Yetnal Jjajang ??????? (Hongdae, Seoul), Yasnal

Yetnal Jjajang ??????? (Hongdae, Seoul)

Hours of Operation: 11am to 9pm. Closed on Sundays.

Directions: Come out Sangsu Station (Line 6, Exit 1) and walk straight down about 300 meters. The restaurant will be to your right, near a side street.

I won’t lie or exaggerate. This jajangmyun was average at best, but after having some good bowel movements a few hours later, I knew this dish was a little more special than others. Here’s the bibimbab. Nicely balanced with the regular ingredients, but good stuff. We ordered jajangmyun along with this, which matched perfectly if you’re into swapping. Holding no more than 15 customers at one time, you’ll find this place busy during peak hours. A simple, no-fuss menu that anyone can read and order. If you’re starving, go ahead and order two items. Hand-pressing their noodles every day for their regular customers. Being curious on their operation, the ajumma was nice enough to show me the jajang sauce (black bean sauce) that she prepares early morning, every day. It has a curry-like consistency without extra MSG and other additives. Good, simple, and filling. Here are the gracious and humble owners who you will surely see if you ever make a visit. Among all the fancy signs and exterior of other places, this place keeps it simple and has been around for over 15 years.

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Augmentin (Amoxicillin Clavulanate) Side Effects, Interactions, Warning, Dosage & Uses, Fugentin

DRUG DESCRIPTION

AUGMENTIN is an oral antibacterial combination consisting of amoxicillin and the beta lactamase inhibitor, clavulanate potassium (the potassium salt of clavulanic acid).

Amoxicillin is an analog of ampicillin, derived from the basic penicillin nucleus. 6 aminopenicillanic acid. The amoxicillin molecular formula is C 16 H 19 N 3 O 5 S•3H 2 O, and the molecular weight is 419.46. Chemically, amoxicillin is (2S,5R,6R)-6-[(R)-(-)-2-Amino-2-(p-hydroxyphenyl)acetamido]-3,3- dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylic acid trihydrate and may be represented structurally as:

Clavulanic acid is produced by the fermentation of Streptomyces clavuligerus. It is a beta-lactam structurally related to the penicillins and possesses the ability to inactivate some beta lactamases by blocking the active sites of these enzymes. The clavulanate potassium molecular formula is C 8 H 8 KNO 5 . and the molecular weight is 237.25. Chemically, clavulanate potassium is potassium (Z)(2R,5R)-3-(2-hydroxyethylidene)-7-oxo-4-oxa-1-azabicyclo[3.2.0]-heptane-2-carboxylate and may be represented structurally as:

Inactive Ingredients

Tablets - Colloidal silicon dioxide, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, sodium starch glycolate, and titanium dioxide. Each tablet of AUGMENTIN contains 0.63 mEq potassium.

Powder for Oral Suspension - Colloidal silicon dioxide, flavorings, xanthan gum, and one or more of the following: hypromellose, mannitol, silica gel, silicon dioxide, succinic acid, sodium saccharin. and aspartame. [see WARNINGS AND PRECAUTIONS ]

Chewable Tablets - Colloidal silicon dioxide, flavorings, magnesium stearate, mannitol, and one or more of the following: D&C Yellow No. 10, FD&C Red No. 40, glycine. sodium saccharin, and aspartame. [see WARNINGS AND PRECAUTIONS

Each 125-mg chewable tablet and each 5 mL of reconstituted 125/5 mL oral suspension of AUGMENTIN contains 0.16 mEq potassium

Each 250-mg chewable tablet and each 5 mL of reconstituted 250/5 mL oral suspension of AUGMENTIN contains 0.32 mEq potassium

Each 200-mg chewable tablet and each 5 mL of reconstituted 200/5 mL oral suspension of AUGMENTIN contains 0.14 mEq potassium

Each 400-mg chewable tablet and each 5 mL of reconstituted 400/5 mL oral suspension of AUGMENTIN contains 0.29 mEq potassium

What are the possible side effects of amoxicillin and clavulanate potassium (Augmentin, Augmentin ES-600, Augmentin XR)?

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

Stop using this medicine and call your doctor at once if you have a serious side effect such as:

diarrhea that is watery or has blood in it;

pale or yellowed skin, dark colored urine, fever, confusion or weakness;

easy bruising or bleeding;

skin rash, bruising, severe tingling, numbness, pain, muscle weakness;

agitation.

Last reviewed on RxList: 8/31/2016 This monograph has been modified to include the generic and brand name in many instances.

Fusidic Acid, Fucidine

Fusidic Acid

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

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

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Bupropion Side Effects In Detail, Bupropiona

Bupropion Side Effects

In Summary

Commonly reported side effects of bupropion include: insomnia, nausea, weight loss, pharyngitis, constipation, dizziness, headache, and xerostomia. Other side effects include: abdominal pain, migraine, chest pain, arthralgia, skin rash, urinary frequency, agitation, palpitations, diarrhea, hypertension, weakness, confusion, myalgia, hostility, tinnitus, pruritus, nervousness, vomiting, anxiety, lack of concentration, tremor, dysgeusia, anorexia, diaphoresis, flushing, and abnormal dreams. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to bupropion: oral tablet, oral tablet extended release, oral tablet extended release 12 hr, oral tablet extended release 24 hr

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

Major Side Effects

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

More common:

Anxiety

dry mouth

hyperventilation

irregular heartbeats

irritability

restlessness

shaking

shortness of breath

trouble sleeping

Less common:

Buzzing or ringing in the ears

headache (severe)

skin rash, hives, or itching

Rare

Confusion

fainting

false beliefs that cannot be changed by facts

having extreme distrust of people

seeing, hearing, or feeling things that are not there

seizures (convulsions)

trouble concentrating

Incidence not known:

Actions that are out of control

anger

assaulting others

attacking others

being aggressive

being impulsive

chest pain or discomfort

fast or pounding heartbeat

force

inability to sit still

need to keep moving

sweating

talking, feeling, or acting with excitement

Minor Side Effects

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

More common:

Abdominal or stomach pain

constipation

decrease in appetite

dizziness

increased sweating

trembling

weight loss (unusual)

Less common:

Blurred vision

change in sense of taste

drowsiness

frequent need to urinate

sore throat

unusual feeling of wellbeing

For Healthcare Professionals

Applies to bupropion: oral tablet, oral tablet extended release

General

In placebo-controlled clinical studies, the specific adverse events that led to discontinuation in at least 1% of patients treated with either 300 mg or 400 mg per day of Wellbutrin SR (R)included rash, nausea, agitation, and migraine. Additional events leading to discontinuation in the immediate-release formulation included mental state abnormalities, vomiting, seizures, headaches, and sleep disturbances, many of which occurred at doses greater than the recommended daily dose.

Adverse events leading to treatment discontinuation with Zyban (R) included tremors, and rashes. The most commonly observed adverse reactions were dry mouth and insomnia. Smoking cessation is often associated with nicotine withdrawal symptoms, some of which are also recognized as adverse events associated with bupropion. [Ref ]

Psychiatric

The Australian Adverse Drug Reaction Advisory Committee reported that 285 of the 780 reports it received in association with bupropion through mid-May 2001 involved psychological disturbances.

Two cases of tactile hallucinations ("bugs crawling over skin") have been reported in association with bupropion extended-release (200 mg twice daily) therapy. In both cases the symptoms abated following a reduction in the total daily dose of bupropion (300 mg daily).

Insomnia may also be dose-dependent. In a dose response clinical study for smoking cessation, 29% of patients receiving bupropion 150 mg/day versus 35% of those receiving 300 mg/day reported insomnia. Insomnia may be minimized by reducing the dosage or avoiding administration at bedtime. [Ref ]

Very common (10% or more): Insomnia Common (1% to 10%): Abnormal dreams, agitation, anxiety, confusion, decreased memory, delusions, depression, disturbed concentration, euphoria, hallucinations, hostility, impaired sleep quality, irritability, mania/hypomania, nervousness, thinking abnormality Uncommon (0.1% to 1%): Bruxism, depersonalization, dysphoria, emotional lability, formal thought disorder, frigidity, mood instability, paranoia, psychosis, suicidal ideation Rare (less than 0.1%): Derealization, dysarthria, impaired attention, suicidal ideation Very rare (0.01% to 0.1%): Aggression, paranoid ideation, restlessness Frequency not reported: Completed suicide, delirium, manic reaction, suicide attempt [Ref ]

Nervous system

The Australian Adverse Drug Reaction Advisory Committee reported that 268 of the 780 reports it received in association with bupropion through mid-May 2001 involved nervous system disorders.

Grand mal seizures have been reported in 0.4% of patients undergoing bupropion therapy at dosages up to 450 mg daily. The incidence of seizures increases dramatically at higher dosages. The seizure rate in patients taking sustained-release bupropion up to a dosage of 300 mg/day (e. g. for smoking cessation) has been approximated at 0.1%.

The risk of seizure appears to be dose-related. Other risk factors are related to patient factors e. g. severe head injury, arteriovenous malformation, CNS tumor or CNS infection, or severe stroke, concomitant medications that lower the seizure threshold (e. g. other bupropion products, antipsychotics, tricyclic antidepressants, theophylline, and systemic corticosteroids), metabolic disorders, illicit drug use, abuse or misuse of prescription drugs such as CNS stimulants, diabetes mellitus treated with oral hypoglycemics or insulin, treatment with anorectic drugs, and excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates.

Two cases of elderly patients falling backwards have been attributed to the effects of bupropion on the basal ganglia. [Ref ]

Very common (10% or more): Dizziness, headache, sedation Common (1% to 10%): Akathisia, central nervous system stimulation, decreased memory, dyskinesia, dystonia, myoclonus, paresthesia, somnolence, taste perversion, tremor Uncommon (0.1% to 1%): Abnormal coordination, hypesthesia, hyperkinesia, hypertonia Rare (less than 0.1%): Abnormal electroencephalogram, amnesia, ataxia, migraine, parkinsonism, seizure, syncope Frequency not reported: Akinesia, aphasia, coma, extrapyramidal syndrome, hypokinesia, neuralgia, neuropathy, unmasking tardive dyskinesia Postmarketing reports: Dysarthria [Ref ]

Cardiovascular

Very Common (10% or more): Tachycardia Common (1% to 10%): Cardiac arrhythmias, chest pain, flushing, hot flashes, hypertension, hypotension, migraine, palpitation Uncommon (0.1% to 1%): Edema, electrocardiogram abnormalities (premature beats and nonspecific ST-T changes), peripheral edema, postural hypotension, stroke, vasodilation Rare (less than 0.1%): Myocardial infarction Frequency not reported: Cardiovascular disorder, complete AV block, extrasystoles, phlebitis Postmarketing reports: Third degree heart block [Ref ]

In clinical practice, hypertension, in some cases severe, requiring acute treatment, has been reported in patients receiving bupropion alone and in combination with nicotine replacement therapy. These events have been observed in both patients with and without evidence of preexisting hypertension.

Some investigators have suggested that bupropion therapy may be 10 to 100 times less likely to induce conduction problems than tricyclic antidepressants. [Ref ]

Gastrointestinal

Very common (10% or more): Constipation, dry mouth, nausea, vomiting Common (1% to 10%): Abdominal pain, diarrhea, dyspepsia, dysphagia, flatulence, gustatory disturbance, stomatitis Uncommon (0.1% to 1%): Gastric reflux, gingivitis, glossitis, gum irritation, increased salivation, inguinal hernia, mouth ulcer, oral edema, thirst disturbance, toothache Rare (less than 0.1%): Edema of the tongue, intestinal perforation Frequency not reported: Colitis, esophagitis, gastrointestinal hemorrhage, gum hemorrhage, pancreatitis, stomach ulcer, stool abnormality [Ref ]

Genitourinary

One study in which 150 patients received the sustained released form of bupropion reported the incidence of orgasm dysfunction at 8% in patients receiving a 300 mg daily dose and 10% in patients receiving a 400 mg daily dose.

Among antidepressants, bupropion may be associated with the lowest incidence of sexual dysfunction (i. e. impotence, abnormal ejaculation, changes in libido). [Ref ]

Common (1% to 10%): Decrease in sexual function, dysmenorrhea, increased/decreased libido, menstrual complaints, nocturia, urinary frequency, urinary tract infection, urinary urgency, vaginal hemorrhage Uncommon (0.1% to 1%): Impotence, polyuria, prostate disorder, testicular swelling, vaginal irritation Rare (less than 0.1%): Enuresis, urinary incontinence Frequency not reported: Abnormal ejaculation, cystitis, dyspareunia, dysuria, gynecomastia, menopause, painful erection, salpingitis, urinary retention, vaginitis Postmarketing reports: Prostate disorder, urinary tract disorder [Ref ]

Dermatologic

The Australian Adverse Drug Reaction Advisory Committee reported that 307 of the 780 reports it received in association with bupropion through mid - May 2001 involved skin reactions. Urticaria was the most commonly reported event (167 cases). Other rashes (86 cases) were also reported. [Ref ]

Common (1% to 10%): Dry skin, pruritus, rash, sweating, urticaria Uncommon (0.1% to 1%): Alopecia, ecchymosis Rare (less than 0.1%): Erythema multiforme, exacerbation of psoriasis, maculopapular rash, photosensitivity, Stevens-Johnson syndrome Frequency not reported: Angioedema, exfoliative dermatitis, hirsutism [Ref ]

Endocrine

Frequency not reported: Syndrome of inappropriate antidiuretic hormone [Ref ]

Hematologic

Frequency not reported: Anemia, leukocytosis, leukopenia, lymphadenopathy, pancytopenia, thrombocytopenia [Ref ]

Hepatic

Uncommon (0.1% to 1%): Abnormal liver function, jaundice Rare (less than 0.1%): Hepatitis, liver damage [Ref ]

Hypersensitivity

Common (1% to 10%): Allergic reaction Uncommon (0.1% to 1%): Fever with rash and other symptoms suggestive of delayed hypersensitivity Frequency not reported: Serum sickness-like reaction [Ref ]

Metabolic

Common (1% to 10%): Anorexia, decreased appetite, increased appetite Rare (less than 0.1%): Blood glucose disturbances, glycosuria [Ref ]

Musculoskeletal

Common (1% to 10%): Arthralgia, arthritis, musculoskeletal chest pain, myalgia, neck pain, pain in extremity, twitch Uncommon (0.1% to 1%): Leg cramps Frequency not reported: Muscle rigidity, muscle weakness, rhabdomyolysis [Ref ]

Ocular

Common (1% to 10%): Blurred vision or diplopia Uncommon (0.1% to 1%): Accommodation abnormality, dry eye, mydriasis, visual disturbance Frequency not reported: Increased intraocular pressure [Ref ]

Other

Common (1% to 10%): Accidental injury, asthenia, auditory disturbance, feeling jittery, fever, infection, pain, sensory disturbance, temperature disturbance, tinnitus Uncommon (0.1% to 1%): Chills, facial edema, vertigo Rare (less than 0.1%): Malaise Frequency not reported: Deafness [Ref ]

Respiratory

Very common (10% or more): Nasopharyngitis, pharyngitis, rhinitis Common (1% to 10%): Bronchitis, dyspnea, epistaxis, increased cough, sinusitis, upper respiratory tract infection Rare (less than 0.1%): Bronchospasm Frequency not reported: Pneumonia, pulmonary embolism [Ref ]

References

1. "Product Information. Wellbutrin XL (buPROPion)." GlaxoSmithKline, Philadelphia, PA.

2. Ministerio de Sanidad y Consumo. Gobierno de Espana "AEMPS. Agencia Espanola de Medicamentos y Productos Sanitarios. Available from: URL: https://sinaem4.agemed. es/consaem/fichasTecnicas. do? metodo=detalleForm."

3. "Product Information. Wellbutrin SR (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.

4. "Product Information. Zyban (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.

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

6. "Product Information. Wellbutrin (bupropion)." Glaxo Wellcome, Research Triangle Park, NC.

7. Ames D, Wirshing WC, Szuba MP "Organic mental disorders associated with bupropion in three patients." J Clin Psychiatry 53 (1992): 53-5

8. Golden RN, James SP, Sherer MA, Rudorfer MV, Sack DA, Potter WZ "Psychoses associated with bupropion treatment." Am J Psychiatry 142 (1985): 1459-62

9. Benson E "Bupropion-induced hypersensitivity reactions." Med J Australia 174 (2001): 650-1

10. Zubieta JK, Demitrack MA "Possible bupropion precipitation of mania and a mixed affective state." J Clin Psychopharmacol 11 (1991): 327-8

11. Paluck EC, McCormack JP, Ensom MH, Levine M, Soon JA, Fielding DW "Outcomes of bupropion therapy for smoking cessation during routine clinical use." Ann Pharmacother 40 (2006): 185-90

12. Liu CY, Chien YS "Perceptual Disturbances Associated With Low-Dose Bupropion Sustained-Release Treatment." J Clin Psychopharmacol 27 (2007): 543-544

13. van Putten T, Shaffer I "Delirium associated with bupropion." J Clin Psychopharmacol 10 (1990): 234

14. Charuvastra A, Yaeger D "Tactile Hallucinations Associated With Therapeutic Doses of Bupropion in 2 Patients." J Clin Psychiatry 67 (2006): 1820-1821

15. Dager SR, Heritch AJ "A case of bupropion-associated delirium." J Clin Psychiatry 51 (1990): 307-8

16. Bittman BJ, Young RC "Mania in an elderly man treated with bupropion." Am J Psychiatry 148 (1991): 541

17. Liberzon I, Dequardo JR, Silk KR "Bupropion and delirium." Am J Psychiatry 147 (1990): 1689-90

18. Szuba MP, Leuchter AF "Falling backward in two elderly patients taking bupropion." J Clin Psychiatry 53 (1992): 157-9

19. Johnston JA, Lineberry CG, Ascher JA, et al. "A 102-center prospective study of seizure in association with bupropion." J Clin Psychiatry 52 (1991): 450-6

20. Hansen RA, Gartlehner G, Lohr KN, Gaynes BN, Carey TS "Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder." Ann Intern Med 143 (2005): 415-26

21. Sheehan DV, Welch JB, Fishman SM "A case of bupropion-induced seizure." J Nerv Ment Dis 174 (1986): 496-8

22. Settle EC, Jr "Tinnitus related to bupropion treatment." J Clin Psychiatry 52 (1991): 352

23. Shepherd G "Adverse effects associated with extra doses of bupropion." Pharmacotherapy 25 (2005): 1378-82

24. Gittelman DK, Kirby MG "A seizure following bupropion overdose." J Clin Psychiatry 54 (1993): 162

25. Wilson S, Argyropoulos S "Antidepressants and sleep: a qualitative review of the literature." Drugs 65 (2005): 927-47

26. Storrow AB "Bupropion overdose and seizure." Am J Emerg Med 12 (1994): 183-4

27. Dufresne RL, Weber SS, Becker RE "Bupropion hydrochloride." Drug Intell Clin Pharm 18 (1984): 957-64

28. Landau J, Ajani AE "Bupropion and bradycardia." Med J Aust 189 (2008): 180

29. Glassman AH, Preud'homme XA "Review of the cardiovascular effects of heterocyclic antidepressants." J Clin Psychiatry 54 (1993): 16-22

30. Halbreich U, Rojansky N, Bakhai Y, Wang K "Menstrual irregularities associated with bupropion treatment." J Clin Psychiatry 52 (1991): 15-6

31. Levenson JL "Priapism associated with bupropion treatment." Am J Psychiatry 152 (1995): 813

32. Coleman CC, King BR, BoldenWatson C, Book MJ, Segraves RT, Richard N, Ascher J, Batey S, Jamerson B, Metz A "A placebo-controlled comparison of the effects on sexual functioning of bupropion sustained release and fluoxetine." Clin Ther 23 (2001): 1040-58

33. Ginzburg R, Wong Y, Fader JS "Effect of bupropion on sexual dysfunction." Ann Pharmacother 39 (2005): 2096-9

34. Menaster MJ "Weight gain, sexual dysfunction, and bupropion." J Clin Psychiatry 66 (2005): 1335-6; author reply 1336-9

35. Rowland DL, Myers L, Culver A, Davidson JM "Bupropion and sexual function: A placebo-controlled prospective study on diabetic men with erectile dysfunction." J Clin Psychopharmacol 17 (1997): 350-7

36. Gautam M "Alopecia due to psychotropic medications." Ann Pharmacother 33 (1999): 631-7

37. Lineberry MTW, Peters GE, Bostwick JM "Bupropion-induced erythema multiforme." Mayo Clin Proc 76 (2001): 664-6

38. CarrilloJimenez R, Zogby M, Treadwell TL "Erythema multiforme associated with bupropion use." Arch Intern Med 161 (2001): 1556

39. Malesker MA, Soori GS, Malone PM, Mahowald JA, Housel GJ "Eosinophilia associated wih bupropion." Ann Pharmacother 29 (1995): 867-9

40. McCollom RA, Ritchie AH "Bupropion-induced serum sickness-like reaction." Ann Pharmacother 34 (2000): 471-3

41. Peloso PM, Baillie C "Serum sickness-like reaction with bupropion." JAMA 282 (1999): 1817

42. Yolles JC, Armenta WA, Alao AO "Serum sickness induced by bupropion." Ann Pharmacother 33 (1999): 931-3

43. Bagley SC, Yaeger D "Hyponatremia associated with bupropion, a case verified by rechallenge." J Clin Psychopharmacol 25 (2005): 98-9

44. Gardos G "Reversible dyskinesia during bupropion therapy." J Clin Psychiatry 58 (1997): 218

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

L Aven, Laaven

P. O Box 222, Leasburg NC 27291    We specialize in dry and temperature controlled, non-hazardous freight.

Family owned and operated, providing the personal attention, commitment and devotion to services that you need. We aim to please each and every customer. ​ Interested in driving, print the Application packet at the bottom right, complete and mail it to. L aven LLC, Box 222, Leasburg, NC 27291

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Zomax - Drug Information, Indications, Dosage, Side Effects, Drug Prices, Zomax

Zomax is an antibiotic from Helix Pharmaceuticals . The generic formula of Zomax is Azithromycin which is a synthetic antibiotic.

Zomax – Azithromycin Drug Information

Azithromycin is a semisynthetic derivative of Erythromycin which is made by addition of methylated nitrogen into the lactone ring of Erythromycin. Azithromycin shows its activity against gram positive bacterias. A patient who have been prescribed with Azithromycin must take full dose at appropriate intervals to maintain the level of drug in the body for proper medical results. It is also important for indication treatment.

Zomax – Azithromycin Indications

Azithromycin, which is an antibiotic is prescribed by doctors for many medical indications. It includes Cervicitits, Lower respiratory tract infections, Multiple myeloma, Otitis media, Reversal of excessive bradycardia, Rtis; otitis media, Skin and soft tissue infections, Soft tissue and skin infections, Status epilepticus (unlicensed use), Upper respiratory tract infections, Urethritis.

Zomax – Azithromycin Dosage

Adult Dosage of Azithromycin is given in a dosage of 500mg Q24 Hourly Oral.

Pediatric Dose of Azithromycin is 20mg/KG as recommended

Zomax – Azithromycin Side Effects

Some of the side effects of Azithromycin are Pseudomembranous colitis, Jaundice, Maculopapular rash, Cholestasis. Some more adverse effects includes Dizziness, Vertigo, Headache, Fatigue, Nausea, Vomiting, Diarrhea, Palpitation, Abdominal pain, Rashes, Photosensitivity, GI disturbance.

Zomax – Azithromycin Drug Prices

Zomax Syrup . Azithromycin:200mg/5ml – Rs. 140/

Zomax Capsules . Azithromycin:250mg – Rs. 180/

Zomax Capsules Azithromycin:500mh – Rs. 275/

I have been given Zomax drip (about 15 minutes) every month. for the last 6 months. I have 8-years of prostate cancer and was told this was for bone strenthing. However….since I began this treatment, I’ve had these violent eruptions of shitting myself and must wear diapers. I mean it can come on 2 steps out of getting out of bed. Then I’ll need to go 2-3 times before I dare leave the house. Is this a side-effect or something more serious with me? It just seems these symptoms seem to coincide with the begining of a Zomax monthy drip from my Oncologist. Any reply?

plz write more info. in details

Clinical Evaluation Of 2, 3 And 4 Days Of Amoxicillin Treatment (Cofamox 15 La) In Neonatal Piglets

Clinical evaluation of 2, 3 and 4 days of amoxicillin treatment (Cofamox 15 LA) in neonatal piglets suffering from (poly)arthritis

(2013) Faculty of Veterinary Medicine Theses

Septic (poly)arthritis is a frequently seen severe illness in neonatal piglets. Although 3rd generation cephalosporins are often used, amoxicillin is theoretically a more efficient and more rational choice of treatment. This trial is a pilot-study to determine if Cofamox® 15 LA, a 150 mg/ml amoxicillin suspension, is suitable for treating . read more arthritis in neonatal piglets and investigates the required duration of treatment. Sixty five piglets with signs of arthritis were treated for 2, 3 or 4 days. The piglets were scored for several clinical parameters (such as lameness-score) during 7 days. The results clearly show that a duration of treatment of 3 and 4 days of 15 mg/kg amoxicillin (Cofamox® 15 LA) is effective against arthritis in neonatal piglets, while a duration of 2 days is insufficient. These data suggest that amoxicillin is a potential candidate to replace 3rd generation cephalosporins for treating septic (poly)arthritis and justify the launch of a large scale trial for registration. show less

Not available. The author may have various reasons for not providing access, for instance because it is prohibited by the commissioner of the research, or because the author is conducting further research on the subject.

Author keywords: Streptococcus suis, amoxicillin, pig, neonatal, arthritis, therapeutic regimen

Topiramate Indications, Side Effects, Warnings, Topimatil

Topiramate

Treating seizures in certain patients. It may be used alone or with other medicines. It is also used to prevent migraine headaches. It may also be used for other conditions as determined by your doctor.

Topiramate is an anticonvulsant that is also effective for preventing migraine headaches. It works by affecting several chemicals in the brain that help to reduce seizure activity and prevent migraine headaches from occurring.

Do NOT use topiramate if:

you are allergic to any ingredient in topiramate

you have high blood acid levels (metabolic acidosis) and are also taking a medicine that contains metformin. Check with your doctor or pharmacist if you are not sure if a medicine you take contains metformin

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

Before using topiramate:

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

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

if you are able 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 eye problems (eg, glaucoma), liver or kidney problems, kidney stones, metabolism problems, osteoporosis (weak bones), soft bones, bleeding problems, or low blood platelet levels

if you have diarrhea, lung or breathing problems, low bicarbonate levels in the blood, or a growth problem, or you will be having surgery

if you drink alcohol regularly, you are on a diet high in fat and low in carbohydrates (ketogenic diet), or you are receiving kidney dialysis

if you have a history of status epilepticus (continuous seizure activity or a series of seizures without a full return to consciousness) or metabolic acidosis

if you have a history of mental or mood problems (eg, depression), or suicidal thoughts or actions

if you take any other medicine for seizures

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

Anticoagulants (eg, warfarin), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), or selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine) because the risk of bleeding may be increased

Anticholinergics (eg, benztropine) or carbonic anhydrase inhibitors (eg, acetazolamide, dichlorphenamide, zonisamide) because the risk of decreased sweating may be increased

Valproic acid because the risk of high blood ammonia levels or low body temperature may be increased

Pioglitazone because blood glucose control may be altered; monitor your blood sugar carefully if you use topiramate with pioglitazone

Hydrochlorothiazide or metformin because they may increase the risk of topiramate's side effects

Carbamazepine or hydantoins (eg, phenytoin) because they may decrease topiramate's effectiveness

Amitriptyline or lithium because the risk of their side effects may be increased by topiramate

Cabazitaxel, hormonal birth control (eg, birth control pills), or ulipristal because their effectiveness may be decreased by topiramate

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

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

Topiramate comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get topiramate refilled.

Take topiramate by mouth with or without food.

Drinking extra fluids while you are taking topiramate is recommended. Doing so may help to prevent kidney stones from forming. Check with your doctor for instructions.

Swallow whole. Do not crush or chew. The tablet may leave a bitter taste.

Do not suddenly stop taking topiramate. Suddenly stopping topiramate may increase the risk of seizures. If you need to stop topiramate, your doctor will gradually lower your dose.

If you miss a dose of topiramate, take it as soon as possible. If it is within 6 hours of your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Contact your doctor if you miss more than 1 dose of topiramate.

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

Important safety information:

Topiramate may cause drowsiness, dizziness, confusion, trouble concentrating, or vision changes. These effects may be worse if you take it with alcohol or certain medicines. Use topiramate with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

Do not change your dose without checking with your doctor.

Do not drink alcohol while you take topiramate.

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

Topiramate may reduce sweating, which could raise body temperature, especially in children. This risk is greater in hot weather and/or during vigorous exercise. Drink plenty of fluids. Dress lightly in hot climates or when exercising. Check carefully for signs of decreased sweating. If this occurs, promptly seek cooler or air-conditioned shelter and/or stop exercising. Seek medical attention right away if you have decreased sweating, fever, mental or mood changes, headache, or dizziness.

Topiramate may cause high blood acid levels (metabolic acidosis). The risk may be greater in children and in patients with kidney problems, severe breathing problems, or diarrhea. It may also be greater in patients who are taking certain other medicines (eg, acetazolamide), will be having surgery, or are on a ketogenic diet. Over a period of time, metabolic acidosis may cause kidney stones, bone problems, or decreased growth in children. Contact your doctor immediately if you experience fast breathing, unusual tiredness or weakness, sluggishness, persistent loss of appetite, or fast or irregular heartbeat.

Topiramate may cause high blood ammonia levels (hyperammonemia). This risk may be greater in patients with metabolism problems or certain liver problems. It may also be greater in patients who are taking valproic acid. Contact your doctor immediately if you experience decreased alertness, mental changes, sluggishness, unusual tiredness, or vomiting.

Patients who take topiramate may be at increased risk of suicidal thoughts or actions. The risk may be greater in patients who have had suicidal thoughts or actions in the past. Watch patients who take topiramate closely. Contact the doctor at once if new, worsened, or sudden symptoms such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual change in mood or behavior occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur.

Topiramate may cause serious eye problems that could lead to permanent loss of vision if not treated. Seek medical attention right away if you experience new eye symptoms (eg, blurred vision or other vision changes, eye pain or redness).

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

Hormonal birth control (eg, birth control pills) may not work as well while you are using topiramate. To prevent pregnancy, use an extra form of birth control (eg, condoms). Discuss any questions or concerns with your doctor.

Lab tests, including serum bicarbonate levels, may be performed while you use topiramate. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Caution is advised when using topiramate in CHILDREN; they may be more sensitive to its effects, especially decreased sweating and decreased bicarbonate levels.

Topiramate may affect growth rate in CHILDREN and teenagers in some cases. They may need regular growth checks while they take topiramate.

Topiramate may cause birth defects if you take it while you are pregnant. If you may become pregnant, discuss other possible treatment options with your doctor. If a decision is made to take topiramate, use effective birth control while you are taking it. Talk with your doctor about the best kind of birth control to use while taking topiramate, if you are planning to become pregnant, and if you have questions or concerns about this information.

PREGNANCY and BREAST-FEEDING: Topiramate may cause birth defects if you take it while you are pregnant. If you think you may be pregnant, contact your doctor right away. You will need to discuss the benefits and risks of taking topiramate while you are pregnant. You and your doctor will need to decide if you will continue to take topiramate while you are pregnant. Topiramate is found in breast milk. If you are or will be breast-feeding while you take topiramate, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of topiramate:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; dry mouth; flushing; headache; loss of appetite; nausea; nervousness; stomach pain or upset; symptoms of upper respiratory tract infection (eg, cough, mild sore throat, running or stuffy nose, sneezing); taste changes; tiredness; trouble sleeping; weakness; weight loss.

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); bone pain; burning, numbness, or tingling; chest pain; confusion; decreased coordination; decreased or painful urination; fever, chills, or persistent cough or sore throat; loss of consciousness; memory problems; menstrual changes; muscle or joint pain, cramps, or weakness; new or worsening mental, mood, or behavior changes (eg, aggressiveness, agitation, anxiety, depression, exaggerated feeling of well-being, hostility, impulsiveness, inability to sit still, irritability, panic attacks, restlessness); red, swollen, blistered, or peeling skin; ringing in the ears; severe or persistent drowsiness; severe stomach, side, or back pain; significant weight loss; speech problems; stupor; suicidal thoughts or actions; symptoms of bleeding (eg, throwing up blood or vomit that looks like coffee grounds; coughing up blood; blood in urine; black, red, or tarry stools; bleeding from the gums; unusual vaginal bleeding; bruises without a reason or bruises that get bigger; any bleeding that is severe or that you cannot stop); tremor; trouble focusing; trouble walking; unusual eye movements.

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

If OVERDOSE is suspected:

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

Proper storage of topiramate:

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

General information:

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

Topiramate 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 topiramate 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 topiramate. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to topiramate. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your health care provider for complete information about the risks and benefits of using topiramate.

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 topiramate

Clotrimazole - Side Effects, Dosage, Interactions, Mycelex

Clotrimazole

Clotrimazole is an anti-fungal medication used to treat yeast infections of the vagina, skin, and mouth. It is commonly used for athlete's foot, jock itch, body ringworm. and oral thrush.

Lotrimin is one of the brand names of clotrimazole. There are several other brand names, and this medicine is also used in combination products.

The drug prevents the growth of fungi by interfering with the production of the membrane that surrounds fungal cells.

Clotrimazole comes as a cream, powder, and lotion to apply to the skin. It also comes as a lozenge to dissolve in the mouth and a vaginal tablet and cream to be inserted into the vagina.

Clotrimazole (Lotrimin) Warnings

Clotrimazole cream, lotion, and solution should only be used externally. Do not swallow or let the medication get in your eyes. Also, do not swallow the vaginal tablets or cream.

If you have a vaginal infection, you should avoid sexual intercourse. An ingredient in clotrimazole cream may weaken certain latex products like condoms or diaphragms, so you should not use these products within 72 hours of taking clotrimazole.

Continue to use clotrimazole even if you feel well. You should not stop taking this drug without talking to your doctor. You should also keep taking it during your menstrual period.

Before taking this drug, you should tell your doctor if you have or have ever had liver disease, problems with your immune system, HIV, AIDS, a history of alcohol abuse, or diabetes. You should also tell your doctor if you drink alcohol before taking this medicine.

Studies have shown clotrimazole is poorly absorbed into the blood and body when applied to the skin or vagina. Women in their second or third trimesters of pregnancy have shown no ill effects while taking clotrimazole. It is not known whether this drug is secreted in breast milk.

Clotrimazole (Lotrimin) Side Effects

This should slowly dissolve in the mouth after being placed on the tongue. One troche (lozenge) is typically given five times a day for 14 days.

Cream, lotion, or solution forms:

These are typically applied to the affected area and surrounding skin twice a day, in the morning and evening.

This is inserted through an applicator once daily for seven consecutive days (preferably at bedtime).

The 100-milligram (mg) suppository is inserted once a day for seven consecutive days (preferably at bedtime).

The 200 mg suppository is inserted once a day for three days (preferably at bedtime).

Clotrimazole (Lotrimin) Overdose

If you suspect an overdose, contact a poison control center or emergency room immediately. You can get in touch with a poison control center at (800) 222-1222.

Missed Dose of Clotrimazole (Lotrimin)

If you miss a dose of clotrimazole, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and follow your regular dosing schedule. Do not "double up" to make up for a missed dose.

Indocin - Where To Buy, No Prescription, Discount Coupon, Compare Prices, Indomelan

Indocin

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No Prescription

Indocid is prescribed for the following: - Painful inflammatory disorders affecting the muscles, bones and joints like back pain and tendon inflammation known as tendonitis; - Pain and inflammation following orthopedic procedures; - Osteoarthritis; - Inflammatory disease of the joints or what is called rheumatoid arthritis; - Acute gout; - Abdominal pain associated with menstrual periods or commonly known as dysmenorrhoea; - A form of arthritis affecting the joints of the spine known as ankylosing spondylitis;

Prostaglandins are substances produced by our body to signal pain. Indocid is a drug, which relieves pain and inflammation, caused by prostaglandin. Indocid is a drug, which belongs to the group known as NSAIDs or non-steroidal anti-inflammatory drugs.

Indocin. a nonsteroidal anti-inflammatory drug, is prescribed to relieve the inflammation, swelling, stiffness and joint pain associated with moderate or severe rheumatoid arthritis and osteoarthritis (the most common form of arthritis), and ankylosing spondylitis (arthritis of the spine). It is also prescribed to treat bursitis, tendinitis (acute painful shoulder), acute gouty arthritis, and other kinds of pain.

Contraindications

Indocin is contraindicated if you have any of the following conditions: - The seal around the cap has been broken; - The expiry date on the bottle has passed; - The bottle or packaging has shown signs of tampering; - Psychiatric disorders; - Parkinson's disease; - History of asthma; - History of allergies; - High blood pressure or hypertension; - Heart failure; - Epilepsy; - Elderly people; - Decreased liver function; - Decreased kidney function; - Blood clotting disorders;

Interactions

Do not take Indocin with any of the following drugs: - ACE inhibitors such as enalapril; - Beta-blockers such as Atenolol; - Ciclosporin; - Diflunisal; - Digoxin; - Diuretics such as furosemide and bendroflumethiazide; - Haloperidol; - Lithium; - Methotrexate; - Probenecid;

Side Effects

Indocin side effects that you should report to your health care professional or doctor as soon as possible: - Blood disorders; - Blurred vision; - Confusion; - Disturbances of the gut such as nausea, vomiting, diarrhea or abdominal pain; - Dizziness; - Facial flushing; - Fits; - Headache; - Indigestion or Dyspepsia; - Itch; - Kidney disorders; - Mood changes, strange or abnormal thoughts or depression; - Narrowing of airways; - Pain in the eye; - Rise in blood pressure; - Sensation of ringing, or other noise in the ears; - Skin rash; - Skin rashes; - Swelling of lips, tongue or throat; - Ulceration or bleeding of the stomach or intestines;

Indocin side effects that you should report to your health care professional or doctor as soon as possible: - Vomiting; - Vertigo; - Stomach Upset; - Stomach Pain; - Sleepiness Or Excessive Drowsiness; - Ringing In The Ears; - Nausea; - Indigestion; - Heartburn; - Headache; - Fatigue; - Dizziness; - Diarrhea; - Depression; - Constipation; - Abdominal Pain;

Other Brand Names

In some countries Indocin may also be known as: - Agilex; - Agilisin; - Aliviosin; - Antalgin; - Artaxol; - Arthrexin; - Artrinovo; - Autritis; - Catlep; - Chrono-Indocid; - Confortid; - Dolcidium; - Dolcispray; - Draxil; - Elmetacin; - Flexidin; - Flexono; - Fortathrine; - Hastel; - IM 75; - Imbrilon; - Indo; - Indobene; - Indocarsil; - Indocid PDA; - Indocolir; - Indocollirio; - Indocollyre; - Indoflex; - Indohexal; - Indomelan; - Indometacin; - Indomet-ratiopharm; - Indo-paed; - Indoptol; - Indotex; - Infree; - Italon; - Itapredin; - Klonametacina; - Labymetacyn; - Liometacen; - Luiflex; - Maximet SR; - Metacidil; - Methocaps; - Mobilat Akut Indo; - Nisaid; - Novo-Methacin; - Nu-Indo; - Pardelprin; - Ralicid; - Reumacid; - Reumadolor; - Rheubalmin Indo; - Rhodacine; - Rimacid; - Slo-Indo; - Soltacina; - Vonum Cutan;

Dosage

This medication is available in liquid, capsule, and suppository form. The following dosages are for the capsule form. If you prefer the liquid form ask your doctor to make the proper substitution. Do not try to convert the medication or dosage yourself.

Moderate to Severe Rheumatoid Arthritis, Osteoarthritis, Ankylosing Spondylitis

The usual dose is 25 mg 2 or 3 times a day, increasing to a total daily dose of 150 to 200 mg. Your doctor should monitor you carefully for side effects when you are taking this drug.

Your doctor may prescribe a single daily 75-mg capsule of Indocin SR in place of regular Indocin.

Bursitis or Tendinitis

The usual dose is 75 to 150 mg daily divided into 3 to 4 small doses for 1 to 2 weeks, until symptoms disappear.

Acute Gouty Arthritis

The usual dose is 50 mg 3 times a day until pain is reduced to a tolerable level (usually 3 to 5 days). Your doctor will advise you when to stop taking this drug for this condition. Keep him informed of its effects on your symptoms.

The safety and effectiveness of Indocin have not been established in children under 14 years of age. However, your doctor may decide that the benefits of this medication outweigh any potential risks.

Your doctor will adjust the dosage as needed.

Spophyllin, Spophyllin

Search Chemicals

MyChemicals

THEOPHYLLINE

Slightly soluble in water.

Flash point data for this chemical are not available, however it is probably combustible. (NTP, 1992)

SYMPTOMS: Symptoms of exposure to this compound include nausea, vomiting, epigastric pain, hematemesis, diarrhea, headaches, irritability, restlessness, insomnia, reflex hyperexcitability, muscle twitching, clonic and tonic generalized convulsions, palpitations, tachycardia, extrasystoles, potentiation of diuresis, hyperglycemia, flushing, hypotension, tachypnea, albuminuria, inappropriate ADH secretion and rash. Other symptoms include collapse, a fall in blood pressure; coma, hyperreflexia, ventricular arrythmias including fibrillation, hypotension, respiratory arrest, restlessness, fever, agitation and hyperventilation. It may also cause central nervous system stimulation, nervousness, insomnia, tremors, hyperesthesia, stimulation of the medullary respiratory centers; apnea, emesis, decreases in peripheral vascular resistance; increased perfusion of most organs and death.

ACUTE/CHRONIC HAZARDS: When heated to decomposition this compound emits toxic fumes of NOx. (NTP, 1992)

THEOPHYLLINE neutralizes acids in exothermic reactions to form salts plus water. May be incompatible with isocyanates, halogenated organics, peroxides, phenols (acidic), epoxides, anhydrides, and acid halides. Flammable gaseous hydrogen may be generated in combination with strong reducing agents, such as hydrides.

Belongs to the Following Reactive Group(s)

Potentially Incompatible Absorbents

Use caution: Liquids with this reactive group classification have been known to react with the absorbent listed below. More info about absorbents, including situations to watch out for.

Mineral-Based & Clay-Based Absorbents

Response Recommendations

The Response Recommendation fields include isolation and evacuation distances, as well as recommendations for firefighting, non-fire response, protective clothing, and first aid. The information in CAMEO Chemicals comes from a variety of data sources.

Isolation and Evacuation

No information available.

Fires involving this compound can be controlled using a dry chemical, carbon dioxide or Halon extinguisher. (NTP, 1992)

SMALL SPILLS AND LEAKAGE: If you spill this chemical, you should dampen the solid spill material with water, then transfer the dampened material to a suitable container. Use absorbent paper dampened with water to pick up any remaining material. Seal your contaminated clothing and the absorbent paper in a vapor-tight plastic bag for eventual disposal. Wash all contaminated surfaces with a soap and water solution. Do not reenter the contaminated area until the Safety Officer (or other responsible person) has verified that the area has been properly cleaned.

STORAGE PRECAUTIONS: You should store this material under ambient temperatures. (NTP, 1992)

RECOMMENDED RESPIRATOR: Where the neat test chemical is weighed and diluted, wear a NIOSH-approved half face respirator equipped with an organic vapor/acid gas cartridge (specific for organic vapors, HCl, acid gas and SO2) with a dust/mist filter. (NTP, 1992)

DuPont Tychem® Suit Fabrics

No information available.

EYES: First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments, oils, or medication in the victim's eyes without specific instructions from a physician. If symptoms (such as redness or irritation) develop, immediately transport the victim to a hospital.

SKIN: IMMEDIATELY flood affected skin with water while removing and isolating all contaminated clothing. Gently wash all affected skin areas thoroughly with soap and water. If symptoms such as redness or irritation develop, IMMEDIATELY call a physician and be prepared to transport the victim to a hospital for treatment.

INHALATION: IMMEDIATELY leave the contaminated area; take deep breaths of fresh air. If symptoms (such as wheezing, coughing, shortness of breath, or burning in the mouth, throat, or chest) develop, call a physician and be prepared to transport the victim to a hospital. Provide proper respiratory protection to rescuers entering an unknown atmosphere. Whenever possible, Self-Contained Breathing Apparatus (SCBA) should be used; if not available, use a level of protection greater than or equal to that advised under Protective Clothing.

INGESTION: DO NOT INDUCE VOMITING. If the victim is conscious and not convulsing, give 1 or 2 glasses of water to dilute the chemical and IMMEDIATELY call a hospital or poison control center. Be prepared to transport the victim to a hospital if advised by a physician. If the victim is convulsing or unconscious, do not give anything by mouth, ensure that the victim's airway is open and lay the victim on his/her side with the head lower than the body. DO NOT INDUCE VOMITING. IMMEDIATELY transport the victim to a hospital. (NTP, 1992)

Physical Properties

The Physical Property fields include properties such as vapor pressure and boiling point, as well as explosive limits and toxic exposure thresholds. The information in CAMEO Chemicals comes from a variety of data sources.

PharmGKB contains no Clinical Variants that meet the highest level of criteria.

Disclaimer: The PharmGKB's clinical annotations reflect expert consensus based on clinical evidence and peer-reviewed literature available at the time they are written and are intended only to assist clinicians in decision-making and to identify questions for further research. New evidence may have emerged since the time an annotation was submitted to the PharmGKB. The annotations are limited in scope and are not applicable to interventions or diseases that are not specifically identified.

The annotations do not account for individual variations among patients, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It remains the responsibility of the health-care provider to determine the best course of treatment for a patient. Adherence to any guideline is voluntary, with the ultimate determination regarding its application to be made solely by the clinician and the patient. PharmGKB assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the PharmGKB clinical annotations, or for any errors or omissions.

= Mouse-over for quick help

The table below contains information about pharmacogenomic variants on PharmGKB. Please follow the link in the "Variant" column for more information about a particular variant. Each link in the "Variant" column leads to the corresponding PharmGKB Variant Page. The Variant Page contains summary data, including PharmGKB manually curated information about variant-drug pairs based on individual PubMed publications. The PMIDs for these PubMed publications can be found on the Variant Page.

The tags in the first column of the table indicate what type of information can be found on the corresponding Variant Page.

Links in the "Gene" column lead to PharmGKB Gene Pages.

The following icons indicate that data of a certain type is available:

DG Dosing Guideline information is available DL Drug Label information is available CA High-level Clinical Annotation is available VA Variant Annotation is available VIP VIP information is available PW Pathway is available

Dimethylxanthine

Pseudotheophylline

Theophyline

Theophyllin

Theophylline Anhydrous

Theophylline aminoacetate

Accurbron

Acet-Theocin

Aerobin

Aerolate

Aerolate III

Aerolate SR

Afonilm

Afonilum

Aquaphyllin

Armophylline

Asbron

Asmalix

Asmax

Austyn

Bilordyl

Bronchoretard

Bronkodyl

Bronkodyl SR

Cetraphylline

Choledyl SA

Chronophyllin

Constant T

Diffumal

Diphyllin

Doraphyllin

Duraphyl

Duraphyllin

Dyspne-Inhal

Egifilin

Elan

Elixex

Elixicon

Elixomin

Elixophyllin

Elixophyllin SR

Elixophylline

Etheophyl

Euphyllin

Euphylline

Euphylong

Labid

Lanophyllin

Lasma

Liquophylline

Liquorice

Maphylline

Medaphyllin

Nuelin

Optiphyllin

Parkophyllin

Physpan

Pro-Vent

Pulmidur

Pulmo-Timelets

Quibron

Quibron T

Quibron T/SR

Quibron-T

Quibron-T/SR

Respbid

Respicur

Respid

Slo-Bid

Slo-Phyllin

Solosin

Somophyllin CRT

Somophyllin T

Somophyllin-CRT

Somophyllin-DF

Somophyllin-T

Spophyllin Retard

Sustaire

Synophylate

Synophylate-L. A. Cenules

T-Phyl

Talotren

Tefamin

Telb-DS

Telbans Dry Syrup

Teocen 200

Teofilina

Teofyllamin

Teolair

Teonova

Teosona

Tesona

Theacitin

Theal Tablets

Theo 24

Theo-11

Theo-24

Theo-DS

Theo-Dur

Theo-Nite

Theo-Sav

Theobid

Theobid Duracap

Theobid Jr.

Theochron

Theocin

Theoclair-SR

Theoclear

Theoclear 80

Theoclear L. A.-130

Theoclear LA

Theoclear-200

Theoclear-80

Theocontin

Theodel

Theodrip

Theodur Dry Syrup

Theofol

Theograd

Theolair

Theolair-SR

Theolix

Theolixir

Theon

Theona P

Theopek

Theophyl

Theophyl-225

Theophyl-SR

Theophylline-SR

Theoplus

Theospan

Theostat

Theostat 80

Theotard

Theovent

Uni-Dur

Unifyl

Unilong

Uniphyl

Uniphyllin

Xanthium

Xantivent

Brand Mixture Names

Bronchyl Syrup (alcohol anhydrous + beechwood creosote + cocillana + eucalyptus + guaiacol oleate + ipecac + lobelia inflata + menthol + myroxylon balsamum + theophylline + white pine)

Choledyl Expectorant Elixir (guaifenesin + oxtriphylline)

Diuerb tab (oil of fleabane + theophylline + urea)

IDM Expectorant tab (guaifenesin + potassium iodide + pyrilamine maleate + theophylline)

IDM tab (potassium iodide + pyrilamine maleate + theophylline)

PMS-Oxtriphylline Elixir (alcohol anhydrous + oxtriphylline)

Pulmo Septol Sirop (beechwood creosote + cocillana + eucalyptus oil + guaiacol + ipecac + lobelia inflata + myroxylon balsamum + theophylline + white pine)

Ratio-theo-bronc (guaifenesin + potassium iodide + pyrilamine maleate + theophylline)

Tedral tab (l-ephedrine hydrochloride + phenobarbital + theophylline)

Theophylline 0.8mg and 5% dextrose inj (dextrose + theophylline)

Theophylline 0.8mg/ml in 5% dextrose inj (dextrose + theophylline)

Theophylline 1.6mg and 5% dextrose inj (dextrose + theophylline)

Theophylline 4mg and 5% dextrose inj (dextrose + theophylline)

Theophylline rougier elixir (alcohol anhydrous + theophylline)

PharmGKB Accession Id

Type(s):

Route of Elimination

Theophylline does not undergo any appreciable pre-systemic elimination, distributes freely into fat-free tissues and is extensively metabolized in the liver. Renal excretion of unchanged theophylline in neonates amounts to about 50% of the dose, compared to about 10% in children older than three months and in adults.

Source: Drug Bank

Volume of Distribution

Source: Drug Bank

Accutane (Isotretinoin) - How It Works, Side Effects, And Reviews, Acetan

Accutane (isotretinoin)

Introduction to Accutane

Accutane (isotretinoin), or Roaccutane as it is known in parts of the world, was discovered in 1979 when it was first given to patients with severe acne, most of whom reacted with dramatic and permanent clearing of their acne symptoms. It is a vitamin A derivative (13-cis-retinoic acid) that is administered orally in pill form with a meal that contains an adequate amount of fat, 1 normally for 15-20 weeks (3.5-4.5 months), 2 although it is also sometimes prescribed at lower dosages for up to six months or longer. It was originally recommended for people with severe acne that did not respond to other treatments, 3 but has gained in popularity in the past 25 years and is prescribed more and more frequently for less severe acne. 4-6 This practice is controversial because Accutane is a serious medication that can cause severe birth defects as well as potentially long-lasting side effects to the user. Accutane need not be paired with other medications. 7

How does Accutane work?

Exactly how Accutane works on a cellular level is unknown but we do know that it affects all four ways that acne develops.

1. It dramatically reduces the size of the skin's oil glands (35%-58%) and even more dramatically reduces the amount of oil these glands produce (around 80%). 8-9

2. Acne bacteria ( P. acnes ) live in skin oil. Since oil is dramatically reduced, so is the amount of acne bacteria in the skin. 9

3. It slows down how fast the skin produces skin cells inside the pore, which helps pores from becoming clogged in the first place. 10

4. It has anti-inflammatory properties. 10

Although acne may get worse within the first month of Accutane use for about 30% of patients, the ultimate results are usually dramatic. 11 Accutane works to achieve partial or complete clearance of acne in about 95% of people who complete a cycle, regardless of whether they have inflammatory or non-inflammatory acne. 12 The majority of people who take it see their acne effectively cured, experiencing long-term remission of acne symptoms. Studies show an average relapse rate of around 33%, and in these cases sometimes a second course is given. 7,9,12-17 This relapse rate is dose-dependent. 13 Patients who receive a cumulative dose of 100-120 mg/kg see the best results and lowest relapse rates. Patients who receive a lower dose relapse more frequently. Daily dosage depends on how much the patient weighs; 0.5 mg - 2 mg/kg is typical. 15

Low and intermittent dosing . Researchers have published several studies attempting to gauge whether people with mild to moderate acne can achieve long-term remission of acne with lower dosages of Accutane. Initial data is showing that patients with mild to moderate acne may be able to achieve long-term remission with significantly lower dosages, and thus suffer less side effects, 18-20 including lower incidence of scarring. For people with more severe acne, staying on a lower dose of Accutane for a longer period of time until the full 120mg/kg cumulative dose is achieved may be a way to produce long-term remission with significantly less side effects. 21 Intermittent dosing (taking Accutane only 1 week of every month) appears to work less well, producing significantly poorer outcomes for more than half of the patients studied. 19,22

Read Accutane Reviews Accutane Forum Accutane Member Gallery

References

Del Rosso, JQ. "Face to face with oral isotretinoin: a closer look at the spectrum of therapeutic outcomes and why some patients need repeated courses." The Journal of Clinical and Aesthetic Dermatology . 2012; 5(11): 17-24.

Ganceviciene R and Zouboulis CC. "Isotretinoin: State of the art treatment for acne vulgaris." Journal of the German Society of Dermatology . 2009; 8 Suppl. 1: S47-S59.

Dreno B, et al. "An expert view on the treatment of acne with systemic antibiotics and/or oral isotretinoin in the light of the new European recommendations." European Journal of Dermatology . 2006; 16(5): 565-71.

Chen K, et al. "Oral isotretinoin: an analysis of its utilization in a managed care organization." Journal of Managed Care Pharmacy . 2002; 8(4): 272-7.

Wysowski DK, Swann J and Vega A. "Use of isotretinoin (Accutane) in the United States: Rapid increase from 1992 through 2000." Journal of the American Academy of Dermatology . 2002; 46(4): 505-9.

Rigopoulos D, Larios G and Katsambas AD. "The role of isotretinoin in acne therapy: Why not as first-line therapy? Facts and controversies." Clinics in Dermatology . 2010; 28(1): 24-30.

Dhir R, et al. "Oral isotretinoin is as effective as a combination of oral isotretinoin and topical anti-acne agents in nodulocystic acne." Indian Journal of Dermatology, Venereology and Leprology . 2008; 74(2): 187.

Nelson AM, et al. "13-cis-retinoic acid induces apoptosis and cell cycle arrest in human SEB-1 sebocytes." Journal of Investigative Dermatology . 2006; 126(10): 2178-89.

Plewig G, et al. "Low dose isotretinoin combined with tretinoin is effective to correct abnormalities in acne." Journal of the German Society of Dermatology . 2004; 2(1): 31-45.

Ellis CN and Krach KJ. "Uses and complications of isotretinoin therapy." Journal of American Academy of Dermatology . 2001; 45(5): S150-7.

Demircay Z, Kus S and Sur H. "Predictive factors for acne flare during isotretinoin treatment." European Journal of Dermatology . 2008; 18(4): 452-456.

Mandekou-Lefaki I, et al. "Low-dose schema of isotretinoin in acne vulgaris." International Journal of Clinical Pharmacological Research . 2003; 23(2-3): 41-6.

Ng PP and Goh CL. "Treatment outcome of acne vulgaris with oral isotretinoin in 89 patients." International Journal of Dermatology . 1999; 38(3): 213-6.

Quereux G, et al. "Prospective study of risk factors of relapse after treatment of acne with oral isotretinoin." Dermatology . 2006; 212(2): 168-76.

Haryati I and Jacinto SS. "Profile of acne patients in the Philippines requiring a second course of isotretinoin." International Journal of Dermatology . 2005; 44(12): 999-1001.

Akman A, et al. "Treatment of acne vulgaris with intermittent and conventional isotretinoin: a randomized, controlled multicenter study." Archives of Dermatological Research . 2007; 299(10): 467-73.

Morales-Cardona CA and Sanchez-Vanegas G. "Acne relapse rate and predictors of relapse following treatment with oral isotretinoin." Actas Dermo-Sifiliograficas . 2013; 104(1): 61-6.

Rademaker M, Wishart JM and Birchall NM. "Isotretinoin 5 mg daily for low-grade adult acne vulgaris – a placebo-controlled, randomized double blind study." Journal of the European Academy of Dermatology and Venereology . 2013; [ahead of print].

Boyraz N and Mustak PK. "Comparison of the efficacies of intermittent and continuous low-dose isotretinoin regimens in the treatment of moderate acne vulgaris." International Journal of Dermatology . 2013; [ahead of print].

Borghi A, et al "Low-cumulative dose isotretinoin treatment in mild-to-moderate acne: Efficacy in achieving stable remission." Journal of the American Academy of Dermatology . 2011; 25(9): 1094-1098.

Rasi A, et al. "Efficacy of fixed daily 20 mg of isotretinoin in moderate to severe scar prone acne." Advanced Biomedical Research . 2014; 3: 103.

Lee JW, et al. "Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: A randomized, controlled comparative study." British Journal of Dermatology . 2011; 164(6): 1369-1375.

Accutane side effects

Accutane is a systemic medication that affects the entire body. Side effects are numerous and widespread, and affect upwards of 80% of patients. 1 Side effects are most often mild to moderate and reversible, but in some cases can be severe or long-term. When data exists, incidence information is listed.

References

Rademaker M. "Adverse effects of isotretinoin: A retrospective review of 1743 patients started on isotretinoin." Australasian Journal of Dermatology . 2010; 51(4): 248-253.

Honein MA, Paulozzi LJ and Erickson JD. "Continued occurrence of Accutane-exposed pregnancies." Teratology . 2001; 64(3): 142-7.

relsford M and Beute TC. "Preventing and managing the side effects of isotretinoin." Seminars in Cutaneous Medicine and Surgery . 2008; 27(3): 197-206.

erard A, et al. "Isotretinoin, pregnancies, abortions and birth defects: a population-based perspective." British Journal of Clinical Pharmacology . 2007; 63(2): 196-205.

broms L, et al. "What is the best approach to reducing birth defects associated with isotretinoin?" PLoS Medicine . Nov; 3(11): e483.

hin J, et al. "The impact of the iPLEDGE program on isotretinoin fetal exposure in an integrated health care system." Journal of the American Academy of Dermatology . 2011 May 10.

oulden V, Layton AM and Cunliffe WJ. "Long-term safety of isotretinoin as a treatment for acne vulgaris." British Journal of Dermatology . 1994; 131(3): 360-3.

cLane J. "Analysis of common side effects of isotretinoin." Journal of the American Academy of Dermatology . 2001; 45(5): S188-94.

urkhart CG. "Another threat to the availability of isotretinoin: ocular side effects have aviation authorities considering restricting use from (even potential) pilots." Dermatology Online Journal . 2008; 14(7): 2.

Barzilai A, et al. "Seborrheic dermatitis-like eruption in patients taking isotretinoin therapy for acne: retrospective study of five patients." American Journal of Clinical Dermatology . 2008; 9(4): 255-61.

DiGiovanna JJ. "Isotretinoin effects on bone." Journal of the American Academy of Dermatology . 2001; 45(5): S176-82.

DiGiovanna JJ, et al. "Effect of a single course of isotretinoin therapy on bone mineral density in adolescent patients with severe, recalcitrant, nodular acne." Journal of the American Academy of Dermatology . 2004; 51(5): 709-17.

Eksioglu E, et al. "Sacroiliitis and polyneuropathy during isotretinoin treatment." Clinical and Experimental Dermatology . 2008; 33(2): 122-4.

De Francesco V, Stinco G and Campanella M. "Acute arthritis during isotretinoin treatment for acne conglobata." Dermatology . 1997; 194(2): 195.

Bewley AP, et al. "Isotretinoin causing acute aseptic arthropathy." Clinical and Experimental Dermatology . 1995; 20(3): 279.

Kaplan G and Haettich B. "Rheumatological symptoms due to retinoids." Bailliere's Clinical Rheumatology . 1991; 5(1): 77-97.

Hughes RA. "Arthritis precipitated by isotretinoin treatment for acne vulgaris." The Journal of Rheumatology . 1993; 20(7): 1241-2.

Lehucher Ceyrac D. "Acute arthritis after isotretinoin." Dermatology . 1999; 198(4): 406-7.

Kaymak Y, et al. "Creatine phosphokinase values during isotretinoin treatment for acne." International Journal of Dermatology . 2008; 47(4): 398-401.

Dicken CH. "Retinoids: A Review." Journal of American Academy of Dermatology . 1984;11:541-552.21. Kaymak Y, Taner E and Taner Y. "Comparison of depression, anxiety and life quality in acne vulgaris partients who were treated with either isotretinoin or topical agents." International Journal of Dermatology . 2009; 48(1): 41-46.

Sundstrom A, et al. "Association of suicide attempts with acne and treatment with isotretinoin: Retrospective Swedish cohort study." British Medical Journal . 2010 Nov. 11.

Laroche ML, et al. "Cerebral ischemia probably related to isotretinoin." The Annals of Pharmacotherapy . 2007; 41(6): 1073-1076.

Zane LT, et al. "A population-based analysis of laboratory abnormalities during isotretinoin therapy for acne vulgaris." Archives of Dermatology . 2006; 142(8): 1016-22.

Karadag AS, et al. "Short-term isotretinoin treatment decreases insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels: Does isotretinoin affect growth hormone physiology?" British Journal of Dermatology . 2010; 162(4): 798-802.

Ozdemir MA, et al. "Isotretinoin-induced agranulocytosis." Pediatric Dermatology . 2007; 24(4): 425-6.

Reddy D, et al. "Possible association between isotretinoin and inflammatory bowel disease." American Journal of Gastroenterology . 2006; 101(7): 1569-73.

Crockett SD, et al. "Isotretinoin use and the risk of inflammatory bowel disease: A case-control study." The American Journal of Gastroenterology . 2010; 105(9): 1986-1993.

Erturan I, Naziroglu M and Akkaya VB. "Isotretinoin treatment induces oxidative toxicity in blood of patients with acne vulgaris: a clinical pilot study." Cell Biochemistry and Function . 2012; 30(7): 552-7.

Neudorfer M, et al. "Ocular adverse effects of systemic treatment with isotretinoin." JAMA Dermatology . 2012; 148(7): 803-8.

Alhusayen RO, et al. "Isotretinoin use and the risk of inflammatory bowel disease: a population-based cohort study." Journal of Investigative Dermatology . 2013; 133(4): 907-12.

Etminan M, et al. "Isotretinoin and risk for inflammatory bowel disease: a nested case-control study and meta-analysis of published and unpublished data." JAMA Dermatology . 2013; 149(2): 216-20.

Stobaugh DJ, Deepak P and Ehrenpreis ED. "Alleged isotretinoin-associated bowel disease: Disproportionate reporting by attorneys to the Food and Drug Administration Adverse Event Reporting System." Journal of the American Academy of Dermatology . 2013; 69(3): 393-8.

Gungor S and Gokdemir G. "Anal fissure and rectal bleeding as a complication of systemic isotretinoin therapy. Dermatologists knows this side effect, what about proctologists?" Colorectal Disease . 2013 [ahead of print].

Javanbakht AM, Pour HM and Tarrahic MJ. "Effects of oral isotretinoin on serum folic acid levels." Journal of Drugs in Dermatology . 2012; 11(9): 23-24.

Akturk AS, et al. "Effects of isotretinoin on serum vitamin E levels in patients with acne." International Journal of Dermatology . 2013; 52(3): 363-6.

Pregnancy and Accutane

The birth defects caused by Accutane are devastating and life threatening. Birth defects include skull, ear, eye, facial, central nervous system, cardiovascular, thymus, parathyroid abnormalities, and death. 3 Clinical research shows extremely high risk for birth defects in pregnant women. 4 The effects and risks of Accutane on unborn children are so severe that female patients of childbearing age are required to use two (2) forms of birth control while on Accutane. 5

Pregnancy control

The iPLEDGE program was launched in March 2006 to prevent women from becoming pregnant while on Accutane. 5-6

iPLEDGE program telephone: 1-866-495-0654 iPLEDGE program website: ipledgeprogram. com

Roche started with a program called SMART (System to Manage Accutane Related Teratogenicity) in 2000, which became the iPLEDGE program in March, 2006. Female patients of childbearing age are required to use two (2) forms of birth control while on Accutane.

Suicide and depression

Significant reductions in anxiety were observed. after treatment [with isotretinoin], with mitigation of anxiety and depression most robust in those patients with the greatest. improvement [in acne symptoms]. Although a direct cause and effect between use of isotretinoin and depression and suicide has not been established; it may never be. Since we cannot predict which patients may exhibit these symptoms. it is in the best interest of our patients to educate them regarding the signs and symptoms of depression. 25

Journal of the American Academy of Dermatology, 2013

Patients have reported depressive symptoms while taking Accutane since shortly after the drug became legal in 1982. Whether the drug caused these depressive feelings remains a subject of intense debate. There are, after all, millions of people taking the drug, and there are bound to be people experiencing depression amongst them. Despite the confusion around this topic, Roche Pharmaceuticals®, the makers of Accutane, added a warning to its label regarding suicide and depression in 1998.

Media coverage on the topic spiked in 2000 when Michigan Congressman Bart Stupak's son BJ committed suicide while on Accutane. Research began in earnest to determine whether there is a causal link between Accutane, suicide & depression. 1-2

Quite a few studies have been conducted since. These have included large population-based cohort studies, retrospective analysis studies, relative risk estimates, prospective, observational, longitudinal studies, and questionnaires performed in the United States and around the world. 3-16 The first of these studies showed no conclusive evidence linking Accutane with depression or suicide. 1-2 As the studies mounted, the data continued to show no evidence of a link. 7-9,17 One study published in the New England Journal of Medicine found, "431 cases of depression, suicidal ideation, suicide attempts, or suicide in U. S. patients treated with isotretinoin," within a 10 year period. The article went on to note that the numbers listed do not exceed the U. S. suicide rate. 18

If a researcher were to examine the evidence from 2000 until 2005, he or she would likely conclude that there is no evidence linking Accutane with suicide or depression. 7-9 However, as is often the case, further analysis showed limitations to many of the studies. 19-20 A general overview published in 2006 by the International Journal of Dermatology noted, "the overall lack of concrete scientific data limits any conclusion that can be drawn about a causal relationship between isotretinoin and psychiatric adverse events." 21

Then, in 2006, depression-related behavior was shown in mice injected with the drug. While animal studies often do not reflect human models, it was marginally intriguing. 10 But even more provocative was a large cohort case-crossover study published in 2008 by the Journal of Clinical Psychiatry . which was the first controlled study to find a correlation between Accutane, suicide and depression, albeit relatively minor. 11 More recent studies have lent more credibility to the argument that Accutane does not negatively affect depression or mood, 5-6 and several show significant improvements to depression, anxiety, and obsessive thoughts, 12-16 presumably due to the power of Accutane to clear acne and thus increase quality of life.

The preponderance of the evidence at this point is that Accutane does not appear to be linked with suicide and depression. 22-24 However, to be safe, it is important for anyone taking Accutane to closely monitor their mental health while on the drug. 1,4,25 If you find yourself feeling depressed or suicidal, seek help right away.

References

Jacobs DG, Deutsch NL and Brewer M. "Suicide, depression, and isotretinoin: is there a causal link?" Journal of the American Academy of Dermatology . 2001; 45(5): S168-75.

Jick SS, Kremers HM and Vasilakis-Scaramozza C. Isotretinoin use and risk of depression, psychotic symptoms, suicide, and attempted suicide. Archives of Dermatology . 2000; 136(10): 1231-6.

Hull PR and D'Arcy C. "Acne, depression, and suicide." Clinics in Dermatology . 2005; 23(4): 665-74.

Magin P, Pond D and Smith W. "Isotretinoin, depression and suicide: a review of the evidence." British Journal of General Practice . 2005; 55(511): 134-8.

Kaymak Y, Taner E. and Taner Y. "Comparison of depression, anxiety and life quality in acne vulgaris partients who were treated with either isotretinoin or topical agents." International Journal of Dermatology . 2009; 48(1): 41-46.

Sundstrom A, et al. "Association of suicide attempts with acne and treatment with isotretinoin: Retrospective Swedish cohort study." British Medical Journal . 2010 Nov. 11.

Chia CY, et al. "Isotretinoin therapy and mood changes in adolescents with moderate to severe acne: a cohort study." Archives of Dermatology . 2005; 141(5): 557-60.

Hersom K, et al. "Isotretinoin and antidepressant pharmacotherapy: a prescription sequence symmetry analysis." Journal of the American Academy of Dermatology . 2003; 49(3): 424-32.

Ferahbas A, et al. "A pilot study evaluating anxiety and depressive scores in acne patients treated with isotretinoin." The Journal of Dermatological Treatment . 2004; 15(3): 153-7.

O'Reilly KC, et al. "Chronic administration of 13-cis-retinoic acid increases depression-related behavior in mice." Neuropsychopharmacology . 2006; 31(9): 1919-27.

Azoulay L, et al. "Isotretinoin and the risk of depression in patients with acne vulgaris: a case-crossover study." The Journal of Clinical Psychiatry . 2008; 69(4): 526-32.

Yesilova Y, et al. "Effects of isotretinoin on obsessive compulsive symptoms, depression, and anxiety in patients with acne vulgaris." Journal of Dermatological Treatment . 2012; 23(4): 268-71.

Ergun T, et al. "Istotretinoin has no negative effect on attention, executive function and mood." Journal of the European Academy of Dermatology and Venereology . 2012; 26(4): 431-9.

Marron SE, Tomas-Aragones L and Boira S. "Anxiety, Depression, Quality of Life and Patient Satisfaction in Acne Patients Treated with Oral Isotretinoin." Acta-Dermato-Venereologica . 2013; [ahead of print].

Nevoralova Z and Dvorakova D. "Mood changes, depression and suicide risk during isotretinoin treatment: a prospective study." International Journal of Dermatology . 2013; 52(2): 163-8.

Yesilova Y, et al. "Effects of isotretinoin on social anxiety and quality of life in patients with acne vulgaris: a prospective trial." Acta-Dermato-Venereologica . 2012; 20(2): 80-3.

Cohen J, Adams S and Patten S. "No association found between patients receiving isotretinoin for acne and the development of depression in a Canadian prospective cohort." The Canadian Journal of Clinical Pharmacology . 2007; 14(2): e227-33.

Wysowski DK, Pitts M and Beitz J. "Depression and suicide in patients treated with isotretinoin [letter]." The New England Journal of Medicine . 2001; 344: 460.

Marqueling AL and Zane LT. "Depression and suicidal behavior in acne patients treated with isotretinoin: a systematic review." Seminars in Cutaneous Medicine and Surgery . 2005; 24(2): 92-102.

Wysowski DK and Beitz J. "Methodological limitations of the study "isotretinoin use and risk of depression, psychotic symptoms, suicide, and attempted suicide." Archives of Dermatology . 2001; 137(8): 1102-3.

Strahan JE and Raimer S. "Isotretinoin and the controversy of psychiatric adverse events." International Journal of Dermatology . 2006; 45(7): 789-99.

Wysowski DK, Pitts M and Beitz J. "An analysis of reports of depression and suicide in patients treated with isotretinoin." Journal of the American Academy of Dermatology . 2001; 45(4): 515-9.

Wolverton SE and Harper JC. "Important controversies associated with isotretinoin therapy for acne." American Journal of Clinical Dermatology . 2013; 14(2): 71-6.

Misery L, et al. "[Isotretinoin and adolescent depression]." Annales de Dermatologie et de Venereologie . 2012; 139(2): 118-23.

Thiboutot D and Zaenglein A. "Isotretinoin and affective disorders: thirty years later." Journal of The American Academy of Dermatology . 2013; 68(4): 675-6.

Take with a high fat meal

Because isotretinoin as a molecule dissolves best in fat, it is essential that you take it with a meal that contains an adequate amount of dietary fat. According to drug labeling information submitted to the U. S. National Library of Medicine by the makers of Accutane, "Both peak plasma concentration (Cmax) and the total exposure (AUC) of isotretinoin were more than doubled following a standardized high-fat meal when compared with Accutane given under fasted conditions. Therefore, Accutane capsules should always be taken with food. Failure to take Accutane with food will significantly decrease absorption." 1 This failure to take Accutane with meals may account for some of the relapse that we see post-Accutane.

So what kind of meal should you eat when taking Accutane, and how much dietary fat should it contain? So far only 2 studies have been performed. The first asked participants to ingest approximately 20g of fat (2 poached eggs, toast with margarine, plus 8oz. of skimmed milk), and found that this was enough to approximately double the absorption of Accutane. 2 The second asked participants to ingest 50g of fat (1 bagel, 2 tablespoons of peanut butter, 5 slices of bacon, 6 ounces of apple juice, and 1 donut), and found that this was also enough to approximately double the absorption rate. 3 Further research is required to determine exactly how much fat one must optimally ingest to reach maximum isotretinoin levels in the blood, but suffice it to say that Accutane must be taken with a meal which contains dietary fat to deliver its full potential. Based on the research thus far, it is prudent to ingest at least 20 grams of fat when you take your Accutane pill.

One exception – Absorica™: In 2012, the FDA approved a new version of isotretinoin for sale in the U. S. that is marketed under the brand name Absorica. The package insert states that Absorica (1) is bioequivalent with Accutane when both are taken with a high fat meal; (2) has 83% greater absorption than Accutane under fasted conditions; (3) is not interchangeable with generic products of Accutane; and (4) can be dosed without regard to meals. 4 While data does show that Absorica is absorbed significantly more than regular isotretinoin on an empty stomach, the claim that Absorica can be dosed without regard to meals may be skewed, since data shows that even with Absorica, the amount of isotretinoin in the blood remains significantly higher when taken with a high-fat meal. Thus, it may also be prudent to take Absorica with a meal which contains an adequate amount of dietary fat.

References

Roche Laboratories, Inc. (2006/8). accutane (isotretinoin) capsule, liquid filled. Available: http://dailymed. nlm. nih. gov/dailymed/archives/fdaDrugInfo. cfm? archiveid=8655#section-13. Last accessed 16th Jan 2014.

Colburn WA, et al. "Food Increases the Bioavailability of Isotretinoin." Journal of Clinical Pharmacology . 1983; 23: 534-539.

Webster GF, et al. "Comparative pharmacokinetic profiles of a novel isotretinoin formulation (isotretinoin-Lidose) and the innovator isotretinoin formulation: A randomized, 4-treatment, crossover study." Journal of the American Academy of Dermatology . 2013; 69(5): 762-7.

ABSORICA [prescribing information]. Jacksonville, FL: Ranbaxy Laboratories Inc; May 2012.

History of Accutane

Gerald Peck and co-workers from the NIH (National Institutes of Health) in Bethesda, Maryland first studied isotretinoin in patients with skin cell disorders. They accidentally found that it also worked on patients with severe acne. Isotretinoin was registered in 1979, released in the United States in 1982 as Accutane, and released in Europe in 1985 as Roaccutane. 1

Roche's patent expired in 2002, and manufacturers began selling generic forms of the drug.

In June, 2009, shortly after a jury awarded $33 million in damages to people who claimed Accutane caused bowel disease, Roche decided to discontinue selling brand name Accutane. The company cited declining sales as their reason.

Topical isotretinoin

Topical isotretinoin exists but does not produce the results of oral isotretinoin. It is largely of historical significance in acne treatment.

Warning: Do not buy Accutane on the Internet

According to the FDA.

". Buying (Accutane) over the Internet bypasses important procedures to ensure that patients can take this drug safely. When these procedures are ignored, isotretinoin can cause serious and harmful side effects. "

You should NEVER buy Accutane (isotretinoin) without first seeing your healthcare professional.

You should NEVER take Accutane (isotretinoin) or any of the generic versions of Accutane if you are pregnant or trying to get pregnant or could accidentally become pregnant.

Some websites sell prescription drugs without a prescription. This is illegal and DANGEROUS.

Buying Accutane or any other prescription over the Internet often means you will receive pills that contain little or no active ingredient, or in some cases, a different medication entirely. Buying Accutane over the Internet is not only illegal, it is potentially dangerous and is also a waste of money. 4 I agree strongly with the FDA. NEVER buy Accutane over the Internet."

Presentation of bias

As a critical sociology major in college, I learned that it is important for an author to present his or her bias. Because we are human and it is impossible to be completely unbiased, the presentation of bias allows the reader to take the author's bias into account when absorbing content.

My bias . I suffered with moderately severe acne in my adolescence and early adulthood. I took Accutane at age 20. It cleared me up completely within weeks. I transformed from a shy introvert to an outgoing college student. As a result of my skin clearing up, my mental state felt relatively light and good, albeit still somewhat anxious as I had always been. My side effects included severely dry lips, extremely dry skin, dry eyes and sometimes severe joint pain. Since Accutane, whenever I sprint or exert myself in quick bursts my joints react with inflammation. Whether this is coincidence or the result of Accutane is unclear. My acne relapsed post-Accutane to what would be described as moderate acne. I am now able to control my acne symptoms with The Acne. org Regimen ."

Lametec 100mg Online, Lamidac

Lametec - 100mg

About the drug:

Lamotrigine is an anticonvulsant or an anti-epileptic drug. It is available under different trade names in different nations, one of which is Lametec (made by Cipla, India).

Uses of the drug:

Lamotrigine is prescribed either as a standalone medication or in combination with other drugs to treat epileptic seizures in both adult and children. This medication is also used to delay mood episodes in adults who have bipolar disorder (manic depression).

Lamotrigine may also be given for conditions not mentioned here.

Working of the drug:

The drug lamotrigine is a member of the sodium channel blocking class of antiepileptic drugs, and it works by acting as a triazine derivate to inhibits voltage-sensitive sodium channels present in the membranes and leading to stabilization of neuronal membranes.

Manufacturer:

Lametec is manufactured by Cipla. The drugs are available on our website under various pack sizes. To buy Lametec 100 mg online, visit alldaychemist. com.

Dosage form and strengths:

The drug is available in the form of tablet under the following brand name and strength on our website:

Lametec 100 mg

Lametec 50 mg

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Buy Lametec 100 mg online at alldaychemist. com.

Before you take the drug:

Do not take the drug if you:

Are allergic to this active ingredient Lamotrigine or any other ingredient of the drug

Are pregnant or planning to be pregnant

Are breastfeeding as the drug may pass into the breast milk

Tell your doctor if you:

Have high blood pressure

Have past episodes of depression or suicidal thoughts

Have a history of epilepsy

Have the condition of vertigo or very fast heart beat

Have a diabetes history

Have allergy to other anticonvulsant drugs

Dosage:

How much to take the drug?

Take Lamotrigine (Lamictal, Lamitor, Lametec) strictly according to your doctor's direction or according to the instructions on the medication label. Do not alter the dosage unless your doctor advises you to do so. Your doctor may occasionally change the dosage over several weeks or months to ensure proper treatment. Follow your doctor's directions properly. Also, do not take this medication after the prescribed period is over. Avoid taking a high dose at the start of the treatment as doing so may increase the risk of contracting a severe and life threatening skin rash.

The immediate-release type of Lamotrigine anti covulsant medication is suitable for children as young as 2 years old when given as part of a combination of seizure medications. It should however, not be used as a standalone medication in a child or teenager below 16 years of age. The extended-release form of Lamotrigine on the other hand is only recommended for people above 13 years of age.

How to take the drug?

Avoid crushing, chewing, or breaking a regular Lamotrigine tablet and swallow it whole. While taking an orally disintegrating tablet of Lamotrigine, place the tablet on your tongue and motion it in your mouth. Let it dissolve fully and swallow several times as the tablet disintegrates. You may take some liquid to help swallow the disintegrated tablet. To take the chewable dispersible tablet, you may swallow it whole with a glass of water, or swallow if after chewing it. You can also disperse the tablet in a teaspoon of water or fruit juice and then drink it.

For how long to take it?

Avoid stopping Lamotrigine medication suddenly without the advice of your doctor, even if you feel alright. Your condition may become worse with increased seizures if you stop this medication suddenly.

Overdose:

If overdose, talk to Doctor or Poisons information center for advice. Take medical help as soon as possible. Overdose may lead to blurred vision, co-ordination problems, increased seizures, light headedness, or fainting.

Miss dose:

If you miss a dose of Lamotrigine, take it as soon as you remember. Do not take the missed dose if the time to take the next dose is almost up. Taking multiple doses near to each other can lead to excess medication in your body which can be dangerous.

Side effects of the drug:

Lamotrigine usage may result in severe or life-threatening skin rash, especially in children and in people who take a very high dose in the initial stage of the treatment. A severe skin rash is likely to occur if Lamotrigine is taken with other medications like valproic acid or divalproex. Get urgent medical attention if you experience these conditions after taking Lamotrigine: fever, sore throat, swelling in your face or tongue, burning sensation in eyes, skin pain followed by red or purple colored rash that spreads (primarily in the face or upper body) causing blisters and peeling

Lamotrigine usage causes suicidal thoughts. This side effect may require you to undergo regular follow up checks by your doctor. You must notify your doctor about any new or deteriorating symptoms like mood or behavior changes, depression, anxiety, suicidal or self hurting thoughts, increased agitation, hostility, restlessness, hyperactivity (mentally or physically).

Common drug interactions:

Some medications can interact with Lamotrigine and reduce its effectiveness or cause severe effects. Let your doctor know if you already use any of these interacting medications: hormonal birth control pills, carbamazepine, divalproex, oxcarbazepine, Phenobarbital, primidone, phenytoin, rifampin, or valproic acid. The drugs mentioned here are not the only ones that can interact with Lamotrigine anti - convulsant medication. There may be others as well. Share the list of all type of medications and related products which you are using with your doctor and never start a new medication without his or her advice.

Warning:

Things to remember:

Lamotrigine is not recommended during early pregnancy as it can increase the risk of cleft lip or cleft palate in the baby. Inform your doctor in advance if you are pregnant or planning to become pregnant. Birth control pills can reduce the effectiveness of Lamotrigine. Notify your doctor if you use birth control pills as your Lamotrigine dosage may need adjustment if taken while on birth control pills.

Always store Lamotrigine medication in a cool and dry place, away from any kind of heat and moisture. Ensure that children or pets do not have access to this medication.

Please note that not all medications, including any referenced on this page, are dispensed from our affiliated Indian pharmacy. The medications in your order may be filled and shipped from an approved International fulfilment center located in a country other than India. In addition to dispensing medications from our Indian pharmacy, medication orders are also filled and shipped from international fulfilment centers that are approved by the regulatory bodies from their respective countries.

Medication orders are filled and shipped from approved fulfilment centers around the world including, but not limited to, India, United Kingdom, New Zealand, Mauritius and the United States. The items in your order may be filled and shipped from any one of the above jurisdictions. The products are sourced from various countries as well as those listed above. All of our affiliated fulfilment centers have been approved by the regulatory bodies from their respective countries.

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Cognitiv, Cognitiv

Welcome to Cognitiv, the not-for-profit industry group created to put the spotlight on Wakefield’s Creative, Digital and IT sector.

Join today and take advantage of the benefits of being a member:

Informal meet ups to foster partnerships and share know-how

Formal meetings with inspirational speakers

Representation on key issues such as skills

Online member directory to promote your organisation

PR opportunities to share your success

Join Cognitiv and be part of the movement to help further develop Wakefield's growing creative, digital and IT sector.

Smart Cities: An Introduction

Member Spotlight - Stada Video

Social Capitalists, The Key to Your Success

Techtrade Yorkshire

cognitive

cog·ni·tive

Pertaining to cognition.

cognitive (cog´nitiv) ,

adj/n pertaining to the mental processes of knowing, perceiving, or being aware; an expression of intellectual capacity.

Patient discussion about cognitive

Q. What is cognitive behavioral therapy for treatment of depression? What is it all about? Please explain? Could someone who has actually had this explain what it is all about. I don't want to get a copy and paste answer from a web page somewhere, just a simple explanation in plain simple terms that I could relate to.

A. You mention "for example thoughts of worthlessness"

Could anyone identify other examples of these types of thoughts?

I struggle the most with guilt and shame.

Others: What others think of me being a recovering alcoholic, someone who has depression, having a son who has been in a penitentiary several times. ---

What can anyone really do about these thoughts anyway. I have not come up with anything that works except to offer them all back up to God and let them all go.

What else could a professional come up that is any better than that? I would really like to know. Otherwise, what good would it really do?

Link to this page:

References in periodicals archive ?

Shlomo Breznitz, PhD, founded CogniFit in 1999 with the goal of using the latest cognitive research to help people of all ages maintain and improve their quality of life through brain fitness assessment and training.

Those sustaining a mild traumatic brain injury within three months before cognitive testing and those sustaining one within two years after cognitive testing had similar cognitive scores.

Future studies should further explore the use of plasma beta-amyloid as a biomarker, assess the mechanisms by which cognitive reserve modifies this association, and determine whether increasing cognitive reserve through interventions can reduce the risk of Alzheimer disease.

Black race was strongly associated with severe cognitive impairment among patients with CKD (P less than .

Cognitive remediation training has been developed to improve functioning either in a particular cognitive domain, which can be referred to as domain-specific training, or in global cognition, which can be referred to as global cognitive training.

This process requires children to master specific cultural tools--including language and other symbolic systems--which they can use to gain control over their physical, emotional, and cognitive functioning.

CBR arose out of cognitive science research in the late 1970s (Schank & Abelson 1977; Schank 1982).

In addition, some cognitive problems affect vision or communication.

This year we didn't get started with the Cognitive Tutor programs until late September," Highfield says.

The purpose of this article is to review the current research base in MLD with the related literature in developmental, cognitive. social, and neuro - psychology in order to refine the reader's knowledge of relevant factors in mathematics learning and intervention planning for individual learners.

Information seeking is founded on the cognitive paradigm that ascribes the purpose of an information retrieval system as to "help solve problems rather than to merely find texts about those problems" (Raber, 2003, p.

Additional research, therefore, is needed to address all aspects of inhalant abuse, including the epidemiology, the behavioral, cognitive. and neurobiological antecedents and consequences of inhalant abuse, as well as the treatment and prevention of inhalant abuse.

Buy Citivir Online Without Prescriptions, Citivir

Aciclovir is indicated for the treatment of HSV and VZV infections, including:

Genital herpex simplex

Herpes simplex labialis

Herpes zoster (shingles)

Acute chickenpox in immunocompromised patients

Herpes simplex encephalitis

Acute mucocutaneous HSV infections in immunocompromised patients

Herpes simplex keratitis (ocular herpes)

Herpes simplex blepharitis

Bell's Palsy

Aciclovir is an antiviral. It works by stopping viral replication. However, Aciclovir does not eliminate the virus, is not a cure, and does not prevent transmission to others.

Use Aciclovir as directed by your doctor!

Take Aciclovir by mouth with or without food.

Start therapy with Aciclovir at the earliest sign or symptom of shingles or genital herpes (pain, burning, blisters).

If treating an acute outbreak, continue using Aciclovir for the full course of treatment even if you feel better in a few days.

For suppressive therapy, Aciclovir works best if it is taken at the same times each day.

If you miss a dose of Aciclovir, 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 Aciclovir.

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

Do NOT use Aciclovir if:

you are allergic to any ingredient in Aciclovir or to valacyclovir

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

Some medical conditions may interact with Aciclovir. 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 kidney problems or a weakened immune system.

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

Medicines that may harm the kidney (eg, aminoglycoside antibiotics [eg, gentamicin], amphotericin B, cyclosporine, nonsteroidal anti-inflammatory drugs [NSAIDs] [eg, ibuprofen], tacrolimus, vancomycin) because the risk of kidney side effects may be increased. Ask your doctor if you are unsure if any of your medicines might harm the kidney.

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

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

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

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

Aciclovir is not a cure for genital herpes and will not prevent the virus from spreading. Avoid sexual intercourse when sores are present to prevent infecting your partner. You can also be contagious and spread the herpes virus but not have any signs or symptoms at all. This is called asymptomatic viral shedding.

Lab tests, including kidney function and serum urea nitrogen (BUN), may be performed while you use Aciclovir. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Use Aciclovir with caution in the elderly; they may be more sensitive to its effects, especially confusion, drowsiness, or hallucinations.

Aciclovir is not recommended for use in children younger than 2 years old as safety and effectiveness for 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 Aciclovir while you are pregnant. Aciclovir is found in breast milk. If you are or will be breast-feeding while you use Aciclovir, check with your doctor. Discuss any possible risks to your baby.

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

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

Diarrhea; general body discomfort; headache; nausea/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); aggressive behavior; blood in the urine; confusion; decreased consciousness; decreased urination; hallucinations; lower back pain; mental or mood changes; red, swollen, blistered, or peeling skin; seizures; unusual bruising or bleeding.

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

Customers who bought this product also bought

Copyright © 2004-2016 All Rights Reserved

Nordox 75 Wg 12, Nordox

Product Description

Our newest copper spray from 83.9 % Cuprous Oxide (Cu 2 O) = to 75% metallic Copper equivalent. This is a wettable granule used as a natural fungicide and bactericide. Labeled for fruits, vegetables, flowers and ornamentals for prevention of numerous leaf diseases, blights, mildews and leaf spots. Use as a protectant for tomato early or late blight. For use on fruit trees such as peach brown rot. The granuale size on this WG product is about 1 to 1 . 2 micron range.

There are no issues with shelf life for this product. It will last for ages.

A general application rate ranges from 1 1/3 tsp to 3 1/2 tsp per 1000 sq ft in 1 gallon of water.

Large application rate averages from 1 to 3 pounds per acre in 100 gallons of water.

Hours to re-entry is 12 hrs. Hours to harvest is 24 hrs.

Also available in a 20 lb bag at a better price per lb

Question from vineyard about their grapes

Good afternoon, I recently had a petiole analysis done for wine vines. The result came back saying critical for copper and foliar apply 0.5 lbs of copper per acre.

I see that Nordox is 83.9% cuprous oxide. I also see from the label that to use as fungicide ( and I would like to not only add the copper but double up ad one of my preventive sprays for powdery mildew) I should use 1.25 lbs per acre. I wonder if you can help me with the amount I need fir that "0.5 lbs of copper per acre" please. Regards Fiona

To Nordox rep, I have a customer asking a question. They not only want to use Nordox 75WG as a fungicide on their wine vines but also to add some copper to the plant. As shown in the email below they had a tissue analysis that is requiring that they apply 0.5 lbs of copper per acre. My question to you is can this product actually provide copper to the plant in this manner and if so what kind of qty would they need to apply to achieve the 0.5 lb copper per acre. Thanks Ron

Dear Ron, Thanks for your mail and your interest in Nordox products.

There’ll always be foliar uptake of copper when applying fixed-copper fungicides. A part of the dissolved copper in the leaf surface “solution” will be taken up by the pathogens present in the leaf surface, but also taken up by the plant (another fraction of dissolved copper will be complexed to other substances or simply washed off by rain). Therefore, we can say that when one is applying fixed-copper fungicides, one is also supplying certain amount of copper as fertilizer. The more soluble the source of copper, the higher the amount of copper that can go inside the plant, therefore increasing the risk of phytotoxicity (toxicity by copper to plants). Cuprous oxide (Nordox copper) solubilizes very slowly, releasing Cu 2+ at a slower rate than other coppers, and therefore optimising its use by the plant throughout time.

We recommend your customer to stick to 1.25 lbs/acre, the recommended amount for use in grapes in USA. This should suffice to correct the amount of copper required by their vines, and also to protect against fungus and bacteria without increasing the risk of phytotocity.

Other Details

Synvisc Vs, Hyalgan

Synvisc vs. Hyalgan: Is There a Difference?

Osteoarthritis (OA) is the most common form of arthritis. Typical age of onset is mid to late 40s, with obesity and prior sports injuries increasing the chance of having it.

OA is a painful type of arthritis affecting the joints. It’s a degenerative condition, which means it worsens over time. One of the characteristics of OA is loss of cartilage due to the mechanical breakdown of the joint. This loss of protective cushion can cause debilitating pain and weakness, and may lead to costly joint replacement surgery.

Due to stress throughout life and the possibility of injury, OA is particularly common in knee joints. There is no treatment that can reverse OA or regenerate knee cartilage. However, there are treatments available for those suffering from acute knee pain. Over-the-counter (OTC) pain relievers, physical therapy, diet modification, injections, and joint replacement are all options. What your doctor recommends will be based on the severity of your OA and joint pain.

One treatment option, known as viscosupplementation, involves cushioning the knee joint with injections of a gel-like fluid. The fluid acts as a shock absorber and enables the bones to move more smoothly.

Two possible viscosupplementation therapies are Synvisc-One and Hyalgan. Learn about the similarities and differences between these two therapies, and find out how they compare.

How Are They Similar?

Synvisc-One (hylan GF 20) and Hyalgan (hyaluronic acid) are used to treat severe pain caused by OA of the knee. They both use a naturally occurring substance called hyaluronic acid, found in rooster combs, to cushion and lubricate the joint. The acid also occurs naturally in the human body.

Both drugs are considered “second line” therapies. That means you’ll likely try pain relievers, physical therapy, or weight reduction (if obesity is a factor) before you choose Synvisc or Hyalgan.

Both Synvisc-One and Hyalgan are:

indicated for treatment of pain due to OA of the knee

given by injection directly into the cavity surrounding the knee joint

administered in a doctor’s office

proven to be safe and effective at reducing pain from OA

Neither therapy will provide immediate pain relief. You’ll likely need a series of injections to experience reduced symptoms.

How Are They Different?

Even though they are both made of hyaluronic acid produced from chicken combs, Synvisc-One is chemically modified to increase its molecular weight. Hyalgan, on the other hand, is not.

The Synvisc-One shot series requires only three doses. Hyalgan requires five doses. Even though both can reduce OA knee pain for up to six months, one study showed people using Synvisc-One were able to go longer between treatments.

Comparing Adverse Effects

Understanding the possibility of complications and adverse effects is important in making any treatment decision.

Possible side effects of Synvisc-One include:

pain, redness, swelling at the injection site

fluid buildup around the joint

rash (seen less frequently)

According to the FDA. potential complications of Synvisc include:

arthralgia

arthritis

arthropathy

injection site pain

joint effusion

According to the manufacturer, Hyalgan can cause:

pain around the knee

knee swelling

effusion around the knee

Repeat injections of Synvisc or Synvisc-One may cause you to have a hypersensitive reaction known as a "flare." This reaction may be uncomfortable or painful. Hypersensitivity may occur even if you have received a successful shot before.

Who Should Not Take Synvisc-One or Hyalgan?

With either drug, you should tell your doctor if you are allergic to eggs. The injection may not be right for you if your leg is swollen or infected. You should not receive an injection of either treatment if you have an infection.

The Choice Is Yours

As we age or experience knee injuries, OA knee pain becomes a real possibility at some point in life. However, it’s reassuring to know that these therapeutic options exist. Both therapies have excellent safety profiles and similar mechanisms of action. As with any drug or therapy, speak to your doctor and weigh the pros and cons of each option so together you can decide with one seems right for you.

Article resources

Altman, R. D. & Moskowitz, R. (1998). The knee: A randomized clinical Trial. Hyalgan Study Group. The Journal of Rheumatology, 25 (11), 2203-2212. Retrieved from http://europepmc. org/abstract/MED/9818665

Ayhan, E. Kesmezacar, H. & Akgun, I. (2014, July 18). Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World Journal of Orthopedics, 5 (3), 351-361. Retrieved from http://www. wjgnet. com/2218-5836/full/v5/i3/351.htm

Conrozier, T. & Chevalier, X. (2008, July 9). Long-term experience with hylan GF-20 in the treatment of knee osteoarthritis [Abstract]. Expert Opinion on Pharmacotherapy, 9 (10), 1797-804. Retrieved from http://www. ncbi. nlm. nih. gov/pubmed/18570611

FDA summary of safety and effectiveness data. (2009). Retrieved from http://www. accessdata. fda. gov/cdrh_docs/pdf/P940015S012b. pdf

Get answers to your questions about SYNVISC. (n. d.). Retrieved from http://www. synviscone. com/what-is-synvisc-one/synvisc-faqs. aspx

Grefsrud, T. (2005). Comparing the effectiveness of Hyalgan and Synvisc hyaluronic acid injections for treatment of osteoarthritis of the knee. School of Physician Assistant Studies, paper 86 . Retrieved from http://commons. pacificu. edu/pa/86/

HYALGAN®: About HYALGAN®. (n. d.). Retrieved from http://www. hyalgan. com/patient/about_hyalgan

Hamburger, M. I. Lakhanpal, S. Mooar, P. A. & Oster, D. (2003). Intra-articular hyaluronans: A review of product-specific safety profiles. Seminars in Arthritis and Rheumatism, 32 (5), 296-309. Retrieved from http://www. ncbi. nlm. nih. gov/pubmed/12701040

Iannitti, T. Lodi, D. Palmieri, B. (2011). Intra-articular injections for the treatment of osteoarthritis. Drugs in R & D, 11 (1), 13-27. Retrieved from http://www. ncbi. nlm. nih. gov/pmc/articles/PMC3586124 /

Murphy, L. B. Helmick, C. G. Schwartz, T. A. Renner, J. B. Tudor, G. Koch, G. G. … Jordan, J. M. (2010, August 16). One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis and Cartilage, 18 (11), 1372-1379. Retrieved from http://www. oarsijournal. com/article/S1063-4584(10)00275-X/abstract

Treatments & procedures viscosupplementation. (n. d.). Retrieved from http://my. clevelandclinic. org/health/treatments_and_procedures/hic_viscosupplementation

Marino, A. Waddell, D. Kolomytkin, O. Pruett, S. Sadasivan, K. & Albright, J. (2006, January). Assessment of Immunologic Mechanisms for Flare Reactions to Synvisc. Clincial Orthopaedics & Related Research . 442, 187-194.

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Pamergan, Pamergan

Why register with MediGuard?

We are a free monitoring service designed for patients like you who want to be in the driver seat of your medical treatment. We have a community of more than 2.6 million members and offer the services below.

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Share your story! Tell us how MediGuard has helped you or someone you love. Download the MediGuard Mobile App to manage your prescription and over-the-counter medications, for free. Taking multiple medications puts you at risk for possible drug-drug interactions Monitor the medical treatment of you and your loved ones.

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.

© Quintiles 2016

About Arimidex 1 Mg, Framidex

What is ARIMIDEX?

ARIMIDEX is a prescription medicine approved as an adjuvant treatment for postmenopausal women with hormone receptor-positive early breast cancer.

ARIMIDEX is also approved for the initial treatment of postmenopausal women with hormone receptor-positive or hormone receptor-unknown locally advanced or metastatic breast cancer and for the treatment of postmenopausal women with advanced breast cancer that has progressed following treatment with tamoxifen.

ARIMIDEX 1 mg helps fight breast cancer by lowering the amount of the hormone estrogen in the body.

Still have questions about ARIMIDEX, including side effects? Check out the FAQs about ARIMIDEX and get information on ARIMIDEX side effects and ideas to help manage them on the full site .

Important Safety Information About ARIMIDEX

Prescription ARIMIDEX is only for postmenopausal women. ARIMIDEX should not be taken if you are pregnant because it may harm your unborn child. Do not take ARIMIDEX if you are allergic to any of its ingredients

Based on information from a study in patients with early breast cancer, women with a history of blockages in heart arteries (ischemic heart disease) who take ARIMIDEX may have a slight increase in this type of heart disease compared to similar patients who take tamoxifen

ARIMIDEX can cause bone softening/weakening (osteoporosis) increasing the chance of fractures. In a clinical study in early breast cancer, there were more fractures (including fractures of the spine, hip, and wrist) with ARIMIDEX (10%) than with tamoxifen (7%)

In a clinical study in early breast cancer, some patients taking ARIMIDEX had an increase in cholesterol. Skin reactions, allergic reactions, and changes in blood tests of liver function have also been reported

In the early breast cancer clinical trial, the most common side effects seen with ARIMIDEX include hot flashes, joint symptoms (including arthritis and arthralgia), weakness, mood changes, pain, back pain, sore throat, nausea and vomiting, rash, depression, high blood pressure, osteoporosis, fractures, swelling of arms/legs, insomnia, and headache

In advanced breast cancer trials, the most common side effects seen with ARIMIDEX versus tamoxifen include hot flashes, nausea, decreased energy and weakness, pain, back pain, headache, bone pain, increased cough, shortness of breath, sore throat, and swelling of arms and legs. Joint pain/stiffness has been reported in association with the use of ARIMIDEX

ARIMIDEX should not be taken with tamoxifen or estrogen-containing therapies

Approved Uses for ARIMIDEX

ARIMIDEX is approved for adjuvant treatment (treatment following surgery with or without radiation) of postmenopausal women with hormone receptor-positive early breast cancer.

ARIMIDEX is approved for the initial treatment of postmenopausal women with hormone receptor-positive or hormone receptor-unknown locally advanced or metastatic breast cancer and for the treatment of postmenopausal women with advanced breast cancer that has progressed following treatment with tamoxifen. Patients with hormone receptor-negative disease and patients who did not previously respond to tamoxifen therapy rarely responded to ARIMIDEX.

For more information, see your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www. FDA. gov/medwatch or call 1-800 - FDA -1088.

If you have any questions or would like additional information, please contact AstraZeneca at 1-800-236-9933. Monday through Friday, 8 am to 6 pm. excluding holidays.

ARIMIDEX is a registered trademark of the AstraZeneca group of companies.

©2015 AstraZeneca. All rights reserved. 1732892- 3173109 Last Updated 11/15

What Does “Mazel Tov” Mean Questions & Answers, Mazetol

What Does “Mazel Tov” Mean?

I always thought Mazel Tov meant “congratulations.” I recently heard that it actually means “good luck.” But I thought Jews don’t believe in luck.

Your confusion is understandable. The Talmud — the ancient encyclopedia of Jewish wisdom—seems to contradict itself on the issue. In one place it states, “On your birthday, your mazel is strong.” Elsewhere the Talmud reports, “The Jewish people are not subject to mazel ”!

The word mazel literally means “a drip from above.” Mazel can have different connotations depending on its context, but they are all connected to this basic definition—something trickling down from above.

The signs of the zodiac are called mazalot . Jewish tradition sees the constellations on high as directing the destiny of individuals and nations down below. Thus mazel is the influence dripping down from the stars. (Over the years, bad or good mazel came to mean “luck” more than “destiny.”) When the Talmud says that we are not subject to mazel . it means that we are not limited to our destiny; rather, our own actions determine our fate.

There is another meaning of the word mazel that is more relevant to the phrase Mazel Tov . Mazel is the term used in Jewish mysticism to describe the root of the soul. The mystics say that only a ray of our soul actually inhabits our body. The main part of the soul, our mazel . remains above, shining down on us from a distance.

Have you ever experienced a sense of spontaneous intuition, where out of the blue you suddenly feel at peace with yourself and the universe? Or a sudden flash of inspiration that makes you see life in a new light? Occasionally we may receive an extra flux of energy from our soul above. It can happen at any time, but is most common at a time of celebration—a birth, birthday, brit . bar/ bat mitzvah or wedding. It is especially at these times of joy that we are able to see beyond the mundane and the petty, and to sense the deeper truths of life.

When we tell someone Mazel Tov . we are giving them a blessing: May this drip of inspiration from your soul above not dissipate, but rather have a positive and lasting effect, that from this event onwards you should live your life with higher consciousness. You should be aware of the blessings in your life, and be ready to receive more and more.

In other words: Good Mazel!

7 Daleron Pl, South Amboy, Nj 08879, Daleron

7 Daleron Pl, South Amboy, NJ 08879

Well maintained tri level home close to bus/train/GSP to NYC. Hardwood floors, vaulted ceilings, granite & corian counters, ceramic tile, Jr suite with private full bath & walk in closet, Spacious Mstr suite w/custom closets, Mstr bath has glass tiles, dual custom sinks, jacuzzi tub, attic garage, new furnace, HWH, deck & roof.

Facts

Townhouse

Built in 1992

All time views: 2,191

HOA Fee: $243/mo

Cooling: Central

Heating: Forced air

Last sold: Jan 2016 for $290,000

Last sale price/sqft: $151

Features

Deck

Fireplace

Flooring: Carpet, Hardwood

Intercom

Parking: Garage - Attached, 1 space

Skylight

Additional Features

Appliances Included

Room Types

Construction

Exterior material: Stucco, Vinyl

Roof type: Other

Room count: 6

Stories: 3

Structure type: Other

Other

Floor size: 1,925 sqft

Heating: Gas

Laundry: In Unit

Zillow Home ID: 2108185239

Sun Number™ rates a home's potential for solar using a scale of 1-100. The higher the number, the better suited a home is for solar and the more money you could save.

Sun Number™ Score Components:

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Problemas De La Piel, Crotanol

Problemas de la piel

Las parasitosis cutaneas se caracterizadas por la presencia de parasitos sobre la piel o dentro de ella; como viven en la superficie mas externa del huesped son llamados ectoparasitos. Los artropodos son los parasitos que mas frecuentemente infestan al hombre, poseen un esqueleto externo duro, patas articuladas y otros apendices. Se clasifican en: aracnidos que tienen 8 patas como los acaros y aranas y hexapodos que tienen 6 patas como los piojos, mosquitos, moscas, hormigas y abejas

ESCABIOSIS

Etiologia Es una de las parasitosis cutaneas mas comunes en nuestros paises. El agente causal es el acaro Sarcoptes scabiei var. hominis. La hembra de cuerpo redondo y mucho mas grande que el macho habita bajo el estrato corneo donde pone 2 a 3 huevos por dia, migran dando lugar al caracteristico surco o tunel; despues de 3 o 4 dias eclosionan dando lugar a las larvas que maduran en 14 a 17 dias. La vida media de una hembra adulta es de aproximadamente 30 dias.

Epidemiologia El contagio de la enfermedad se realiza por contacto directo piel a piel aunque tambien puede trasmitirse a traves de los fomites, porque los acaros pueden permanecer vivos hasta por 3 dias fuera de su habitat natural. La transmision sexual es comun en los adultos. Algunas variedades zoofilicas del Sarcoptes pueden infestar temporalmente a los humanos, pero no pueden completar su ciclo vital en el humano, por eso dan pocos problemas a los humanos. El grupo etario mas afectado corresponde a lactantes y preescolares que viven en condiciones de pobreza

Diagnostico El diagnostico es eminentemente clinico, los pacientes presentan un caracteristico prurito nocturno con un polimorfismo de lesiones que van desde la papula eritematosa inicial hasta papulas escoriadas, pustulas, costras, nodulos, maculas residuales y descamacion; la lesion patognomonica es el surco o tunel. Las localizaciones mas frecuentes en edad infantil son. cara anterior de axilas, areas interdigitales de manos, superficies flexoras de munecas, palmas. plantas, ombligo. region inguinal y area del cinturon, con frecuencia se observan en tronco o genitales nodulos eritemato pigmentados conocidos como nodulos escabioticos; en un 25 % de estos pacientes se presentan lesiones en la cara . En adultos las lesiones inicialmente predominan en tronco (mamas), abdomen y region glutea siendo excepcional su localizacion en cara. El numero de acaros presentes en la piel no se correlaciona con la intensidad del prurito, en promedio una persona con escabiosis puede tener un maximo 20 acaros, mientras que en la forma costrosa el numero de parasitos es mucho mayor. La sarna Costrosa, tambien denomina sarna Noruega, se caracteriza por la presencia de placas queratosicas, costrosas, localizadas predominantemente en manos y pies, las formas eritrodermicas no son infrecuentes. Estas lesiones son poco pruriginosas y muy contagiosas. El diagnostico se confirma por medio del examen parasitologico obtenido por raspado de una lesion indemne o de un surco, previamente humedecidas. colocando el material en una lamina con KOH o agua ; se observa al microscopio de luz donde se puede apreciar el acaro, los huevos o residuos fecales conocidos como escibalos.

Tratamiento El tratamiento debe realizarse a la persona infestada que consulta y a todas las demas personas que convivan con ella, la mayoria de las fallas en el tratamiento se deben a la mala adherencia al tratamiento y a no desinfectar las ropas que se usaron y a no fumigar los enseres de la casa.

Terapia de primera linea Permetrina en crema al 5%, es un piretroide sintetico seguro y eficaz que se usa en ninos desde los 2 meses de edad y en mujeres despues de las 12 semanas de gestacion. Se aplica en la noche desde la cabeza hasta los pies y se retira con el bano en la manana, se repite la aplicacion a los 8 dias. Ivermectina oral a dosis de 200 µg/kg e igual dosis a la semana, puede usarse en ninos mayores de 5 anos, aunque se ha usado desde el ano de edad sin riesgo alguno. No se usa en mujeres embarazadas ni en madres en lactancia. Azufre al 5% en locion, crema o unguento, aplicado en las noches durante 7 dias. Es el tratamiento de eleccion en ninos menores de 1 ano y en mujeres embarazadas y en lactancia.

Terapia de segunda linea Lindane o hexacloruro de gammabenceno al 1% en locion, es neurotoxico, no debe ser usado en ninos menores de 2 anos, ni en mujeres embarazadas ni en lactancia. Se aplica en la noche desde la cabeza hasta los pies y se retira con el bano en la manana, se repite la aplicacion a los 8 dias. Crotanol al 10% en locion, de baja eficacia, se aplica en la noche 3 veces a la semana. Benzoato de bencilo al 20% en locion, se aplica tambien 3 veces a la semana, causa irritacion en la piel e incluso dermatitis de contacto, no debe ser usado en ninos, mujeres embarazadas ni en lactancia.

La pediculosis es causada por piojos pertenecientes al orden Anoplura, genero Pediculus de 2 a 3 mm de longitud, no vuelan ya que son apteros, ademas son aplanados y provistos de unas terminales en forma de garra para adherirse al cabello o a la ropa. Estos insectos son ectoparasitos que se alimentan exclusivamente de sangre humana que obtienen por picadura. Las pediculosis son producidas por Pediculus humanus con 2 variedades, capitis y corporis, y el Phthirrus pubis morfologicamente muy distinto. De los 3 el unico que transmite enfermedad al humano es el Pediculus humanus variedad corporis.

Etiologia La pediculosis pubis es causada por el piojo Pthirus pubis que parece un cangrejo y tiene 3 pares de patas. Puede ser visto sin ayuda de microscopio, la hembra adulta tiene un ciclo de vida de 3 semanas, pone de 30 a 50 huevos en ese tiempo. De alli salen las ninfas que tienen una vida de 14 a 22 dias adicionales hasta madurar en la vida adulta. El piojo del pubis no vive mas de 24 horas fuera del cuerpo humano.

Epidemiologia Es muy comun en personas de 15 a 40 anos, en quienes se transmite por via sexual, pero tambien puede ser transmitida por los fomites como tendidos de cama y toallas. Prefiere la zona pubica, pero puede comprometer otras areas donde el pelo es corto como el tronco, las extremidades, axilas, barba, bigotes, cejas, pestanas y occipucio. Este piojo no es vector de enfermedad humana.

Diagnostico Se presenta tipicamente con prurito en el area pubica, los piojos se observan pegados a la base de los pelos, simulando pecas. La piel puede mostrar excoriaciones y una dermatitis secundaria a la accion irritante de las heces y saliva de los piojos. La presencia de maculas ceruleas, azules o grises de 0.5 a 1 cm son casi patognomonicas, que se creen sean debidas a la degradacion de bilirrubina a biliverdina.

Tratamiento Terapia de primera linea La pediculosis pubis puede ser tratada exitosamente con piretrinas naturales (piperonil butoxido) o sinteticas (permetrina) o tambien con lindane al 1% en shampoo. Ivermectina oral a dosis de 200 µg/kg e igual dosis a la semana. No se usa en mujeres embarazadas ni en madres en lactancia.

Etiologia La pediculosis capitis es causada por el piojo Pediculus humanus capitis, tiene un cuerpo elongado con 3 segmento y 3 pares de patas. Es un insecto succionador de sangre, el ciclo de vida de una hembra adulta es de 9 a 30 dias, vive en el cuero cabelludo y pone sus huevos cerca de la base de los cabellos. Ponen de 7 a 10 huevos por dia que eclosionan 8 a 10 dias despues, las ninfas maduran en 8 a 15 dias. Los huevos pueden sobrevivir hasta 10 dias y los piojos adultos hasta 3 dias fuera del huesped humano. El piojo de la cabeza no es vector de enfermedad humana.

Epidemiologia No existen reservorios animales de estos piojos. La enfermedad es transmitida por contacto directo de pelo a pelo y por los fomites como accesorios para el cabello, peinetas, vestidos y ropa de cama al acostarse. La higiene no tiene que ver con la infestacion, los ninos mas afectados estan entre los 3 y 10 anos de edad.

Diagnostico El principal sintoma es el prurito en el cuero cabelludo, que produce excoriaciones y manchas oscuras correspondientes a las heces de los piojos. Encontrar un piojo adulto en el cuero cabelludo es dificil, sin embargo, al ser examinados los cabellos se encuentran facilmente las liendres o huevos adheridos fuertemente a ellos por un material pegante llamado cementina. Las liendres viables se ven oscuras, infladas por el aire que contiene la camara del huevo, mientras que las liendres no viables o eclosionadas se ven blancas o translucidas y colapsadas. Es comun observar linfadenopatias cervicales posteriores.

Tratamiento Como ninguna de las drogas disponibles son completamente ovicidas los tratamientos deben repetirse a la semana. La remocion de las liendres o huevos es muy importante para erradicar la infestacion. Se recomienda peinar el cabello con peinetas de dientes muy juntos y que previamente hayan sido tratados con solucion de vinagre o acido acetico al 20% o tambien con acido formico, que sirve para reblandecer la cementina que adhiere la liendre al cabello.

Terapia de primera linea El lindane en shampoo al 1% se usa como la permetrina. Ivermectina oral a dosis de 200 µg/kg e igual dosis a la semana, puede usarse en ninos mayores de 5 anos, aunque se ha usado desde el ano de edad sin riesgo alguno. Terapia de segunda linea Malathion en shampoo, crotamiton en locion y cotrimoxazole oral han sido utilizados con resultados variables.

PEDICULOSIS CORPORIS

Etiologia La pediculosis corporis es causada por el piojo Pediculus corporis que morfologicamente es identico al que causa la pediculosis capitis, aunque es mas grande. La hembra adulta puede poner 3000 huevos en su vida, eclosionan a los 7 a 10 dias y requieren 9 dias adicionales para su maduracion a la vida adulta. La hembra adulta tiene un ciclo de vida de 20 dias y puede sobrevivir mas de 10 dias sin sangre en el medio ambiente adecuado. En contraste con el piojo de la cabeza y del pubis, el piojo del cuerpo no vive sobre la piel, el vive en las costuras de los vestidos donde deja sus huevos. Generalmente en la noche, los piojos adultos emergen de los vestidos para tomar su comida de sangre del huesped.

Epidemiologia El piojo del cuerpo se alimenta solo de sangre humana, no existen reservorios animales o del medio ambiente. Es conocida como la enfermedad de los vagabundos y es transmitida por los vestidos y la ropa de cama. El piojo del cuerpo es vector de varias enfermedades humanas que incluyen tifo (Rickettsia prowazekii), fiebre recurrente (Borrelia recurrentis), y fiebre de las trincheras (Bartonella [ Rochalimaea] quintana).

Diagnostico El sintoma mas caracteristico es el prurito de exacerbacion nocturna. Se presentan papulas eritematosas en areas cubiertas del cuerpo, especialmente en el tronco, las axilas y las ingles. La cara, brazos y pies tipicamente estan respetados. En los casos cronicos es comun encontrar excoriaciones, acompanadas de una pigmentacion cafe-bronceada conocida como "piel del vagabundo" en los casos mas severos. Como es tan dificil encontrar los piojo en la piel, se recomienda buscar los piojos y sus huevos en las ropas, especialmente en las zonas de las axilas y de la cintura.

Tratamiento

Terapia de primera linea Cuando la infestacion no es muy grande, el uso de pediculicidas es innecesario. Con solo medidas de higiene, que incluyen el bano del paciente y lavar las ropas de cama y vestidos infestados, son mas que suficientes para erradicar la infestacion. El uso de pediculicidas es recomendado en situaciones de epidemia e incluye el uso de lindane al 1%, permetrina la 1% o piretrinas sinergizadas con piperonil butoxido.

LARVA MIGRANS CUTANEA

Etiologia La larva migrans cutanea es una erupcion cutanea autolimitada. Es tambien conocida como erupcion serpenteante o enfermedad del gusano de la arena. Es causada por larvas de nematodos que normalmente afectan perros, gatos y otros mamiferos. El gusano de perros y gatos Ancylostoma braziliense, es la causa mas comun y otros parasitos incluyen: Ancylostoma caninum, Ancylostoma ceylonicum, Uncinaria stenocephala, Bunostomum phlebotomum, Gnathostoma spinigerum, Dirofilaria conjunctivae, Capillaria sp, Strongyloides myopotami, Strongyloidespapillosus, y Strongyloides westeri.

Epidemiologia La larva migrans cutanea se encuentra en todo el mundo, pero afecta mas a personas de areas tropicales y subtropicales. Las larvas se encuentran en la arena o en el suelo contaminado con heces de animales. Son factores de riesgo caminar descalzo por la playa, sentarse o acostarse en la playa o jugar con arena contaminada. Los huevos eclosionan en la arena en forma de larvas filariformes que son capaces de penetrar la piel de los humanos, permanece en ella, no es capaz de penetrar la membrana basal y muere meses despues porque no puede completar su ciclo de vida en el huesped humano.

Diagnostico Los pacientes afectados notan al principio la sensacion de cosquilleo o comezon y luego se desarrolla una dermatitis inespecifica en el sitio de la penetracion. A los 6 dias aparece una erupcion tipica sobre pies, gluteos o genitales, consistente en un trayecto serpiginoso, vesicular, ligeramente levantado, eritematoso y muy pruriginoso. La larva se encuentra en el polo de avance 1 a 2 cm al frente de la erupcion serpiginosa. El termino "erupcion reptante" se origina en la migracion de la larva sobre la piel que lo hace a razon de varios milimetros a 2 cm por dia.

Tratamiento Terapia de primera linea Las drogas para tratar la larva migrans cutanea producida por gusanos de perros o gatos son el tiabendazole oral o topico, albendazole oral y tambien ivermectina oral. Tiabendazole oral 25 mg/kg 2 veces al dia por 2 dias, tiene efectos colaterales como nausea, vomito y diarrea que limitan su uso, por lo que se usa tiabendazole topico del 10% al 15% aplicado 2 a 4 veces al dia. El albendazole oral se da a dosis de 400 mg por dia por 3 dias. La ivermectina oral se da a dosis de 200 µg/kg como unica dosis con excelentes resultados.

Terapia de segunda linea Crioterapia, aplicada sobre el polo de avance de la larva, buen tratamiento pero doloroso.

MIASIS

Etiologia Es causada por la invasion de las larvas de las moscas a la piel o a tejidos profundos, la palabra miasis viene del griego myia que significa mosca. Las moscas causantes de miasis se dividen en 3 grupos: a). Parasitos obligados para su fase larvaria en animales o en el hombre, son del genero Dermatobia, Hypoderma, Cordylobia, Gasterophilus, Chrysomya y Oestrus. Producen infestaciones en piel, mucosas, oidos, fosas nasales e intestino b). Parasitos facultativos que depositan sus huevos en tejidos muertos o en descomposicion, son del genero Sarcophaga, Calliphora, Musca, Fannia, Cochliomya, Lucilia y Phaenicia. No penetran la piel intacta, pero si los tejidos necroticos y a traves de ellos pueden alcanzar tejidos vivos profundos. c). Parasitos que producen miasis accidentales en region genital o anal, son del genero Musca, Stomoxys y Fannia.

Epidemiologia La Dermatobia hominis, causante de la miasis troncular o furunculosa, la mas comun de las miasis que se ven en el hombre, adhieren sus huevos a artropodos hematofagos como mosquitos y garrapatas donde eclosionan en larvas que son llevadas por los artropodos hasta que se posan sobre la piel para chupar sangre. De esta manera las larvas llegan a la piel del huesped y la penetran.

Diagnostico Las formas clinicas mas comunes de miasis sobre la piel son: a). Miasis troncular o furunculosa, es una forma cutanea fija que se muestra como un nodulo eritematoso inflamado al que se le observa un pequeno orificio por donde le entra aire a la larva, mide entre 2 y 5 cm, algunas veces doloroso y con la sensacion de que algo se mueve en su interior. Se localiza en areas expuestas del cuerpo como el cuero cabelludo, extremidades y tronco. Si la larva madura, en 6 a 12 semanas sale espontaneamente y la herida cicatriza. Esta larva crece hasta 18 o 24 mm y es dificil su extraccion porque tiene unos ganchos que la adhieren al tejido subcutaneo. b). Miasis cavitaria, es una forma que compromete las cavidades nasal, oral, ocular, urogenital y auricular. Se presenta con inflamacion, nodulos, necrosis de los tejidos, secrecion purulenta e intenso dolor. La localizacion determina la gravedad de la infestacion porque por continuidad con tejidos o estructuras vecinas puede comprometer organos importantes como senos paranasales, ojos, oidos e incluso el sistema nervioso central. c). Miasis de las heridas, es una forma producida por las moscas que al ser atraidas por lesiones purulentas o necroticas con mal olor atraen a la mosca Cochliomyia hominivorax quien deposita sus huevos, eclosionan y las larvas invaden localmente e incluso pueden migrar a planos profundos.

Tratamiento El tratamiento consiste en la extraccion de las larvas por metodos manuales o quirurgicos.

Tratamiento de primera linea Ivermectina oral 200 µg/kg como unica dosis, las larvas mueren y minimo a las 2 horas o al dia siguiente son extraidas las larvas. La miasis furunculosa con el tratamiento, permite que por simple apretamiento del nodulo la larva sale facilmente. En las demas miasis las larvas son extraidas con una pinza de diseccion o con lavado abundante y vigoroso.

Tratamiento de segunda linea En la miasis troncular se acostumbra ocluir el orificio del nodulo para asfixiar la larva, usando vaselina, parafina, aceite mineral y aun remedios caseros muy conocidos (aproximar el calor de un cigarrillo, tocino crudo puesto de un dia para otro, humo de cigarrillo, mantequilla, etc). En las demas miasis solo queda desbridar y extraer las larvas vivas.

GENERALIDADES Una gran variedad de parasitos pueden llegar a la piel, a las mucosas y a los anexos y causar por diversos mecanismos variadas infecciones: los principales y mas frecuentes pertenecen a los siguientes Phylum o grupos: PROTOZOARIOS, HELMINTOS Y ARTROPODOS.

Dentro de los PROTOZOARIOS tenemos los generos: Leishmania, Tripanosoma y Ameba.

Dentro de los HELMINTOS: los generos Nematode y Trematode, en el primero los Subgeneros Anquilostoma, Uncinaria, Necator, Strogyloides y Bunostomum, causantes de Larva Migrans Superficial y Gnathostoma causante de Larva migrans profunda y en el segundo (Trematode) los: Shistosomas, que producen la Dermatitis por Cercarias o Dermatitis del Nadador.

Y dentro los ARTROPODOS tenemos: Insectos y aracnidos. Entre los insectos o hexapodos (que tienen tres pares de patas) estan las larvas de moscas que causan la Miasis, los Pediculos que producen la pediculosis. Y el Paederus causante del Foetazo. Y entre los aracnidos, (que tienen cuatro pares de patas), estan las garrapatas que trasmiten la Borreliosis y los Acaros causantes de la Acariasis o Sarna.

Ademas dentro de este ultimo grupo o Phylum (artropodos) hay una gran cantidad de especies que viven en las cercanias del hombre y pueden causar dano a su piel de diversas maneras, asi tenemos eczemas de contactos por mariposas y coleopteros, necrosis cutaneas y reacciones alergicas por toxinas y o venenos de Avispas y Aracnidos.

Dr. Gonzalo Calero Hidalgo

La Leishmaniasis es una infeccion principalmente cutaneo mucosa, causada por un hematozoario del genero Leishmania, es propia de ciertos animales que constituyen el reservorio de la infeccion, pero puede accidentalmente llegar al humano por medio de las picadas de un insecto vector, perteneciente al genero Lutzomia (manta blanca) y causar una gran variedad de cuadros clinicos de caracter cutaneo, cutaneo-mucoso e incluso visceral.

AGENTE CAUSAL Y CICLO EVOLUTIVO El Genero Leishmania comprende varias especies agrupadas en dos Subgeneros: Leishmania y Vianna, todos ellos propios de ciertos animales (reservorio), estos parasitos presentan dos formas evolutivas distintas: Amastigote y promastigote. La primera es redonda u ovalada no tiene flagelos y con tinciones especiales como la de Giemsa tine su citoplasma de color azul claro y su nucleo ligeramente excentrico de rojo purpura al igual que el cinetoplasto ubicado por delante de el en forma de barra. Esta forma se encuentra y desarrolla en los animales reservorio y en los humanos cuando se infectan. La otra forma, la promastigote, se encuentra y desarrolla en los insectos vectores del genero Lutzomya, es alargada o fusiforme, su extremidad posterior es mas delgada, de ahi sale un flagelo libre, tambien tiene nucleo central y cinetoplasto posterior. Se tine igual que la forma amastigote.

Estas formas evolutivas se desarrollan de la siguiente manera: el insecto vector al picar un animal infectado, adquiere con su sangre la forma amastigote del parasito que en su aparato digestivo cambia a la forma promastigote, forma que es inoculada por medio de nuevas picadas a otros animales o al hombre, donde vuelven a la forma amastigote dentro de los macrofagos de la piel, reiniciando asi la infeccion en el reservorio o iniciandola en el hombre.

En America Latina en general, incluyendo al Ecuador la enfermedad es rural, ya que el reservorio y los vectores viven en areas geograficas montanosas calurosas y humedas, aunque entre nosotros como veremos mas adelante, tambien se la ha encontrado en areas de la sierra, de igual manera en diversas ciudades de America latina se la ha reportado en areas urbano marginales donde el perro u otro animal casero se ha convertido en su reservorio.

En el Ecuador la enfermedad se presenta en forma endemica en diversas areas montanosas y selvaticas de la costa y del oriente, en Galapagos no se han reportado casos hasta el momento. Con cierta frecuencia en diversos sectores de las areas en mencion se presentan brotes epidemicos relacionados con determinados cambios climaticos o demograficos.

ESPECIES DE AGENTES, RESERVORIOS Y VECTORES EN AMERICA LATINA Y EN EL ECUADOR. AGENTES: SUGENERO LEISHMANIA.- L. L. Mexicana, L. L amazonensis, L. L. pifanoi, L L. garhnami, L. L. venezuelensis y L. L. chagasi SUGENERO VIANNA.- L. V. braziliensis, L. V. guyanensis, L. V. panamensis y L. V.colombianensis. En nuestro pais se han reportado las siguientes especies: L. L. mexicana, L. L. amazonensis, L. V. guyanensis, L V. panamensis y L. ecuadoriensis (aun sin clasificar).

RESERVORIOS Los principales reservorios en America Latina son de tipo rural (areas montanosas y o selvaticas) asi tenemos: roedores como guantas y ardillas, marsupiales como la zariguella, desdentados como el perezoso y otros primates inferiores. Sin embargo tambien se han encontrado afectados otros animales mas relacionados con el hombre, como perros y equinos En el Ecuador se han encontrado infectados; la rata negra, la ardilla gris, el oso hormiguero, el cusumbo y el perro

VECTORES Son varias las especies de Lutzomyas implicadas en la transmision y varian de un sector geografico a otro. En nuestro pais se han encontrado infectados: Lu. trapidoi, Lu. hartmanni, Lu. gomezi y Lu. Ayacuchensis.

CUADRO CLINICO Despues de inoculadas a la piel por medio de las picadas de los vectores, las formas amastigotes son englobadas por los macrofagos cutaneos y de acuerdo a los tropismos especiales de cada especie y a los mecanismos defensivos de los afectados van a desarrollar las diversas lesiones de la enfermedad que pueden ser de compromiso solo cutaneo, cutaneo - mucosa o visceral, de esta ultima forma, solo se ha descrito en el Ecuador un caso procedente de la provincia de Esmeraldas.

FORMA CUTANEA PURA. Entre nosotros la mayoria de casos son de afectacion solo cutanea, pero de un gran polimorfismo clinico que resulta necesario tomar en cuenta esta enfermedad en el diagnostico diferencial de todas las patologias cutaneas tropicales, asi tenemos:

VARIEDADES.- Ulcerosas, no Ulcerosas, mixtas y anergicas. Entre las Ulcerosas tenemos: clasica, impetigenoide, ectimatoide, costrosa, fegedemica y oreja de chiclero principalmente. Entre las no Ulcerosas tenemos: las vegetantes como: papulosa, verrugosa y lupoide; y la nodular o esporotricoidea.

El analisis de las lesiones y o el seguimiento de las mismas nos ha permitido observar varias combinaciones de los cuadros anteriores asi tenemos: papuloulcerosos, ulcerovegetantes, noduloulcerosos.

EVOLUCION.- En el sitio de la inoculacion se produce una papula que puede confundirse con la reaccion propia de cualquier picada, pero esta es persistente y mas tarde erosiona o ulcera adoptando lo que al parecer es la forma mas frecuente, la ulcera tipica, la cual es redonda, de bordes elevados, cortados a pico y de superficie limpia o ligeramente granulomatosa.

Su numero y ubicacion es de lo mas variado, dependiendo del sitio o sitios de la (s) picadas, pueden haber varias ulceras por inoculacion multiple o por diseminacion linfatica o sanguinea. Las areas expuestas son por logica las mas afectadas. Si las ulceras se extienden constituyen la forma fagedenica. Si se cubren de costras la forma ulcerocostrosa y si al contrario permanece pequena y superficial la impetiginoide.

Cuando la inoculacion es en el pabellon auricular origina la forma Oreja de chiclero, denominada asi, por que se presentaba mas en trabajadores mexicanos del caucho.

En ciertos sectores de la cordillera andina ecuatoriana (provincias de Azuay y Chimborazo) cercanas a las ciudades de Cuenca o Alausi se ha descrito en la cara de menores, lesiones papulosas o papuloerosivas que tienden a involucionar despues de algun tiempo de evolucion, se piensa que esta forma llamada de altura es causada por una especie de poca agresividad, la presentacion en la cara se deberia a que es la unica area descubierta del menor por el frio de la region.

En la provincia de Esmeraldas es donde mas se han observado las formas vegetantes y ulcerovegetantes.

La formas nodulares pueden ulcerarse y dar una imagen muy semejante al de la esporotricosis, esto es una lesion noduloulcerosa inicial y luego varios nodulos que siguen el curso de un cordon linfatico. La forma lupoidea es aquella que cicatriza por un lado y progresa por otra. Tambien hemos visto casos que aparentemente auto involucionan, pero meses despues reactivan, constituyendo la forma cronica recidivante. Finalmente tenemos la forma anergica caracterizada por presentar como la lepra lepromatosa, multiples lesiones papulosas, nodulares y o placas infiltradas en todo el cuerpo, ha sido descrita en el Ecuador en un solo paciente procedente de la provincia de Esmeraldas. Los pacientes con esta variedad clinica son negativos a la prueba de Montenegro, pero tienen abundantes parasitos en sus lesiones de donde se ha aislado la L V. amazonensis.

FORMA CUTANEO MUCOSA Leishmaniasis Cutaneo Mucosa

Al contrario de los que se creia antes esta forma clinica no es la que predomina en el pais, en su mayoria proceden del oriente amazonico y de la parte norte de la costa ecuatoriana (prov. de Esmeraldas y sectores vecinos), la LV. braziliensis al parecer es la que tiene un mayor tropismo para comprometer las mucosas y ser su agente causal, tambien lo pueden hacer con mucho menor frecuencia las otras especies del subgenero Vianna.

Las manifestaciones mucosas se presentan despues de las cutaneas en un tiempo variable, que puede ser de semanas o meses, hay casos que se han presentado anos despues, incluso despues de haber aparentemente cicatrizada la lesion cutanea inicial: El septun nasal es el sitio de inicio de las manifestaciones mucosas, se presenta edematoso e infiltrado para luego ulcerarse, ulcera que puede progresar y causar grandes mutilaciones de las mucosas nasal y orofaringea, la caida del septun por su destruccion da lugar a la imagen caracteristica de nariz de tapir.

Segun las defensas del afectado estas lesiones pueden llevarlo a la muerte por complicaciones respiratorias.

LEISHMANIASIS VISCERAL Ha sido reportada con poca frecuencia en diversos paises de America latina como: Venezuela, Brasil y Bolivia, en el Ecuador solo se ha reportado un caso procedente de la provincia de Esmeraldas, se le atribuye a la L. L. chagasi el agente causal. En el sitio de la inoculacion no se produce ninguna lesion importante, el parasito va directamente a las visceras, produciendo despues de una incubacion de 2 a 6 meses, adenomegalias y hepato-esplenomegalia (Kalazar), se acompana de malestar general y fiebre en dromedario (dos alzas termicas diarias), tiempo despues se presentan en la piel manchas melanodermicas (Postkalazar).

DIAGNOSTICO Los metodos de laboratorio para el diagnostico de la enfermedad pueden ser directos que visualizan el parasito e indirectos que detectan la respuesta inmune celular o humoral: Directos e Indirectos. Directos, entre ellos tenemos: frotis, estudio histopatologico, cultivo, inoculacion al hamster y PCR principalmente e Indirectos, como: intradermoreacion de Montenegro e inmunofluorescencia indirecta (IFI) Veamos cada uno de ellos.

El frotis con tincion de Giemsa es el procedimiento mas usado por su relativa sencillez. La muestra se toma del borde de una lesion en los casos ulcerados o abiertos y por puncion en casos cerrados, el personal entrenado puede identificar las Leishmanias por su forma y por sus cualidades tintoriales, se muestra redondeado u ovalado, con citoplasma azulado y nucleo y cinetoplasto rojo purpura. Como todas las especies son similares no se puede determinar la variedad causal, aunque ultimamente se esta demostrando que las del Subgenero Vianna son mas pequenas. En lesiones antiguas, en que hay pocos parasitos este examen puede ser negativo.

El medio de cultivo mas usado es el denominado de NNM que utiliza un agar sangre modificado, donde al cabo de 7 a 12 dias del sembrado, se desarrollan las formas promastigotes correspondientes. La histopatologia es otro metodo muy usado por los dermatologos, por existir rasgos o parametros histologicos especiales que un patologo entrenado puede recocerlos, la visualizacion del parasito tambien es factible, libres o en el interior de macrofagos, con las nuevas tecnicas de la biologia molecular en laboratorios de investigacion se los reconoce con facilidad por medio del PCR, aunque se encuentren en pequeno numero, ademas con esta tecnica que amplifica el genoma del parasito y teniendo los “primer” de cada especie, se puede identificar la especie causal.

De los indirectos, la intradermoreaccion de Montenegro es la mas usada, mide la respuesta inmune celular del paciente frente a la infeccion por medio de una reaccion cutanea. En la cara anterior del antebrazo se aplica intradermicamente o, 1cc. de extracto de Leishmanias inactivadas y al cabo de 48 horas se hace la lectura, la formacion de una papula o nodulo de mas de 5 mm. de diametro indica infeccion presente o anterior, a pesar de que en infecciones muy recientes puede ser negativa, al igual que en la forma Anergica ya que esta, justamente se caracteriza, por no dar reaccion inmune celular a pesar de haber abundantes parasitos en sus multiples lesiones.

Otras pruebas indirectas son las que miden los anticuerpos circulantes, esto es la inmunidad humoral, tiene mas utilidad en las formas viscerales y cutaneomucosas e incluso en las cutaneas multiples o diseminadas, de estas la inmunofluorescencia indirecta (IFI) es la mas usada, ella detecta en sangre los anticuerpos contra Leishmanias, los cuales se unirian en los casos positivos con el antigeno de la prueba y la fluoresceina agregada, por ello las Leishmanias del antigeno se verian de un color verde brillante al microscopio con luz fluorescente.

Las distintas especies de Leishmanias solo se pueden identificar mediante examenes especiales que se realizan en laboratorios de investigacion entre las cuales tenemos: PCR, Deteccion de anticuerpos monoclonales por IFI, Electroforesis de las isoenzimas y Medicion del gradiente de flotacion del ADN de cada Leishmania.

TRATAMIENTO El comportamiento clinico evolutivo de cada enfermo es de lo mas variado, hemos visto casos en especial de formas cutaneas localizadas que al igual que las formas cutaneas puras de Europa, involucionan en forma espontanea, pero tambien hemos visto enfermos con formas cutaneas multiples o extensas o con formas cutaneo mucosas que no responden ni al tratamiento especifico del glucantime, tambien hemos observado pacientes con lesiones de lo mas variadas que han cicatrizado con diversos medicamentos aparentemente no especificos como antibioticos y otros antiparasitarios. Es posible que la respuesta de cada paciente a las terapeuticas en general dependa por una parte a la variedad de la especie de Leishmania causante, al parecer hay especies de variada agresividad (dentro del Subgenero Vianna estan las mas agresivas) y por otra, a la respuesta inmune de cada afectado.

Los medicamentos especificos son compuestos pentavalentes de antimonio como: antimoniato de N - metilglucamine (Glucantime) y el estibogluconato de sodio (Pentostan), ademas en casos resistentes tenemos las Diamidinas aromaticas (pentamidina) y la Anfotericina B.

Existen diversos ensayos terapeuticos con otros medicamentos que llamariamos no especificos, entre los cuales tenemos:antibioticos: paromomicina topica, vibramicina oral y fosfomicina I. M. antipaludicos: mefloquina oral y pamoato de cicloguanil I. M. y antiamebianos: metronidazol y ornidazol orales. Es necesario que estas experiencias que aparentemente han dado buenos resultados se las realicen tomando en cuenta las especies de Leishmanias implicadas, es posible que los resultados obtenidos solo se vean en pacientes infectados con especies poco agresivas. El uso del glucantime perilesional tambien da buenos resultados. Las formas cutaneas difusas o invasivas o que procedan de zonas endemicas de la forma cutaneo mucosa deben ser tratadas siempre con los medicamentos especificos.

DOSIS DE LOS MEDICAMENTOS ESPECIFICOS.- GLUCANTIME; 25mg. Kg. IM. cada dia por 15 dias, un ciclo mensual hasta cicatrizacion de lesiones. PENTOSTAN; 10mg. Kg. I. M. cada 8 horas por 30 dias. PENTAMIDINA; 4 mg. kg. IM. Pasando un dia por 15 dias ANFOTERICINA B; Por via endovenosa en pacientes hospitalizados.

La administracion del glucantime sistemico no esta exenta de problemas, es necesario controlar los funcionamientos renales, hepaticos y principalmente cardiacos ya que puede causar alteraciones hepaticas, renales y de conduccion electrica cardiaca. Los otros medicamentos especificos tambien son de uso delicado. Actualmente se esta experimentando el uso de vacunas preventivas, usando como antigenos, diversas especies de Leishmanias muertas o fracciones proteicas de las mismas, con buenas expectativas para el futuro, estos tipos de estudios requieren mucho tiempo de observacion. El evitar la picada del insecto trasmisor es muy dificil por ser un vector rural y afectar mas a personas de escasos recursos economicos, tampoco se puede eliminar el vector, el uso de ropas impregnadas con repelentes ( como se usan para combatir el paludismo) es una buena alternativa de prevencion.

LARVA MIGRANS Ciertos estados larvarios de algunos parasitos, especialmente nematodes del tubo digestivo, pueden llegar a la piel y desplazarse por ella ocasionando diversos cuadros clinicos migratorios de gran notoriedad.

La forma como llegan a la piel y como se desplazan por ella es muy variado, en terminos generales hay dos formas:

LARVA MIGRANS SUPERFICIAL Las larvas filariformes de Anquilostoma duodenal, Necator americano y Uncinarias, evolucionan en el suelo una ves que han sido expulsados los correspondientes huevos del intestino de los animales portadores, perros y gatos principalmente, los suelos mas aptos para su desarrollo son tierras arenosas de agua dulce, (playas de rios), estas larvas infectantes una ves desarrolladas, al ponerse en contacto con la piel del hombre la penetran y en ves de dirigirse por via sanguinea al intestino del nuevo huesped (reservorio animal) migran por su epidermis, por su capa espinosa, produciendo un intenso prurito y causando lesiones papulosas foliculares y extrafoliculares que luego se convierten en lineas eritemicas reptantes que configuran variadas imagenes, el extremo anterior de estas lineas avanza continuamente, mientras que la posterior se adelgaza, pierde color y va dejando huellas pigmentarias, que tardan en desaparecer. A mas de perros y gatos otros animales como vacas y borregos principalmente, tambien pueden causar esta infeccion, en estos casos los suelos infectantes lo constituyen pastizales o establos contaminados con las heces de estos animales en cuyos intestinos pueden albergar al Bunustomun flebotomum.

Larva Migrans Superficial

Se denomina Larva migrans currens a la causada por la larva filariforme del Strongyloides estercoralis, parasito intestinal humano cuyos huevos eclosionan en las margenes del ano de los infectados y dan lugar a estas larvas que migran desde ese sitio hacia la piel circundante.

Larva Migrans Currens

El tratamiento de eleccion para todas estas formas de larvas migrans lo constituye la ivermectina, a la dosis de 200 micro gramos/K/d, por via oral, por 3 dias.

Tambien son utiles los imidazolicos orales como el tiabendazol, el mebendazol y el ornidazole.

PANICULITIS NODULAR MIGRATORIA EOSINOFILICA (SINONIMOS: GNATHOSTOMIASIS, LARVA MIGRANS PROFUNDA, FIEBRE DEL RIO YANG-TZE)

Dr. Jose M. Ollague Torres

Concepto La paniculitis Nodular Migratoria Eosinofilica o Gnathostomiasis es una enfermedad actualmente cosmopolita causada por un gusano redondo del Genero Gnathostoma que produce una cuadro clinico caracteristico con placas eritemato-edematosas, migratorias, pruriginosas, que evolucionan en periodos de hasta 20 dias y que al desaparecer pueden dejar pigmentaciones epidermicas residuales. El cuadro histologico caracteristico es el de una paniculitis eosinofilica.

Historia El parasito fue inicialmente descubierto por Sir Richard Owen en el estomago de un tigre en el Zoologico de Londres en 1836, en 1889 Deutzner describe el primer caso en humanos. En 1933 se completa el ciclo biologico del parasito. En 1970 en Mexico se publica el primer caso en Latinoamerica. En 1980 el Dr. Wenceslao Ollague Loayza y su grupo describen en el Ecuador los primeros casos en Sudamerica. En 1981 Pinkus relata el primer caso en USA. En 1984 y 1985 Jose M. Ollague tambien en Ecuador describe cronologicamente el cuadro histologico y reporta los primeros casos tratados con Ivermectina respectivamente. En anos recientes los reportes de casos aumentan en paises vecinos como el Peru y se relatan casos de viajeros europeos y norteamericanos infestados en viajes a Latinoamerica o al Sudeste Asiatico.

Escala Zoologica del gnathostoma:

Ciclo Biologico El ciclo biologico se realiza en ambientes de agua dulce semi - estancada y en pequenos brazos de mar llamados esteros, los hospedadores definitivos que son mamiferos mayores como gatos, perros, tigres, depositan heces contaminadas con huevos de Gnathostomas en rios, represas, lagunas, arrozales, alli se libera el primer estadio larvario que es ingerido por un copepodo de la familia Cyclops el cual abunda en este ambiente y forma parte de la Fauna de la que se alimentan peces, aves etc. En el copepodo se realiza la maduracion a segundo estado larvario y cuando es ingerido por cualquiera de los hospedadores intermedios (peces, aves, batracios o reptiles) o paratenicos sufre una nueva maduracion a tercer estadio larvario. En este punto si es ingerido por cualquiera de los hospedadores definitivos entonces el ciclo se completa ya que las larvas de tercer estadio maduran el pared del estomago de los hospedadores definitivos. Ocasionalmente el Hombre interrumpe este ciclo e ingiere hospedadores intermediarios crudos como los peces en forma de “Ceviche” en nuestro pais y se infesta convirtiendose en un hospedador no natural y por ende no permitiendo que se complete el ciclo biologico. Por periodos muy prolongados, bien documentados, de hasta 15 anos el parasito en forma de tercer estadio larvario inmaduro, puede vivir en el humano haciendo migraciones esporadicas y produciendo signos y sintomas caracteristicos al igual que un cuadro histologico bien definido.

Parasitologia Los parasitos de este genero son Helmintos (redondos), la hembra es mucho mas grande que el macho; tienen una extremidad cefalica o bulbo que contiene dos labios succionadores y posee ganchos en variable cantidad de hileras lo que permite su identificacion, el cuerpo tiene espiculas cuticulares de diferente forma, tamano y localizacion de acuerdo a las especies. La extremidad caudal tiene la cloaca en forma de Y, y en los machos las espiculas cuticulares. Las hembras a mitad de su cuerpo tienen un orificio vaginal. Internamente poseen cuatro sacos celomicos que sirven para ayudar en sus movimientos de traslacion, un esofago muscular central y luego un intestino muy grande que tiene muchas curvaturas, rodeando al aparato gastrointestinal se observan las gonadas o el utero en los adultos. Tiene un color cafe oscuro debido a un pigmento de oxihemoglobina.

El parasito adulto anida en pequenos tumores en el estomago de los hospedadores definitivos donde cohabitan machos y hembras los cuales tiene su extremidad cefalica incrustada en la pared estomacal. Hemos encontrado hasta diez adultos en un mismo tumor lo que provoca habitualmente anemias severas en los hospedadores conduciendolos a la muerte. Las hembras eliminan constantemente huevos a la luz estomacal durante toda su vida fertil.

Cuadro Clinico Hasta 21 dias despues de haber ingerido la larva (periodo de incubacion) se pueden producir los signos y sintomas iniciales de la enfermedad que consisten basicamente en dos tipos: a) Superficial o rampante b) Profunda o clasica

a La forma superficial se caracteriza por la aparicion de un cordon eritemato-edematoso que migra a razon de un cm. por hora sin afectar la epidermis y que desaparece despues de varios dias pudiendo dejar secuelas pigmentarias lineares, esta lesion se acompana de prurito y ocasionalmente se pueden ver excoriaciones en su superficie.

b La forma profunda se presenta como una placa eritemato-edematosa compacta de bordes poco definidos, que migra por uno de sus costados muy rapidamente, se acompana de prurito y ocasionalmente de dolor moderado. Tiene focos hemorragicos o pequenos hematomas en el centro y su tamano varia entre 2 y 30 cm. las areas preferidas de aparicion suelen ser el tronco y las extremidades proximales donde existe mayor cantidad de tejido adiposo, sin embargo hemos visto localizaciones en cualquier parte del cuerpo incluyendo mucosas, el tiempo de duracion del brote puede ser hasta de 20 dias, pero continuas reapariciones pueden coincidir con escasos dias de diferencia.

Ocasionalmente nodulos duros residuales pueden observarse en las areas de migracion de las lesiones. La diferenciacion con las celulitis y las paniculitis inflamatorias es obligatoria al igual que algunas reacciones medicamentosas peculiares.

Las localizaciones de la cara semejan cuadros de angio-edema y existe la posibilidad teorica de obstruccion de las vias respiratorias al igual que la molestia en otras funciones cuando las lesiones se localizan alrededor de orificios naturales.

HISTOLOGIA El cuadro histologico es altamente caracteristico y consiste en una paniculitis lobular y septal con abundante cantidad de eosinofilos en el paniculo).

En la dermis reticular profunda este infiltrado es mixto con neutrofilos y linfocitos, se nota edema de la dermis papilar, edema de los septos, presencia de figuras en flama, hemorragias lineares horizontales, diapedesis de eosinofilos en vasos de mediano calibre, infiltracion de eosinofilos en filetes nerviosos y muy ocasionalmente leucocitoclasia.

El diagnostico diferencial histologico debe incluir la Celulitis Eosinofilica (Wells), pseudogranuloma piogeno, foliculitis eosinofilica (O’Fuji), granuloma eosinofilico de la cara, hiperplasia angiolinfoide con eosinofilia, sindrome hipereosinofilico y la fasceitis eosinofilica (Schulman). En muy pocos pacientes en relacion al numero de biopsias practicadas hemos podido recuperar el parasito, sobre todo en areas de tejido adiposo desprovistas de fenomenos inflamatorios pudiendo notarse sus caracteristicas estructurales.

TRATAMIENTO Durante mucho tiempo varias modalidades terapeuticas han sido utilizadas en el tratamiento de la Paniculitis Nodular Migratoria Eosinofilica; muchas de ellas solo sobre bases empiricas o anecdoticas tales como las que se mencionan abajo con resultados dificiles de cuantificar por falta de estudios controlados y por la particular biologia del parasito. Muchos de esos medicamentos como el Albendazol siguen representando junto con la Ivermectina las mejores posibilidades terapeuticas con que se cuentan. Otras demostraron su poca utilidad y ya no son parte del armamentario terapeutico.

Corticoides topicos Corticoides intralesionales Metronidazol Levamizole Mebendazole Tiabendazole Ruelene Albendazole Yoduro de potasio DDS Cloroquina Praziquantel Glucantime intramuscular Glucantime intralesional Antihistaminicos H1 Cirugia Diatermia

Desde el ano 1983 hemos usado la Ivermectina inicialmente en forma inyectable subcutanea perilesional en dosis equivalentes a 200 microgramos/Kg./dia, inicialmente en una sola dosis pero despues en varias aplicaciones, basados en su efectividad sobre las microfiliarias de la Onchocercosis. Hace cinco anos utilizamos la ivermectina oral de mejor dosificacion y casi sin efectos colaterales excepto gastrointestinales escasos.

La Ivermectina es una lactona macrociclica semi-sintetica de amplio uso en veterinaria que actua a nivel de los canales de calcio modificando la entrada de iones especialmente del potasio induciendo paralisis en los parasitos. A dosis de 200 microgramos/k/d, ha probado tener un efecto filaricida extraordinario en onchocercosis, superior a la Dietilcarbamazina. Criterios empiricos nos impulsaron a usar esta droga en la Paniculitis nodular migratoria eosinofilica con resultados altamente satisfactorios siendo el dolo de la inyeccion la unica molestia pasajera constante. La forma oral ocasionalmente induce nauseas y diarreas sobre todo en ninos.

Definicion La miasis es la infestacion de cualquier parte del cuerpo, tanto en animales como en el hombre, por larvas de moscas.

Etiologia El interes de la medicina por conocer a este diptero, radica en la capacidad del insecto de transmitir enfermedades - bien sea por picadura o mecanicamente asi como de dar origen a una miasis.

Los generos a los que pertenecen las numerosas especies de moscas causantes de esta enfermedad parasitaria, pueden clasificarse de una manera general en tres grupos:

a) En el primero, tenemos a los generos Chrysomyia, Callitroga, Calliphora, Lucilia, Musca, Phormia, Sarcophaga, Wohlfahrtia, Fannia y Phaenicia, todos ellos responsables de producir una miasis semiespecifica o semiobligada. Las larvas de sus moscas usualmente se desarrollan en la carne en estado de descomposicion, pero, pueden asentarse en las heridas que supuran.

b) En el segundo grupo, hay ocho generos, los cuales dan lugar a una miasis obligada. Las larvas solo crecen en los seres vivos, incluyendo al hombre. Las moscas de los generos Hypoderma, Gastrophilus y Oestrus tienen predileccion, principalmente, por los animales domesticos, y de manera accidental infestan a los seres humanos. Cuando se encuentran involucrados los generos Dermatobia, Callitroga, Chrysomyia y Cordylobia, puede presentarse en las personas una enfermedad extensa y grave; una gran variedad de animales son huespedes de sus moscas. Finalmente, nos referiremos el genero Wohlfahrtia, el cual es la principal causa de miasis en Norteamerica, Asia y el norte de Africa.

c) En el tercer grupo, encontramos a los generos Musca, Fannia, Stomoxys, entre otros, productores de una miasis accidental. Situacion, esta ultima, presente cuando se ingiere los huevos o las larvas de las moscas, bien sea a traves de una bebida o de un alimento contaminados, lo que origina una miasis intestina.

Cuadro clinico La miasis cutanea - tema que nos compete tratar – se presenta bajo dos formas clinicas diferentes: la furuncular y la de erupcion reptante. En ambos casos, las lesiones se situan en la cara, piel cabelluda, brazos o piernas.

En la forma furuncular, se observa una o varias tumefacciones en la piel; cada una de ellas posee orificios por los que se puede apreciar los movimientos de las larvas y que, por otra parte, permiten que estas respiren. La resolucion del proceso inflamatorio y la cicatrizacion se producen toda vez que se hallan extraido las larvas. La intensidad del dolor varia de un paciente a otro.

La segunda forma clinica, se caracteriza por la presencia de un signo que indica el paso de la larva por la piel: una linea de color rojo y de trayecto tortuoso, la cual, termina en una vesicula. Por otra parte, cabe destacar que la larva no se encuentra en las lesiones anteriormente descritas sino en la piel normal que esta por delante de la vesicula.

Diagnostico El diagnostico de la miasis es clinico. Sin embargo, hay que enviar al Entomologo las larvas extraidas al paciente para la identificacion de la especie de mosca causante de la infestacion. El preservante empleado en estos casos es el etanol al 70% o el formaldehido.

Diagnostico diferencial La miasis de tipo furuncular no ofrece dificultad diagnostica. Por el contrario, la miasis tipo erupcion reptante debe distinguirse de la forma clinica superficial (cutanea) de la Gnathostomiasis y de la Larva Migrans.

Tratamiento Las larvas deben ser extraidas con una pinza 1,2,4. En la forma clinica furuncular, la oclusion temporal de los orificios cutaneos con vaselina obliga a las larvas a emerger para respirar, facilitandose asi su captura 4. Las lesiones deben ser examinadas periodicamente hasta que se inicie la cicatrizacion (una semana, en promedio). La prescripcion de un antibiotico y de un analgesico se hacen mandatarios; igualmente una inmunizacion antitetanica.

ONCOCERCOSIS Sinonimo: Ceguera de los rios

Dr. Jorge Adum Saade

Definicion La Oncocercosis es una enfermedad causada por una filaria, Onchocerca volvulus, la cual pertenece a la clase Nematoda.

Modo de transmision Unicamente, mediante la picadura de la hembra de insectos, infectados, del genero Simulium. Las microfilarias vivas son ingeridas por el simulido en el momento en que este se alimenta de la sangre de una persona enferma; posteriormente, ellas se transformaran al interior del organismo del insecto en larvas infectantes, las cuales, infestaran a un nuevo huesped cuando el vector vuelva a alimentarse. Es el ser humano el reservorio de esta enfermedad. Las microfilarias pueden detectarse en la piel al cabo de un ano de haberse producido una picadura infectante, y por espacio de 10 a 15 anos, si las personas no son tratadas.

Distribucion geografica En el continente americano, la oncocercosis, ha sido reportada en los siguientes paises: Guatemala, Mexico, Venezuela, Colombia, Ecuador y Brasil; en el resto del mundo, solo hay enfermos en el Africa, donde la enfermedad en el pasado fue endemica en ciertas zonas.

Epidemiologia La oncocercosis afecta aproximadamente a 18 millones de personas en el mundo; es responsable de la ceguera de 350.000 personas.

En America Latina se estima que hay alrededor de 100.000 casos y 1.400 personas ciegas por esta causa.

Cuadro clinico La oncocercosis produce, principalmente, lesiones cutaneas y oculares. Entre las primeras, contamos con los oncocercomas y las manifestaciones en piel de caracter agudo o cronico de esta enfermedad.

Los oncocercomas son quistes, subcutaneos, duros, indoloros y de tamano variable; en su interior se encuentra el gusano adulto. Selocalizan en la cabeza y en los hombros (en pacientes americanos) o en la pelvis y las extremidades inferiores (en pacientes africanos). Desde aqui, la filaria hembra libera a las microfilarias, las cuales, viajan a traves de la piel; cuando alcanzan los ojos, producen alteraciones visuales y ceguera.

Los terminos "erisipela de la costa" o "mal morado" califican a una dermatosis aguda, caracterizada por eritema, edema y prurito intensos, en la cara, cuello y pecho de pacientes oncocercosicos; el cuadro puede desarrollarse espontaneamente o secundariamente al tratamiento con dietilcarbamazina.

Las manifestaciones cronicas se caracterizan por la presencia de una piel flacida con acentuacion de sus pliegues y cambios en su coloracion.

Las lesiones oculares, causadas por la invasion y muerte ulterior de las microfilarias en este organo, son las mas importantes de todas debido a que conllevan el riesgo de producir alteraciones visuales y ceguera en el paciente, citaremos algunas de ellas: la queratitis puntata, la iridociclitis fibrinosa cronica, sinequias y atrofia del iris y la atrofia del nervio optico.

Diagnostico Existen varias formas de confirmar un diagnostico clinico de oncocercosis en un paciente:

1. Biopsia de la piel: El estudio histopatologico del especimen obtenido debe revelar la presencia de microfilarias en el tejido.

2. Examen de la orina: En ocasiones las microfilarias pueden hallarse aqui.

3. Extirpacion de los oncocercomas: Lo que permite detectar la presencia de los gusanos adultos en su interior.

4. Examen oftalmologico: La lampara de hendidura permite visualizar las microfilarias en la cornea, en la camara anterior del ojo o en el humor vitreo.

5. La prueba de Mazzotti: Este estudio ya no se lo emplea en muchos paises.

Puede resultar peligroso en personas muy infestadas. Consiste en administrar al paciente por la via oral, citrato de dietilcarbamazina, lo cual produce en el paciente oncocercosico una reaccion alergica por la destruccion de las microfilarias. Caracterizado por eritema y prurito en cara y cuello, seguido de edema, fiebre y malestar general; desaparecen en 5 dias sin dejar secuela.

6. La reaccion en cadena de la polimerasa lPCR): Se la realiza con material obtenido de la piel del paciente y sirve para detectar la presencia del ADN del parasito.

Tratamiento Consiste en la extirpacion quirurgica de los oncocercomas asi como en el empleo de drogas filaricidas.

1. Ivermectina (Mectizan): en una dosis oral, unica, de 150 ug (microgramos) por Kg de peso, y con un segundo tratamiento, un ano despues, este medicamento disminuye la poblacion de microfilarias y evita la liberacion de las mismas por parte de la hembra adulta.

2. Citrato de dietilcarbamazina (DEC, Banocide, Hetrazan, Notezine): es una droga microfilaricida con efectos secundarios severos (reaccion de Mazzotti) que mejoran poco con el uso de los corticosteroides. Este farmaco ya no se lo emplea para el tratamiento de la oncocercosis, excepto en casos especiales en donde se la usa conjuntamente con la suramina (Bayer 205, Naphuride, Antrypol); este ultimo medicamento, destruye solo a las filarias adultas y es nefrotoxico. Ninguna de las dos drogas mencionadas se las emplea para el tratamiento comunitario.

Prevencion Evitar la picadura de los simulidos cubriendose la mayor parte del cuerpo y la cabeza o empleando repelentes para insectos. Igualmente, identificando al vector y sus criaderos; combatiendo las larvas mediante le empleo de insecticidas biodegradables.

La oncocercosis en el Ecuador Al inicio del ano de 1980, los doctores Carvajal y Zerega, reportaron el primer caso, confirmado, de oncocercosis en nuestro pais. A mediado del mismo ano, Arzube, dio a conocer de la existencia de una zona endemica de esta parasitosis en nuestro territorio patrio: se trataba de San Miguel de Cayapas, en la provincia de Esmeraldas. Pocos meses despues, se inicio en esta provincia, un trabajo de campo multidiciplinario, con la finalidad de conocer los aspectos clinicos y epidemiologicos de la oncocercosis en el Ecuador. Los datos mas relevantes del estudio fueron los siguientes: las manifestaciones de caracter cronico predominaban entre los pacientes atendidos; las lesiones oculares no eran tan severas como las reportadas en los enfermos africanos; las poblaciones de Vargas Torres, Playa de Tigre y Selva Alegre, en la cuenca del rio Santiago, la de Hoja Blanca, en la cuenca del rio Cayapas, y la de Santo Domingo, en la cuenca del rio Onzole, eran las mas afectadas por este mal.

Definicion La tungiasis es una dermatosis parasitaria causada por la hembra de la pulga de la arena, denominada Tunga penetrans y conocida popularmente como nigua, la cual penetra la epidermis de sus huespedes.

Etiologia La infestacion humana con este ectoparasito es endemica en varios paises del Africa Subsahariana, el Caribe y Sudamerica.

La pulga es de color negro rojizo y como de un mm. de longitud, y se alimenta de la sangre de los humanos asi como la de otros mamiferos. Habita en los suelos arenosos. Los sitios por donde la hembra, cuando esta fecundada, suele entrar en la piel de las personas son los siguientes: los espacios interdigitales de los pies, debajo de las unas y los arcos plantares; ocasionalmente, se introduce por otros lugares de la superficie cutanea. Aqui ella se desarrolla, deposita sus huevos y eventualmente muere; todo este proceso dura de 4 a 6 semanas.

Cuadro clinico Las lesiones de la tungiasis se localizan generalmente en las plantas de los pies por la costumbre de las personas de andar descalzas. El sitio de la penetracion se lo reconoce por la presencia de un punto de color negro; posteriormente, se inicia un proceso inflamatorio.

La infeccion secundaria es una complicacion comun y esta causada por una variedad de microorganismos patogenos, tanto aerobios como anaerobios; la mas seria de ellas es el tetanos.

Tratamiento Actualmente, no se dispone de un medicamento efectivo para tratar la tungiasis. La extraccion de la pulga, la prescripcion de antibioticos, la vacunacion antitetanica y el uso de zapatos constituyen las medidas, tanto terapeuticas como preventiva, de esta dermatosis.

En fase de investigacion se encuentra el empleo de la Ivermectina (locion), el tiabendazol (unguento y locion) y el metrifonato (locion).

Dr. Adolfo Molina Holguin

La escabiosis o acariasis es una infeccion cutanea, causada por un insecto del grupo de los Aracnidos que parasita y vive en la piel humana, existen varias especies de Acaros o Sarcoptes que parasitan diversos animales, cada animal es infectado por una especie determinada. hay agentes especificos para perros, gatos, aves etc. El que afecta al humano es el Sarcoptes scabiei var. hominis, sin embargo las otras especies pueden tambien producir molestias temporales al hombre (picaduras y sensibilizaciones como prurigos y urticarias).

ETIOPATOGENIA El acaro que afecta al hombre se caracteriza por ser redondeado con cuatro pares de patas, la hembra es mas grande que el macho mide de 0,3 -0,4 mm. De longitud. Tiene un ciclo evolutivo completo: luego, larva, ninfa y parasito adulto, que lo realiza en la piel del paciente y dura de 1 a 3 semanas, para unos autores y hasta 1 mes para otros. Una vez fertilizada la hembra, excava tuneles en la epidermis avanzando unos 2 o 3 mm. diarios y deposita los huevos (cantidad variable) al final del mismo, despues las larvas salen de los huevos para luego transformarse en ninfas octopodas y completar su desarrollo saliendo la piel en forma de parasitos adultos en 8 a 15 dias.

Desde el punto de vista epidemiologico se puede decir que el reservorio es el mismo hombre pues la capacidad de sobrevivir del acaro es de apenas 3 dias fuera del ser humano, por eso el contagio es directo o a traves de ropas del paciente o de la cama. Puede afectar cualquier raza, edad o condicion social.

CLINICA El sintoma que trae al paciente a la consulta del medico es el prurito con predominio nocturno. Las manifestaciones cutaneas caracteristicas son los surcos acarinos y las vesiculas o eminencias acarinas, los surcos son la expresion de las galerias causadas por las hembras en la epidermis y se localizan mas en las munecas, espacios interdigitales de manos y pies, codos, pliegues axilares, areolas mamarias y pene. Sarna

El surco es una lesion tortuosa ligeramente elevada que termina en una vesicula (perlada) serosa y transparente que en muchas ocasiones nos sirve para realizar el diagnostico. Tambien pueden encontrarse lesiones papulosas, vesiculosas, nodulares, costrosas y excoriaciones en la piel, producto del rascado debido al intenso prurito. Generalmente las lesiones afectan todo el cuerpo respetando la cara, pero en los ninos puede afectarla asi como tambien: cuero cabelludo, palmas y plantas.

Existen casos menos frecuentes de una forma de acariasis llamada Sarna Noruega o “Costrosa” descrita por Danielssen y Brock en pacientes leprosos en Noruega (1848). Los pacientes son debilitados o inmunodeprimidos como ancianos, desnutridos, transplantados, retrasados mentales o afectados con: SIDA, LES, Leucemias y Linfomas principalmente. Al examen fisico muestran lesiones costrosas en diferentes zonas del cuerpo como: cuello, cara, axilas e ingles, tambien pueden hacer formas eritrodermicas.

DIAGNOSTICO Es principalmente clinico y se basa en el reconocimiento de sus lesiones tipicas, de sus localizaciones y de la existencia del genio epidemico (otros casos en la familia). Actualmente existen varios metodos, diagnosticos a traves de los cuales se puede tener la certeza de que el paciente tiene acariasis.

El primero es la observacion al microscopio de la hembra gravida, de sus huevos o de las ninfas, raspando con una hoja de bisturi un surco o una eminencia acarina y colocando el material obtenido en una lamina porta objeto a la cual se le agrega unas gotas de hidroxido de potasio al 10%.

La segunda forma de observar al parasito es por medio de la dermatoscopia o microscopia de superficie. La biopsia o estudio histopatologico de las lesiones tambien puede identificar al parasito.

TRATAMIENTO El de eleccion es el hexacloruro de Gamma Benceno al 1% (Lindane, Davesol), se comercializa en locion y shampoo, produce la muerte del parasito, se aplica en toda la superficie de la piel desde el cuello hasta los pies durmiendo con ella, la locion se debe aplicar 3 dias seguidos despues del bano, se descansa 2 o 3 dias y se vuelve a aplicar en la misma forma, 1 o 2 ciclos mas.

Esta contraindicada en pacientes embarazadas y en menores de 2 anos.

Todos los componentes de la familia deben realizar el tratamiento si tienen algun sintoma y deben desinfectarse la ropa y las sabanas de los pacientes.

Ademas podemos usar: lociones azufradas del 5 al 10%, indicadas mas que nada en lactantes, embarazadas y en pacientes con areas denudadas o con trastornos neurologicos. El benzoato de Bencilo del 20 al 25%, se lo usa menos por su poder irritativo, pero es un buen acaricida. Permetrinas al 5% en locion, es muy util en ninos por ausencia de toxicidad, se utiliza por 3 dias seguidos aplicada en todo el cuerpo y se repite una vez mas 7 dias despues. Ivermectina por via oral a la dosis de 200 micro gramos/K/d, da buenos resultados principalmente cuando hay problemas con las otras terapeuticas.

PEDICULOSIS Dr. Adolfo Molina Holguin

Esta dermatosis es causada por una variedad de insectos del orden Anoplura, familia Pediculidae los cuales son hematofagos, no alados, contienen 3 pares de patas y tienen el cuerpo aplanado en sentido dorso-ventral (conocidos comunmente como piojos).

Los que afectan al hombre comprenden 3 especies: Pediculos capites, causante de la Pediculosis del cuero cabelludo, Pediculos corpuris causante de la Pediculosis del cuerpo y el Pediculos Pubis (ladilla) causante de la Pediculosis Pubis.

PEDICULOSIS CAPITIS Es causado por el Pediculos humano variedad capites mide de 2 a 3mm. de largo, sus huevos o liendres on ovales y estas adheridos al pelo por medio de una substancia sementante que ellos liberan.

CLINICA.- Esta infeccion es mas frecuentes en ninos escolares, en quienes se observan epidemias al inicio de clases, tambien se presentan en adultos en especial en mendigos desasiados. La parte posterior de la cabeza y la region retroauricular son las mas afectadas, se presentan tambien en zonas como la barba. Como son hematofagos pican para alimentarse, produciendo intenso prurito con el consecuente rascado ocasionando maculas y papulas eritematosas y luego excoriaciones que a su vez producen eccemas y piodermias. Es frecuente la

Melic, Melic

Melic

development in ancient Greek literature

In ancient Greece an early distinction was made between the poetry chanted by a choir of singers (choral lyrics) and the song that expressed the sentiments of a single poet. The latter, the melos, or song proper, had reached a height of technical perfection in “the Isles of Greece, where burning Sappho loved and sung,” as early as the 7th century bc. That poetess, together.

genre of ancient Greek literature

covers many sorts of poems. On the one hand, poems sung by individuals or chorus to the lyre, or sometimes to the aulos (double-reed pipe), were called melic ; elegiacs, in which the epic hexameter, or verse line of six metrical feet, alternated with a shorter line, were traditionally associated with lamentation and an.

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Melic are a four-piece rock band based in London with a sound derived from an eclectic blend of musicians – fusing a funk-rock bassist, a metal drummer, a classically trained pianist and saxophonist, and a rock singer/song-writer guitarist. In 2012 the band won ‘Best Overall Band’ in the UK Unsigned Awards, run by Play Music Magazine (UK), and have since been signed to Beatnik Geek Records. Melic released their debut album ‘An Hour To Anywhere’ on Aug 5th 2013, paired with a sell out launch show at London’s Bush Hall. The band are taking a break from gigging but will be releasing 2 brand new singles during the course of 2015.

Melic is: Andrew Coogan: drums Mark Hitchcock: vocals, guitar, trumpet Steve Hitchcock: bass, vocals Romy Attewell: saxophone, keyboards

NEXT GIG…

Melic are taking a break from gigging, but don’t worry – we have new music coming in 2015! Follow us on Twitter or Facebook to stay up to date.

BUY TICKETS:

COMING UP…

Live at Juice Bar – Auckland, NZ 09/06/2012

Live at The Garage 28/04/2012

Live at Under The Bridge 17/02/12

Live at The Borderline 21/10/11

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Contact Melic

If you would like to contact Melic, whether it be to tell us what you think about our music or just want to find out more, please send an email to the following address – We would love to hear from you!

For gig bookings & enquiries please email: manager@melicband. com

Motrin - Pain Relief, Pabiprofen

Motrin is used for treating rheumatoid arthritis, osteoarthritis, menstrual cramps, or mild to moderate pain. Motrin is an NSAID. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms.

Use Motrin as directed by your doctor.

Take Motrin by mouth with or without food. It may be taken with food if it upsets your stomach. Taking it with food may not lower the risk of stomach or bowel problems (eg, bleeding, ulcers). Talk with your doctor or pharmacist if you have persistent stomach upset.

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

If you miss a dose of Motrin 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. 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 the proper use of Motrin .

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

Active Ingredient: Ibuprofen.

Do NOT use Motrin if:

you are allergic to any ingredient in Motrin

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

you have recently had or will be having bypass heart surgery

you are in the last 3 months of pregnancy.

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

Some medical conditions may interact with Motrin. 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 product, or dietary supplement

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

if you have a history of kidney or liver disease, diabetes, or stomach or bowel problems (eg, bleeding, perforation, ulcers)

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

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

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

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

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

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

Cyclosporine, lithium, methotrexate, or quinolones (eg, ciprofloxacin) because the risk of their side effects may be increased by Motrin

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

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

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

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

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

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

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

Lab tests, including kidney function, complete blood cell counts, and blood pressure, may be done to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.

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

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

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

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

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

Constipation; diarrhea; dizziness; gas; headache; heartburn; nausea; stomach pain or upset.

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

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

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

Motrin is used for treating rheumatoid arthritis, osteoarthritis, menstrual cramps, or mild to moderate pain. Motrin is an NSAID. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms.

Use Motrin as directed by your doctor.

Take Motrin by mouth with or without food. It may be taken with food if it upsets your stomach. Taking it with food may not lower the risk of stomach or bowel problems (eg, bleeding, ulcers). Talk with your doctor or pharmacist if you have persistent stomach upset.

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

If you miss a dose of Motrin 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. 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 the proper use of Motrin .

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

Active Ingredient: Ibuprofen.

Do NOT use Motrin if:

you are allergic to any ingredient in Motrin

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

you have recently had or will be having bypass heart surgery

you are in the last 3 months of pregnancy.

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

Some medical conditions may interact with Motrin. 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 product, or dietary supplement

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

if you have a history of kidney or liver disease, diabetes, or stomach or bowel problems (eg, bleeding, perforation, ulcers)

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

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

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

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

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

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

Cyclosporine, lithium, methotrexate, or quinolones (eg, ciprofloxacin) because the risk of their side effects may be increased by Motrin

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

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

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

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

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

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

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

Lab tests, including kidney function, complete blood cell counts, and blood pressure, may be done to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.

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

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

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

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

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

Constipation; diarrhea; dizziness; gas; headache; heartburn; nausea; stomach pain or upset.

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

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

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

Motrin is used for treating rheumatoid arthritis, osteoarthritis, menstrual cramps, or mild to moderate pain. Motrin is an NSAID. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms.

Use Motrin as directed by your doctor.

Take Motrin by mouth with or without food. It may be taken with food if it upsets your stomach. Taking it with food may not lower the risk of stomach or bowel problems (eg, bleeding, ulcers). Talk with your doctor or pharmacist if you have persistent stomach upset.

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

If you miss a dose of Motrin 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. 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 the proper use of Motrin .

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

Active Ingredient: Ibuprofen.

Do NOT use Motrin if:

you are allergic to any ingredient in Motrin

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

you have recently had or will be having bypass heart surgery

you are in the last 3 months of pregnancy.

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

Some medical conditions may interact with Motrin. 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 product, or dietary supplement

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

if you have a history of kidney or liver disease, diabetes, or stomach or bowel problems (eg, bleeding, perforation, ulcers)

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

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

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

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

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

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

Cyclosporine, lithium, methotrexate, or quinolones (eg, ciprofloxacin) because the risk of their side effects may be increased by Motrin

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

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

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

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

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

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

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

Lab tests, including kidney function, complete blood cell counts, and blood pressure, may be done to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.

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

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

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

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

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

Constipation; diarrhea; dizziness; gas; headache; heartburn; nausea; stomach pain or upset.

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

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

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

Caprimida Soya, Caprimida

Colombia

CAPRIMIDA SOYA

Suplemento de las deficiencias de calcio y vitamina D.

ComposiciпїЅn.

Cada tableta de Caprimida soya es recubierta y contiene: itrato de calcio tetrahidrato 1.500 mg, equivalente a 315 mg de calcio elemental. Isoflavonas de soya 25 mg. Vitamina D 3 300 U. I.

FarmacologпїЅa.

CaracterпїЅsticas del calcio: CAPRIMIDA SOYA contiene citrato de calcio, la sal de calcio de mejor absorciпїЅn y por lo tanto biodisponibilidad. Su forma farmacпїЅutica de tabletas recubiertas de una pelпїЅcula de gelatina, de forma oblonga, color blanco en una de sus caras y amarillo perlado en la parte inversa, garantiza una excelente palatabilidad. Al ser el citrato de calcio mпїЅs biodisponible se requerirпїЅn dosis menores de calcio elemental, lo que disminuye la incidencia de efectos adversos gastrointestinales ofreciendo una mayor tolerabilidad que otras sales de calcio. CaracterпїЅsticas de las isoflavonas: Las isoflavonas de soya de CAPRIMIDA SOYA contienen fitoestrпїЅgenos, los cuales tienen estructura y actividad biolпїЅgica similar a los estrпїЅgenos y por lo tanto se pueden ligar a receptores estrogпїЅnicos. Se conocen tres tipos de receptores estrogпїЅnicos, las formas ER alfa, ER beta y ER gama, siendo los dos primeros los mпїЅs estudiados. El ER alfa abunda en tejidos como el пїЅtero, la vagina, el ovario y la glпїЅndula mamaria; tambiпїЅn se encuentran en el hipotпїЅlamo, las cпїЅlulas endoteliales y las fibras musculares lisas. Este receptor estпїЅ relacionado con tumores de mama. El ER beta se encuentra en una amplia variedad de tejidos como la prпїЅstata, el aparato cardiovascular, el пїЅseo, los riпїЅones, los pulmones, el cerebro y el sistema nervioso central. Las isoflavonas de soya son principalmente selectivas del receptor beta. La genisteпїЅna, una de las isoflavonas presentes en CAPRIMIDA, se liga al receptor beta con una afinidad en promedio cinco veces mayor que la observada para el receptor alfa, en forma semejante al raloxifeno. La genisteпїЅna, tiene un efecto especial sobre masa пїЅsea. Estudios in vitro han demostrado que las isoflavonas protegen los osteoblastos de la apoptosis y ejercen efectos estrogпїЅnicos asociados con aumento en el nпїЅmero, la actividad funcional y el periodo de vida de los osteoblastos. En un gran nпїЅmero de estudios clпїЅnicos las isoflavonas de soya han demostrado sus beneficios en la reducciпїЅn de los sпїЅntomas que acompaпїЅan la menopausia: vasomotores como las oleadas de calor y los sudores nocturnos, la mastalgia, la preservaciпїЅn de la densidad mineral пїЅsea, y la salud cardiovascular. La calidad de las isoflavonas presentes en CAPRIMIDA estпїЅ respaldada por los rigurosos procesos de extracciпїЅn y los altos estпїЅndares de Buenas PrпїЅcticas de Manufactura. Estas condiciones garantizan una excelente eficacia terapпїЅutica y mпїЅxima seguridad farmacolпїЅgica. La vitamina D 3 . presente en CAPRIMIDA, es la forma mпїЅs activa de la vitamina D y su funciпїЅn es estimular la absorciпїЅn intestinal de calcio y fosfatos.

Indicaciones.

Suplemento de las deficiencias de calcio y vitamina D. PrevenciпїЅn y tratamiento de la osteoporosis, menopausia y postmenopausia.

DosificaciпїЅn.

1 o 2 tabletas al dпїЅa, preferiblemente con o despuпїЅs de las comidas. La duraciпїЅn del tratamiento depende de la tasa de recuperaciпїЅn de la hemoglobina y de la necesidad de crear reservas de hierro. La primera dependerпїЅ de la severidad de la anemia. La segunda requiere de una terapia mпїЅs prolongada, incluso meses de tratamiento. Las mujeres en menopausia con sпїЅntomas leves, deben recibir asesorпїЅa acerca de las medidas de estilo de vida como regulaciпїЅn de la temperatura corporal central, ejercicio, dejar de fumar y tпїЅcnicas de relajaciпїЅn. Si se amerita por decisiпїЅn facultativa, se puede prescribir una terapia complementaria como CAPRIMIDA SOYA. En mujeres con sпїЅntomas moderados, se debe comenzar CAPRIMIDA SOYA por un periodo de 12 semanas con modificaciones del estilo de vida. Deben tenerse en cuenta las expectativas de las pacientes en cuanto a la mejorпїЅa de los sпїЅntomas, ya que este enfoque puede no aliviar completamente los sпїЅntomas. Si la paciente no experimenta reducciпїЅn satisfactoria de los sпїЅntomas hacia el final de este periodo y de acuerdo al criterio mпїЅdico, se pueden prescribir dosis bajas de Terapia Hormonal - TH-. Para las mujeres con sпїЅntomas graves, la TH es el tratamiento de primera lпїЅnea, a menos que estпїЅ contraindicada o alguna paciente tenga aversiпїЅn a la TH.

Contraindicaciones.

Hipersensibilidad al principio activo y/o alguno de sus componentes. Hipercalcemia, hipercalciuria. AdminпїЅstrese con precauciпїЅn en pacientes con litiasis o insuficiencia renal. EvпїЅtese la administraciпїЅn concomitante con digitпїЅlicos. Su administraciпїЅn por tiempo prolongado puede producir hipercalcemia o hipercalciuria. No se debe administrar con diurпїЅticos tiazпїЅdicos. Se debe tener precauciпїЅn en pacientes con пїЅlcera gпїЅstrica y anastomosis gastrointestinal. La terapia de suplencia no debe ser administrada a pacientes que reciben transfusiones repetidas o en casos de anemia no producida por deficiencia de hierro. No es recomendable usar concomitantemente terapia oral y la parenteral. En toda forma de suplencia de hierro oral se debe tener precauciпїЅn en pacientes con hemocromatosis o hemoglobinopatпїЅas, enfermedades inflamatorias del colon y diverticulitis. Se ha reportado eliminaciпїЅn de las isoflavonas en la leche materna pero su significancia clпїЅnica no ha sido evaluada suficientemente. De igual manera no se recomienda su uso durante el embarazo.

Reacciones adversas.

Ocasionalmente se puede presentar pirosis, nпїЅuseas o molestias epigпїЅstricas, estreпїЅimiento o diarrea. Estas manifestaciones serпїЅn mпїЅs frecuentes en la medida que se utilicen dosis mпїЅs elevadas. Las heces de los pacientes pueden tomar una coloraciпїЅn oscura o negra. Se debe recordar que la administraciпїЅn crпїЅnica de calcio podrпїЅa inducir hipercalcemia y/o hipercalciuria.

Interacciones.

La absorciпїЅn de hierro se puede ver alterada por compuestos que contienen magnesio, incluidos antiпїЅcidos y suplementos minerales, bicarbonatos, carbonatos, oxalatos y fosfatos los cuales pueden formar complejos solubles. Las sales de zinc tambiпїЅn pueden disminuir la absorciпїЅn del hierro. La absorciпїЅn de tetraciclinas se puede disminuir al ser administradas concomitantemente con hierro, entonces se debe dar con un intervalo de dosificaciпїЅn de 2 a 3 horas. El hierro no se debe administrar con dimercaprol pues puede formar complejos tпїЅxicos. Los diurпїЅticos tiazпїЅdicos favorecen la reabsorciпїЅn tubular de calcio y por lo tanto se debe tener especial precauciпїЅn de no administrarlos con suplementos de calcio pues se puede inducir hipercalcemia. El calcio incrementa los efectos de los glucпїЅsidos digitпїЅlicos y puede precipitar intoxicaciпїЅn digitпїЅlica. El citrato puede incrementar la absorciпїЅn de aluminio desde el tracto gastrointestinal, de esta manera los pacientes con falla renal que tomen compuestos de aluminio deberпїЅan evitar tomar citrato de calcio. Las sales de calcio pueden disminuir la absorciпїЅn de numerosos medicamentos como los bisfosfonatos, algunas fluoroquinolonas y tetraciclinas. Por esta razпїЅn es deseable mantener un intervalo de tiempo de por lo menos 3 horas entre uno y otro. La administraciпїЅn de los inhibidores de la bomba de protones o los antagonistas de los receptores H2 al igual que los antibiпїЅticos, pueden reducir la eficacia de los suplementos de isoflavonas. EstrпїЅgenos: Puesto que las isoflavonas son sustancias que ocurren naturalmente y se encuentran en la dieta, se esperarпїЅa que los contraceptivos orales y las isoflavonas sean compatibles. Warfarina: Como sucede con cualquier cambio de dieta o adiciпїЅn de un suplemento dietпїЅtico en pacientes anticoagulados con warfarina, se debe vigilar con regularidad el INR.

PresentaciпїЅn.

Cajas por 10, 20, 30, 60 y 120 tabletas con recubrimiento de gelatina en blпїЅster ALU/PVDC por 10 tabletas (Reg. San. INVIMA 2009M-0010071).

Clindox Ecrf - The Team Who Are Removing The Barriers To Effective Clinical Trials, Clindox

The Team

Our vision

“My father had a business that designed and printed case report forms and I always wondered why his clients still printed forms rather than using a computer application. The more I explored the reasoning the more I understood why and the idea formed to do something about it. Typical software solutions are both complex and expensive, making them impractical for smaller trials and requiring significant commitments in terms of time, training and infrastructure.

I formed a team to create a solution that would remove those barriers. A system that would make those difficult choices clients have to make in terms of investment of time and money completely redundant. A system you can set up yourself that frees you from paperwork and lengthy and complex data entry, so you can concentrate on what really matters. the trial itself. In CRFweb, I believe we have succeeded in creating a complete solution that’s accessible to all, and that gives trial managers greater control of their trials.”

Mats Forsgren - CEO

Meet the founders

Mats Forsgren, CEO

Prior to founding Clindox, Mats was the Global Sales Director for a financial software company based in London. Concurrently, he acted in an advisory role with DMP; a CRF design and printing company based in Sweden.

Mats has an unblemished track record of founding and building up businesses in the Nordics, the UK and US. He founded Financial Distribution Services (FDS) an anglo-scandinavian financial courier and printing service. As Global Head of Sales he helped build the business to a ?5M turnover in only 5 years before selling the business to the Royal Mail. He subsequently took over printing business Citiprint which after several years of consecutive growth he sold to financial print specialist Chris Fowler International. As part of that deal Mats agreed to become President of Chris Fowler’s US business, whose decline he turned around before they too were sold on.

Tom Beaufoy, CTO

Prior to founding Clindox Tom’s background was in the healthcare industry. In recent years his focus being specifically within Information Governance and Compliance - ensuring an organisation’s systems are fit for purpose and its staff recognise and adhere to compliant procedures.

Tom has a wealth of experience in developing and mobilising management frameworks for both large and small organisations at various stages from concept to established businesses. He has extensive knowledge of software development project management, specifically SaaS, from his career spanning the Pharmaceutical, Logistics and Healthcare sectors.

Carsten Lonfeldt, Director

Carsten was involved in the management of the, Danish listed, International med tech company Coloplast A/S for 20 years. His responsibilities there included a number of key strategic areas including finance, planning, corporate control and investor relations, and at the time of his retirement held the position of Group Director and Chief Financial Officer. Since Coloplast, he’s worked with a number of start up companies, taking on the role of non-executive director, and is a member of the Advisory Board for OMX The Nordic Exchange, Copenhagen.

David O’Flynn, Chairman

David has worked in business development and corporate finance for more than 15 years. He brings broad board and C-level experience to Clindox, having worked internationally with many growing companies in the medical technology and pharmaceutical fields. He holds a degree in biochemistry, an M. B.A. and he is a member of the Institute of Directors.

Clindox is fully compliant with and a Gold Member of the Clinical Data Interchange Standards Consortium

Call us on: +353 1 4800 540

Clindox is a limited company registered in Ireland

Registered number: 526690 © Copyright Clindox 2015

Provera - Woman S Health, Petogen-Fresenius

Common use Provera contains medroxyprogesterone acetate, female hormone used to regulate ovulation and menstrual periods. The medication is used to treat secondary amenorrhea and abnormal uterine bleeding caused by hormonal imbalance (fibroids, uterine cancer), to reduce the incidence of endometrial hyperplasia in postmenopausal women.

Dosage and direction Take 5 or 10 mg of this medication daily for 5 -10 days. Take in strict accordance with recommendations of your doctor. Avoid taking larger amounts of the medication. Your doctor may administer to start taking the medication on a certain day of your menses. While you are on Provera, examine your breasts for lumps on a monthly basis. Provera may change results of certain medical tests. Inform your doctor that you are taking this drug.

Precautions Do not smoke while taking Provera, unless risk of blood clotting increases. Inform your doctor about conditions you may have as dose adjustment may be required: hypertension, heart disease, recent stroke or heart attack, congestive heart failure, hypercalcinemia, high cholesterol or triglycerides, recent miscarriage or abortion, severe pelvic pain, asthma, migraine headaches, epilepsy, a thyroid disorder, diabetes, kidney disease, lupus, depression.

Do not take this medication if you have hypersensitivity to its components, pregnant, suffer with a hormone-related cancer of genitals or mammary gland, abnormal vaginal bleeding that has not been diagnosed, have liver disease, a history of stroke or blood clot, or breastfeed.

Side effects The most frequent side effects of Provera are headache, dizziness, irritability, insomnia, drowsiness, fatigue, depression, nausea, abdominal pain, thrombophlebitis, cerebrovascular disorders, hypersensitivity nipple breast, galactorrhoea, erosion of the cervix, dysmenorrhea. High doses of the medication may produce acne, hirsutism, changes in body weight, moon face, hyperthermia, alopecia. Allergic reactions such as hives, rash, facial swelling and difficulty breathing are also possible.

Aminoglutethimide reduces plasma concentrations and reduces efficiency of Provera. Inform your doctor about all prescribed and over-the-counter medications, herbal products, vitamins and food supplements you use.

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

Overdose Overdose symptoms may be: dizziness, drowsiness, stomach pain, nausea, vomiting, breast tenderness, or vaginal bleeding. Seek immediate medical help if you experience the symptoms listed above.

Storage Store at room temperature between 20-25 C (68-77 F). Store away from moisture, heat, and sunlight. It is not recommended to store in a bathroom and places available for children.

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

Megafen For Treatment Of Minor Aches And Pains - Online Pharmacy, Megafen

Tablets: Each tablet contains: ibuprofen 200 mg Paracetamol 325 mg

Suspension: Each teaspoonful (Srn!) contains: lbuprofen 100 mg Paracetamol 162.5 mg

Megafen is a combination of two well effective, safe agents; Ibuprofen and Paracetamol * lbuprofen is a time tested non-steroidal anti-inflammatory, which possesses analgesic and antipyretic activities. * Paracetamol is an effective antipyretic, analgesic with mild anti-inflammatory properties. Combining these two agents which act by two different mechanisms gives a dual effect in the treatment of pain and fever.

Megafen is indicated in the treatment of minor aches and pains such as headaches, toothaches, muscular aches, backaches, pain due to inflammation and for reduction of fever with any of the above conditions

*Allergy to any pain reliever. * Peptic ulcer. * Asthma. *Hepatic and renal impairment. * Alcohol dependence.

egafen can oe given to pregnant and lactating women only if potential benefits outweigh the risks.

Caution should be taken while using Megafen with the following: * Anticoagulants *Cytotoxics * Antibacterials * Antidiabetics * Lithium * vasodttarors *Aruiepileptics *Antidepressants * Diuretics *ACE inhibitors & Angiotensin II antagonists.( Ibuprofen antagonizes the hypotensive effects).

*With any other product that contains Ibuprofen or other pain reliever / fever reliever, unless directed by a doctor. *FOr more than 3 day f feve r pairrtmtess trrrecred by a doctor. *For stomach pain unless described by a doctor.

MEGAFEN is generally well tolerated, but may cause mild nausea, vomiting, dyspepsia skin rashes, hepatic disturbances, dizziness, bronchospasm and insomnia.

DOSAGE AND ADMINISTRATION:

Adults and Children (12 years and over) one tablet three times daily preferably during meals to decrease side effects. Children (6-12 years): half tablet or one teaspoonful of suspension three times daily preferably during meals to decrease side effects. Children (1-6 years) one leaspoonful three times daily. preferably during meals. N. B. MEGAFEN suspension is not recommended for children below 6 months of age or below 7 kg in weight

PRECAUTIONS & WARNING:

Cardiovascular Risk NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovasculardisease may be at greater risk. NSAIDs is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CAB G) surgery. Gastrointestinal Risk NSAIDs cause an increased risk of serious gastrointestinal adverse events including inflammation, bleeding, ulceration, and perforation of the stomach or intestines. which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events.

Keep at room temperature (30°C).

Megafen Tablets: Boxes of 10 or 20 Tablets in strips. Megafen Suspension: Bottles of60 or 120 ml. Keep all medicaments out of reach of children

RAMEDA (lliE TENTH OF RAMADAH) t». For Phannaceulical Indttstries& Diagnostic Reagenls. SlhofOClobefCityA. RE.

Alendros - Drug Review Dosage, Side Effects, Action, Buy Alendros, Alendros

Alendros

Alendros review

Osteoporosis naturally comes with aging for people who ignored their daily calcium needs while they were young. Your lifestyle might be a high risk factor for osteoporosis. especially if it is constricting in a sense that you lack activity. Yes, other unavoidable factors may cause osteoporosis. But if you really want to lessen your risks of contracting the disease, you must take a lifestyle check early and convert your harmful ways to maintain your health at any age.

For those who already have the disease, Alendros is a good antidote. This bisphosphonate medication is used to treat not just osteoporosis but other bone ailments as well. Sometimes it is used in combination with Vitamin D to prevent deficiency. It is also used as a treatment for Paget's disease, an disease that usually involves deformed bones.

Alendros is taken orally by mouth in tablet and liquid formulas. The usual dose is one 5mg-10mg tablet or liquid solution once a day or one 30mg-70mg tablet or liquid solution once a week. Alendros is taken on an empty stomach early in the morning. Your dose requirement and prescription period depends on your level of affliction and your body's strength. Several medical histories are to be considered as well to ensure safety while using the medication. Concerning factors that may affect your dose requirement include your histories of allergies to Alendros or to any of the ingredients in the tablet or liquid formula. Prescription and non-prescription medications that you are currently using and might be taking alongside Alendros must also be determined. Some medications or medication ingredients may react to Alendros, something that should be stopped from happening. Other medical conditions like anaemia or undergoing radiation therapy for another disease must also be discussed with your doctor.

To help boost the healing effects of Alendros, adjust your diet because consuming good nutrients in huge amounts is important to complement Alendros's health benefits.

Like any other medication, Alendros comes with side effects. These side effects can be mild or severe depending on how your body is reacting to the medication. Normal side effects include: feeling a bit constipated, bloated, and dizzy or having bouts with headache. diarrhoea, nausea. emesis, bone, muscle and joint pains, and other flu-related symptoms. If your symptoms continue or become more serious, seek medical attention immediately. Fever. chest pains, swallowing and breathing difficulties, and hoarseness are among the alarming signs that should tell you Alendros is not working properly with your system.

Never alter your dose of Alendros from your doctor's prescription. Medication overdose may lead to pyrosis, severe headache, bloody vomit, and bloody stools. If you notice of any of these signs or suspect that you abused the medication, you must rush to the nearest hospital immediately. If you have collapsed or stopped breathing altogether, someone must call 911 or take you to the closest emergency room. They should not allow you to lie down or make you vomit while you are at this stage.

Alendros has the following structural formula:

• Molecular formula of alendros is C4H13NO7P2 • Chemical IUPAC Name is (4-amino-1-hydroxy-1-phosphono-butyl)phosphonic acid • Molecular weight is 249.096 g/mol • Alendros available. 35mg tablets, 70mg tablets

Generic name: Alendronate

Nanniflorence S Carbolithium History, Carbolithium

Carbolithium

About Carbolithium (Prescription Drug)

A generic brand of lithium carbonate dosed once a day. Lithium is used to treat and prevent episodes of mania in people with bipolar disorder (manic depressive disorder). Lithium is in a class of medications called antimanic agents, which work by decreasing abnormal activity in the brain. Read more

More about Carbolithium

From Wikipeda: Lithium in pharmacology refers to use of the lithium ion. Li +. as a drug. A number of chemical salts of lithium are used medically as a mood stabilizing drug. primarily in the treatment of bipolar disorder. where they have a role in the treatment of depression and particularly of mania. both acutely and in the long term. As a mood stabilizer, lithium is probably more effective in preventing mania than depression, and may reduce the risk of suicide. [1] In depression alone (unipolar disorder) lithium can be used to augment other antidepressants. Lithium carbonate (Li 2 CO 3 ), sold under several trade names, is the most commonly prescribed, while the citrate salt lithium citrate (Li 3 C 6 H 5 O 7 ), the sulfate salt lithium sulfate (Li 2 SO 4 ), aspartate and the orotate salt lithium orotate are alternatives.

Upon ingestion, lithium becomes widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors. decreasing norepinephrine release and increasing serotonin synthesis.

Read more at US National Library of Medicine Medline Plus:

Here is a link describing symptoms of Lithium Overdose:

Elvenavir, Elvenavir

Indinavir

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

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

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Effexor Xr Extended-Release Capsules Indications, Side Effects, Warnings, Venlaxor

Effexor XR extended-release capsules

Generic Name: venlafaxine (VEN-la-FAX-een) Brand Name: Effexor XR

Antidepressants may increase the risk of suicidal thoughts or actions in children, teenagers, and young adults. However, depression and certain other mental problems may also increase the risk of suicide. Talk with the patient's doctor to be sure that the benefits of using Effexor XR extended-release capsules outweigh the risks.

Families and caregivers must closely watch patients who take Effexor XR extended-release capsules. It is important to keep in close contact with the patient's doctor. Tell the doctor right away if the patient has symptoms like worsened depression, suicidal thoughts, or changes in behavior. Discuss any questions with the patient's doctor.

Effexor XR extended-release capsules are used for:

Treating depression, generalized or social anxiety disorder, or panic disorder. It may also be used for other conditions as determined by your doctor.

Effexor XR extended-release capsules are a serotonin-norepinephrine reuptake inhibitor (SNRI). It works by restoring the balance of certain natural substances in the brain (serotonin and norepinephrine), which helps to improve certain mood problems.

Do NOT use Effexor XR extended-release capsules if:

you are allergic to any ingredient in Effexor XR extended-release capsules

you are taking or have taken a monoamine oxidase inhibitor (MAOI) (eg, phenelzine, selegiline) within the last 14 days

you are taking linezolid or medicines for weight loss (eg, phentermine)

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

Before using Effexor XR extended-release capsules:

Some medical conditions may interact with Effexor XR extended-release capsules. 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 or a family member has a history of bipolar disorder (manic-depression), other mental or mood problems, suicidal thoughts or attempts, or alcohol or substance abuse

if you have a history of seizures, heart problems (eg, heart failure, irregular heartbeat), abnormal electrocardiograms (ECGs), a recent heart attack, high blood pressure, high cholesterol, an overactive thyroid, liver problems, lung problems, kidney problems, stomach or bowel bleeding, blood or bleeding problems, diabetes, increased eye pressure or glaucoma, nervous system problems, or metabolism problems

if you are dehydrated, have low blood sodium levels, or drink alcohol

if you will be having electroconvulsive therapy (ECT)

if you are taking a medicine that contains methylene blue

Some MEDICINES MAY INTERACT with Effexor XR extended-release capsules. Tell your health care provider if you are taking any other medicines, especially any of the following:

Buspirone, fentanyl, linezolid, lithium, MAOIs (eg, phenelzine, selegiline), medicines for weight loss (eg, phentermine), selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine), serotonin 5-HT 1 receptor agonists (eg, sumatriptan), SNRIs (eg, duloxetine), St. John's wort, tramadol, tricyclic antidepressants (eg, amitriptyline), or tryptophan because severe side effects, such as a reaction that may include fever, rigid muscles, blood pressure changes, mental changes, confusion, irritability, agitation, delirium, and coma, may occur

Anticoagulants (eg, warfarin), aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen) because the risk of bleeding, including stomach bleeding, may be increased

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

Azole antifungals (eg, ketoconazole) or cimetidine because they may increase the risk of Effexor XR extended-release capsules's side effects

Metoprolol because its effectiveness may be decreased by Effexor XR extended-release capsules

This may not be a complete list of all interactions that may occur. Ask your health care provider if Effexor XR extended-release capsules 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 Effexor XR extended-release capsules:

Use Effexor XR extended-release capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Effexor XR extended-release capsules comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Effexor XR extended-release capsules refilled.

Take Effexor XR extended-release capsules by mouth with food.

Take Effexor XR extended-release capsules with a full glass of water (8 oz [240 mL]).

Swallow Effexor XR extended-release capsules whole. Do not break, crush, chew, or place in water before swallowing. If you cannot swallow the capsule whole, you may open it and sprinkle the contents over a spoonful of applesauce. Mix the medicine with the applesauce and swallow the mixture right away, followed by a glass of water. Do not crush or chew the medicine before swallowing.

Effexor XR extended-release capsules works best if it is taken at the same time each day.

Continue to take Effexor XR extended-release capsules even if you feel well. Do not miss any doses.

Do not suddenly stop taking Effexor XR extended-release capsules without checking with your doctor. You may have an increased risk of side effects (eg, mental or mood changes, numbness or tingling of the skin, dizziness, confusion, headache, increased sweating, diarrhea, nausea, vomiting, trouble sleeping, or unusual tiredness. If you need to stop Effexor XR extended-release capsules, your doctor may need to gradually lower your dose.

If you miss a dose of Effexor XR extended-release capsules, 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 Effexor XR extended-release capsules.

Important safety information:

Effexor XR extended-release capsules may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Effexor XR extended-release capsules 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 taking Effexor XR extended-release capsules.

Check with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Effexor XR extended-release capsules without checking with your doctor; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.

Several weeks may pass before your symptoms improve. Do NOT take more than the recommended dose, or use for longer than prescribed without checking with your doctor.

Children, teenagers, and young adults who take Effexor XR extended-release capsules may be at increased risk for suicidal thoughts or actions. Watch all patients who take Effexor XR extended-release capsules closely. Contact the doctor at once if new, worsened, or sudden symptoms such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual change in mood or behavior occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur.

Serotonin syndrome is a possibly fatal syndrome that can be caused by Effexor XR extended-release capsules. Your risk may be greater if you take Effexor XR extended-release capsules with certain other medicines (eg, "triptans," MAOIs, SSRIs). Symptoms may include agitation; confusion; hallucinations; coma; fever; fast or irregular heartbeat; tremor; excessive sweating; and nausea, vomiting, or diarrhea. Contact your doctor at once if you have any of these symptoms.

Tell your doctor or dentist that you take Effexor XR extended-release capsules before you receive any medical or dental care, emergency care, or surgery.

If your doctor tells you to stop taking Effexor XR extended-release capsules, you will need to wait for a period of time before beginning to take certain other medicines (eg, MAOIs, nefazodone, thioridazine). Ask your doctor when you should start to take your new medicines after you have stopped taking Effexor XR extended-release capsules.

Certain antidepressants, including Effexor XR extended-release capsules, may increase the risk of bleeding. Sometimes bleeding can be life-threatening. Discuss any questions or concern with your doctor.

Some people may be at risk for eye problems from Effexor XR extended-release capsules. Your doctor may want you to have an eye exam to see if you are at risk for these eye problems. Call your doctor right away if you have eye pain, vision changes, or swelling or redness in or around the eye.

You may notice undissolved parts of Effexor XR extended-release capsules in your stool. This is normal and not a cause for concern.

Have your blood pressure checked often. Talk with your doctor.

Effexor XR extended-release capsules may interfere with certain lab tests. Be sure your doctor and lab personnel know you are taking Effexor XR extended-release capsules.

Lab tests may be performed while you use Effexor XR extended-release capsules. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Use Effexor XR extended-release capsules with caution in the ELDERLY; they may be more sensitive to its effects, especially low blood sodium levels.

Caution is advised when using Effexor XR extended-release capsules in CHILDREN; they may be more sensitive to its effects, especially increased risk of suicidal thoughts or actions.

Effexor XR extended-release capsules are not approved for use in children. Talk with the doctor.

Effexor XR extended-release capsules may cause weight changes and growth changes. CHILDREN and teenagers may need regular weight and growth checks while they take Effexor XR extended-release capsules.

PREGNANCY and BREAST-FEEDING: Effexor XR extended-release capsules may cause harm to the fetus if it is used during the last 3 months of pregnancy. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Effexor XR extended-release capsules while you are pregnant. Effexor XR extended-release capsules are found in breast milk. Do not breast-feed while taking Effexor XR extended-release capsules.

Possible side effects of Effexor XR extended-release capsules:

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:

Abnormal dreams; constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; increased sweating; loss of appetite; nausea; nervousness; tiredness; trouble sleeping; vomiting; weakness; weight loss; yawning.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry, or bloody stools; chest pain or discomfort; decreased coordination; decreased sexual desire or ability; decreased urination; fainting; fast or irregular heartbeat; fever, chills, cough, or persistent sore throat; hallucinations; new or worsening mental, mood, or behavior changes (eg, aggressiveness, agitation, anxiety, depression, hostility, impulsiveness, inability to sit still, irritability, panic attacks, or restlessness); persistent trouble sleeping; red, swollen, blistered, or peeling skin; ringing in the ears; seizures; severe stomach pain; severe or persistent headache or dizziness; shortness of breath; significant weight loss; suicidal thoughts or attempts; symptoms of low sodium levels (eg, headache, trouble concentrating, memory problems, confusion, weakness, seizures, unsteadiness); tremor; unusual bruising or bleeding; unusual weakness.

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

If OVERDOSE is suspected:

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

Proper storage of Effexor XR extended-release capsules:

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

General information:

If you have any questions about Effexor XR extended-release capsules, please talk with your doctor, pharmacist, or other health care provider.

Effexor XR extended-release capsules are 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 Effexor XR extended-release capsules 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 Effexor XR extended-release capsules. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Effexor XR extended-release capsules. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your health care provider for complete information about the risks and benefits of using Effexor XR extended-release capsules.

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 Effexor XR (venlafaxine)

Rubromycin - Alx-380-067 - Enzo Life Sciences, Rubromicin

β-Rubromycin

Product Literature References

Inhibition of human telomerase by rubromycins: implication of spiroketal system of the compounds as an active moiety . T. Ueno, et al.; Biochemistry 39 . 5995 (2000), Abstract ;

Structural and Biosynthetic Investigations of the Rubromycins . C. Puder, et al.; Eur. J. Org. Chem. 2000 . 729 (2000),

Inhibition of human immunodeficiency virus-1 reverse transcriptase activity by rubromycins: competitive interaction at the template. primer site . M. E. Goldman, et al.; Mol. Pharmacol. 38 . 20 (1990), Abstract ;

Rubromycins. 3. The constitution of alpha-rubromycin, beta-rubromycin, gamma-rubromycin, and gamma-iso-rubromycin . H. Brockmann & A. Zeeck; Chem. Ber. 103 . 1709 (1970), Abstract ;

Rubromycin II . H. Brockmann, et al.; Chem. Ber. 102 . 126 (1969), Abstract ;

The structure of rubromycin . H. Brockmann, et al.; THL 30 . 3525 (1966), (Article in German), Abstract ;

Glustin Indication, Action Of Glustin, Interactions, Glustin

Glustin [in more detail]

Treatment of Type II diabetes mellitus

Glustin Mechanism Of Action:

Glustin acts as an agonist at peroxisome proliferator activated receptors (PPAR) in target tissues for insulin action such as adipose tissue, skeletal muscle, and liver. Activation of PPAR-gamma receptors regulates the transcription of insulin-responsive genes involved in the control of glucose production, transport, and utilization. In this way, pioglitazone enhances tissue sensitivity to insulin.

Glustin Drug Interactions:

Ethinyl Estradiol Possible loss of contraceptive effect Gemfibrozil Gemfibrozil increases the effect and toxicity of rosiglitazone/pioglitazone Glucosamine Possibly hyperglycemia Ketoconazole Ketoconazole increases the effect of pioglitazone Mestranol Possible loss of contraceptive effect Norethindrone Possible loss of contraceptive effect Pregabalin Possible loss of contraceptive effect

Food Interactions:

Glustin Chemical Formula:

Pardoclin, Pardoclin

Antibiotics - Pardoclin (Brand name: minocin)

Minocin is used for treating certain infections. It may also be used with other medicines to treat severe acne. Minocin is a tetracycline antibiotic. It works by slowing the growth of certain bacteria and allowing the body's immune system to kill them.

Use Minocin as directed by your doctor.

Some brands of Minocin may be taken with food. Others should be taken on an empty stomach. Check with your doctor or pharmacist about how to take your brand of Minocin.

Some brands of Minocin must be swallowed whole. Check with your doctor or pharmacist to see if your medicine is a brand that must be swallowed whole.

Take Minocin by mouth with or without food.

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

If you also take bismuth salts (eg, bismuth subsalicylate), calcium salts (eg, calcium carbonate), colestipol, iron salts (eg, iron sulfate), magnesium, urinary alkalinizers (eg, daily antacids), sucralfate, vitamins/minerals, quinapril, didanosine, or zinc salts (eg, zinc sulfate), do not take them within 2 to 3 hours before or after taking Minocin. Check with your doctor if you have questions.

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

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

If you miss a dose of Minocin, 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 Minocin.

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

Active Ingredient: Minocycline hydrochloride.

Do NOT use Minocin if:

you are allergic to any ingredient in Minocin

you are taking acitretin, qisotretinoin, methoxyflurane, or a penicillin.

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

Some medical conditions may interact with Minocin. 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 kidney problems

if you have an autoimmune disorder (eg, lupus).

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

Aluminum salts (eg, carbonate) or cimetidine because they may decrease Minocin's effectiveness

Acitretin, anticoagulants (eg, warfarin), digoxin, ergot alkaloids (eg, ergotamine), insulin, isotretinoin, methotrexate, methoxyflurane, or theophyllines because the risk of their side effects may be increased by Minocin

Live oral typhoid vaccine, oral contraceptives (birth control pills), or penicillins because their effectiveness may be decreased by Minocin.

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

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

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

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

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

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

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

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

Hormonal birth control (eg, birth control pills) may not work as well while you are using Minocin. To prevent pregnancy, use an extra form of birth control (eg, condoms).

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

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

Use Minocin with extreme caution in children younger 10 years who have diarrhea or an infection of the stomach or bowel.

Minocin should not be used in children younger than 8 years old; safety and effectiveness in these children have not been confirmed. Using Minocin in children younger than 8 years old or in women during the last half of pregnancy may cause a permanent change in the tooth coloring of the child.

Pregnancy and breast-feeding: Minocin has been shown to cause harm to the fetus. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Minocin while you are pregnant. Minocin is found in breast milk. Do not breastfeed while taking Minocin.

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; lightheadedness; loss of appetite; nausea; stomach upset; 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); bloody stools; blurred vision; bulging soft spots in infants; fever; headache; increased pressure in the head; inflammation of the pancreas (increased pulse, nausea, stomach tenderness, vomiting); joint pain, muscle pain or weakness; red, swollen, blistered, or peeling skin; ringing in the ears; seizures; severe diarrhea; severe skin reaction to the sun; stomach pain/cramps; trouble swallowing; unusual tiredness or weakness; vaginal irritation or discharge; yellowing of the skin or eyes.

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

MINOMYCIN is used to treat acne, which is resistant to other antibiotics. It is also used to treat various other infections.

MINOMYCIN belongs to a group of antibiotics called tetracyclines. They work by stopping the growth of bacteria.

Take MINOMYCIN exactly as your doctor has prescribed.

Follow all directions given to you by your doctor.

They may differ from the information contained in this leaflet.

If you do not understand the instructions on the box, ask your doctor or pharmacist for help. How much to take

For treating infections . the usual dose of MINOMYCIN is: 200 mg to start with, followed by 100 mg every 12 hours.

For controlling acne . the usual dose is: 100 mg daily, preferably in two separate doses of 50 mg each.

Swallow MINOMYCIN whole with a full glass of water or milk. This medicine may be taken with food.

Do not take it immediately before lying down.

Take your medicine at about the same time each day.

Taking it at the same time each day will have the best effect. It will also help you remember when to take it.

Your doctor may prescribe MINOMYCIN for long periods.

Check with your doctor if you are not sure how long you should be taking it.

For treating infections, MINOMYCIN must be taken for at least 48 hours after you feel well and the fever has gone.

For controlling acne, MINOMYCIN is normally taken for a few months.

Visit your doctor regularly. He/she may do blood tests to check your progress.

Continue taking it until your doctor tells you to stop.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember, then go back to taking it as you would normally.

Do not try to make up for missed doses by taking more than one dose at a time.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your doctor or Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency (Casualty) at your nearest hospital if you think you or anyone else may have taken too much MINOMYCIN. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

Follow your doctor's prescripion.

Store this medicine at room temperature in a tightly-closed container, away from heat and light.

Active ingredient: Minocycline

Do not give this medicine to anyone else, even if their symptoms seem similar to yours.

Do not use MINOMYCIN to treat any other medical complaints unless your doctor says to.

Do not stop taking your medicine or lower the dosage without checking with your doctor.

Important safety information:

Be careful driving or operating machinery until you know how MINOMYCIN affects you.

MINOMYCIN may cause dizziness or light-headedness in some people.

Be careful when drinking alcohol while you are taking this medicine.

If you drink alcohol, dizziness or light-headedness may be worse.

MINOMYCIN may cause your skin to be much more sensitive to sunlight than it is normally. Exposure to sunlight may cause a skin rash, itching, redness or severe sunburn.

If outdoors, wear protective clothing and use a SPF 15+ sunscreen.

If your skin does appear to be burning, stop taking MINOMYCIN and tell your doctor.

If you get thrush or any other infection while taking, or soon after stopping MINOMYCIN, tell your doctor.

Overgrowth of certain organisms not sensitive to MINOMYCIN can sometimes occur.

If you get severe diarrhoea, immediately contact your doctor. Do this even if it occurs several weeks after stopping MINOMYCIN.

This may be a sign of a serious side effect that affects the bowel.

Do not take any medicines to treat this diarrhoea unless directed by your doctor.

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking MINOMYCIN.

MINOMYCIN is effective against some infections and acne in most people, but may have unwanted side effects in some. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Tell your doctor if you notice any of the following immediately:

The more common side effects are:

dizziness, light-headedness, unsteadiness

loss of appetite

allergic reactions such as swelling of face or tongue

difficulty in swallowing

burning in the throat or food tube

Rare side effects include:

increased sensitivity to sunlight

infection by other bacteria or organisms resistant to MINOMYCIN (eg intestinal thrush)

staining of skin, mouth, teeth or nails

inflammation of the bowel

liver, kidney or blood disorders

severe allergic reactions

drug-induced hepatitis and acute liver failure

This is not a complete list of all possible side effects. Others may occur in some people and there may be some side effects not yet known.

Tell your doctor if you notice anything else that is making you feel unwell, even if it is not on this list.

Ask your doctor or pharmacist if you do not understand anything in this list.

Do not be alarmed by this list of possible side effects.

You may not experience any of them.

MINOMYCIN is used to treat acne, which is resistant to other antibiotics. It is also used to treat various other infections.

MINOMYCIN belongs to a group of antibiotics called tetracyclines. They work by stopping the growth of bacteria.

Take MINOMYCIN exactly as your doctor has prescribed.

Follow all directions given to you by your doctor.

They may differ from the information contained in this leaflet.

If you do not understand the instructions on the box, ask your doctor or pharmacist for help. How much to take

For treating infections . the usual dose of MINOMYCIN is: 200 mg to start with, followed by 100 mg every 12 hours.

For controlling acne . the usual dose is: 100 mg daily, preferably in two separate doses of 50 mg each.

Swallow MINOMYCIN whole with a full glass of water or milk. This medicine may be taken with food.

Do not take it immediately before lying down.

Take your medicine at about the same time each day.

Taking it at the same time each day will have the best effect. It will also help you remember when to take it.

Your doctor may prescribe MINOMYCIN for long periods.

Check with your doctor if you are not sure how long you should be taking it.

For treating infections, MINOMYCIN must be taken for at least 48 hours after you feel well and the fever has gone.

For controlling acne, MINOMYCIN is normally taken for a few months.

Visit your doctor regularly. He/she may do blood tests to check your progress.

Continue taking it until your doctor tells you to stop.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember, then go back to taking it as you would normally.

Do not try to make up for missed doses by taking more than one dose at a time.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your doctor or Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency (Casualty) at your nearest hospital if you think you or anyone else may have taken too much MINOMYCIN. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

Follow your doctor's prescripion.

Store this medicine at room temperature in a tightly-closed container, away from heat and light.

Active ingredient: Minocycline

Do not give this medicine to anyone else, even if their symptoms seem similar to yours.

Do not use MINOMYCIN to treat any other medical complaints unless your doctor says to.

Do not stop taking your medicine or lower the dosage without checking with your doctor.

Important safety information:

Be careful driving or operating machinery until you know how MINOMYCIN affects you.

MINOMYCIN may cause dizziness or light-headedness in some people.

Be careful when drinking alcohol while you are taking this medicine.

If you drink alcohol, dizziness or light-headedness may be worse.

MINOMYCIN may cause your skin to be much more sensitive to sunlight than it is normally. Exposure to sunlight may cause a skin rash, itching, redness or severe sunburn.

If outdoors, wear protective clothing and use a SPF 15+ sunscreen.

If your skin does appear to be burning, stop taking MINOMYCIN and tell your doctor.

If you get thrush or any other infection while taking, or soon after stopping MINOMYCIN, tell your doctor.

Overgrowth of certain organisms not sensitive to MINOMYCIN can sometimes occur.

If you get severe diarrhoea, immediately contact your doctor. Do this even if it occurs several weeks after stopping MINOMYCIN.

This may be a sign of a serious side effect that affects the bowel.

Do not take any medicines to treat this diarrhoea unless directed by your doctor.

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking MINOMYCIN.

MINOMYCIN is effective against some infections and acne in most people, but may have unwanted side effects in some. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Tell your doctor if you notice any of the following immediately:

The more common side effects are:

dizziness, light-headedness, unsteadiness

loss of appetite

allergic reactions such as swelling of face or tongue

difficulty in swallowing

burning in the throat or food tube

Rare side effects include:

increased sensitivity to sunlight

infection by other bacteria or organisms resistant to MINOMYCIN (eg intestinal thrush)

staining of skin, mouth, teeth or nails

inflammation of the bowel

liver, kidney or blood disorders

severe allergic reactions

drug-induced hepatitis and acute liver failure

This is not a complete list of all possible side effects. Others may occur in some people and there may be some side effects not yet known.

Tell your doctor if you notice anything else that is making you feel unwell, even if it is not on this list.

Ask your doctor or pharmacist if you do not understand anything in this list.

Do not be alarmed by this list of possible side effects.

You may not experience any of them.

Xafenor, Xafenor

Xafenor

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

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Skid, Skid

a plank, log, low platform, etc. on or by which a load is supported.

Nautical.

any of a number of parallel beams or timbers fixed in place as a raised support for boats, spars, etc.

any of a number of timbers on which a heavy object is placed to be shoved along on rollers or slid.

an arrangement of planks serving as a runway for cargo.

an arrangement of planks serving as a fender to protect the side of a vessel during transfer of cargo.

sidewise motion of a vessel; leeway.

a shoe or some other choke or drag for preventing the wheel of a vehicle from rotating, as when descending a hill.

a runner on the under part of some airplanes, enabling the aircraft to slide along the ground when landing.

an unexpected or uncontrollable sliding on a smooth surface by something not rotating, especially an oblique or wavering veering by a vehicle or its tires:

The bus went into a skid on the icy road.

verb (used with object). skidded, skidding.

1 . one of a group of objects (as planks or logs) used to support or elevate a structure or object

2 . a wooden fender hung over a ship's side to protect it in handling cargo

3 . a usually iron shoe or clog attached to a chain and placed under a wheel to prevent its turning when descending a steep hill. drag

4 . a timber, bar, rail, pole, or log used in pairs or sets to form a slideway (as for an incline from a truck to the sidewalk)

6 . a runner used as a member of the landing gear of an airplane or helicopter

7 a plural . a route to defeat or downfall <on the skid s > <his career hit the skid s > b . a losing streak <a 5-game skid >

8 . a low platform mounted (as on wheels) on which material is set for handling and moving; also . pallet 3

skidproof

Anti-Protozole Treatment, Protozole

Anti-ProtoZole Treatment

Anti-ProtoZole is an anti-protozoal used to treat everything from parasites to bacterial infections. This is a common medication that actually helps to increase good gut flora as a positive side effect while helping to eliminate protozoa and coccidia. When treating reptiles, 100mg/mL is the recommended strength and they only need 1 or 2 doses of .1cc per 100g of body weight given every 3 days.

This treatment is very effective for babies that suddenly stop eating and refuse food for a week or more. Always be sure babies are well hydrated before giving any medications.

The Anti-ProtoZole Treatment includes the following

3cc, 6cc, or 15cc Anti-ProtoZole Treatment Liquid 1cc Oral Dosing Syringe Printed Dosing Instructions

Optional Flavoring & Mixing Bottles also available

NOT FOR HUMAN OR ANIMAL USE - REPTILE USE ONLY

Information for Treating Protozoal Infections for Reptile Owners

Many vets will prescribe a broad spectrum antibiotic such as metronidazole with a dosage of 50mg, 100mg, or 150mg per kilogram to treat protozoal infections in reptiles. It is safe when used properly and is known to help stimulate appetites, but has different dosage amounts depending on the treatment.

If you can get a strength of 10% or 100mg per mL, it will be easier to calculate dosage.

Common dosage is 50mg/kg to 100mg/kg for protozoal infections. Give 1 dose, wait 3 days, give 2nd dose if necessary or as directed by your vet.

Fluid intake should be 2mL to 5mL per kg of body weight per day if a reptile is on any antibiotic medication.

This type of substance is rapidly absorbed into the bloodstream when taken orally and is a concentration dependent. It reaches high concentrations in humans within an hour and has a half life of about 8 hours, this can be 3 to 4 times longer in ectotherms. This kind of a ntibiotic distributes itself throughout the body in all the body's water and penetrates effectively from the bloodstream into the body's tissues. It is mostly metabolized by the liver, but also shows up in the feces and urine. Dosages in reptiles can range from 20-50 mg/kg to 100-150 mg/kg depending on the treatment. Extreme care should be taken when using this drug in higher doses, Sometimes toxicity can result in neurologic disorders and liver damage. It is essential that reptiles reach optimum body temperature when given any medication, as sub optimal temperatures can result in drug overdose. Always prime warm reptiles with warmed fluids or diluted electrolytes before giving such medications.

These types of antibiotics are used in animals to treat bacterial infections caused by anaerobic bacteria (bacteria that do not live in the presence of oxygen). While they are very effective against most anaerobic bacteria, even antibiotics such as metronidazole have no activity against aerobic bacteria (bacteria that require oxygen). Many infections are caused by a mixture of aerobic and anaerobic bacteria. In these types of cases, antibiotics such as metronidazole are commonly given with other antibiotics that have activity against the aerobic bacteria. It also is used to treat infections caused by an intestinal protozoal parasite called Giardia .

Like many other drugs in veterinary medicine, these types of antibiotics are not FDA approved for use in many animals, including reptiles and is not available from a veterinary pharmaceutical manufacturer; however, it may be compounded by a vet or pharmacy. There is also a form of metronidazole marketed without a prescription that is labeled for aquarium use. It is most commonly is used in reptiles to treat infections caused by anaerobic bacteria or protozoa, and is considered accepted practice in exotic veterinary medicine.

There are absolutely no medications on the market, prescription or over the counter, that are actually FDA approved and labeled for use with any reptile. Any vet that prescribes or recommends a specific drug or treatment for your reptile is relying on their own experience or recommendations from other vets for proper extra label use of that drug. Be sure your vet is familiar with reptiles before trusting any advice given.

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Litizem, Litizem

Diltiazem

Brand names of diltiazem

Albert Diltiazem CD

Apo-Diltiaz

Alti-Diltiazem

Cardizem

Cardizem CD

Cardizem SR

Cartia XT

Dilacor XR

Diltia XT

Diltiazem

Diltiazem ER

Gen-Diltiazem

Med Diltiazem SR

Novo-Diltiazem

Nu-Diltiaz

Pharma-Diltiaz

Rhoxal-Diltiazem CD

Syn-Diltiazem

Teczem [CD]

Tiamate

Tiazac

Diltiazem is a member of the drug group known as calcium channel blockers or CCBs and is employed in the treatment of angina (heart pain ), hypertension as well as irregular rhythm of the heart. Other medications belonging to this class of medications include verapamil. amlodipine. nifedipine and others. Calcium channel blockers work by obstructing the admission of calcium in the cells of the heart muscles and those surrounding the arteries. It may be noted that the transportation of calcium to the cells of heart muscles enables the contraction of the heart making it possible for the heart to propel blood to the different body parts and enables the arteries to contract. Diltiazem works to obstruct the transport of calcium, thereby lessening the power with as well as the pace at which the heart muscles contract. At the same time, this medicament also helps the muscles encircling the arteries to relax enabling the arteries to dilate (widen).

The heart requires adequate supply of oxygen for pumping blood. The more effort the heart puts in pumping blood, the more amount of oxygen is required by it. Angina or heart/ chest pain occurs when the supply of oxygen is inadequate compared to the work that needs to be done by the heart. As diltiazem dilates the arteries, it lessens the pressure within the arteries through which the blood pumped by the heart reaches the different parts of the body. Consequently, the heart needs to undertake less work or burden and also needs less oxygen. As diltiazem lessens the heart?s requirement for oxygen, it helps to alleviate as also to avoid occurrence of angina. In addition, the blood pressure is also lowered when this medication dilates the arteries. Diltiazem was approved for sale and use in the United States by the Food and Drug Administration (FDA) in 1982.

Things you need to tell your physician before taking diltiazem

Before starting treatment with the calcium channel blocker drug diltiazem, you need to talk to your physician and pharmacist on whether you have allergies to this medication, any of its constituents, or any additional type of allergy. You should know that this drug may include several inactive elements that may possibly bring about allergies or additional health problems. So, in case you are unaware of the constituents of diltiazem ask your pharmacist to make a list of the same available to you.

Diltiazem should not be given to people having specific health problems. Before you take diltiazem, notify your physician or pharmacist about your entire health problems, especially if you are suffering from specific problems related to the heart rhythm (for instance, an atrioventricular block or sick sinus syndrome, provided you have not implanted a pacemaker). Also let your physician know about your medical history before you start using taking this drug, especially regarding a heart failure. and/ or ailments related to the liver and kidneys .

Prior to using diltiazem, you ought to be aware that this medication may cause dizziness. Therefore, you are advisable not to use any machinery, drive or undertake any activity that may require attentiveness till the time you are certain regarding the impact of diltiazem on your body and also till such time when you are able to perform such tasks safely. It is also important for people taking this drug to restrict their consumption of alcoholic beverages.

Prior to having a dental process or any other operation. you should let your dentist or physicians know that you are using this calcium channel blocker (CCB). During pregnancy. diltiazem should be used when it is extremely necessary for the patient. Before taking this drug, pregnant women should essentially talk over with their physician regarding the advantages and dangers of taking diltiazem. It has been found that diltiazem passes onto the breast milk and may possibly have unwanted consequences on the nursing newborn. Therefore, new mothers taking this medication ought to consult their physician prior to breast feeding .

Usage

The calcium channel blocker diltiazem is employed to regulate as well as alleviate angina (a chest pain related to heart ailment ); to lower hypertension (high blood pressure); and also to treat cardiac arrhythmia (irregular heartbeats).

How to use diltiazem

Diltiazem is available in a number of forms, including regular tablets, extended-release (also called long-acting) tablets, and extended-release capsules, which need to be taken orally. The normal diltiazem tablet is generally taken thrice or at the most four times every day. Usually, the extended-release tablets as well as capsules are taken once or twice daily. As the prescription label instruction on each brand of diltiazem may differ, it is advisable that you ask your physician if you need to take this drug with or with no food. Like many other prescription drugs, you need to take diltiazem at similar time(s) of the day and also strictly as you have been directed. It is important that you carefully follow the instructions on the prescription label and in case you fail to understand any direction, seek help from your physician or pharmacist. Never take this drug in excess, lower doses or repeat it more frequently than what your physician has prescribed.

You should swallow the extended release tablets as well as capsules as a whole and never crush or chew them. If you take diltiazem on a regular basis, it will help in controlling angina, but this medication will not stop the heart pain that has already started. In fact, it is likely that your physician will prescribe other medications for stopping the chest pain in such cases. It may be reiterated that diltiazem helps to regulate hypertension as well as angina (heart pain), but it does not have the ability to cure these conditions.

Generally, your physician is likely to prescribe a small dose of this drug when you start treatment and increase the dose gradually. The dosage is not likely to be increased exceeding once in a week to a fortnight provided you are using the extended-release capsule or tablet form of diltiazem. In case you are using the normal tablet, the dosage will be increased to once in every couple of days.

In order to obtain the complete benefits of using diltiazem you need to take this medication regularly for a minimum period of two weeks. Keep taking this drug even when you start feeling better and do not discontinue it suddenly or without consulting your physician.

How diltiazem works

Diltiazem is a calcium channel blocker that impedes the transportation of calcium to the muscle cells of the heart as well as the cells of smooth muscles present in the arterial walls. This action of diltiazem helps the blood vessels to relax (making them dilated), which, in turn, brings down high blood pressure. At the same time, the action of this medicament helps to augment the flow of blood in the direction of the heart and reduces the total burden on the heart.

Side effects

Possible interactions

Herbal medicines or minerals: Certain herbal remedies and/ or minerals may interact with diltiazem and, therefore, they should never be used together. For example, ginseng may possibly raise your blood pressure, thereby, diminishing the advantages of taking the drug. Additional herbs such as saw palmetto. licorice. hawthorn. yohimbe. goldenseal. and ma huang. are also likely to result in elevated blood pressure. Then again, using St. John?s work may possibly diminish the levels of calcium channel blockers, as it enhances P-glycoprotein in the stomach. In addition, using diltiazem in conjunction with St. John?s wort may also enhance photosensitivity. People suffering from high blood pressure should avoid using ma huang and Siberian ginseng . Although Indian snakeroot possesses a German Commission E monograph indication for high blood pressure, it is important to consult your physician before you start using this herb. In fact, you need to consult your physician before you start using any herbal product or mineral supplement while you are taking diltiazem. Foods: Some foods may enhance the assimilation of this drug by the body causing a 30 per cent rise in its presence in the bloodstream. People using diltiazem should take care to stay away from ingesting salt in excessive amounts. Alcohol: Consuming alcoholic beverages or taking it in any different form is prohibited while using diltiazem, as it may augment the blood pressure lowering effects of this medicament. Tobacco smoking: People taking diltiazem should keep away from smoking tobacco. because nicotine diminishes the benefits offered by this drug. Marijuana smoking: Smoking marijuana may probably lessen the efficacy of diltiazem; results in slight to reasonable angina pain; may make the laboratory readings confusing; and possibly may also alter the electrocardiogram (ECG) readings. Exposure to heat: Patients taking diltiazem should take care to stay away from hot surroundings, as this may intensify the medication?s ability to lower blood pressure and require additional dose of the drug. When you are in contact with a hot environment, monitor if you are experiencing debility or feeling dizzy. Exposure to sun: Avoid going out in the sun while you are being treated with diltiazem, as it may possibly make you susceptible to sunlight. Heavy exercise or exertion: Exercising along with using diltiazem may perhaps enhance one?s ability to remain further active without experiencing the excruciating pain caused by angina. However, you need to exercise precaution and keep away from work-outs that may possibly be rigorous and still not cause any warning pain.

Discontinuation

It is not advisable to discontinue taking diltiazem all of a sudden. Before you stop taking this CCB drug, you should discuss with your physician on the subject of slowly decreasing the dosage of diltiazem.

Storage instructions

Always keep diltiazem at normal room temperature varying from 20?C to 25?C and a dark as well as dry place. Never keep this medication in your bathroom. You should ensure that you store all medications in a place beyond children as well as pets? reach. It is important to note that diltiazem is available under different brand names and each of them may possibly require being stored at different temperature ranges. Therefore, you should ask about the storage details regarding the brand you use. Never discard medications that are not required any more or have become outdated by flushing them down your toilet or pouring them into any drain. All such products need to be disposed of safely and in the appropriate manner. It is advisable that you talk to your pharmacist regarding the safe disposal of such products.

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Trileptal Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Trileptin

Trileptal

Uses

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This medication may also be used to help treat certain types of nerve pain (such as trigeminal neuralgia ).

How to use Trileptal

Read the Medication Guide provided by your pharmacist before you start using oxcarbazepine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually twice daily. The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on their weight. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

Do not stop taking this medication without consulting your doctor. Some conditions (such as seizures) may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.

Tell your doctor if your seizures worsen.

Side Effects

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

A small number of people who take anticonvulsants for any condition (such as seizure, bipolar disorder. pain) may experience depression. suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression. suicidal thoughts/attempts, thoughts about harming yourself.

Tell your doctor right away if you have any serious side effects, including: loss of coordination, vision changes (such as double vision ), rapid/uncontrollable eye movements, shaking (tremor), easy bleeding/bruising, unusual tiredness, signs of an infection (such as sore throat that doesn't go away, coughing ).

Get medical help right away if you have any very serious side effects, including: chest pain. symptoms of low sodium level (severe nausea, extreme drowsiness, confusion, seizures), signs of liver disease (such as nausea/vomiting that doesn't stop, loss of appetite, severe stomach /abdominal pain, yellowing eyes /skin. dark urine), signs of kidney problems (such as change in the amount of urine), muscle weakness /tenderness/pain.

Oxcarbazepine may rarely cause very serious (possibly fatal) skin reactions. Some people in certain ethnic groups (including people of Asian/South Asian descent) are at greater risk. Your doctor may order a blood test to measure your risk before you start this medication. If the blood test shows you are at greater risk, your doctor should discuss the risks and benefits of oxcarbazepine and other treatment choices with you. Such skin reactions have developed mostly within the first few months of treatment. Get medical help right away if you develop symptoms of a serious skin reaction such as skin rash /blisters /peeling, itching. or swelling. Ask your doctor or pharmacist for more details.

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

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

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

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

Precautions

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

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, mineral imbalance (low level of sodium in the blood).

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

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

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. However, since untreated seizures are a serious condition that can harm both a pregnant woman and her unborn baby, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, discuss with your doctor right away the benefits and risks of using this medication during pregnancy. Since hormonal birth control may not work if taken with this medication (see also Drug Interactions section), discuss reliable forms of birth control with your doctor.

This medication passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

Interactions

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

This medication can speed up the removal of other medications from your body, which may affect how they work. Examples of affected drugs include cobicistat, elvitegravir, certain drugs used to treat chronic hepatitis C (such as simeprevir, sofosbuvir), rilpivirine, among others.

This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable birth control methods while using this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.

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

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

Oxcarbazepine is very similar to eslicarbazepine. Do not use medications containing eslicarbazepine while using oxcarbazepine.

Overdose

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

Notes

Do not share this medication with others.

Lab and/or medical tests (such as sodium levels, complete blood count) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Storage

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

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

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

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

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