having diarrhoea or passing water very often. It can also happen if you are having trouble drinking or eating * You are going to have a glucose test * You are taking any other water tablets * You rely on your voice to make a living. Lasilactone can cause changes to your voice

Ask your doctor or pharmacist for advice before taking any medicine if you are pregnant or breast-feeding.

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

Taking this medicine * Take this medicine by mouth * Swallow the capsules whole with a drink of water * This medicine is not suitable for use in children * If you feel the effect of your medicine is too weak or too strong, do not change the dose yourself, but ask your doctor

Taking other medicines Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines. This includes medicines you buy without a prescription, including herbal medicines. This is because Lasilactone can affect the way some other medicines work. Also, some medicines can affect the way Lasilactone work.

Driving and using machines You may feel dizzy or unwell after taking Lasilactone. If this happens, do not drive or use any tools or machines. Important information about some of the ingredients of Lasilactone This medicine contains: * Lactose. If you have been told by your doctor that you cannot tolerate some sugars, talk to your doctor before taking this medicine.

How to take Lasilactone

Always take Lasilactone exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

How much Lasilactone to take The usual dose is one to four capsules daily. Your doctor will tell you how many capsules to take. If you have to take your capsules once each day, take with your breakfast. If you have to take your capsules twice each day, take with your breakfast and lunch. Do not take your capsules in the evening, as it could affect your sleep.

Lasilactone Capsules / Lasilacton Capsules Patient Information Leaflet (continued) If you are taking sucralfate (a medicine for stomach ulcers) Do not take sucralfate at the same time as Lasilactone. Take your dose at least 2 hours before or after Lasilactone. This is because it can affect the way your medicine works. If you take more Lasilactone than you should If you think you may have taken more Lasilactone than you should, or if a child has swallowed any of your capsules, tell your doctor or go to you nearest hospital casualty department straight away. Remember to take with you any medicine that is left so the doctor knows what you have taken. The following effects may happen: dry mouth, feeling thirsty, muscle pain or cramps, feeling sick or being sick (vomiting), weak or uneven heartbeat, feeling dizzy, weak or sleepy.

Blood tests Lasilactone can change the levels of liver enzymes or body fats known as cholesterol and triglycerides. 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.

If you forget to take Lasilactone If you forget a dose, take it as soon as you remember it. Then continue the following morning as normal. Do not take a double dose to make up for a forgotten dose. If you stop taking Lasilactone Keep taking Lasilactone until your doctor tells you to stop taking it. Blood tests Your doctor may carry out blood tests to check that the levels of some salts in the blood are at the correct levels. If you have any further questions on the use of this product, ask your doctor or pharmacist.

Possible side effects

Like all medicines, Lasilactone can cause side effects, although not everybody gets them. Tell a doctor straight away if you notice any of the following serious side effects - you may need urgent medical treatment * If you have an allergic reaction. The signs may include inflammation of the kidney (nephritis), swollen ankles or high blood pressure, skin rashes, change in skin colour, severe blistering of the skin, being more sensitive to the sun than usual, high temperature (fever), and itching * Severe allergic reactions. The signs may include shock such as difficulty in breathing, cold clammy skin, pale skin colour and racing heart beat * Severe stomach or back pain. These could be signs of ‘pancreatitis’ * Brusing more easily, getting more infections, feeling weak or tired more than usual. Lasilactone can affect the number of blood cells, causing serious blood problems. * Increased thirst, headache, feeling dizzy or light-headed, fainting, confusion, muscle or joint pains or weakness, cramps or spasms, stomach upsets or uneven heartbeats. These could be signs of dehydration or changes in your normal body chemicals. Severe dehydration can lead to blood clots or ‘gout’ * You notice yellowing of your skin or eyes and your urine becomes darker in colour. These could be signs of a liver problem. In patients who already have liver problems, a more serious liver problem known as liver encephalopathy may occur. Symptoms include forgetfulness, fits, mood changes and coma. * Blistering or peeling of the skin around the lips, eyes, mouth, nose and genitals, flu-like symptoms and fever. This could be a condition called Stevens-Johnson syndrome. In a more severe form of the condition called Toxic Epidermal Necrolysis, layers of the skin may peel off to leave large areas of raw exposed skin all over the body. Tell your doctor as soon as possible if you have any of the following side effects: * Problems hearing or ringing in the ears (tinnitus). This especially affects people who already have problems with their kidneys * Deafness * Tingling or feeling numb on the skin * Small changes in your mood such as feeling agitated or anxious * Headaches, feeling dizzy or light-headed when standing up quickly. Also loss of concentration, slower reactions, feeling sleepy or weak, problems with your sight, dry mouth. This could be due to low blood pressure * Pain before or after eating, black or tar-like stools. This could be a sign of an ulcer in your stomach or gut. Tell your doctor or pharmacist if any of the following side effects get serious or last longer than a few days, or if you notice any side effects not listed in this leaflet * Feeling sick (nausea) or a general feeling of being unwell, diarrhoea and being sick (vomiting) and constipation * Feeling confused, moving unsteadily or staggering * Breast swelling or growth sometimes with nipple pain or sensitivity * Difficulty in getting or maintaining an erection, or in ejaculation * Redness of the skin * Hair grows more than normal on the body or face * Menstrual periods which are heavier or last longer than usual * Voice changes. For example hoarseness or deepening of the voice in women and changes in the pitch in men. This may remain even after you stop taking these capsules. * People with bladder and prostate problems may notice pain when passing water. This is due to an increase in the amount of water passed * If you have diabetes you may be less able to control the levels of glucose in your blood * Passing more water (urine) than you usually do. This normally happens 1 or 2 hours after taking this medicine.

How to store Lasilactone

KEEP THIS MEDICINE OUT OF THE SIGHT AND REACH OF CHILDREN. Store at ambient temperature protected from light Store in original packaging

Do not use this medicine after the expiry date shown on the carton label or blister strip. If your doctor tells you to stop taking this medicine, return any unused capsules to your pharmacist (chemist) for safe disposal. Only keep this medicine, if your doctor tells you to. If your capsules become discoloured or show any other signs of deterioration, consult your pharmacist (chemist) 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.

What this medicine contains: Each capsule contains 20mg of Furosemide and 50mg of Spironolactone as the active ingredients. Your medicine also contains the following inactive ingredients: microcrystalline cellulose, lactose, talc, magnesium stearate, sodium amylopectin glycolate, indigotin (FD&C Blue 2) (E132), titanium dioxide (E171) and gelatin What this medicine looks like and contents of the pack Lasilactone are hard gelatine capsules with a white opaque body and blue cap with no markings and are available in packs of 20, 30 or 50 capsules. Manufacturer and Licence Holder Your medicine is manufactured by Sanofi-Aventis Sp. z. o.o ul. Lubelska 52, 35-233 Rzeszow, Poland and is procured from within the EU and repackaged by the Product Licence Holder: Lexon (UK) Limited, Unit 18, Oxleasow Road, East Moons Moat, Redditch, Worcestershire, B98 0RE.

Lasilactone is a registered trademark of Aventis Pharma Deutschland GmbH. Revision date: 12/05/14

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

Source: Medicines and Healthcare Products Regulatory Agency

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

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Ashwagandha Uses, Benefits - Dosage - Herbal Database, Amangura

Ashwagandha

Scientific Name(s): Withania somnifera (L.) Dunal, (synonym Physalis somnifera L.). Family: Solanaceae (nightshade)

Common Name(s): Withania. aswaganda. winter cherry. Indian ginseng. ajagandha. kanaje Hindi. samm al ferakh. asgand (Hindi), amukkirag (Tamil), amangura (Kannada), asvagandha (Bengali), ashvagandha (Sanskrit), asundha (Gujarati), kuthmithi

Uses

Ashwagandha has been used as an adaptogen, diuretic, and sedative and is available in the United States as a dietary supplement. Trials supporting its clinical use are limited; however, many in vitro and animal experiments suggest effects on the immune and CNS systems, as well as in the pathogenesis of cancer and inflammatory conditions.

Dosing

Dosing information is limited. W. somnifera root powder has generally been used at dosages of 450 mg to 2 g in combination with other preparations.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Abortifacient properties have been reported for ashwagandha. Avoid use.

Interactions

None well documented.

Adverse Reactions

Limited clinical trials are available and case reports are lacking.

Toxicology

Acute toxicity of W. somnifera is modest; at reasonable doses, ashwagandha is nontoxic.

Botany

W. somnifera is an erect, greyish, slightly hairy evergreen shrub that grows to about 1.5 m in height and has fairly long tuberous roots. It is widely cultivated in India and throughout the Middle East and is found in eastern Africa. The small and greenish-yellow flowers can be single or in clusters. The fruit is smooth, round, and fleshy, with many seeds; it is orange-red when ripe and enclosed in a membranous covering. 1

History

The root of W. somnifera is used to make the Ayurvedic tonic ashwagandha. which has been translated to “smells like a horse.” 2 Ashwagandha has been used as an adaptogen, diuretic, and sedative and is available in the United States as a dietary supplement. Other parts of the plant (eg, seeds, leaves) have been used as a pain reliever, to kill lice, and in making soap. The fresh berries have been used as an emetic. 2. 3

Chemistry

The principal bioactive compounds of W. somnifera are withanolides, which are triterpene lactones. More than 40 withanolides and approximately 12 alkaloids and several sitoindosides have been isolated and identified from W. somnifera. The withanolides are structurally related to the ginsenosides of Panax ginseng, hence the common name “Indian ginseng.” 3. 4 Chemical constituents for the roots, fruits, seeds, and stem include withanone; withaferin A; withanolides A, D, an G; and sitoindosides IX, X, VII, and VIII. High performance liquid chromatography techniques to quantify constituents have also been established. 2. 3. 4

Additional compounds, especially withanolides, have been described and evaluated, with variations dependent upon cultivation and varieties. 5. 6. 7 Large amounts of iron are also found in the plant. 4

Uses and Pharmacology

Well-designed clinical studies in which W. somnifera or its extracts are used as a single agent are lacking.

In vitro and animal experiments suggest W. somnifera may possess anti-inflammatory properties. Cultures of cartilage from patients with osteoarthritis and rheumatoid arthritis have been used to demonstrate W. somnifera 's protective effects on chondroplasts. 8. 9. 10. 11 Related effects on cytokines and transcription factors, and suppression of nitric oxide have also been demonstrated. 12 In experiments in rats with induced inflammation, decreased inflammation (paw volume), pain, and disability were noted, as well as an antipyretic effect after administration of W. somnifera root powder. The ulcerogenic effect of W. somnifera was lower than that of indomethacin. 4. 13. 14. 15. 16 A small clinical study evaluating a combination therapy that included ashwagandha demonstrated decreased pain and disability in arthritis, while no changes were observed in the erythrocyte sedimentation rate. 3. 4

Despite more than 30 years of research into a potential role for W. somnifera extracts in the treatment of cancer, clinical trials are lacking. In vitro and animal experiments have been conducted using whole plant extract, ethanol root extracts, aqueous and methanolic leaf extracts, individual withanolides, and withaferin A. Human cancer cell line investigations include HL-60 leukemic and myeloid leukemia cell lines, and bladder, breast, prostate, colon, kidney, gastric, and lung cancer cell lines. Mechanisms of action described include antiproliferative effects, apoptosis, radio-sensitization, mitotic arrest, antiangiogenesis, and enhancement of cell defense mechanisms. 4. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29 Limited studies suggest withanone, withaferin A, and withanolide A have protective effects on glioma cell lines, as well as human fibroblasts, and thereby slow senescence. 30. 31

Experiments in mice have demonstrated decreased lung adenoma tumor incidence with whole plant extract and complete regression of mouse sarcoma tumor with ethanol root extract, as well as radio-sensitizing of carcinomas and increased apoptosis of human breast cancer cells by withaferin A, a steroidal lactone of W. somnifera. 4. 24

Damage to the bladder by cyclophosphamide was ameliorated by W. somnifera extract, 32 as was leukopenia induced by cyclophosphamide. 33

In vitro studies and experiments in animals suggest CNS effects, including modulation of acetylcholinesterase and butyrylcholinesterase activity, inhibition of calcium ion influx, blockade of gamma-aminobutyric acid receptors, modulation of 5-HT 1 and 5-HT 2 receptors, antioxidant activity, and regeneration of neurites, 4. 6. 11 with some researchers suggesting potential applications in Alzheimer and Parkinson diseases. 3. 5. 6

Withania extract protected against pentylenetetrazol-induced seizures in a mouse anticonvulsant model when administered over a 9-week period. 34 The same research group found the extract active in a rat status epilepticus model. 35 A depressant effect on the CNS was indicated by potentiation of pentobarbital effects on the righting reflex in mice, 36 and a mild tranquilizing/relaxant effect in monkeys, cats, dogs, rats, and mice by a total alkaloid extract from the plant roots. 4

A further study of the extract found that it inhibited the development of tolerance to morphine in mice, while suppressing withdrawal symptoms precipitated by naloxone. 37 A withanolide-containing fraction reversed morphine-induced reduction in intestinal motility and confirmed the previous finding of inhibition of development of tolerance to morphine. 38 A role in the management of drug addiction has been suggested. 11

An experiment supported the traditional Ayurvedic medicinal claim that the plant's use could be attributed to effects on learning and memory. Ibotenic acid-induced lesions in intact rat brain that led to cognitive deficit, as measured by performance in a learning task, were reversed by treatment with a withanolide mixture. 39 Limited trials in elderly populations using traditional combination therapies showed mixed results. One study of 2 g of root extract twice daily (in combination) administered over 6 months made no difference in sleep onset times or duration. 40 In another study, increased balance was determined in elderly patients with long-term progressive degenerative ataxia. 41

Immune system effects

Withanolides inhibit murine spleen cell proliferation, 42 and an extract of W. somnifera reversed ochratoxin's suppressive effect on murine macrophage chemotaxis. 43 Withanolide glycosides activated murine macrophages and phagocytosis, and increased lysosomal enzymatic activity secreted by the macrophages, while also displaying antistress activity and positive effects on learning and memory in rats. 44 Alpha-2 macroglobulin synthesis stimulated by inflammation was reduced by W. somnifera extract. 45 Similarly, the extract prevented myelosuppression caused by cyclophosphamide, azathioprine, or prednisolone in mice. 46 In a clinical study, ashwagandha 6 mL root extract administered twice daily for 4 days resulted in increases in CD4 expression, as well as activation of natural killer cells. 47 Additional effects on cytokines and the complement system, lymphocyte proliferation, and humoral and cell-mediated responses have been discussed. 48

Animal experiments have been conducted to describe adaptogenic properties (increased swimming endurance and reduced stress response) of W. somnifera. Clinical trials are lacking. 49. 50. 51. 52. 53. 54. 55. 56. 57

Effects on aging have been promoted, based on claims regarding increased hemoglobin, red blood cell count, hair quality, and melanin levels in a non-peer-reviewed study conducted among healthy men. Serum cholesterol was also reduced and seated-stature improved in this study. 30

Antimicrobial effects 58 and antivenom activity via hyaluronidase inhibition have been described. 59

Dosage

Dosing information is limited.

In a study in which a polyherbal mixture was used for arthritis, W. somnifera 450 mg root powder was administered 4 times per day. 60

In a sleep study with elderly subjects, Withania 2 g root powder was administered with other ingredients twice daily for up to 3 months. 40

In elderly patients with long-term progressive degenerative ataxia, ashwagandha 500 mg tablets were administered 3 times a day for 1 month (in combination). 41

Pregnancy/Lactation

Abortifacient properties have been reported for ashwagandha. Avoid use. 61

In animal experiments, no fetal abnormalities were found in mice fed Withania root extract for 4 weeks. The progeny of experiment animals had a higher birth weight than those of controls. 3 Because of the plant's antiangiogenic and cytotoxic properties, Withania should be avoided during pregnancy.

Interactions

Case reports are lacking. 3 Animal studies report potentiation of phenobarbital-induced sleep, 3 while interactions with some digoxin immunoassays have been demonstrated and are thought to be caused by similarity in chemical structure. 62. 63

Adverse Reactions

Limited clinical trials are available and case reports are lacking.

Toxicology

Acute toxicity of W. somnifera is modest; at reasonable doses ashwagandha is nontoxic. 3. 4

In mice, an oral median lethal dose was determined to be 1,750 mg/kg in 1 study 12 and 1,260 mg/kg by the intraperitoneal route. 64

Subacute intraperitoneal toxicity studies at 100 mg/kg/day for 30 days led to decreased spleen, thymus, and adrenal weights, but no mortality or hematological changes were noted. 64

A longer-term study (180 days) in rats at an oral dose of 100 mg/kg found no lethality, but did discover unfavorable increases in catecholamine content of the heart and decreases in the adrenal glands. 17 At higher dosages (200 mg/kg/day), increases in lung and liver weight were observed. 3. 4

In mice fed the extract of the entire plant as 25% of the total diet, microscopic lesions in the lung and liver were apparent, and vascular and tubular congestion were described. 3

Bibliography

1. Withania somnifera (L.) USDA, NRCS. 2007. The PLANTS Database ( http://plants. usda. gov. 8 April 2010). National Plant Data Center, Baton Rouge, LA 70874-4490 USA. 2. Ganzera M, Choudhary MI, Khan IA. Quantitative HPLC analysis of withanolides in Withania somnifera. Fitoterapia. 2003;74(1-2):68-76. 3. Kulkarni SK, Dhir A. Withania somnifera. an Indian ginseng. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32(5):1093-1105. 4. Mishra LC, Singh BB, Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Altern Med Rev. 2000;5(4):334-346. 5. Zhao J, Nakamura N, Hattori M, Kuboyama T, Tohda C, Komatsu K. Withanolide derivatives from the roots of Withania somnifera and their neurite outgrowth activities. Chem Pharm Bull (Tokyo). 2002;50(6):760-765. 6. Choudhary MI, Nawaz SA, ul-Haq Z, et al. Withanolides, a new class of natural cholinesterase inhibitors with calcium antagonistic properties. Biochem Biophys Res Commun. 2005;334(1):276-287. 7. Xu YM, Marron MT, Seddon E, et al. 2,3-Dihydrowithaferin A-3beta-O-sulfate, a new potential prodrug of withaferin A from aeroponically grown Withania somnifera. Bioorg Med Chem. 2009;17(6):2210-2214. 8. Sumantran VN, Chandwaskar R, Joshi AK, et al. The relationship between chondroprotective and antiinflammatory effects of Withania somnifera root and glucosamine sulphate on human osteoarthritic cartilage in vitro. Phytother Res. 2008;22(10):1342-1348. 9. Sumantran VN, Kulkarni A, Boddul S, et al. Chondroprotective potential of root extracts of Withania somnifera in osteoarthritis. J Biosci. 2007;32(2):299-307. 10. Singh RH, Narsimhamurthy K, Singh G. Neuronutrient impact of Ayurvedic Rasayana therapy in brain aging. Biogerontology. 2008;9(6):369-374. 11. Lu L, Liu Y, Zhu W, et al. Traditional medicine in the treatment of drug addiction. Am J Drug Alcohol Abuse. 2009;35(1):1-11. 12. Kaileh M, Vanden Berghe W, Heyerick A, et al. Withaferin a strongly elicits IkappaB kinase beta hyperphosphorylation concomitant with potent inhibition of its kinase activity. J Biol Chem. 2007;282(7):4253-4264. 13. Rasool M, Varalakshmi P. Suppressive effect of Withania somnifera root powder on experimental gouty arthritis: An in vivo and in vitro study. Chem Biol Interact. 2006;164(3):174-180. 14. Khanna D, Sethi G, Ahn KS, et al. Natural products as a gold mine for arthritis treatment. Curr Opin Pharmacol. 2007;7(3):344-351. 15. Al-Hindawi MK, Al-Deen IH, Nabi MH, Ismail MA. Anti-inflammatory activity of some Iraqi plants using intact rats. J Ethnopharmacol. 1989;26(2):163-168. 16. Agarwal R, Diwanay S, Patki P, Patwardhan B. Studies on immunomodulatory activity of Withania somnifera (Ashwagandha) extracts in experimental immune inflammation. J Ethnopharmacol. 1999;67(1):27-35. 17. Senthil V, Ramadevi S, Venkatakrishnan V, et al Withanolide induces apoptosis in HL-60 leukemia cells via mitochondria mediated cytochrome c release and caspase activation. Chem Biol Interact. 2007;167(1):19-30. 18. Al-Fatimi M, Friedrich U, Jenett-Siems K. Cytotoxicity of plants used in traditional medicine in Yemen. Fitoterapia. 2005;76(3-4):355-358. 19. Kaur K, Rani G, Widodo N, et al. Evaluation of the anti-proliferative and anti-oxidative activities of leaf extract from in vivo and in vitro raised Ashwagandha. Food Chem Toxicol. 2004;42(12):2015-2020. 20. Niture SK, Rao US, Srivenugopal KS. Chemopreventative strategies targeting the MGMT repair protein: augmented expression in human lymphocytes and tumor cells by ethanolic and aqueous extracts of several Indian medicinal plants. Int J Oncol. 2006;29(5):1269-1278. 21. Mathur R, Gupta SK, Singh N, Mathur S, Kochupillai V, Velpandian T. Evaluation of the effect of Withania somnifera root extracts on cell cycle and angiogenesis. J Ethnopharmacol. 2006;105(3):336-341. 22. Ichikawa H, Takada Y, Shishodia S, Jayaprakasam B, Nair MG, Aggarwal BB. Withanolides potentiate apoptosis, inhibit invasion, and abolish osteoclastogenesis through suppression of nuclear factor-kappaB (NF-kappaB) activation and NF-kappaB-regulated gene expression. Mol Cancer Ther. 2006;5(6):1434-1445. 23. Stan SD, Hahm ER, Warin R, Singh SV. Withaferin A causes FOXO3a - and Bim-dependent apoptosis and inhibits growth of human breast cancer cells in vivo. Cancer Res. 2008;68(18):7661-7669. 24. Stan SD, Zeng Y, Singh SV. Ayurvedic medicine constituent withaferin a causes G2 and M phase cell cycle arrest in human breast cancer cells. Nutr Cancer. 2008;60(suppl 1):51-60. 25. Mulabagal V, Subbaraju GV, Rao CV, et al. Withanolide sulfoxide from Aswagandha roots inhibits nuclear transcription factor-kappa-B, cyclooxygenase and tumor cell proliferation. Phytother Res. 2009;23(7):987-992. 26. Malik F, Kumar A, Bhushan S, et al. Reactive oxygen species generation and mitochondrial dysfunction in the apoptotic cell death of human myeloid leukemia HL-60 cells by a dietary compound withaferin A with concomitant protection by N-acetyl cysteine. Apoptosis. 2007;12(11):2115-2133. 27. Oh JH, Lee TJ, Kim SH, et al. Induction of apoptosis by withaferin A in human leukemia U937 cells through down-regulation of Akt phosphorylation. Apoptosis. 2008;13(12):1494-1504. 28. Mohan R, Hammers HJ, Bargagna-Mohan P, et al. Withaferin A is a potent inhibitor of angiogenesis. Angiogenesis. 2004;7(2):115-122. 29. Srinivasan S, Ranga RS, Burikhanov R, Han SS, Chendil D. Par-4-dependent apoptosis by the dietary compound withaferin A in prostate cancer cells. Cancer Res. 2007;67(1):246-253. 30. Widodo N, Shah N, Priyandoko D, Ishii T, Kaul SC, Wadhwa R. Deceleration of senescence in normal human fibroblasts by withanone extracted from ashwagandha leaves. J Gerontol A Biol Sci Med Sci. 2009;64(10):1031-1038. 31. Shah N, Kataria H, Kaul SC, et al. Effect of the alcoholic extract of Ashwagandha leaves and its components on proliferation, migration, and differentiation of glioblastoma cells: combinational approach for enhanced differentiation. Cancer Sci. 2009;100(9):1740-1747. 32. Davis L, Kuttan G. Effect of Withania somnifera on cyclophosphamide-induced urotoxicity. Cancer Lett. 2000;148(1):9-17. 33. Davis L, Kuttan G. Suppressive effect of cyclophosphamide-induced toxicity by Withania somnifera extract in mice. J Ethnopharmacol. 1998;62(3):209-214. 34. Kulkarni SK, George B. Anticonvulsant action of Withania somnifera (Ashwaganda) root extract against pentylenetetrazol-induced kindling in mice. Phytother Res. 1996;10(5):447-449. 35. Kulkarni SK, George B, Mathur R. Protective effect of Withania somnifera root extract on electrographic activity in a lithium-pilocarpine model of status epilepticus. Phytother Res. 1998;12(6):451-453. 36. Ahumada F, Trincado MA, Arellano JA, Hancke J, Wikman G. Effect of certain adaptogenic plant extracts on drug-induced narcosis in female and male mice. Phytother Res. 1991;5(1):29-31. 37. Kulkarni S, Ninan I. Inhibition of morphine tolerance and dependence by Withania somnifera in mice. J Ethnopharmacol. 1997;57(3):213-217. 38. Ramarao P, Rao KT, Srivastava RS, Ghosal S. Effects of glycowithanolides from Withania somnifera on morphine-induced inhibition of intestinal motility and tolerance to analgesia in mice. Phytother Res. 1995;9(1):66-68. 39. Bhattacharya SK, Kumar S, Ghosal S. Effects of glycowithanolides from Withania somnifera on an animal model of Alzheimer's disease and perturbed central cholinergic markers of cognition in rats. Phytother Res. 1995;9(2):110-113. 40. Manjunath NK, Telles S. Influence of Yoga and Ayurveda on self-rated sleep in a geriatric population. Indian J Med Res. 2005;121(5):683-690. 41. Sriranjini SJ, Pal PK, Devidas KV, Ganpathy S. Improvement of balance in progressive degenerative cerebellar ataxias after Ayurvedic therapy: a preliminary report. Neurol India. 2009;57(2):166-171. 42. Bähr V, Hänsel R. Immunomodulating properties of 5,20-alpha(R)-dihydroxy-6-alpha-7-alpha-epoxy-1-oxo-(5-alpha)-witha-2,24-dieno lide and solasodine. Planta Med. 1982;44(1):32-33. 43. Dhuley JN. Effect of some Indian herbs on macrophage functions in ochratoxin A treated mice. J Ethnopharmacol. 1997;58(1):15-20. 44. Ghosal S, Lal J, Srivastava R, et al. Immunomodulatory and CNS effects of sitoindosides IX and X, two new glycowithanolides from Withania somnifera. Phytother Res. 1989;3(5):201-206. 45. Anbalagan K, Sadique J. Withania somnifera (Ashwagandha), a rejuvenating herbal drug which controls a-2 macroglobulin synthesis during inflammation. Int J Crude Drug Res. 1985;23(4):177-183. 46. Ziauddin M, Phansalkar N, Patki P, Diwanay S, Patwardhan B. Studies on the immunomodulatory effects of Ashwagandha. J Ethnopharmacol. 1996;50(2):69-76. 47. Mikolai J, Erlandsen A, Murison A, et al. In vivo effects of Ashwagandha ( Withania somnifera ) extract on the activation of lymphocytes. J Altern Complement Med. 2009;15(4):423-430. 48. Rasool M, Varalakshmi P. Immunomodulatory role of Withania somnifera root powder on experimental induced inflammation: An in vivo and in vitro study. Vascul Pharmacol. 2006;44(6):406-410. 49. Singh N, Nath R, Lata A, Singh SP, Kohli RP, Bhargava KP. Withania somnifera (Ashwagandha), a rejuvenating herbal drug which enhances survival during stress (an adaptogen). Int J Crude Drug Res. 1982;20(1):29-35. 50. Bhattacharya SK, Goel RK, Kaur R, Ghosal S. Anti-stress activity of sitoindosides VII and VIII, new acylsterylglucosides from Withania somnifera. Phytother Res. 1987;1(1):32-37. 51. Grandhi A, Mujumdar AM, Patwardhan B. A comparative pharmacological investigation of Ashwagandha and Ginseng. J Ethnopharmacol. 1994;44(3):131-135. 52. Dhuley JN. Effect of ashwagandha on lipid peroxidation in stress-induced animals. J Ethnopharmacol. 1998;60(2):173-178. 53. Archana R, Namasivayam A. Antistressor effect of Withania somnifera. J Ethnopharmacol. 1999;64(1):91-93. 54. Dhuley JN. Adaptogenic and cardioprotective action of ashwagandha in rats and frogs. J Ethnopharmacol. 2000;70(1):57-63. 55. Panda S, Kar A. Withania somnifera and Bauhinia purpurea in the regulation of circulating thyroid hormone concentrations in female mice. J Ethnopharmacol. 1999;67(2):233-239. 56. Singh A, Saxena E, Bhutani KK. Adrenocorticosterone alterations in male, albino mice treated with Trichopus zeylanicus. Withania somnifera. and Panax ginseng preparations. Phytother Res. 2000;14(2):122-125. 57. Bucci LR. Selected herbals and human exercise performance. Am J Clin Nutr. 2000;72(2 suppl):624S-636S. 58. Girish KS, Machiah KD, Ushanandini S, et al. Antimicrobial properties of a non-toxic glycoprotein (WSG) from Withania somnifera (Ashwagandha). J Basic Microbiol. 2006;46(5):365-374. 59. Machiah DK, Girish KS, Gowda TV. A glycoprotein from a folk medicinal plant, Withania somnifera. inhibits hyaluronidase activity of snake venoms. Comp Biochem Physiol C Toxicol Pharmacol. 2006;143(2):158-161. 60. Kulkarni RR, Patki PS, Jog VP, Gandage SC, Patwardhan B. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol. 1991;33(1-2):91-95. 61. Ernst E. Herbal medicinal products during pregnancy: are they safe? BJOG. 2002;109(3):227-235. 62. Dasgupta A. Herbal supplements and therapeutic drug monitoring: focus on digoxin immunoassays and interactions with St. John's wort. Ther Drug Monit. 2008;30(2):212-217. 63. Dasgupta A, Tso G, Wells A. Effect of Asian ginseng, Siberian ginseng, and Indian ayurvedic medicine Ashwagandha on serum digoxin measurement by Digoxin III, a new digoxin immunoassay. J Clin Lab Anal. 2008;22(4):295-301. 64. Sharada AC, Solmon FE, Devi PU. Toxicity of Withania somnifera root extract in rats and mice. Int J Pharmacognosy. 1993;31(3):205-212.

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Buy Dil-Sanorania - Diltiazem - Online Without Prescriptions, Dil-Sanorania

Cardizem (Dil-sanorania)

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

Use Cardizem as directed by your doctor.

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

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

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

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

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

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

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

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

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

Active Ingredient: Diltiazem.

Do NOT use Cardizem if:

you are allergic to any ingredient in Cardizem

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

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

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

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

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

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

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

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

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

if you have kidney or liver disease.

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

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

Rifampin because it may decrease the effectiveness of Cardizem

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

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

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

Important safety information:

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

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

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

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

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

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

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

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

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

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

Constipation; dizziness; facial flushing; headache; weakness.

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

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

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

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Cardizem (Dil-sanorania)

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

Use Cardizem as directed by your doctor.

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

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

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

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

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

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

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

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

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

Active Ingredient: Diltiazem.

Do NOT use Cardizem if:

you are allergic to any ingredient in Cardizem

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

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

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

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

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

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

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

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

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

if you have kidney or liver disease.

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

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

Rifampin because it may decrease the effectiveness of Cardizem

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

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

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

Important safety information:

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

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

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

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

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

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

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

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

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

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

Constipation; dizziness; facial flushing; headache; weakness.

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

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

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

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Allergan Gets FDA Approval for Orzurdex, Rejection for Levadex

Allergan Inc. the drugmaker resisting a takeover by Valeant Pharmaceuticals International Inc. won U. S. approval for a treatment of vision loss in diabetics and rejection for its migraine inhaler.

The Food and Drug Administration approved Allergan’s Ozurdex, a drug for diabetic macular edema, which can cause vision loss and eventual blindness in people with diabetes, according to a regulatory filing today. The agency rejected Semprana, formerly known as Levadex, an inhalable treatment for migraines, because of problems with the drug’s delivery device.

An eventual approval for Levadex could “vindicate” Allergan’s research capabilities and its argument to investors that it’s better off alone than as part of Valeant, according to Shibani Malhotra, an analyst at Sterne Agee & Leach Inc. wrote in a June 23 note to clients. Allergan plans to meet with the FDA about Semprana and estimates the agency could have an answer on the drug by July 2015, according to the filing.

Allergan, based in Irvine, California, is resisting a $54 billion takeover offer by Valeant, which has twice raised its bid as it seeks to become one of the world’s five biggest drugmakers. Valeant has teamed with Bill Ackman, whose hedge fund Pershing Square Capital Management LP took a 9.7 percent stake in Allergan to drive the deal.

The company said its experimental treatment for wet age-related macular degeneration, a disease that causes vision loss, will start the last of three stages of clinical trials typically required for FDA approval. A glaucoma treatment will also move into phase 3 trials by the end of this year, the company said.

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The 3 Worlds Of Gulliver (1960), Makovan

The 3 Worlds of Gulliver (1960 ) More at IMDbPro »

Did You Know?

Trivia:

As of this film's production, both Ray Harryhausen (the creator of special visual effects) and producer Charles H. Schneer decided to make their permanent homes in London. This was not only because of Harryhausen's love for the exotic European locales he would use in all of his future projects, but it was also cheaper to make his kind of movies there. Harryhausen lived in London ever after, whereas Schneer lived there for 45 years before moving to Florida in 2005, four years before his own passing. See more »

Goofs:

Continuity: The quantity, type and relative size of fish caught by Gulliver in his hat on the beach in Lilliput changes between his point of view and when he drops them at the feet of the Lilliputians. See more »

Quotes:

Dr. Lemuel Gulliver . you don't need Reldresal or me to fight a war! Emperor of Lilliput :Of course I don't need a prime minister to fight a war! But I need one to blame in case we lose it. See more »

Movie Connections:

Soundtrack:

Gentle LoveSee more »

FAQ

User Reviews

6 out of 6 people found the following review useful.

What you don't understand you want to destroy! . 28 June 2010

The Three Worlds of Gulliver is produced out of Columbia Pictures and is directed by Jack Sher. It stars Kerwin Matthews as Lemuel Gulliver, June Thorburn as his fiancée Elizabeth, with support coming from Basil Sydney (The Emperor of Lilliput), Grégoire Aslan (King Brob), Mary Ellis (Queen), Charles Lloyd Pack (Prime Minister Makovan) & child actor Sherry Alberoni as Glumdalclitch. Filmed in England and Spain, it features stop-motion animation and special visual effects by Superdynamation genius Ray Harryhausen. Sher & Arthur Ross adapt for the screen with a loose reworking of the 18th-century English novel Gulliver's Travels written by Jonathan Swift. And music maestro Bernard Herrmann provides the score.

Swift's biting satirical novel has been watered down and given a romantic edge for the family market. That said, as the kids are enjoying the froth and tickle, the adults will note that there's just enough caustic comment in the piece to get the message across. This adaptation has slimmed down the four parts of Swift's work to just the two; Lilliput land of the little people and Brobdingnag land of the giants. With our intrepid normal sized hero Gulliver and his stowaway fiancée Elizabeth under threat either way.

While the script has its pleasing moments it is still only serving as a bridging work for Harryhausen's effects to be shown. Be it the giant and tiny people sequences or the perils that come to our undersized protagonists courtesy of a Gator and a Squirrel, it's these that the children will find beguiling. This, however, can not be said for Harryhausen aficionados or adults more accustomed to more modern advancements. For this is bottom rung for Harryhausen, not bad at all, yet although there's a charm here, and no one should ever dismiss the painstaking amount of time it took him to weave it together, the work is creaky and lacking the dynamism so befitting his best work.

Major bonus' come with the swirling and pounding score from Herrmann and the vibrant performance of Matthews. The role of Gulliver was first offered to Danny Kaye, which naturally makes sense given Kaye's previous work on Hans Christian Andersen some years earlier. That it was also offered to Jack Lemmon, tho, makes no sense at all. Anyway, Matthews got the gig, and following on from his fine work in The 7th Voyage of Sinbad, he laid down a marker in the fantasy adventure genre that secured him fondness from legions of fans throughout the years. A safe, colourful and pleasant enough piece if ultimately not one for most fantasy adventure fans to revisit often. 6/10

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Brevinor (Ethinylestradiol And Norethisterone), Brevinor

Brevinor (ethinylestradiol and norethisterone)

What is Brevinor used for?

Taking the contraceptive pill usually results in lighter, less painful and more regular menstrual bleeding. This means it is sometimes also prescribed for women who have problems with particularly heavy. painful or irregular periods.

How does Brevinor work?

Brevinor tablets are a type of hormonal contraception commonly known as 'the pill' or combined oral contraceptive pill. Brevinor tablets contain two active ingredients, ethinylestradiol and norethisterone. These are synthetic versions of the naturally occurring female sex hormones, oestrogen and progesterone. Ethinylestradiol is a synthetic version of oestrogen and norethisterone is a synthetic form of progesterone.

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Combined oral contraceptives like Brevinor work by over-riding the normal menstrual cycle. In a woman's normal menstrual cycle, levels of the sex hormones change throughout each month. The hormones cause an egg to be released from the ovaries (ovulation) and prepare the lining of the womb for a possible pregnancy. At the end of each cycle, if the egg has not been fertilised the levels of the hormones fall, causing the womb lining to be shed as a monthly period.

The daily dose of hormones taken in the pill work mainly by tricking your body into thinking that ovulation has already happened. This prevents an egg from ripening and being released from the ovaries each month.

The hormones also increase the thickness of the natural mucus at the neck of the womb, which makes it more difficult for sperm to cross from the vagina into the womb and reach an egg. They also change the quality of the womb lining (endometrium), making it less likely that a fertilised egg can implant there.

How do I take Brevinor?

Brevinor is a monophasic pill. This means that each tablet has the same dose of hormones in it. One tablet is taken every day for 21 days and you then have a seven day break from pill-taking. During your seven day break, the levels of the hormones in your blood drop, which results in a withdrawal bleed that is similar to your normal period. You start the next pack after the seven pill-free days are up, even if you are still bleeding.

The tablets come in a calendar pack marked with days of the week to help you remember to take a pill every day for three weeks, followed by a week off. You will still be protected against pregnancy in your pill-free week, provided you took all the pills correctly, you start the next packet on time and nothing else happened that could make the pill less effective (eg sickness, diarrhoea, or taking certain other medicines - see below).

You should try and take your pill at the same time every day; this will help you remember to take it. Each tablet should be swallowed with a drink. They can be taken either with or without food.

When can I start taking it?

Ideally, you should start taking this pill on day one of your menstrual cycle (the first day of your period). This will protect you from pregnancy immediately and you won't need to use any additional methods of contraception. If necessary, you can also start taking it up to day five of your cycle without needing to use additional contraception when you start. However, if you have a short menstrual cycle (with your period coming every 23 days or less), starting as late as the fifth day of your cycle may not provide you with immediate contraceptive protection. You should talk to your doctor or nurse about this and whether you need to use an additional contraceptive method for the first seven days.

You can also start taking this pill at any other time in your cycle if your doctor is reasonably sure that you are not pregnant. However, if you start taking this pill at any other time in your cycle, you won't be protected from pregnancy straight away and you will need to use additional contraception, eg condoms (or not have sex) for the first seven days of pill taking.

If you have given birth and are not breastfeeding. you can start taking this pill on day 21 after the birth. You will be protected against pregnancy immediately and do not need to use extra contraception. If you start taking it later than 21 days after giving birth, you will need to use extra contraception for the first seven days.

If you are starting this pill immediately after a miscarriage or abortion at under 24 weeks, you will protected against pregnancy immediately. If you start taking it more than seven days after the miscarriage or abortion, you should use extra contraception for the first seven days of pill taking.

What do I do if I miss a pill?

If you forget to take your pill at your usual time, take it as soon as you remember. A missed pill is one that is 24 hours or more late. If you miss a pill, follow the instructions below.

One pill missed

If you forget to take ONE pill, or start your new pack one day late, you should take the pill you missed as soon as possible, even if this means taking two pills at the same time. Then continue taking the rest of the pack as normal. You will still be protected against pregnancy and you don't need to use extra contraception.

Two or more pills missed

If you forget to take TWO or more pills, or start your new pack two or more days late, you won't be protected against pregnancy. You should take the last pill you missed as soon as possible, even if this means taking two pills at the same time. Leave out the other missed ones. Then continue to take your pills, one every day, as normal. You should either not have sex, or use an extra barrier method of contraception, eg condoms. for the next seven days.

If there are fewer than seven pills left in your pack after your last missed pill, you should finish the pack and then start a new pack straight away without a break. This means skipping your pill-free week.

If there are seven or more pills left in your pack after your last missed pill, you should finish the pack and have your seven day break as usual before starting the next pack.

If you had unprotected sex in the seven days before you missed pills, you may need emergency contraception (the morning after pill). Ask for medical advice.

If you are confused about any of this, you can get individual advice for your circumstances from your doctor, pharmacist or local family planning clinic.

What if I have vomiting or diarrhoea?

If you vomit within two hours of taking a pill, it may not have been fully absorbed into your bloodstream. You should take another pill as soon as you feel well enough and take your next pill at your usual time. You should still be protected from pregnancy. However, if vomiting continues for more than 24 hours, this may make your pill less effective. You should keep taking your pill at your normal time, but treat each day that you have vomiting as if you had forgotten to take a pill and follow the instructions under "what do I do if I miss a pill" above.

If you have very severe diarrhoea for more than 24 hours, this may make your pill less effective. You should keep taking your pill at your normal time, but treat each day that you have severe diarrhoea as if you had forgotten to take a pill and follow the instructions under "what do I do if I miss a pill" above.

Important information about Brevinor

This contraceptive pill will not protect you against sexually transmitted infections. so you may still need to use condoms as well.

Women using this contraceptive for the first time may experience menstrual irregularities such as spotting, breakthrough bleeding or missed periods. Consult your doctor if any breakthrough bleeding persists. If you don't have a withdrawal bleed for two consecutive months you should do a pregnancy test before starting the next month's contraceptive cycle.

It is important to be aware that, compared with women who do not use these contraceptives, women taking the combined pill appear to have a small increase in the risk of developing a blood clot in a vein, eg in the leg (deep vein thrombosis ) or in the lungs (pulmonary embolism ), or a blood clot in an artery, eg causing a stroke or a heart attack. This risk is greater in certain groups of women, particularly smokers and women who are obese - see cautions and not to be used in below). However, pregnancy carries a much higher risk of blood clots than any pill, so the potential risk must be weighed against the benefits of the contraceptive. You should discuss this with your doctor.

The risk of blood clots forming in the veins (venous thromboembolism) while taking the pill may be temporarily increased if you are immobile for prolonged periods of time, for example if you have a major accident or major surgery . For this reason, your doctor will usually recommend that you stop taking this pill for a period of time (usually four to six weeks) before any planned surgery, particularly abdominal surgery or orthopaedic surgery on the lower limbs (but not before minor surgery like teeth extraction). You will also need to stop taking this pill if you are going to be immobile for long periods, for example because you are confined to bed or have a leg in a plaster cast. You should not start taking the pill again until at least two weeks after you are fully mobile.

There may also be an increased risk of blood clots in the veins if you are travelling for long periods of time where you will be sat still (over three hours). The risk of blood clots during long journeys may be reduced by appropriate exercise during the journey and possibly by wearing elastic hosiery. You should ask your doctor or pharmacist for more advice.

It is important to be aware that women using hormonal contraceptives appear to have a small increase in the risk of being diagnosed with breast cancer. compared with women who do not use these contraceptives. Women who use oral contraceptives for longer than five years may also have a small increase in the risk of being diagnosed with cervical cancer. However, these risks must be weighed against the benefits of using the contraceptive, which include a decrease in the risk of cancers of the ovaries and endometrium (womb). You should discuss the risks and benefits of the pill with your doctor before you start taking it.

Stop taking this medicine and inform your doctor immediately if you get any of the following symptoms . stabbing pains and/or unusual swelling in one leg, pain on breathing or coughing, coughing up blood, sudden breathlessness, sudden severe chest pain, migraine or severe headaches, sudden disturbance in vision, hearing or speech, sudden weakness or numbness on one side of the body, fainting, collapse, epileptic seizure, significant rise in blood pressure, itching of the whole body, yellowing of the skin or whites of the eyes (jaundice), severe stomach pain, severe depression, or if you think you could be pregnant.

Brevinor should not be used by

Women who are breastfeeding (the combined pill shouldn't be taken until weaning or for six months after birth - see below for more information).

Women who have ever had a blood clot in a vein (venous thromboembolism), eg in the leg (deep vein thrombosis ) or in the lungs (pulmonary embolism ).

Women with blood disorders that increase the risk of blood clots in the veins, eg antiphospholipid syndrome or factor V Leiden .

Women having sclerosing treatment for varicose veins .

Women with two or more other risk factors for getting a blood clot in a vein, eg family history of deep vein thrombosis or pulmonary embolism before the age of 45 (parent, brother or sister), obesity. smoking. long-term immobility.

Women who have ever had a heart attack. stroke or mini-stroke caused by a blood clot in an artery.

Women with angina. heart valve disease or an irregular heartbeat called atrial fibrillation.

Women with moderate to severe high blood pressure (hypertension) .

Women who smoke more than 40 cigarettes per day.

Women over 50 years of age.

Women over 35 years of age who smoke more than 15 cigarettes per day.

Women with severe diabetes. eg with complications affecting the eyes, kidneys or nerves.

Women with two or more other risk factors for getting a blood clot in an artery, eg family history of heart attack or stroke before the age of 45 (parent, brother or sister), diabetes. high blood pressure. smoking. high cholesterol levels. obesity. migraines .

Women who get migraines with aura, severe migraines regularly lasting over 72 hours despite treatment, or migraines that are treated with ergot derivatives.

Women with breast cancer or a history of breast cancer (although the pill can be used if you have been free of cancer for five years and you don''t want to use non-hormonal methods of contraception).

Women with abnormal vaginal bleeding where the cause is not known.

Women with a long-term condition called systemic lupus erythematosus (SLE).

Women with a history of excess of urea in the blood, causing damaged red blood cells (haemolytic uraemic syndrome).

Women with active liver disease, eg liver cancer. hepatitis .

Women with a history of liver disease when liver function has not returned to normal.

Women with disorders of bile excretion that cause jaundice (eg Dubin-Johnson or Rotor syndrome).

Women with gallstones .

Women with a history of jaundice. severe itching, hearing disorder called otosclerosis, or rash called pemphigoid gestationis during a previous pregnancy, or previous use of sex hormones.

Hereditary blood disorders known as porphyrias.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Brevinor should be used with caution by

Women aged over 35 years.

Women whose parent, brother or sister had a heart attack or stroke caused by a blood clot before the age of 45.

Women with a parent, brother or sister who has had a blood clot in a vein (venous thromboembolism), eg in the leg (deep vein thrombosis ) or in the lungs (pulmonary embolism ) before the age of 45.

Smokers .

Women who are obese .

Women with diabetes mellitus .

Women with high blood pressure (hypertension) .

Women with heart failure .

Women who use a wheelchair.

Women with a history of inflammation of a vein caused by a superficial blood clot (thrombophlebitis).

Women with anaemia caused by a hereditary blood disorder where abnormal haemoglobin is produced (sickle cell anaemia).

Women with a history of severe depression. especially if this was caused by taking the pill in the past.

Women with a history of migraines (see above).

Women with inflammatory bowel disease, eg Crohn's disease or ulcerative colitis .

Women with a personal or family history of raised levels of fats called triglycerides in the blood (hypertriglyceridaemia).

Women with raised levels of the hormone prolactin in their blood (hyperprolactinaemia).

Women with an undiagnosed breast lump or gene mutations that are associated with breast cancer. eg BRCA1.

Women with a history of irregular brown patches appearing on the skin, usually of the face, during pregnancy or previous use of a contraceptive pill (chloasma). Women with a tendency to this condition should minimise their exposure to the sun or UV light while taking this contraceptive.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine is used to prevent pregnancy and should not be taken during pregnancy. However, if the pill fails or you miss pills and you do get pregnant while taking it, there is no evidence to suggest that the pills you have already taken will harm the baby. If you think you could be pregnant while taking this pill you should stop taking it and consult your doctor immediately.

The hormones in this pill can reduce the production of breast milk. For this reason, it is not recommended for women who are breastfeeding. It should not be used until weaning, or at least six months after the birth. Other methods of contraception are more suitable for women who are breastfeeding. Ask your doctor for advice.

Possible side effects of Brevinor

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. See also the warnings above . Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

Nausea and vomiting.

Abdominal pain.

Headache/migraine.

Breast tenderness and enlargement.

Weight changes.

Retention of water in the body tissues (fluid retention).

Vaginal thrush (candidiasis).

Change in menstrual bleeding, usually lighter periods or sometimes stopping of periods.

Menstrual spotting or breakthrough bleeding.

Depression .

Decreased sex drive.

Rise in blood pressure .

Skin reactions.

Irregular brown patches on the skin, usually of the face (chloasma).

Steepening of corneal curvature, which may make contact lenses uncomfortable.

Disturbance in liver function.

Gallstones .

Blood clots in the blood vessels (eg, DVT, pulmonary embolism, heart attack, stroke - see warnings above).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

If you think you have experienced a side effect from a medicine or vaccine you should check the patient information leaflet. This lists the known side effects and what to do if you get them. You can also get advice from your doctor, nurse or pharmacist. If they think it''s necessary they'll report it for you.

You can also report side effects yourself using the yellow card website: www. mhra. gov. uk/yellowcard .

How can Brevinor affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start taking this contraceptive. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to make sure that the combination is safe .

The following medicines speed up the breakdown of the hormones in this contraceptive by the liver, which makes it less effective at preventing pregnancy:

If you regularly take any of these medicines they are likely to make this contraceptive ineffective at preventing pregnancy. It is important that you talk to your doctor about this. Your doctor will usually recommend that you use a different form of contraception altogether. However, if you want to use the pill (and you are not taking rifampicin or rifabutin - see below), your doctor can prescribe you an additional pill to take in combination with this one, which would give you a higher dose of hormones. (This is unlicensed). If you do this, your doctor will also ask you to take three packets back to back without a break, have only a four day pill-free break, then take three packets back to back again. You repeat this for as long as you are taking the other medicine and for a further four weeks after stopping it. (This is called tricycling and is also unlicensed.) The purpose of this is to reduce the number and duration of hormone free periods in which ovulation could happen and thus minimise the chances of the pill failing.

If you are prescribed a short course (up to two months) of any of the above medicines they will also make this contraceptive less effective. Your doctor may recommend that you temporarily use a different form of contraception to prevent pregnancy. However, if you want to keep taking this pill, your doctor will probably advise you to take three packets back to back without a break, then have only a four day pill-free break. (This is called tricycling and is unlicensed.) You will also need to use an additional method of contraception (eg condoms) while you are doing this, for as long as you take the liver-affecting medicine and for at least four weeks after stopping it. Alternatively, your doctor could prescribe an additional pill to take in combination with this one, as above. Discuss your options with your doctor.

If you are prescribed rifampicin or rifabutin . an alternative method of contraception will always be recommended, because these two antibiotics make the pill so ineffective.

In the past, if you were prescribed an antibiotic other than rifampicin or rifabutin (eg amoxicillin, erythromycin, doxycycline) while taking the pill, the advice used to be that you use an extra method of contraception (eg condoms) while you were taking the antibiotic and for seven days after finishing the course. However, this advice has now changed . You no longer need to use an extra method of contraception with the pill while you take a course of antibiotics. This change in advice comes because to date there is no evidence to prove that antibiotics (other than rifampicin or rifabutin) affect the pill. This is the latest guidance from the Faculty of Sexual & Reproductive Healthcare. However, if you experience vomiting or diarrhoea as a result of taking an antibiotic you should follow the instructions for vomiting and diarrhoea described in the warning section above.

The emergency contraceptive ulipristal ( Ellaone ) has the potential to make the pill less effective. If you take Ellaone as an emergency contraceptive while you are taking Brevinor, you should use an additional method of contraception such as condoms for 14 days after you take it.

The antifungal medicine griseofulvin may make the pill less effective. You should use an extra method of contraception both during treatment with griseofulvin and for one month after stopping treatment.

The weight loss medicine orlistat (bought without a prescription as Alli and prescribed as Xenical ) can cause severe diarrhoea. If you take either of these medicines while taking Brevinor and get diarrhoea that lasts for more than 24 hours, you should follow the instructions for missed pills described above.

If you are taking the cholesterol-lowering medicine colesevelam in combination with the pill, it must be taken at least four hours after taking your pill, as otherwise it can reduce the absorption of the pill from the gut and make it less effective.

The pill may oppose the blood sugar lowering effect of medicines for diabetes . If you have diabetes you should monitor your blood sugar and seek advice from your doctor or pharmacist if your blood sugar control seems to be altered after starting this contraceptive.

The pill may oppose the effect of medicines used to lower high blood pressure. Your blood pressure will usually be checked periodically while you are taking the pill, but this is particularly important if you are also taking medicines for high blood pressure .

The pill may also oppose the fluid-losing effect of diuretic medicines .

If you have an underactive thyroid gland (hypothyroidism) you may need an increased dose of your thyroid hormones while taking the pill. Your thyroid hormone levels should be regularly checked.

The pill may decrease the amount of the antiepileptic medicine lamotrigine in the blood. As this could increase the risk of seizures coming back or getting worse, the pill may not be recommended for women who take lamotrigine on its own for epilepsy.

The pill may increase the blood levels of the following medicines and this could possibly increase the risk of their side effects:

ciclosporin

melatonin

ropinirole

selegiline (should be avoided in combination with the pill)

tacrolimus

theophylline (reduced dose of theophylline may be needed)

tizanidine

voriconazole .

Other contraceptives containing the same active ingredients

Further reading

For background information about our medicine factsheets, including the references used to produce them, click here .

Last updated 10.03.2014

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About - Nel Hydrogen, Nel

Vision

Our business

Nel is a global, dedicated hydrogen company, delivering optimal solutions to produce, store and distribute hydrogen from renewable energy. We serve industries, energy and gas companies with leading hydrogen technology. Since its foundation in 1927, Nel has a proud history of development and continual improvement of hydrogen plants. Our hydrogen solutions cover the entire value chain from hydrogen production technologies to manufacturing of hydrogen fueling stations, providing all fuel cell electric vehicles with the same fast fueling and long range as conventional vehicles today.

Context

Why we believe renewable hydrogen will be number 1 in the future:

The world needs a new energy carrier to replace oil and gas

Hydrogen is the element with the highest energy density

Through electrolysis hydrogen can be produced from water and renewable energy

Access to renewable energy is practically infinite

The electric grids do not have the capacity to handle the entire future energy demand alone

The demand for stable energy supply diverge from the fluctuating nature of renewable energy production in general

Renewable energy production depend upon intermediate storage

Timeline

Jon Andre Lokke CEO

Jon Andre Lokke

Jon Andre Lokke was appointed Chief Executive Officer (CEO) of NEL ASA effective 4 January 2016. Mr. Lokke comes from the position as CEO of Norsk Titanium AS, developing and industrializing 3D printing technology for the production of titanium components for the aerospace and other industries. He has ten years’ experience from the REC Group, including positions as senior vice president in REC Wafer, investor relations officer in REC ASA and CFO in REC ASA. Mr Lokke has also worked for the ABB Group and holds an International MBA degree from Glasgow University and a Bachelor degree in business and economics from Southampton University.

Anders Soreng CTO

Anders Soreng

Anders Soreng joined NEL from May 2016. He has previously served as Senior Vice President in REC Solar, where he held various management positions since 2008. He has recently worked as SVP & CTO of Norsk Titanium and holds a PhD from the Norwegian University of Science and Technology (NTNU).

Bent Skisaker CFO

Bent Skisaker

Bent Skisaker served was appointed CFO effective 1 September 2016. Skisaker comes from a position as Chief Financial Officer (CFO) of Eureka Pumps and has more than ten years experience as CFO in various companies in the Aker Group. Bent has also served eight years as an auditor and financial advisor at Ernst & Young/Arthur Andersen. Skisaker holds a Master in Accounting and Auditing from the Norwegian School of Economics (NHH), a B. A. of Business Organisation from Heriot-Watt University, and is qualified as a State Authorised Public Accountant in Norway

Bjorn Simonsen Market Development/PR

Bjorn Simonsen

Bjorn Simonsen joined NEL Hydrogen September 2014, and has since January 2015 been with NEL ASA. He has experience from the hydrogen sector since 2008, and began as a research engineer at Institute for Energy Technology (IFE), followed by key positions in the HyNor-project, The Norwegian Hydrogen Council and Norwegian Hydrogen Forum. He holds a MSc in Energy and Environmental Science from NTNU.

Mikael Sloth Business Development

Mikael Sloth

Mikael Sloth was appointed Director of Business Development in NEL as of June 2016. He is co-founder and served as Business Development Manager in H2 Logic since 2003. Mikael holds positions of trusts in various European hydrogen forums. Mikael served as board member of the €2,5 billion European Joint Technology Initiative for Hydrogen and Fuel Cells during 2008-2015.

Lars Markus Solheim Nel Hydrogen Electrolyser

Lars Markus Solheim

Lars Markus Solheim has been with Nel since 2005. He has extensive experience from employment in NEL Hydrogen, with previous positions as Lead Automation Engineer and Director of Operations. He has experience in NEL Hydrogen both from engineering, site activity and administrative work. He holds a BSc in System Engineering from Buskerud University College.

Jorn Rosenlund Nel Hydrogen Fueling

Jorn Rosenlund

Jorn Rosenlund was appointed Manager of NEL Hydrogen Fueling as of June 2016. Previously he held the a position as COO in H2 Logic. He has a background of 15 years in senior management positions on operations and supply chain management in EagleBurgmann (2013-2015) and Danfoss (2000-2013) with several years working in Denmark USA, Canada and Germany.

Jacob Krogsgaard Nel Hydrogen Solutions

Jacob Krogsgaard

Jacob Krogsgaard as appointed Manager of Nel Hydrogen Solutions as of June 2016. He is one of the co-founders and was Managing Director of H2 Logic since 2003. Mr. Krogsgaard also serves as CEO and board member of Danish Hydrogen Fuel A/S as well as board member of Copenhagen Hydrogen Network A/S – both are joint venture companies with leading energy and gas companies.

Board members

Martin Nes

CEO of the Ferncliff Group. Martin Nes has a law degree from the University of Oslo, and also holds a Master of Laws degree from University of Southampton, England. He previously spent several years with the Norwegian law rm Wikborg Rein, working in both the Oslo and London of ces, and with the shipping law rm Evensen & Co. Mr Nes has extensive corporate experience and is chairman and/or a member of the boards of several listed companies, including SD Standard Drilling Plc, Aqualis ASA, Nickel Mountain Group AB, Saga Tankers ASA and Weifa ASA.

Oystein Stray Spetalen

Oystein Stray Spetalen

Oystein Stray Spetalen is the chairman and owner of the investment rm Ferncliff TIH AS. He is an independent investor, and has previously worked for the Kistefos Group as an investment manager, as a corporate advisor at various investment banks, and as a portfolio manager for Gjensidige Forsikring. Mr Spetalen is a chartered petroleum engineer, educated at the Norwegian University of Science and Technology. He is a Norwegian citizen and resides in Oslo, Norway.

Eva Dugstad

Eva Dugstad is Innovation promoter and Special adviser at the Institute for Energy Technology (IFE) and holds a Cand. Pharm. degree from the University of Oslo. Her previous appointments include the position as President for IFE from 2010 – 2016, Vice President of IFE and Research Director for Sector Nuclear Technology and Physics. From 2002 – 2003, Dugstad worked with quality assurance in NMD, and from 2000– 2002, she worked for Photocure AS and was responsible for the pharmaceutical development of a new product in the cancer treatment eld. Ms Dugstad has been involved in various committees and boards in both the public and private sectors.

Jan Christian Opsahl

Mr. Opsahl, born in 1949, is the Owner and Chairman of Dallas Asset Manage - ment. He was the Founder, President and Chairman/ CEO of TANDBERG ASA from 1988 to 2010 at which point the Company was sold to Cisco Systems Inc. for 19.4 billion NOK. He was Chair - man of TANDBERG Television ASA from 1989 to 2007, and President/Chairman of Tomra Systems ASA from 1986 to 2008. He was Vice Chairman of Kom - plett ASA from 1996 to 2004 and REC Solar from 2013 to 2015 and is currently a Board Member of NEL Hydrogen asa. He has lived in total 25 years in Argen - tina, Brasil, UK and the USA.

Mr. Opsahl holds a degree in Business and a Diploma in Computer Science, both from the University of Strathclyde in Glasgow. He is also a Sloan Fellow from London Business School/M. I.T. He is an elected member of the Norwegian Academy of Technological Sciences.

Anne Marie Gohli Russell

Anne Marie Gohli Russell

Anne Marie Gohli Russell has been with NEL Hydrogen (Norsk Hydro Electrolysers) since 1986. In the period 1986 to 1993, she worked as a secretary in the project department. From 1993 to 1998, she was a senior secretary and transport coordinator. From 1998 to 2013, she was employed as a purchasing manager, and has been a logistics manager for the company since 2013.

Kristin Hellebust

Kristin Hellebust is the CEO of Nordisk Film Shortcut AS and has previously been CEO of Storm Studios AS and a Lawyer in Selmer DA. Hellebust is currently a board member of Saga Tankers ASA.

Ciplon; Tablet, Sanket Pharmaceuticals Pvt, Ciplon

CIPLON - Tablet, Sanket Pharmaceuticals Pvt. Ltd

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European Medicines Agency - Find Medicine, Novonorm

NovoNorm

About

This is a summary of the European public assessment report (EPAR). It explains how the Committee for Medicinal Products for Human Use (CHMP) assessed the studies performed, to reach its recommendations on how to use the medicine.

If you need more information about your medical condition or your treatment, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist. If you want more information on the basis of the CHMP recommendations, read the scientific discussion (also part of the EPAR).

NovoNorm is a medicine that contains the active substance repaglinide. It is available as round tablets (white: 0.5 mg; yellow: 1 mg; peach: 2 mg).

NovoNorm is used in patients who have type 2 diabetes (non-insulin-dependent diabetes). It is used together with diet and exercise to lower blood glucose (sugar) levels in patients whose hyperglycaemia (high blood glucose levels) cannot be controlled by diet, weight reduction and exercise. NovoNorm may also be used with metformin (another antidiabetes medicine) in type-2 diabetes patients whose blood glucose levels are not satisfactorily controlled on metformin alone.

NovoNorm is taken before meals, normally up to 15 minutes before each main meal. The dose is adjusted to give the best control. A doctor should regularly test the patient’s blood glucose to find the lowest effective dose. NovoNorm can also be used for type 2 diabetes patients whose blood glucose levels are usually controlled well on diet, but are experiencing temporary loss of blood glucose control.

The recommended starting dose is 0.5 mg. This dose may need to be increased after one or two weeks. If patients are transferred from another antidiabetes medicine, the recommended starting dose is 1 mg.

NovoNorm is not recommended for patients below 18 years of age because of a lack of information on safety and effectiveness in this age group.

Type 2 diabetes is a disease in which the pancreas does not make enough insulin to control the level of glucose in the blood or when the body is unable to use insulin effectively. NovoNorm helps the pancreas to produce more insulin at mealtimes and is used to control type 2 diabetes.

NovoNorm has been studied in 45 ‘clinical pharmacology’ studies (looking at how the medicine works in the body) and 16 clinical trials (looking at its effects in treating type-2 diabetes patients). A total of 2,156 patients received NovoNorm in all trials combined.

The main studies compared NovoNorm with other medicines used in type 2 diabetes (glibenclamide, glipizide or gliclazide). Another study looked at the effect of adding NovoNorm to metformin. The studies measured the level of a substance in the blood called glycosylated haemoglobin (HbA1c), which gives an indication of how well the blood glucose is controlled.

In all studies, NovoNorm led to a decrease in the level of HbA1c, which showed that blood glucose levels had been controlled to a similar level to that seen with the comparator medicines. In the study where NovoNorm was added to metformin, the effects of the two medicines were at least additive (equivalent to the effects of the two medicines added together).

NovoNorm produced a good insulin response to a meal within 30 minutes of being dosed in type 2 diabetes patients, leading to a blood glucose-lowering effect throughout the meal. The raised insulin levels returned to normal after the meal.

The most common side effects with NovoNorm (seen in between 1 and 10 patients in 100) are hypoglycaemia (low blood glucose levels), abdominal (tummy) pain and diarrhoea. For the full list of all side effects reported with NovoNorm, see the package leaflet.

NovoNorm should not be used in people who may be hypersensitive (allergic) to repaglinide or any of the other ingredients. It should also not be used in patients with type-1 (insulin-dependent) diabetes who do not have any ‘C-peptide’ in their blood (a marker of type 1 diabetes). It should also not be used in patients with diabetic ketoacidosis (high levels of ketones [acids] in the blood), in patients with severe liver problems or in patients also taking gemfibrozil (a medicine used to reduce blood fat levels). NovoNorm doses may also need to be adjusted when given with some medicines used in heart conditions, and to treat pain, asthma and other conditions. The full list of these medicines is available in the package leaflet.

The Committee for Medicinal Products for Human Use (CHMP) decided that NovoNorm’s benefits are greater than its risks for the treatment of type-2 diabetes. The Committee recommended that NovoNorm be given marketing authorisation.

The European Commission granted a marketing authorisation valid throughout the European Union for NovoNorm to Novo Nordisk A/S on 17 August 1998. The marketing authorisation was renewed on 17 August 2003 and on 17 August 2008.

Pharmacotherapeutic group

Drugs used in diabetes

Therapeutic indication

Repaglinide is indicated in patients with type-2 diabetes (non-insulin-dependent diabetes mellitus (NIDDM)) whose hyperglycaemia can no longer be controlled satisfactorily by diet, weight reduction and exercise. Repaglinide is also indicated in combination with metformin in type 2 diabetes patients who are not satisfactorily controlled on metformin alone.

Treatment should be initiated as an adjunct to diet and exercise to lower the blood glucose in relation to meals.

Assessment History

Changes since initial authorisation of medicine

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