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

Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Topamax; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.

Topamax 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 while 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 unexplained fever, or if you have mental or mood changes, headache, or dizziness.

Tell your doctor or dentist that you take Topamax 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 Topamax. To prevent pregnancy, use an extra form of birth control (eg, condoms).

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

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

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

Topamax may affect growth rate in children and teenagers in some cases. They may need regular growth checks while they take Topamax.

Topamax should be used with extreme caution in children for migraines and in children younger than 2 years old for seizures; safety and effectiveness in these children have not been confirmed.

Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Topamax while you are pregnant. Topamax is found in breast milk. If you are or will be breast-feeding while you use Topamax, 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:

Constipation; decreased sweating; diarrhea; dizziness; drowsiness; dry mouth; flu-like symptoms; headache; loss of appetite; nausea; nervousness or anxiety; numbness or tingling of the skin; runny nose; sore throat; stomach pain or upset; taste changes; tiredness; trouble sleeping; 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); blood in the urine; blurred vision; bone pain; chest pain; confusion; decreased coordination; depression; double vision or other vision changes; eye pain; irregular heartbeat; loss of consciousness; memory problems; menstrual changes; mental or mood changes; muscle or joint pain, cramps, or weakness; rapid, shallow breathing; red, swollen, blistered, or peeling skin; ringing in the ears; severe or persistent loss of appetite; severe stomach, side, or back pain; significant weight loss; speech problems; stupor; suicidal thoughts or actions; tremor; trouble thinking, concentrating, or remembering things; trouble walking; unexplained fever; unusual bruising or bleeding; unusual eye movements; unusual tiredness.

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.

Topamax is used for treating seizures in certain patients. It may be used alone or with other medicines. It is also used to prevent migraine headaches. Topamax is an anticonvulsant that is also effective for preventing migraine headaches. It affects several chemicals in the brain that help to reduce seizure activity and prevent migraine headaches from occurring.

Use Topamax as directed by your doctor.

Take Topamax by mouth with or without food.

Drink plenty of fluids while taking Topamax to prevent kidney stones from forming.

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

Do not suddenly stop taking Topamax. Suddenly stopping Topamax may cause seizures to occur more often. If you need to stop Topamax, your doctor will gradually lower your dose.

If you miss a dose of Topamax, 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 Topamax.

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

Active Ingredient: Topiramate.

Do NOT use Topamax if:

you are allergic to any ingredient in Topamax

you are taking a carbonic anhydrase inhibitor (eg, acetazolamide).

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

Some medical conditions may interact with Topamax. 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 taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

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

if you have liver or kidney problems, kidney stones, osteoporosis (weak bones), or metabolic problems, you drink alcohol regularly, or you are on a ketogenic diet

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

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

if you have a history of mental or mood problems, or suicidal thoughts or actions.

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

Anticholinergics (eg, benztropine), carbonic anhydrase inhibitors (eg, acetazolamide), haloperidol, or tricyclic antidepressants (eg, nortriptyline) because the risk of decreased sweating may be increased

Valproic acid because a serious side effect with symptoms of confusion, lethargy, and vomiting may occur

Metformin or pioglitazone because blood glucose control may be altered; monitor your blood sugar carefully if you use Topamax with metformin or pioglitazone

Hydrochlorothiazide because it may increase the risk of Topamax's side effects

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

Amitriptyline because the risk of its side effects may be increased by Topamax

Lithium because Topamax may have an effect on lithium blood levels

Hormonal birth control (eg, birth control pills) or risperidone because their effectiveness may be decreased by Topamax.

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

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

Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Topamax; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.

Topamax 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 while 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 unexplained fever, or if you have mental or mood changes, headache, or dizziness.

Tell your doctor or dentist that you take Topamax 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 Topamax. To prevent pregnancy, use an extra form of birth control (eg, condoms).

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

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

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

Topamax may affect growth rate in children and teenagers in some cases. They may need regular growth checks while they take Topamax.

Topamax should be used with extreme caution in children for migraines and in children younger than 2 years old for seizures; safety and effectiveness in these children have not been confirmed.

Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Topamax while you are pregnant. Topamax is found in breast milk. If you are or will be breast-feeding while you use Topamax, 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:

Constipation; decreased sweating; diarrhea; dizziness; drowsiness; dry mouth; flu-like symptoms; headache; loss of appetite; nausea; nervousness or anxiety; numbness or tingling of the skin; runny nose; sore throat; stomach pain or upset; taste changes; tiredness; trouble sleeping; 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); blood in the urine; blurred vision; bone pain; chest pain; confusion; decreased coordination; depression; double vision or other vision changes; eye pain; irregular heartbeat; loss of consciousness; memory problems; menstrual changes; mental or mood changes; muscle or joint pain, cramps, or weakness; rapid, shallow breathing; red, swollen, blistered, or peeling skin; ringing in the ears; severe or persistent loss of appetite; severe stomach, side, or back pain; significant weight loss; speech problems; stupor; suicidal thoughts or actions; tremor; trouble thinking, concentrating, or remembering things; trouble walking; unexplained fever; unusual bruising or bleeding; unusual eye movements; unusual tiredness.

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.

What is this medicine?

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

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

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

How should I use this medicine?

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

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

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

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

What if I miss a dose?

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

What may interact with this medicine?

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

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

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

What should I watch for while using this medicine?

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

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

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

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

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

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

What side effects may I notice from this medicine?

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

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

This list may not describe all possible side effects.

Where should I keep my medicine?

Keep out of reach of children.

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



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Dalic Selective Plating - M - Tallisation Electrochimique, Dalic

Dalistick. an innovative, safe and easy-do-it concept !

The Dalistick concept is a major achievement in Surface Finishing. Developed by DALIC in France, the Pioneer of brush plating, it enables with the Dalistick Work-station, various selective electrochemical treatments without generating any leakage of electrolyte . thanks to solutions circulating in closed loop from the tool to the container.

It is designed to achieve, on site, on the aircraft or in workshop, thin metallic layers and surface-finishing on steel substrates or light alloys.

It allows to perform these treatments without any pre-masking and with a simplified surface preparation. The treatments can be achieved in any position, on curved, horizontal or vertical surfaces and edges.

The small volumes of electrolytes are recycled in closed circuit without leakage. The Dalistick work-station is a practical and environment-friendly plating system.

Dalistick. a wide range of applications.

Dalistick can be used for production and for repair applications, fulfilling various protective, functional and also esthetical requirements.

Anti-corrosion on aluminium alloys with CAA and SAA anodizing.

Surface preparation before bonding on light alloys through anodizing.

Anti-corrosion of steel with zinc, zinc-nickel or Cadmium tested L. H.E.

Electrical conductivity, preparation before soldering, with gold or silver.

Shielding and preventing contact corrosion with tin alloys and zinc-nickel.

The quality achieved is equivalent or superior to that produced by the traditional brush plating technique. In other words, it meets the toughest industrial and environmental specifications for selective surface finishing.

What is the Dalistick work-station ?

The Dalistick work-station is a versatile electro-plating unit combining a Dalistick tool, a rectifier, a temperature regulating unit to cool anodizing solutions, a pumping unit, a process monitoring and a trolley for optimum mobility.

Description :

Dalistick Case with tool

ref. 0510 DK 10A - 50V

Regulation Unit UCDK

DK Dalipump and Trolley

Specifications :

50 kg Height. 1460 mm

865 mm Depth. 475 mm

230 V AC - 50 HZ - 11,3 A max.

Compressed air. 7 bars (10 bars max.) Consumption. 25 m 3 /h

Designed according to ISO 9001 V.2000 and EC standards.

Dalistick is a registered Tm.

Perform CAA anodizing with Dalistick for enhanced protection vs chromate

CAA anodizing is recommended by Airbus in SRM 51.21.11 because it provides a protection superior to a chemical conversion coating by chromatation. Areas subject to corrosion should be therefore anodized with a CAA process.

CAA anodizing is approved by Boeing in the specifications BAC 5849 and BAC 5019.

CAA anodizing is also appproved by Airbus, Aernnova for Embraer, BAe, CASA, Dassault, EADS, Eurocopter, Sonaca … Dalistick allows to perform these treatments on wing slats, rivets, airframe, without any pre-masking and with a simplified preparation process.

CAA & SAA anodizing are approved by SAFRAN . by Goodrich . by Liebherr . … for APU, for hydraulic and power transmissions equipments.

Plate safely Cadmium tested L. H.E with Dalistick

Cadmium plating is approved by Airbus in the A.319, A.320, A.321 SRM.51.21.11.

C admium tested L. H.E plating is approved by Boeing in the SRM 20.42.10 and in the BAC 5854.

C admium tested L. H.E plating on steel landing gear components is approved by Messier-Dowty as per the PCS 2141.

DALIC Cd 2023 is tested LHE as per the ASTM F-519 specification in order to ensure that it is low hydrogen embrittling.

Certify your operators with the technical training required by aircraft manufacturers like Boeing in SSC.7649. Asks us for training programs suited to your needs . Specific programs exist for CAA anodizing and for Cadmium tested L. H.E plating. Let’s examine training in our or in your facilities.

Other brush plating requirements ?

Resize worn components. consider Nickel plating or hard anodizing.

Protect from galvanic and contact corrosion . consider Zinc-Plating.

Prepare aluminium before bonding . consider PAA with PANTA anodizing included by Boeing in SRM 51.40.5 & 51.70.10, and by BAe in BAEP 7701.

Alenia, BAe, CFM, Dassault, EADS, Emirates, Eurofighter, Goodrich, Hispano-Suiza, KLM, Lufthansa Technics, Qantas, Rolls-Royce, Sabena Technics, SAS, Snecma, Turbomeca, Tupolev … have approved or are using selective plating.

And also for helicopters : The selective plating process is approved by Eurocopter, Westland, Agusta, Bell, Sikorsky …

Do not hesitate to submit us your requirements, we’ll study them with the technical support of DALIC in France, pioneer of brush plating technology.

The Dalistick concept

The Dalistick tool is a major achievement in Surface Finishing . In association with the Dalistick Work-station, it enables selective electrochemical treatments without generating any leakage of electrolyte . thanks to the flow control by the double-headed pump DK.

It is designed to achieve, on site, on plane or in workshop . thin metallic layers and surface-finishing on steel substrates or light alloys.

It allows to perform these treatments with a limited pre-masking and with a simplified surface preparation. The treatments can be achieved in any position, on curved, horizontal or vertical surfaces and edges.

The small volumes of electrolytes are recycled in closed circuit without leakage. The Dalistick work-station is a practical, environment-friendly and safety-friendly plating or anodising system.

A wide range of applications

Anti-corrosion on light aluminium alloys through chromic or sulphuric anodizing.

Surface preparation before bonding or soldering through phosphoric anodizing.

Anti-corrosion with zinc, zinc nickel LHE, Cadmium L. H.E .

Electrical conductivity . with gold or silver.

Anti-fretting corrosion with tin alloys.

The quality achieved is equivalent or superior to that produced by the traditional brush plating technique. In other words, it meets the toughest industrial specifications.

A detailed technical report ref. dtedalist . is available upon request.

Approved by EADS, Airbus, Embraer, LHT, SAS, CASA, Safran.

The Dalistick work-station

The Dalistick work-station is a mobile electroplating unit combining a Dalistick tool, a rectifier, a temperature regulating unit, a circulation unit with pump and a trolley.

Dalistick Case with tool

ref. 0510 DK 10A – 50V

Regulation Unit UCDK

ref. 15004 (only for model PA)

DK Dalipump & Trolley

50 kg Height. 1460 mm

865 mm Depth. 475 mm

230 V AC –50 HZ – 11,3 A max.

Compressed air. 6 bars (10 bars max.) Consumption. 11 m3/h

Designed according to ISO 9001 and EEC standards.

Dalistick is a registered TM.

Fretting-corrosion, usure, abrasion, rayure, choc, grippage, frottement, conductivité, corrosion, dureté, aluminium. Métalliser, recharger, anodisation, nickel, chrome, Cadmium, zinc, argent, alliages. Fretting-corrosion usure, abrasion rayure, choc grippage, frottement conductivité, corrosion dureté, aluminium. Métalliser recharger, anodisation nickel, chrome Cadmium, zinc argent, alliages. Conception, fabrication d'électrolytes et de matériels de métallisation sélective électrochimique. Dépôts galvaniques localisés de métaux et d'alliages sur aciers ou aluminium, dans un but préventif. dureté,abrasion, corrosion, anti-corrosion, glissement; ou curratif. remise à la cote, rebouchage rayures ou choc.

WHAT IS THE DALIC TECHNOLOGY ? Dalic is a technology for selective electrochemical metallizing, which is achieved without immersion of the part. An anodic tool impregnated with the metalliing solution is placed ont the area to plate. Under the action of current, the metal is plated on the part. It is the DALIC brushplating process (photo 1). Latest development of DALIC R & D, the Dalistick is a no-leak tool for surface finishing in thin layers (photo 2).

ADVANTAGES OF THE PROCESS :

very selective plating. only the exposed or damaged area is treated, with limited masking,

fast plating due to high current density. the downtime is reduced to minimum,

plating thickness is controlled and no further machining is generally required,

in-situ application is possible with minimum dismounting,

environment friendly process due to small quantity of plating solutions,

cold plating process, therefore no stress for the base material.

APPLICATIONS OF THE PROCESS

protection against atmospheric and galvanic corrosion

CAA, SAA et PAA anodizing Plating of Cadmium tested L. H.E and other metals and alloys.

rebuilding the part to its initial specs,

improving surface properties. anti-friction, gliding, hardness,

improve resistance to abrasion, wear, erosion and antisticking,

improvement of electrical properties,

repair of damagesn scratches, holes.

PLATING WITH BRUSH

Photo 1 - Traitement contre le fretting-corrosion d'une portée de disque sur un arbre de turbine hydraulique.

PLATING WITH DALISTICK

Photo 2 - Anodizing of aluminium without immersion with Dalistick.

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DALIC and Machinery. Save time and money ! For maintenance or upon new parts, the selectivity of DALIC selective electroplating is definite advantage for operations in the sector of Machinery and Defense. Corrosion, wear and radioactivity are creating very severe and demanding conditions. DALIC electroplating can be in-situ with a portable equipment that will be operated by our teams of experienced technicians. So your costs of downtime will be reduced to their minimum !

What applications with DALIC ? There is a wide range of components which can benefit from DALIC. electrical motors, diesel engines or gas turbines, shafts, journals, connecting rods, gears, camshafts, crankshafts, bearings, bores, pumps, swivels, seals, hydraulic jacks, … The technical requirements can be numerous.

Corrosion protection on steel with. Nickel, Zinc-Nickel, Tin-Indium, Cadmium, etc…

Anti-Fretting with. Highly ductile Nickel Dalinickle Plus

Repair of scratches or corrosion pittings with. Silver, Copper, Nickel

Resizing after wear with. Nickel

Electrical Conductivity with. Tin, Silver

Anti-friction or babbitt. Lead or ternary alloys like Nickel-Lead Tin

They rely upon DALIC The greatest names in the Machinery sector have approved DALIC technology and among them. ALSTOM, DCN, Thomson, Wartsila, SEMT, Caterpillar, Dresser, Thermodyn, Framatome, SBM, Vallourec, GIAT, SNR, FAG, RKS.

Your Quality Insurance by DALIC Quality insurance of DALIC is certified ISO 9001 by Lloyds Lrqa. agreement n° 943.379 The DALIC technology is approved by Bureau Veritas in March 2000. certificate 09758/AO BV. DALIC technicians are approved for on-site applications by French Nuclear Power Authorities.

Remember, even in case of a mismachining ! Such case of mismachining may sometimes happen and then DALIC can save the part by restoring it back to its required dimension.

Nickel within a bore of gearbox

Silver deposit on cylinders

Nickel-Cobalt within bores of engine block



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Gymnastics: A Healthy Foundation

Gymnastics makes such a wonderful foundation motor development activity because it trains the body in a spherical manner. That means that all kinesthetic directions are covered—forward, lateral or sideways, backwards, and inverted. It is the ideal foundation sport to develop coordination, gross, and fine motor skills at a young age. Children have the opportunity to develop physically, mentally, and emotionally as they master first the easier and the more challenging skills of our sport. And, best of all, it’s so much fun!

Preschool

Preschool gymnastics is crucial for giving your baby the best start, developing fine and gross motor skills, strength, balance, rhythm, and their cognitive development. Classes start as parent-and-me at age 6 months, and through children who have not entered Kindergarten yet.

School Age

A solid foundation for all sports, recreational gymnastics teaches children fall safety, core strength, motor control, spacial awareness, and confidence. School age classes start for children already enrolled in Kindergarten, and go through 8th grade, all levels taught.

Competitive

Competitive gymnastics encompasses so much more than you’d think. From olympic individual events, to the coordinated tumbling of Team Gym, to the high-flying tramp skills of T&T, competitive gymnastics now offers kids individualized programs that fit the student!

Tumbling

Many athletes just want to come into the gym and flip, roll, and twist their way around. Our tumbling programs are divided out by skill, helping each athlete either grow overall or work towards a specific skill needed (such as a back hand spring for tryouts at school!)

(Ages 3-4) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

During this time proper motor skill development is crucial to your growing toddler. These classes are designed to introduce your child to movement, spatial awareness, hand-eye coordination and motor skill development. Each week is themed using obstacle courses, play shapes, gymnastics apparatus and music making the classes so much fun for both the parent and the child!

PARENT OBLIGATION DURING CLASS: Biron Gymnastics requires that a responsible adult (parent, grandparent, etc.) be in attendance and available should the preschooler need to leave the teaching floor for restroom or other assistance during the class.

12-35 months (Walking)

During this time proper motor skill development is crucial to your growing toddler. These classes are designed to introduce your child to movement, spatial awareness, hand-eye coordination and motor skill development. Each week is themed using obstacle courses, play shapes, gymnastics apparatus and music making the classes so much fun for both the parent and the child!

PARENT OBLIGATION DURING CLASS: Biron Gymnastics requires that a responsible adult (parent, grandparent, etc.) be in attendance and available should the preschooler need to leave the teaching floor for restroom or other assistance during the class.

12-35 months (Walking)

(Ages 3-4) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

This is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to obstacle courses, trampoline and tumbling.

Not enrolled in Kindergarten in the fall

_By Invite Only

(Ages 4-5) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

This beginning level class for boys and girls teaches all the olympic events plus trampoline and basic tumbling, but in a fun and casual setting that focuses more on balance, body control, and fun than it does on perfect technique. It serves as a necessary transitional time from our preschool program and is designed around your child’s move to a full-time school day. Students will learn about each of the gymnastics elements, as well as the basic safety rules for gymnastics.

_enrolled in Kindergarten in the fall

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

(Grades 1-6) This beginning level class for girls teaches all Olympic events plus trampoline and basic tumbling. The program focuses on basic gymnastics, flexibility, strength, and body control. Each week offers a new and exciting challenge in a fun and organized setting with multiple stations and our engaging coaching staff. Over the course of the semester, your star will build confidence, strength, and follow purposeful progressions as they are introduced to the fundamentals of gymnastics. Comparable to USAG Level 1.

(Grades 1-6) This beginning level class for girls and boys teaches all Olympic events plus trampoline and basic tumbling. The program focuses on basic gymnastics, flexibility, strength, and body control. Each week offers a new and exciting challenge in a fun and organized setting with multiple stations and our engaging coaching staff. Over the course of the semester, your star will build confidence, strength, and follow purposeful progressions as they are introduced to the fundamentals of gymnastics. Comparable to USAG Level 1.

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

Our advanced tumbling class that teaches all the required gymnastics skills for cheer tumbling through safe and purposeful progressions to the final skill, with a focus on high level inversions and transitioning skills to non-spring floors. Athletes will learn skills and tumbling passes on equipment from the tumble-track, olympic trampoline, spring bed floor, and carpet floor.

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

(Ages 3-4) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

Bronze XCEL / TAAF - Competitive Level 3

Our first competitive focused class offered to our students, this class is only open to female athletes who have advanced past the Super Stars program. Competing as part of the Texas Amateur Athletic Conference (TAAF) and/or USAG XCEL, gymnasts will learn compulsory routines on vault, bars, beam and floor. Note: additional costs are required for team leotards and competition travel, meet fees, and more. Please see our office for details.

Athletes in XCEL/TAAF are required to take at least one additional class

Silver XCEL / TAAF - Competitive Level 4

Our second individual competitive focused class offered to our students, this class is only open to female athletes who have advanced past the Super Stars program and Bronze XCEL / TAAF program. Competing as part of the Texas Amateur Athletic Conference (TAAF) and/or USAG XCEL, gymnasts will learn compulsory routines on vault, bars, beam and floor. Note: additional costs are required for team leotards and competition travel, meet fees, and more. Please see our office for details.

Athletes in XCEL/TAAF are required to take at least one additional class

Beginners & Intermediate Tumbling

Students will work on basic and advance tumbling skills; boys and girls ages are 5-7 years.

Birons Show Team of Houston

Our highest level of gymnastics, the girls on the Biron Show Team work advanced level tumbling, trampoline, dance and acrobatic skills. This group competes in various USAG Power Team Gym competitions and Gymfests both locally and nationally. The team also represents the United States in the World Gymnastrada Games held once every four years in different countries around the world. Note: additional costs for uniforms, costumes, leotards and travel required for this program not included in tuition. Financial assistance is available.

Call Our Office

(Ages 3-4) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

During this time proper motor skill development is crucial to your growing toddler. These classes are designed to introduce your child to movement, spatial awareness, hand-eye coordination and motor skill development. Each week is themed using obstacle courses, play shapes, gymnastics apparatus and music making the classes so much fun for both the parent and the child!

PARENT OBLIGATION DURING CLASS: Biron Gymnastics requires that a responsible adult (parent, grandparent, etc.) be in attendance and available should the preschooler need to leave the teaching floor for restroom or other assistance during the class.

12-35 months (Walking)

(Ages 4-5) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

(Grades 1-6) This beginning level class for girls teaches all Olympic events plus trampoline and basic tumbling. The program focuses on basic gymnastics, flexibility, strength, and body control. Each week offers a new and exciting challenge in a fun and organized setting with multiple stations and our engaging coaching staff. Over the course of the semester, your star will build confidence, strength, and follow purposeful progressions as they are introduced to the fundamentals of gymnastics. Comparable to USAG Level 1.

Super Star Girls

(Grades 1-6) Super Stars are the second skill level of our recreational gymnastics program. Building upon the well-rounded foundation of the Stars program, the Super Stars advance to higher level skills on each of the Olympic elements while still doing so in a stress free, fun, and non-competitive environment. Proper progressions are paramount to a child’s safety, and a child will be required to demonstrate proficiency in all areas of gymnastics before advancing to the Gold Stars level. The Super Stars program offers this well rounded, safe, fun, and intermediate gymnastics course for children to feel welcome, yet challenged to set goals and achieve them. Comparable to USAG Level 2.

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

(Ages 4-5) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

Gold XCEL / TAAF - Competitive Level 5

Our second competitive focused class offered to our students, this class is only open to female athletes who have advanced past the Bronze and Silver levels. Competing as part of the Texas Amateur Athletic Conference (TAAF) and/or USAG XCEL, gymnasts will learn compulsory routines on vault, bars, beam and floor. Note: additional costs are required for team leotards and competition travel, meet fees, and more. Please see our office for details.

Athletes in XCEL/TAAF are required to take at least one additional class

Platinum XCEL / TAAF - Competitive Level 6+

Our highest level individual competitive class, this class is only open to female athletes who have advanced past the Gold XCEL / TAAF level. Competing as part of the Texas Amateur Athletic Conference (TAAF) and/or USAG XCEL, gymnasts will learn compulsory routines on vault, bars, beam and floor. Note: additional costs are required for team leotards and competition travel, meet fees, and more. Please see our office for details.

Athletes in XCEL/TAAF are required to take at least one additional class

Competitive Tramp and Tumbling

Trampoline and Tumbling, or T&T for short, is a fast paced exciting sport which involves learning routines on three events: olympic trampoline, tumbling and double mini-trampoline. Each gymnast competes at his/her ability level on each event, and it allows gymnasts to focus on only the apparatuses they have most interest in instead of the all around elements of TAAF.

Our advanced tumbling class that teaches all the required gymnastics skills for cheer tumbling through safe and purposeful progressions to the final skill, with a focus on high level inversions and transitioning skills to non-spring floors. Athletes will learn skills and tumbling passes on equipment from the tumble-track, olympic trampoline, spring bed floor, and carpet floor.

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

During this time proper motor skill development is crucial to your growing toddler. These classes are designed to introduce your child to movement, spatial awareness, hand-eye coordination and motor skill development. Each week is themed using obstacle courses, play shapes, gymnastics apparatus and music making the classes so much fun for both the parent and the child!

PARENT OBLIGATION DURING CLASS: Biron Gymnastics requires that a responsible adult (parent, grandparent, etc.) be in attendance and available should the preschooler need to leave the teaching floor for restroom or other assistance during the class.

12-35 months (Walking)

(Ages 3-4) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

Our home school gymnastics program is clear to be used as the physical education credit of multiple local ISDs and education institutions. With a focus on core strength, flexibility, balance, and stamina, the class is an ideal all around program both by itself and even as a foundation for other sports.

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

(Ages 4-5) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

(Ages 3-4) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

This beginning level class for boys and girls teaches all the olympic events plus trampoline and basic tumbling, but in a fun and casual setting that focuses more on balance, body control, and fun than it does on perfect technique. It serves as a necessary transitional time from our preschool program and is designed around your child’s move to a full-time school day. Students will learn about each of the gymnastics elements, as well as the basic safety rules for gymnastics.

_enrolled in Kindergarten in the fall

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

(Ages 3-4) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

Super Star Girls

(Grades 1-6) Super Stars are the second skill level of our recreational gymnastics program. Building upon the well-rounded foundation of the Stars program, the Super Stars advance to higher level skills on each of the Olympic elements while still doing so in a stress free, fun, and non-competitive environment. Proper progressions are paramount to a child’s safety, and a child will be required to demonstrate proficiency in all areas of gymnastics before advancing to the Gold Stars level. The Super Stars program offers this well rounded, safe, fun, and intermediate gymnastics course for children to feel welcome, yet challenged to set goals and achieve them. Comparable to USAG Level 2.

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

(Grades 1-6) This beginning level class for girls teaches all Olympic events plus trampoline and basic tumbling. The program focuses on basic gymnastics, flexibility, strength, and body control. Each week offers a new and exciting challenge in a fun and organized setting with multiple stations and our engaging coaching staff. Over the course of the semester, your star will build confidence, strength, and follow purposeful progressions as they are introduced to the fundamentals of gymnastics. Comparable to USAG Level 1.

(Ages 4-5) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

This beginning level class for boys and girls teaches all the olympic events plus trampoline and basic tumbling, but in a fun and casual setting that focuses more on balance, body control, and fun than it does on perfect technique. It serves as a necessary transitional time from our preschool program and is designed around your child’s move to a full-time school day. Students will learn about each of the gymnastics elements, as well as the basic safety rules for gymnastics.

_enrolled in Kindergarten in the fall

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

(Grades 1-6) The Gold Star Program moves our athletes into more advanced tumbling and olympic apparatus work, as well as introducing them to a strong focus on Dance and Ballet terminology, technique and fundamentals. It is also the first level of courses at Birons which requires athletes to be simultaneously enrolled in at least one other gymnastics program at an equal or higher level (Performance, Tumbling, or Competitive options). This give the students a diverse curriculum to keep them engaged, a strong, wide foundation of skills, and the multi-evening practice schedule required to succeed at this level. Comparable to USAG Levels 3+.

Competitive Tramp and Tumbling

Trampoline and Tumbling, or T&T for short, is a fast paced exciting sport which involves learning routines on three events: olympic trampoline, tumbling and double mini-trampoline. Each gymnast competes at his/her ability level on each event, and it allows gymnasts to focus on only the apparatuses they have most interest in instead of the all around elements of TAAF.

The intermediate tumbling class is open for all athletes; to qualify for the intermediate class the athlete has to be able to do a round-off, two back handsprings. The goal of this class is to work towards advance level skills ranging from back tucks, fulls to double backs.

Our advanced tumbling class that teaches all the required gymnastics skills for cheer tumbling through safe and purposeful progressions to the final skill, with a focus on high level inversions and transitioning skills to non-spring floors. Athletes will learn skills and tumbling passes on equipment from the tumble-track, olympic trampoline, spring bed floor, and carpet floor.

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

School Age Performance 1

(Grades 1-6) Student must be currently enrolled in the Kinderstars, Stars, or Super Stars recreational class to be eligible School Age Performance 1. The students in these performance classes prepare a group floor routine involving tumbling, dance, choreography, costumes and more to present at the annual recital. These groups are also given the opportunity to perform at other venues during the year such as school carnivals, grand openings etc.

Add-on to Recreational Classes

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

(Grades 1-6) This beginning level class for girls teaches all Olympic events plus trampoline and basic tumbling. The program focuses on basic gymnastics, flexibility, strength, and body control. Each week offers a new and exciting challenge in a fun and organized setting with multiple stations and our engaging coaching staff. Over the course of the semester, your star will build confidence, strength, and follow purposeful progressions as they are introduced to the fundamentals of gymnastics. Comparable to USAG Level 1.

The students in these performance classes prepare a group floor routine involving tumbling, dance, choreography, costumes and more to present at the annual recital. This class is only open to students already enrolled in the tumbling tots program.

Add-on to Recreational Classes

_not enrolled in Kindergarten in the fall

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

School Age Performance Boys

Student must be currently enrolled in the Kinderstars, Stars 1, or Silver Stars 1 recreational class to be eligible School Age Performance 1. The students in these performance classes prepare a group floor routine involving tumbling, dance, choreography, costumes and more to present at the annual recital. These groups are also given the opportunity to perform at other venues during the year such as school carnivals, grand openings etc.

Add-on to Recreational Classes

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

School Age Performance 2

(Grades 1-6) Student must be currently enrolled in the Stars or Super Stars recreational class to be eligible School Age Performance 2. The students in these performance classes prepare a group floor routine involving tumbling, dance, choreography, costumes and more to present at the annual recital. These groups are also given the opportunity to perform at other venues during the year such as school carnivals, grand opening.

Add-on to Recreational Classes

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Ninja Zone - Boys

A high-activity class mixing obstacle course training, break dancing, gymnastics, strength, and discipline.

During this time proper motor skill development is crucial to your growing toddler. These classes are designed to introduce your child to movement, spatial awareness, hand-eye coordination and motor skill development. Each week is themed using obstacle courses, play shapes, gymnastics apparatus and music making the classes so much fun for both the parent and the child!

PARENT OBLIGATION DURING CLASS: Biron Gymnastics requires that a responsible adult (parent, grandparent, etc.) be in attendance and available should the preschooler need to leave the teaching floor for restroom or other assistance during the class.

12-35 months (Walking)

This beginning level class for boys and girls teaches all the olympic events plus trampoline and basic tumbling, but in a fun and casual setting that focuses more on balance, body control, and fun than it does on perfect technique. It serves as a necessary transitional time from our preschool program and is designed around your child’s move to a full-time school day. Students will learn about each of the gymnastics elements, as well as the basic safety rules for gymnastics.

_enrolled in Kindergarten in the fall

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.

(Grades 1-6) This beginning level class for girls teaches all Olympic events plus trampoline and basic tumbling. The program focuses on basic gymnastics, flexibility, strength, and body control. Each week offers a new and exciting challenge in a fun and organized setting with multiple stations and our engaging coaching staff. Over the course of the semester, your star will build confidence, strength, and follow purposeful progressions as they are introduced to the fundamentals of gymnastics. Comparable to USAG Level 1.

(Ages 3-4) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

(Ages 4-5) More exploration, fun, and rhythm than gymnastics, this is truly a class of continuous fun and learning. Building on a strong motor skill foundation, children learn basic gymnastics on all events in addition to weekly obstacle courses, trampoline time and basic tumbling skills. The main goal of the program is to build your child’s confidence in their first ‘all-by-myself’ class, empowering them to try new things in a safe, loving environment.

See Office for Pricing

(Grades 1-6) This beginning level class for girls teaches all Olympic events plus trampoline and basic tumbling. The program focuses on basic gymnastics, flexibility, strength, and body control. Each week offers a new and exciting challenge in a fun and organized setting with multiple stations and our engaging coaching staff. Over the course of the semester, your star will build confidence, strength, and follow purposeful progressions as they are introduced to the fundamentals of gymnastics. Comparable to USAG Level 1.

This beginning level class for boys and girls teaches all the olympic events plus trampoline and basic tumbling, but in a fun and casual setting that focuses more on balance, body control, and fun than it does on perfect technique. It serves as a necessary transitional time from our preschool program and is designed around your child’s move to a full-time school day. Students will learn about each of the gymnastics elements, as well as the basic safety rules for gymnastics.

_enrolled in Kindergarten in the fall

Dress Code Girls: All female gymnasts should wear the class leotard appropriate for their class level, no baggy shorts or pants will be permitted. Hair must be pulled back out of the gymnasts face.

Dress Code Boys: All male gymnasts should wear the class short appropriate for their class level tucked in to athletic shorts or sweat pants, no jeans.



Buy Online Birons Houston - Youth Sports Center Gymnastics, Biron

Melizide Tablets, Melizide

Melizide

contains the active ingredient glipizide

Consumer Medicine Information

What is in this leaflet

This leaflet answers some common questions about Melizide.

It does not contain all of the available information. It does not take the place of talking to your doctor, pharmacist or diabetes educator.

All medicines have benefits and risks. Your doctor has weighed the risks of you taking Melizide against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, talk to your doctor, pharmacist or diabetes educator.

Keep this leaflet with your medicine. You may need to read it again.

What Melizide is used for

Melizide is used to control blood sugar in patients with Type 2 diabetes mellitus. This type of diabetes is also known as non-insulin dependent diabetes mellitus (NIDDM) or maturity onset diabetes.

Melizide is used when diet and exercise are not enough to control your blood sugar (glucose). It can be used alone, or together with insulin or other medicines for treating diabetes.

Melizide is available only with a doctor's prescription.

There is no evidence that Melizide is addictive.

How Melizide works

Melizide belongs to a group of medicines called sulfonylureas. These medicines lower high blood glucose by increasing the amount of insulin produced by your pancreas.

If your blood glucose is not properly controlled, you may experience hypoglycaemia (low blood glucose) or hyperglycaemia (high blood glucose).

Hypoglycaemia (low blood glucose) can occur suddenly. Signs may include:

weakness, trembling or shaking

sweating

lightheadedness, dizziness, headache or lack of concentration

irritability

tearfulness or crying

hunger

numbness around the lips and tongue.

If not treated quickly, these may progress to:

loss of co-ordination

slurred speech

confusion

fits or loss of consciousness.

Hyperglycaemia (high blood glucose) usually occurs more slowly than hypoglycaemia.

Signs of hyperglycaemia may include:

lethargy or tiredness

headache

thirst

passing large amounts of urine

blurred vision.

Hyperglycaemia can lead to serious problems with your heart, eyes, circulation or kidneys.

Ask your doctor if you have any questions about why Melizide has been prescribed for you.

Your doctor may have prescribed it for another reason.

Use in Children

There is not enough evidence to recommend the use of Melizide in children.

Before you take Melizide

When you must not take it

Do not take Melizide if you are allergic to:

any medicine containing glipizide

other sulphonylureas

sulphur antibiotics (e. g. sulphonamides)

certain types of fluid tablets (thiazide diuretics)

any of the ingredients listed at the end of this leaflet.

Some of the symptoms of an allergic reaction may include:

shortness of breath

wheezing or difficulty breathing

swelling of the face, lips, tongue or other parts of the body

rash, itching or hives on the skin.

Do not take Melizide if you have any of the following medical conditions:

Type 1 diabetes mellitus, also known as insulin dependent diabetes mellitus

severe or unstable diabetes

diabetic ketoacidosis with or without coma

gangrene

severe thyroid disease

severe kidney disease

severe liver disease

infection or high temperature

severe trauma

major surgery.

Do not take Melizide if you are pregnant or plan to become pregnant. Insulin is more suitable for controlling blood glucose during pregnancy. Your doctor will replace Melizide with insulin while you are pregnant.

Do not take Melizide if you are breastfeeding or plan to breastfeed. It is not known whether Melizide passes into breast-milk. There could be a possibility that your baby is affected.

Do not give Melizide to children. Safety and effectiveness in children have not been established.

Do not take Melizide after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering. If it has expired or is damaged, return it to your pharmacist for disposal.

If you are not sure whether you should start taking Melizide, talk to your doctor.

Before you start to take it

Tell your doctor if you have allergies to any other medicines, foods, dyes or preservatives.

Tell your doctor if you have or have had any of the following medical conditions:

adrenal or pituitary problems

glucose-6-phosphate dehydrogenase (G6PD) deficiency, a condition in which the body does not have enough of the enzyme G6PD

liver problems

kidney problems.

Tell your doctor if:

you ever drink alcohol

you do not eat regular meals

you do a lot of exercise

you are feeling ill or unwell.

Alcohol, diet, exercise and your general health all strongly affect the control of your diabetes.

If you have not told your doctor about any of the above, tell him/her before you start taking Melizide.

Taking other medicines

Tell your doctor, pharmacist or diabetes educator if you are taking any other medicines, including any that you buy without a prescription from a pharmacy, supermarket or health food shop.

Some medicines and Melizide may interfere with each other.

Some medicines may lead to low blood glucose (hypoglycaemia) by increasing the blood-glucose-lowering effect of Melizide. These include: - alcohol - some medicines used to treat high blood pressure and other heart conditions (beta-blockers, ACE inhibitors, diazoxide) - some medicines used to treat arthritis, pain and inflammation (salicylates e. g. aspirin; non-steroidal anti-inflammatory drugs) - some antibiotics (sulphonamides, chloramphenicol) - medicines used to prevent blood clots (coumarin derivatives) - medicines used to treat fungal infections (miconazole, fluconazole) - some cholesterol-lowering medicines (clofibrate) - other medicines used to treat diabetes (biguanides) - probenecid (a medicine used to treat gout or to increase the blood levels of some antibiotics) - some medicines used to treat depression (monoamine oxidase inhibitors) - some medicines used to treat reflux and ulcers (H2 receptor antagonists, e. g. cimetidine) - some medicines used to treat cancer (cyclophosphamide).

Some medicines may lead to a loss of control of your diabetes by weakening the blood glucose-lowering effect of Melizide. These include: - alcohol - some medicines used to treat high blood pressure (calcium channel blocking medicines) - glucagon, a medicine used to treat low blood glucose - corticosteroids such as prednisone and cortisone - some medicines used to treat tuberculosis (isoniazid) - nicotinic acid (used for the lowering of blood fats) - oestrogens, progestogens, oral contraceptives and certain other hormonal treatments such as danazol. These medicines are used in birth control, Hormone Replacement Therapy (HRT), or to treat other women's health problems - some medicines used to treat mental illness or psychotic disorders (phenothiazines) - phenytoin, a medicine used to treat epilepsy (convulsions) - diuretics also known as fluid tablets (thiazides) - some asthma medicines, preparations for coughs and colds, and weight-reducing medicines (sympathomimetics) - thyroid hormones - some medicines used to treat cancer (cyclophosphamide).

Melizide may change the effect of some other medicines. These include: - barbiturates (used for sedation).

Tetracycline, a type of antibiotic, can interfere with the measurement of glucose in the urine.

You may need different amounts of your medicine or you may need to take different medicines.

Your doctor, pharmacist or diabetes educator can tell you what to do if you are taking any of these medicines. They also have more information on medicines to be careful with or avoid while taking Melizide.

How to take Melizide

Follow all directions given to you by your doctor or pharmacist carefully. They may differ from the information contained in this leaflet.

If you do not understand the instructions on the pack, ask your doctor or pharmacist for help.

How much to take

The dose varies from patient to patient. Your doctor will recommend how many tablets to take each day.

The usual starting dose is 1 tablet taken before breakfast. However, a lower starting dose may be needed in older people or those with liver problems.

Your doctor may increase or decrease the dose depending on your blood glucose levels.

How to take it

Swallow the tablets whole with a full glass of water.

When to take it

Take Melizide about half an hour before meals. Meal times are generally when your blood glucose levels are highest. Taking Melizide half an hour before a meal helps your body produce insulin when it is needed most.

Do not skip meals while taking Melizide.

How long to take it for

Continue taking Melizide for as long as your doctor tells you. Melizide helps to control diabetes but does not cure it. Therefore, you may have to take it for a long time.

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 the missed dose as soon as you remember, and then go back to taking your tablets as you would normally.

Missed doses can cause hyperglycaemia.

Do not take a double dose to make up for the dose you missed.

If you are not sure what to do, ask your doctor or pharmacist.

If you take too much Melizide (overdose)

Immediately telephone your doctor or the Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at the nearest hospital, if you think you or anyone else may have taken too much Melizide. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

If you take too much Melizide, you may experience symptoms of hypoglycaemia (low blood glucose).

If not treated quickly, these symptoms may progress to loss of co-ordination, slurred speech, confusion, fits or loss of consciousness.

At the first signs of hypoglycaemia, raise your blood glucose quickly by eating jelly beans, sugar or honey, drinking a non-diet soft drink, or taking glucose tablets.

While you are taking Melizide

Things you must do

If you are about to be started on any new medicine, tell your doctor or pharmacist that you are taking Melizide.

Tell any other doctors, dentists and pharmacists who are treating you that you are taking Melizide.

If you become pregnant while taking Melizide, tell your doctor immediately.

Make sure that you, your friends, family and work colleagues can recognise the symptoms of hypoglycaemia and hyperglycaemia and know how to treat them.

If you experience any of the symptoms of hypoglycaemia (low blood glucose), you need to raise your blood glucose immediately. You can do this by doing one of the following:

eating 5-7 jelly beans

eating 3 teaspoons of sugar or honey

drinking half a can of non-diet soft drink

taking 2-3 concentrated glucose tablets.

Unless you are within 10 to 15 minutes of your next meal or snack, follow up with extra carbohydrates such as plain biscuits, fruit or milk. Taking this extra carbohydrate will prevent a second drop in your blood glucose level.

If you are elderly or are taking other medicines for diabetes such as insulin or metformin, the risk of hypoglycaemia is increased.

If you experience any of the symptoms of hyperglycaemia (high blood glucose), contact your doctor immediately.

The risk of hyperglycaemia is increased in the following situations:

uncontrolled diabetes

illness, infection or stress

taking less Melizide than prescribed

taking certain other medicines

too little exercise

eating more carbohydrates than normal.

Tell your doctor if you become ill, or experience extra stress, injury, fever, injection or need surgery. Your blood glucose may become difficult to control at these times. Your doctor may replace Melizide with insulin.

Make sure you check your blood glucose levels regularly. This is the best way to tell if your diabetes is being controlled properly. Your doctor or diabetes educator will show you how and when to do this.

Keep all of your doctor's appointments so that your progress can be checked.

Carefully follow your doctor's and dietician's advice on diet, drinking alcohol and exercise.

Tell your doctor immediately if you notice the return of any symptoms you had before starting Melizide. These may include lethargy or tiredness, headache, thirst, passing large amounts of urine and blurred vision. These may be signs that Melizide is no longer working, even though you may have been taking it successfully for some time.

Things you must not do

Do not take Melizide to treat any other complaints unless your doctor tells you to.

Do not give Melizide to anyone else, even if they have the same condition as you.

Do not stop taking Melizide, or change the dose, without checking with your doctor.

Do not skip meals while taking Melizide.

Things to be careful of

Be careful driving or operating machinery until you know how Melizide affects you. Melizide may cause dizziness and drowsiness in some people. If any of these occur, do not drive, operate machinery or do anything else that could be dangerous.

Be careful not to let your blood glucose levels fall too low. Low blood glucose levels may slow your reaction time and affect your ability to drive or operate machinery.

Protect your skin when you are in the sun, especially between 10 am and 3 pm. If outdoors, wear protective clothing and use a minimum of 30+ sunscreen. If your skin does appear to be burning, tell your doctor immediately. Melizide may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight may cause skin rash, itching, redness or severe sunburn.

Be careful when drinking alcohol while you are taking this medicine. If you drink alcohol while taking Melizide, you may get flushing, headache, breathing difficulties, rapid heart beat, stomach pains or feel sick and vomit.

Things that would be helpful for your condition

Some self help measures suggested below may help your condition. Your doctor or pharmacist can give you more information about these measures.

If you are travelling it is a good idea to:

wear some form of identification showing you have diabetes

carry some form of sugar to treat hypoglycaemia if it occurs e. g. jelly beans, sugar sachets

carry emergency food rations in case of delay e. g. dried fruit, biscuits

keep Melizide readily available.

Sick days If you become sick with a cold, fever or flu, it is very important to continue taking Melizide, even if you feel unable to eat your normal meal. If you have trouble eating solid food, use sugar-sweetened drinks as a carbohydrate substitute, or eat small amounts of bland food. Your diabetes educator or dietician can give you a list of foods to use for sick days.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Melizide. Melizide helps most people with diabetes, but it may have unwanted side effects in some people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.

Ask your doctor or pharmacist to answer any questions you may have.

Do not be alarmed by this list of possible side effects. You may not experience any of them.

Tell your doctor if you notice any of the following and they worry you:

signs of hypoglycaemia which may include weakness, trembling or shaking, sweating, lightheadedness, headache, dizziness, sleepiness, irritability, tearfulness or crying, hunger and lack of concentration.

confusion, shaking and feeling generally unwell. These may be experienced but are usually mild and transient. However, they may also be symptoms of hypoglycaemia.

stomach upset including nausea (feeling sick), vomiting and stomach cramps or pain.

diarrhoea, constipation.

dizziness, drowsiness, headache. These may be experienced but are usually mild and transient. However, they may also be symptoms of hypoglycaemia.

rashes, sores, redness, itching, or eczema. Sometimes these effects may disappear following continued treatment but you should ask your doctor for advice if you experience skin problems while taking Melizide.

unusual weight gain.

visual disturbances which may include blurred vision, double vision and abnormal vision. These may be experienced but are usually mild and transient. However, they may also be symptoms of hypoglycaemia.

symptoms of sunburn such as redness, itching or blistering which may occur more quickly than normal.

Tell your doctor as soon as possible if you notice any of the following:

yellowing of the eyes or skin (jaundice)

bleeding or bruising more easily than normal, reddish or purplish blotches under the skin

signs of frequent infections, such as fever, chills, sore throat or mouth ulcers.

Tell your doctor immediately or go to Accident and Emergency at the nearest hospital if you notice any of the following:

signs of anaemia such as tiredness, being short of breath, looking pale and seizure.

signs of liver disease such as nausea, vomiting, loss of appetite, feeling generally unwell, fever, itching, yellowing of the skin or eyes, and dark coloured urine.

The above list includes serious side effects you may need urgent medical attention or hospitalisation.

Tell your doctor or pharmacist if you notice anything that is making you feel unwell. This is not a complete list of all possible side effects. Other side effects not listed above may also occur in some people.

After using Melizide

Storage

Keep Melizide where children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Keep your tablets in the blister pack until it is time to take them. The blister packaging will help protect the tablets.

Keep your tablets in a cool dry place where the temperature stays below 25°C.

Do not store Melizide or any other medicine in the bathroom or near a sink.

Do not leave Melizide in the car or on window sills. Heat and dampness can destroy some medicines.

Disposal

If your doctor tells you to stop taking Melizide, or your tablets have passed their expiry date, ask your pharmacist what to do with any that are left over.

Product description

What it looks like

Melizide is an oval, white tablet marked GP|5 and a Greek Alpha symbol.

Each pack contains 100 tablets.

Ingredients

The active ingredient in Melizide is glipizide. Each Melizide tablet contains 5 mg of glipizide.

The tablets also contain:

lactose

starch - maize

starch - pregelatinised maize

magnesium stearate.

This medicine does not contain gluten.

Manufacturer

Melizide is made in Australia by: Alphapharm Pty Limited (ABN 93 002 359 739) Level 1, 30 The Bond 30 - 34 Hickson Road Millers Point NSW 2000 Phone: (02) 9298 3999 www. alphapharm. com. au

Medical Information Phone: 1800 028 365

Australian Registration Number: AUST R 46946

This leaflet was prepared on 05 February 2015.

Published by MIMS July 2015

Consumers should be aware that the information provided by the Consumer Medicines Information (CMI) search (CMI Search) is for information purposes only and consumers should continue to obtain professional advice from a qualified healthcare professional regarding any condition for which they have searched for CMI. CMIs are provided by MIMS Australia. CMI is supplied by the relevant pharmaceutical company for each consumer medical product. All copyright and responsibility for CMI is that of the relevant pharmaceutical company. MIMS Australia uses its best endeavours to ensure that at the time of publishing, as indicated on the publishing date for each resource (e. g. Published by MIMS/myDr January 2007), the CMI provided was complete to the best of MIMS Australia's knowledge. The CMI and the CMI Search are not intended to be used by consumers to diagnose, treat, cure or prevent any disease or for any therapeutic purpose. Cirrus Media Pty Limited, its servants and agents shall not be responsible for the continued currency of the CMI, or for any errors, omissions or inaccuracies in the CMI and/or the CMI Search whether arising from negligence or otherwise or from any other consequence arising there from.

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Brilliant Legacy, Brilian

Brilliant Legacy

HopesDD Nov 30 2014 10:39 am An amazing classic, totally love it no matter how much I watch it. A story that looks boring but attract you and warm your heart with its smart script. Seriously, it's GOLD.

love Jun 15 2014 2:12 pm I'm watching Brilliant Legacy Right now and I fall in love with Hwan again and again. SEUNG GI OPPA I LOVE YOU. my cute baby Hope your eye recovers soon and I see you smiling and healthy again my love.

Thilini v. Mar 20 2014 9:46 am Does anybody noticed that in Brilliant Legacy, from the begining on, both Hwan-Sung wore same colour and same type clothes like a true couple, I think Go Eung Sung even wore Sun Woo Hwangs own clothes few times, how romantic :-D

Thilini v Feb 22 2014 1:10 pm I lost count of how many times I've watched BL, great plot, brilliant acting, my all time fav. num.1 K drama, Seung-Joo (Hwan-Sung) is most probably the reason of my BL addiction, Seung-Joo forever! please do another project together, I'll never get tired of watching you both together!

Ozmo Feb 10 2014 10:32 pm @elis - Getting drama confused with real life. Yoona isn't in this drama. She and Seung-Gi love each other in the real world, so whether you like her is irrelevant.

elis Feb 03 2014 12:53 am does sueng gi likes hhj or the other way around? if they do, why arent they together..i dont like yoona

Clarkdale44 Jan 26 2014 3:02 pm Well a nice change of pace. I liked the story and it was entertaining. Casting was superb, both Han Hyo-Joo and Lee Seung-Ki performed their best. But i feel as chemistry between two leads was somewhat weak, don't know if its only me who felt that way. Although the story sequence was alright i felt as it was being dragged unnecessarily. Anyway in the end all worked out good. I enjoyed it.

WARNING:- Don't read further if you have yet to watch this drama:- Although the story is entertaining, you will feel frustrated and angry because of such mother, yeah i am quite familiar with stepmothers in dramas who throws out the children from first marriage in such situations but what she did was beyond explanation. Throughout the entire drama i felt so annoyed by the character of Paek Seong-Hee and even her daughter Yu Seung-Mi that was i about to go crazy. I felt as she was crazy and had some sort of mental problem. I don't think she plans give up in the end if it wasn't for Eun-Seong's father, who threatened her that he will turn himself in. If i talk about supporting cast, i feel sorry for Park Jun-Se, he helped Eun-Seong throughout the series since the beginning and yet his heart was crushed in the end. I still don't understand this feeling called love. He helped her so many times and even helped her father, its hard to believe that she didn't felt anything for him. Also Eun-Seong didn't had the slightest idea that her father was alive and looking for her, she wouldn't even have been able to meet her father if it wasn't for Jun-Se. Well he knew the meaning of loving someone, he must have thought her happiness lies with Hwan, so he gave up. On the other hand i don't feel any bad for Yu Seung-Mi, she got what she deserved. I liked the happy ending. But Eun-Seong could have been announced as future heir of the company. Anyway i liked the character of Grandmother, she saw in Eun-Seong's kindness and pure heart, it was a right decision to make her future successor of the company, although she declined it in the end. 28 episodes was bit too much depending on the story progress, story was being dragged for no reason in the middle of the series. Anyway i enjoyed this drama very much and i will recommend it to all.

I will give it 9.5/10(For great casting, great story, great cinematography)

T Jan 26 2014 2:45 pm My most favourite Korean drama so far, love everything about this drama, specally the chemistry between Seung Gi-Hyo Joo, Hwan-Sung forever! <3



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Novapirina, Novapirina

Novapirina

A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt. [PubChem]

Pharmacology of Novapirina

Novapirina is an acetic acid nonsteroidal antiinflammatory drug (NSAID) with analgesic and antipyretic properties. Novapirina is used to treat pain, dysmenorrhea, ocular inflammation, osteoarthritis. rheumatoid arthritis. ankylosing spondylitis. and actinic keratosis

Novapirina for patients

Diclofenac, like other drugs of its class, is not free of side effects. The side effects of these drugs can cause discomfort and rarely, more serious side effects, such as gastrointestinal bleeding, and more rarely, liver toxicity which may result in hospitalization and even fatal outcomes.

NSAIDs are often essential agents in the management of arthritis and have a major role in the management of pain, but they also may be commonly employed for conditions that are less serious.

Physicians may w. s. to discuss with their patients the potential risks and likely benefits of NSAID treatment, particularly when the drugs are used for less serious conditions where treatment without NSAIDs may represent an acceptable alternative to both the patient and physician.

Because serious G. I. tract ulceration and bleeding can occur without warning symptoms, physicians should follow chronically treated patients for the signs and symptoms of ulceration and bleeding and should inform them of the importance of this follow-up. If diclofenac is used chronically, patients should also be instructed to report any signs and symptoms that might be due to hepatotoxicity of dictofenac; these symptoms may become evident between visits when periodic liver laboratory tests are performed

Novapirina Interactions

Aspirin: Concomitant administration of diclofenac and aspirin is not recommended because diclofenac is displaced from its binding sites during the concomitant administration of aspirin, resulting in lower plasma concentrations, peak plasma levels, and AUC values.

Anticoagulants: While studies have not shown diclofenac to interact with anticoagulants of the warfarin type, caution should be exercised, nonetheless, since interactions have been seen with other NSAIDs. Because prostaglandins play an important role in hemostasis, and NSAIDs affect platelet function as well, concurrent therapy with all NSAIDs, including diclofenac, and warfarin requires close monitoring of patients to be certain that no change in their anticoagulant dosage is required.

Digoxin, Methotrexate, Cyclosporine: Diclofenac, like other NSAIDs, may affect renal prostaglandins and increase the toxicity of certain drugs. Ingestion of diclofenac may increase serum concentrations of digoxin and methotrexate and increase cyclosporineís nephrotoxicity. Patients who begin taking diclofenac or who increase their diclofenac dose or any other NSAID while taking digoxin, methotrexate, or cyclosporine may develop toxicity characteristics for these drugs. They should be observed closely, particularly if renal function is impaired. In the case of digoxin, serum levels should be monitored.

Lithium: Diclofenac decreases lithium renal clearance and increases lithium plasma levels. In patients taking diclofenac and lithium concomitantly, lithium toxicity may develop.

Oral Hypoglycemics: Diclofenac does not alter glucose metabolism in normal subjects nor does it alter the effects of oral hypoglycemic agents. There are rare reports, however, from marketing experiences, of changes in effects of insulin or oral hypoglycemic agents in the presence of diclofenac that necessitated changes in the doses of such agents. Both hypo - and hyperglycemic effects have been reported. A direct causal relationship has not been established, but physicians should consider the possibility that diclofenac may alter a diabetic patientís response to insulin or oral hypoglycemic agents.

Diuretics: Diclofenac and other NSAIDs can inhibit the activity of diuretics. Concomitant treatment with potassium-sparing diuretics may be associated with increased serum potassium levels.

Other Drugs: In small groups of patients (7-10/interaction study), the concomitant administration of azathioprine, gold, chloroquine, D-penicillamine, prednisolone, doxycycline, or digitoxin did not significantly affect the peak levels and AUC values of diclofenac. Phenobarbital toxicity has been reported to have occurred in a patient on chronic phenobarbital treatment following the initiation of diclofenac therapy.

In vitro, diclofenac interferes minimally or not at all with the protein binding of salicylic acid (20% decrease in binding), tolbutamide, prednisolone (10% decrease in binding), or warfarin. Benzylpenicillin, ampicillin, oxacillin, chlortetracycline, doxycycline, cephalothin, erythromycin, and sulfamethoxazole have no influence in vitro on the protein binding of diclofenac in human serum.

Drug/Laboratory Test Interactions

Effect on Blood Coagulation: Diclofenac increases platelet aggregation time but does not affect bleeding time, plasma thrombin clotting time, plasma fibrinogen, or factors V and VII to XII. Statistically significant changes in prothrombin and partial thromboplastin times have been reported in normal volunteers. The mean changes were observed to be less than 1 second in both instances, however, and are unlikely to be clinically important. Diclofenac is a prostaglandin synthetase inhibitor, however, and all drugs that inhibit prostaglandin synthesis interfere with platelet function to some degree; therefore, patients who may be adversely affected by such an action should be carefully observed.

Novapirina Contraindications

Diclofenac in all formulations, Cataflam, Voltaren, and Voltaren-XR, is contraindicated in patients with known hypersensitivity to diclofenac and diclofenac-containing products. Diclofenac should not be given to patients who have experienced asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to diclofenac have been reported in such patients.

Additional information about Novapirina

Novapirina Indication: For the acute and chronic treatment of signs and symptoms of osteoarthritis and rheumatoid arthritis . Mechanism Of Action: The antiinflammatory effects of diclofenac are believed to be due to inhibition of both leukocyte migration and the enzyme cylooxygenase (COX-1 and COX-2), leading to the peripheral inhibition of prostaglandin synthesis. As prostaglandins sensitize pain receptors, inhibition of their synthesis is responsible for the analgesic effects of ketoprofen. Antipyretic effects may be due to action on the hypothalamus, resulting in peripheral dilation, increased cutaneous blood flow, and subsequent heat dissipation. Drug Interactions: Alendronate Increased risk of gastric toxicity Anisindione The NSAID increases the anticoagulant effect Cyclosporine Monitor for nephrotoxicity Dicumarol The NSAID increases the anticoagulant effect Warfarin The NSAID increases the anticoagulant effect Rifampin Decreased levels/effect of the NSAID Food Interactions: Take with food to reduce irritation. Avoid alcohol. Generic Name: Diclofenac Synonyms: Diclofenac Sodium; Diclofenac Potassium; Diclofenac Acid Drug Category: Nonsteroidal Antiinflammatory Agents (NSAIDs); Cyclooxygenase Inhibitors Drug Type: Small Molecule; Approved; Investigational Other Brand Names containing Diclofenac: Allvoran; Apo-Diclo; Assaren; Benfofen; Cataflam; Delphimix; Dichlofenac; Dichronic; Diclo-Phlogont; Diclo-Puren; Diclobenin; Diclord; Dicloreum; Dolobasan; Duravolten; Ecofenac; Effekton; Kriplex; Neriodin; Novapirina; Novo-Difenac; Novo-Difenac SR; Nu-Diclo; Pennsaid; Primofenac; Prophenatin; Rhumalgan; Solaraze; Solaraze T; Tsudohmin; Valetan; Voldal; Voltaren; Voltaren Ophtha; Voltaren Ophthalmic; Voltaren Rapide; Voltaren SR; Voltaren-XR; Voltarol; Xenid; Dyloject; Absorption: Completely absorbed from the gastrointestinal tract. Toxicity (Overdose): Symptoms of overdose include loss of consciousness, increased intracranial pressure. and aspiration pneumonitis. LD 50 =390mg/kg (orally in mice) Protein Binding: More than 99% Biotransformation: Hepatic Half Life: 2 hours Dosage Forms of Novapirina: Tablet Oral Tablet, extended release Oral Solution Topical Tablet, coated Oral Solution Ophthalmic Suppository Rectal Chemical IUPAC Name: 2-[2-[(2,6-dichlorophenyl)amino]phenyl]acetic acid Chemical Formula: C14H11Cl2NO2 Diclofenac on Wikipedia: http://en. wikipedia. org/wiki/Diclofenac Organisms Affected: Humans and other mammals



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Boue - Traduction - Dictionnaire Francais-Anglais, Boues

Dictionnaires de langue en ligne

boue activee nm nom masculin . s'utilise avec les articles "le", "l'" (devant une voyelle ou un h muet), "un" . Ex. garcon - nm > On dira " le garcon" ou " un garcon".

(boue d'epuration biologique) ( waste treatment )

activated sludge n noun . Refers to person, place, thing, quality, etc.

boue de curage nf nom feminin . s'utilise avec les articles "la", "l'" (devant une voyelle ou un h muet), "une" . Ex. fille - nf > On dira " la fille" ou " une fille". Avec un nom feminin, l'adjectif s'accorde. En general, on ajoute un "e" a l'adjectif. Par exemple, on dira "une petit e fille".

(canal. resultat de drague)

sludge, sediment n noun . Refers to person, place, thing, quality, etc.

La boue de curage des canaux portuaires etait autrefois utilisee comme engrais.

boue de forage nf nom feminin . s'utilise avec les articles "la", "l'" (devant une voyelle ou un h muet), "une" . Ex. fille - nf > On dira " la fille" ou " une fille". Avec un nom feminin, l'adjectif s'accorde. En general, on ajoute un "e" a l'adjectif. Par exemple, on dira "une petit e fille".

(residu de forage)

drilling mud, drilling fluid n noun . Refers to person, place, thing, quality, etc.

coulee de boue nf nom feminin . s'utilise avec les articles "la", "l'" (devant une voyelle ou un h muet), "une" . Ex. fille - nf > On dira " la fille" ou " une fille". Avec un nom feminin, l'adjectif s'accorde. En general, on ajoute un "e" a l'adjectif. Par exemple, on dira "une petit e fille".

(mouvement de terrain humide)

mudslide n noun . Refers to person, place, thing, quality, etc.

garde-boue nm inv nom masculin invariable . nom masculin qui a la meme forme au pluriel. Ex. "un? porte-cles . des porte-cles "

(protection sur un vehicule)

mudguard n noun . Refers to person, place, thing, quality, etc.



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Zoom Care, Zomcare

Hawthorne

Location

Services

ZOOM+Care Neighborhood Clinics provide On-Demand treatment for a broad range of illnesses and injuries at a fair, flat price. We also offer on-site prescription medications*, lab tests, vaccinations, and injections at every clinic. Adults and kids welcome. Schedule a same-day visit, online from your phone, today.

* We do not provide narcotics or medical marijuana.

ZOOM+Care Neighborhood Clinics provide On-Demand illness and injury treatments, physical therapy, and well care at a fair, flat price. We also offer on-site prescription medications*, lab tests, vaccinations, and immunizations at every clinic. Adults and kids welcome. Schedule a same-day visit, online from your phone, today.

* We do not provide narcotics or medical marijuana.

Every ZOOM+Care Neighborhood Clinic provides On-Demand, in-depth wellness exams for adults and kids that follow guidelines established by the U. S. Preventive Services Task Force and the American Congress of Obstetricians and Gynecologists. We evaluate the key aspects of your health (physical, mental and lifestyle) and develop a plan to keep you in peak condition. Schedule a well exam today.

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Product Description Common use Decadron is used to treat conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, certain bowel disorders. Also it is used in the treatment of cancers of the white blood cells (leukemias), and lymph gland cancers (lymphomas). Finally, Decadron is used as replacement therapy in patients whose adrenal glands are unable to produce sufficient amounts of corticosteroids.

Dosage and direction Take this medication by mouth as directed by your doctor. The initial oral dose is 0.75 to 9 mg daily depending on the disease. The initial dose should be adjusted according to the response to therapy. Take with food or milk to prevent stomach upset. Take this medication by mouth with food or a full glass of water or milk unless your doctor directs you otherwise. If you take this medication once daily, take it in the morning before 9 AM. Use this medication regularly in order to get the most benefit from it. Take it at the same time(s) each day. It is important to continue taking this medication even if you feel well. Follow the dosing schedule carefully, and take this medication exactly as prescribed. Do not stop taking this medication without consulting your doctor. Inform your doctor if your condition does not improve or worsens.

Precautions Do not get immunizations, vaccinations, or skin tests unless specifically directed by your doctor. Before taking Decadron, tell your doctor or pharmacist if you have any allergies, your medical history: active fungal infections, kidney or liver disease, mental/mood conditions, low blood minerals, thyroid disease, stomach/intestinal problems, high blood pressure, heart problems, diabetes, eye diseases, brittle bones, history of blood clots. If you have been taking this medication for a long time, your body may not make enough natural hormones while you are under physical stress. Your dose may need to be adjusted. If you have stopped taking this drug within the past 12 months, you may need to start taking it again if your body is under physical stress. Before having surgery, tell your doctor or dentist that you are using this medication or have taken it within the last 12 months. If you have a history of ulcers or take large doses of aspirin or other arthritis medication. Limit alcoholic beverages while taking this medication to decrease the risk of stomach/intestinal bleeding. If you have diabetes, this drug may make it harder to control your blood sugar levels. Monitor your blood sugar levels regularly and inform your doctor of the results. During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. This drug may pass into breast milk and could have undesirable effects on a nursing infant. Therefore, breast-feeding is not recommended while using this medication. Avoid contact with people who have recently received oral polio vaccine or flu vaccine inhaled through the nose, chickenpox or measles unless you have previously had these diseases (in childhood). If you are exposed to one of these infections and you have not previously had it, seek immediate medical attention.

Contraindications Do NOT use Decadron if you are allergic to any ingredient in Decadron, you have a systemic fungal infection, you are taking mifepristone. Contact your doctor or health care provider immediately if any of these apply to you.

Possible side effects

Side effects of Decadron depend on the dose, the duration and the frequency of administration. Short courses of dexamethasone usually are well tolerated with few and mild side effects. Long term, high dose dexamethasone usually will produce predictable and potentially serious side effects. Whenever possible, the lowest effective dose of dexamethasone should be used for the shortest possible length of time to minimize side effects. Alternate day dosing also can help reduce side effects. Side effects include fluid retention, weight gain, high blood pressure, loss of potassium, headache, muscle weakness, puffiness, and hair growth on the face, thinning and easy bruising of skin, glaucoma, cataracts, peptic ulceration, worsening of diabetes, irregular menses, growth retardation in children, convulsions, stomach upset, headache, dizziness, menstrual changes, trouble sleeping, increased appetite, or weight gain may occur, depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior. A very serious allergic reaction to this drug is rare. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Drug interactions Drugs such as phenobarbital, ephedrine, phenytoin (Dilantin), and rifampin (Rifadin, Rimactane) may increase the breakdown of corticosteroids by the liver. As a result it may be lower blood levels and reduced effects. Therefore, the dose of corticosteroid may need to be increased if treatment with any of these agents is begun.

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

Overdose Seek emergency medical attention if you think you have used too much of this medicine.

Storage Decadron should be stored at 68-77 F (20-25 C) and not frozen

Disclaimer We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information on the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care 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.



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Familial Adenomatous Polyposis - Genetics Home Reference, Fap

familial adenomatous polyposis

Familial adenomatous polyposis (FAP) is an inherited disorder characterized by cancer of the large intestine (colon) and rectum. People with the classic type of familial adenomatous polyposis may begin to develop multiple noncancerous (benign) growths ( polyps ) in the colon as early as their teenage years. Unless the colon is removed, these polyps will become malignant (cancerous). The average age at which an individual develops colon cancer in classic familial adenomatous polyposis is 39 years. Some people have a variant of the disorder, called attenuated familial adenomatous polyposis. in which polyp growth is delayed. The average age of colorectal cancer onset for attenuated familial adenomatous polyposis is 55 years.

In people with classic familial adenomatous polyposis. the number of polyps increases with age, and hundreds to thousands of polyps can develop in the colon. Also of particular significance are noncancerous growths called desmoid tumors. These fibrous tumors usually occur in the tissue covering the intestines and may be provoked by surgery to remove the colon. Desmoid tumors tend to recur after they are surgically removed. In both classic familial adenomatous polyposis and its attenuated variant, benign and malignant tumors are sometimes found in other places in the body, including the duodenum (a section of the small intestine), stomach, bones, skin, and other tissues. People who have colon polyps as well as growths outside the colon are sometimes described as having Gardner syndrome.

A milder type of familial adenomatous polyposis. called autosomal recessive familial adenomatous polyposis. has also been identified. People with the autosomal recessive type of this disorder have fewer polyps than those with the classic type. Fewer than 100 polyps typically develop, rather than hundreds or thousands. The autosomal recessive type of this disorder is caused by mutations in a different gene than the classic and attenuated types of familial adenomatous polyposis .

Related Information

Frequency

The reported incidence of familial adenomatous polyposis varies from 1 in 7,000 to 1 in 22,000 individuals.

Related Information

Genetic Changes

Mutations in the APC gene cause both classic and attenuated familial adenomatous polyposis. These mutations affect the ability of the cell to maintain normal growth and function. Cell overgrowth resulting from mutations in the APC gene leads to the colon polyps seen in familial adenomatous polyposis. Although most people with mutations in the APC gene will develop colorectal cancer, the number of polyps and the time frame in which they become malignant depend on the location of the mutation in the gene.

Mutations in the MUTYH gene cause autosomal recessive familial adenomatous polyposis (also called MYH-associated polyposis). Mutations in this gene prevent cells from correcting mistakes that are made when DNA is copied (DNA replication) in preparation for cell division. As these mistakes build up in a person's DNA, the likelihood of cell overgrowth increases, leading to colon polyps and the possibility of colon cancer.

Learn more about the genes associated with familial adenomatous polyposis

Familial adenomatous polyposis can have different inheritance patterns.

When familial adenomatous polyposis results from mutations in the APC gene, it is inherited in an autosomal dominant pattern. which means one copy of the altered gene in each cell is sufficient to cause the disorder. In most cases, an affected person has one parent with the condition.

When familial adenomatous polyposis results from mutations in the MUTYH gene, it is inherited in an autosomal recessive pattern. which means both copies of the gene in each cell have mutations. Most often, the parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but do not show signs and symptoms of the condition.

Related Information

Diagnosis & Management

These resources address the diagnosis or management of familial adenomatous polyposis:

These resources from MedlinePlus offer information about the diagnosis and management of various health conditions:

Related Information

Other Names for This Condition

adenomatous familial polyposis

adenomatous familial polyposis syndrome

adenomatous polyposis coli

familial multiple polyposis syndrome

FAP

MYH-associated polyposis

Related Information

Additional Information & Resources

MedlinePlus (5 links)

Genetic and Rare Diseases Information Center (3 links)

Additional NIH Resources (5 links)

Educational Resources (12 links)

Patient Support and Advocacy Resources (3 links)

GeneReviews (2 links)

Genetic Testing Registry (4 links)

ClinicalTrials. gov (1 link)

Scientific articles on PubMed (1 link)

OMIM (3 links)

Sources for This Page

Attard TM, Cuffari C, Tajouri T, Stoner JA, Eisenberg MT, Yardley JH, Abraham SC, Perry D, Vanderhoof J, Lynch H. Multicenter experience with upper gastrointestinal polyps in pediatric patients with familial adenomatous polyposis. Am J Gastroenterol. 2004 Apr;99(4):681-6.

Baglioni S, Genuardi M. Simple and complex genetics of colorectal cancer susceptibility. Am J Med Genet C Semin Med Genet. 2004 Aug 15;129C(1):35-43. Review.

Bienz M. APC. Curr Biol. 2003 Mar 18;13(6):R215-6. Review.

Cheadle JP, Sampson JR. Exposing the MYtH about base excision repair and human inherited disease. Hum Mol Genet. 2003 Oct 15;12 Spec No 2:R159-65. Epub 2003 Aug 5. Review.

Claes K, Dahan K, Tejpar S, De Paepe A, Bonduelle M, Abramowicz M, Verellen C, Franchimont D, Van Cutsem E, Kartheuser A. The genetics of familial adenomatous polyposis (FAP) and MutYH-associated polyposis (MAP). Acta Gastroenterol Belg. 2011 Sep;74(3):421-6. Review.

Crabtree M, Sieber OM, Lipton L, Hodgson SV, Lamlum H, Thomas HJ, Neale K, Phillips RK, Heinimann K, Tomlinson IP. Refining the relation between 'first hits' and 'second hits' at the APC locus: the 'loose fit' model and evidence for differences in somatic mutation spectra among patients. Oncogene. 2003 Jul 3;22(27):4257-65.

Jarvinen HJ, Peltomaki P. The complex genotype-phenotype relationship in familial adenomatous polyposis. Eur J Gastroenterol Hepatol. 2004 Jan;16(1):5-8.

Knudsen AL, Bisgaard ML, Bulow S. Attenuated familial adenomatous polyposis (AFAP). A review of the literature. Fam Cancer. 2003;2(1):43-55. Review.

Lipton L, Tomlinson I. The multiple colorectal adenoma phenotype and MYH, a base excision repair gene. Clin Gastroenterol Hepatol. 2004 Aug;2(8):633-8. Review.

Lucci-Cordisco E, Risio M, Venesio T, Genuardi M. The growing complexity of the intestinal polyposis syndromes. Am J Med Genet A. 2013 Nov;161A(11):2777-87. doi: 10.1002/ajmg. a.36253. Epub 2013 Oct 3. Review.

Lynch HT, Shaw TG, Lynch JF. Inherited predisposition to cancer: a historical overview. Am J Med Genet C Semin Med Genet. 2004 Aug 15;129C(1):5-22.

Rowley PT. Inherited susceptibility to colorectal cancer. Annu Rev Med. 2005;56:539-54. Review.

Rustgi AK. The genetics of hereditary colon cancer. Genes Dev. 2007 Oct 15;21(20):2525-38. Review.

Sampson JR, Dolwani S, Jones S, Eccles D, Ellis A, Evans DG, Frayling I, Jordan S, Maher ER, Mak T, Maynard J, Pigatto F, Shaw J, Cheadle JP. Autosomal recessive colorectal adenomatous polyposis due to inherited mutations of MYH. Lancet. 2003 Jul 5;362(9377):39-41.

Sieber OM, Lipton L, Crabtree M, Heinimann K, Fidalgo P, Phillips RK, Bisgaard ML, Orntoft TF, Aaltonen LA, Hodgson SV, Thomas HJ, Tomlinson IP. Multiple colorectal adenomas, classic adenomatous polyposis, and germ-line mutations in MYH. N Engl J Med. 2003 Feb 27;348(9):791-9.

Wang L, Baudhuin LM, Boardman LA, Steenblock KJ, Petersen GM, Halling KC, French AJ, Johnson RA, Burgart LJ, Rabe K, Lindor NM, Thibodeau SN. MYH mutations in patients with attenuated and classic polyposis and with young-onset colorectal cancer without polyps. Gastroenterology. 2004 Jul;127(1):9-16. Erratum in: Gastroenterology. 2004 Nov;127(5):1651.



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Tamoxifen (Ledertam)

Tamoxifen is used for treating breast cancer that has spread to other sites in the body. It is also used along with other medicines to treat other types of breast cancer. It is used in women who are at high risk for breast cancer and in women with DCIS (after surgery and radiation) to decrease the risk of developing breast cancer. Tamoxifen is an antiestrogen. It works by blocking the effect of estrogen on certain tumors. This may prevent the growth of tumors that are activated by estrogen.

Use Tamoxifen as directed by your doctor.

Tamoxifen may be taken by mouth with or without food.

Take Tamoxifen with water or another nonalcoholic liquid.

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

Continue to take Tamoxifen even if you feel well. Do not miss any dose. Taking Tamoxifen at the same time each day will help you to remember to take it.

If you miss a dose of Tamoxifen, 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 Tamoxifen.

Store Tamoxifen between 68 and 77 degrees F (20 and 25 degrees C) in a tightly closed, light-resistant container. Store away from moisture, heat, and light. Do not store in the bathroom. Do not take tablets after the expiration date printed on the label. Keep Tamoxifen out of the reach of children and away from pets.

Do NOT use Tamoxifen if:

you are allergic to any ingredient in Tamoxifen

you are using Tamoxifen to reduce your risk of breast cancer and you have a history of blood clots in the lung or leg

you are using Tamoxifen to reduce your risk of breast cancer and you also take certain anticoagulants (eg, warfarin)

you are taking anastrozole.

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

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

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

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

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

if you have a history of blood clots in the legs or lungs

if you have high levels of calcium in your blood, a weakened immune system, or low levels of white blood cells or platelets in your blood

if you have high cholesterol or lipid levels

if you have cataracts or other vision problems

if you are using cytotoxic cancer medicines

if you are confined to a bed or chair.

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

Anticoagulants (eg, warfarin) because the risk of bleeding may be increased

Cytotoxic cancer medicines (eg, cisplatin) because the risk of developing blood clots may be increased

Rifampin because it may decrease Tamoxifen's effectiveness

Fluorouracil or mitomycin C because they may increase the risk of Tamoxifen's side effects

Aromatase inhibitors (eg, anastrozole, letrozole) because their effectiveness may be decreased by Tamoxifen.

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

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

Tamoxifen may reduce the number of clot-forming cells (platelets) in your blood. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.

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

New tumors have occurred in body sites other than the uterus in patients taking Tamoxifen. It is unknown if Tamoxifen may be the cause. Discuss any questions or concerns with your doctor.

Women who take Tamoxifen to reduce the risk of breast cancer should have a breast exam, mammogram, and gynecological exam before starting and during treatment with Tamoxifen.

Women who may become pregnant should begin taking Tamoxifen during a menstrual period. Women who have irregular menstrual periods should have a pregnancy test immediately before starting Tamoxifen. Talk to your doctor if you have any questions about how to begin taking Tamoxifen.

Women who may become pregnant must use effective nonhormonal birth control (eg, condoms, diaphragm) during sexual intercourse while they are taking Tamoxifen and for 2 months after they stop taking it. Do not use hormonal birth control (eg, birth control pills); it may not work as well while you are taking Tamoxifen. Discuss any questions about effective nonhormonal birth control with your doctor.

Tamoxifen will not prevent you from becoming pregnant.

Lab tests, including breast exams, mammograms, gynecologic exams, complete blood counts, and liver function tests, may be performed while you use Tamoxifen. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

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

Pregnancy and breast-feeding: Tamoxifen may cause harm to the fetus. Do not become pregnant while you are using it and for 2 months after you stop using it. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Tamoxifen while you are pregnant. It is not known if Tamoxifen is found in breast milk. Do not breastfeed while taking Tamoxifen.

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:

Bone pain; constipation; coughing; hot flashes; muscle pain; nausea; tiredness; vaginal discharge; 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; unexplained hoarseness); abnormal menstrual periods; abnormal vaginal bleeding or bloody discharge; chest pain; coughing up blood; dark urine; decreased sexual desire or ability; depression; fever, chills, or persistent sore throat; groin or pelvic pain or pressure; loss of appetite; loss of balance or coordination; missed menstrual period; new or increased breast tumor or pain; new or unusual lumps; one-sided weakness; pain or swelling in one or both legs; red, swollen, blistered, or peeling skin; severe or persistent tiredness or weakness; shortness of breath; skin changes; stomach pain; sudden severe headache; swelling of the arms or the legs; unusual bleeding or bruising; vision or speech problems; yellowing of the eyes or skin.

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

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A reader clued me in to this great piece in Forbes that discusses the 15-minute office visit. It ties the origin to Medicare’s RVU (relative value unit) formula and its attempts to standardize the calculation of physician fees. The RVU formula factors in geography, practice expenses, liability insurance, and a Medicare “conversion factor” in an attempt to level the playing field for physicians. Translating the average visit’s RVUs using the American Medical Association’s then-current coding guidelines resulted in an average 15-minute office visit.

The RVU formula came into being in 1992. We’ve been through some cyclic changes in healthcare with the rise of managed care, a frenzy of hospitals purchasing practices, the subsequent divestiture of the practices, then back to integrated delivery systems and hospital ownership of physician practices. The change has recently been fueled by the rise of Accountable Care Organizations and other risk-sharing programs as well as the regulatory pressures stemming from HITECH and resulting incentive (now penalty) programs.

Medicine has changed considerably in the last 24 years. Decision-making has gotten more complex. Many patients are more empowered and take an active role in their healthcare. These visits often require more time due to detailed discussions of the pros and cons of various treatment options or diagnostic maneuvers. Unless physicians are coding based on the face-to-face time spent in counseling or coordination of care, it’s hard to get insurance payers to adequately pay for the time spent on those visits. Payers often ask for loads of documentation to justify the visit code, which results in additional work and expense to the practice.

Payers have created lists of codes they won’t pay, regardless of the medical realities. Case in point: I recently diagnosed a patient with a skin infection, most likely from time spent in a hot tub with inadequate cleaning procedures. The patient required antibiotics and I had to take a detailed history to make sure I was selecting the correct drug based on the likely infectious agents. It probably lasted less than 15 minutes, but I was rewarded a week later with a denial because the insurance company refuses to pay for a diagnosis of folliculitis. My staff had to handle the request, then send it to me for potential re-coding, and then we had to submit the claim again. Knowing how much time had already been wasted, I slapped a couple of potential diagnoses on the chart in the hopes that I’d hit the jackpot with one of them and would actually be paid.

Why is that OK? The patient had an actual problem, it required thought to diagnose, antibiotics were needed, and the visit was legitimate. Counseling on hot tub hygiene was given. The problem wasn’t self-limited and was unlikely to resolve without medical attention. I see dozens of people who come in with issues that could be easily handled by a well-trained Scout with a first aid kit and I get paid for those, but this time the insurance decided they just weren’t going to pay for that particular diagnosis.

Whenever physicians complain about everything they’re trying to cram into the 15-minute office visit, the first answer is that maybe we don’t need physicians to provide the care. Nurse practitioners and physician assistants should be used as well as various care team members with a range of clinical training experiences. Regardless of who is delivering a given level of care, it still takes time to deliver it, document it, and make sure the patient understands the steps they need to take prior to the next episode of care.

In many states, nurse practitioners and physician assistants practice independently. We just had a mini-revolt in our practice when we tried to credential our physician assistants to work without a supervising physician. The maneuver was intended to lower the cost of care, but several PAs refused to take part, reminding our leadership that their title was “physician assistant” rather than physician and that they went into the field to assist physicians rather than to try to be interchangeable with them.

I often practice alone, without a second clinician to jump in if the office gets busy. Those 15-minute visits become shorter and shorter when we have six or more patients streaming into the waiting room every hour. Most come because either they can’t get after-hours care from their primary physician or because they don’t have a primary physician. Our mission is to address their issues as completely and compassionately as possible, and knowing that payers can just decide not to pay for our services really puts a shadow over the whole concept of what we’re trying to do.

The editorial mentions that of the typical 15-minute office visit, physicians may spend 37 percent of the time doing paperwork. I’m fortunate to work for an organization that values physician time and staffs the practice with scribes during peak periods so that physicians and our independently-practicing PAs can focus on patients and not paperwork. Most of the time my notes and orders are complete before I walk out of the exam room, which is truly a beautiful thing. Patients appreciate our focus, but having a qualified scribe doesn’t come cheap. A good number of our scribes are students and recent graduates who are applying to medical school and who are looking for experience. It continues to amaze me that people would still consider a career in medicine after what they see in the trenches.

Using a figure of 37 percent leaves eight minutes for the actual office visit. The piece breaks down the patient activities that must fit into that time slot: social constructs like saying hello, disrobing if you didn’t change already, explaining why you’re seeking medical attention, being examined, etc. It suggests that patients shouldn’t take more than two minutes to tell their story, likening the time slot to that of a commercial break during broadcast television. “If four companies can get you to buy things in two minutes, surely you can tell your whole story.” That works if patients have focused or prepared, which is a rarity. Usually when I ask how long something has been going on, patients have to work through a series of cues to figure out the timeline. “Well, it started when I went to Michigan for Dean’s wedding, that was in the spring, no maybe it was early summer…” and there you have it.

I don’t blame patients who haven’t prepared – they should expect more than assembly line care with physicians running on the hamster wheel. They’re seeking care, not auditioning for a play or interviewing for a job. However, as long as insurance companies (including government payers like Medicare and Medicaid) are intermediaries and patients aren’t able to understand the full cost of care, things aren’t going to change. Patients who are actually paying for the physician’s time are going to demand his or her full attention, not an overly-truncated excuse of an office visit.

Building a patient-physician relationship takes time and medicine isn’t something that’s practiced by following a cookbook approach. Technology can help, but it’s not the be-all, end-all solution for healthcare’s problems. However, it seems to get most of our focus. Patient-empowerment movements have helped raise awareness of the need for greater partnership and shared decision-making in healthcare, but no one wants to pay for it. Cost control will continue to be a downward pressure with clinical and emotional consequences for both patients and caregivers. Eventually something has to give.

When will we reach the boiling point? Have ideas on how to fix things? Email me.

Travis Bond is founder and CEO of CareSync of Tampa, FL.

Tell me about yourself and the company.

I’m the founder and CEO of CareSync, which is my ninth company. My last company was Bond Technologies, which created one of the very first browser-based EMRs in the world. We had the opportunity to exit to the Eclipsys Corporation back in 2008, I believe.

I put the band back together in 2011 to create CareSync, which is a patient-centered electronic medical record that has a service on the side that basically acts as a record aggregator service. Carbon-based interfaces go out and get records and put them in a usable format that can be later searched, shared, and collaborated on. That all gave way to a business opportunity that CMS created in 2015 for chronic care management. That’s where we are today as one of the industry’s largest providers of chronic care management services under the new code.

Which is the chicken and which is the egg in offering a product that both consumers and their providers use?

It was probably providential in some ways that we cut our teeth on a consumer product. We weren’t bound by Washington, DC regulatory requirements for a product roadmap. What’s really useful for people when they become a clinical patient is they need information and they need resources that help them to shorten the gap between what providers are saying and doing on their behalf and how they can then respond. That product, started in 2013 and known as CareSync Plus, had about a 3 percent conversion rate when we went out and advertised it to people.

It is the CMS product that now gives us the business-to-business product. We act as the vendor on behalf of the provider to offer essentially the same service. The difference — and why we still have a chicken and an egg — is that about 5,000 members a month come onto the CareSync platform as family members. Some of those family members want the same services that CCM provides under CMS for themselves. We really couldn’t sunset a legacy product when there were still people who wanted to be more of an active caregiver or wanted to be more engaged patient.

What is the scope of the CCM business?

CMS has released information only about twice on how many people and how many claims they’ve produced. At last count several months ago, about 300,000-plus have been enrolled in CCM programs since their inception in 2015. From our point of view,  the geography of that number of claims is all 50 states. We have users in 30 states alone. It’s not really because we had any grand master plan, it’s that there is an alignment with many practices that want to try to care for people where they live, work, and play, not just at points or nodes of care.

I think CMS was disappointed that it did not ramp up as quickly because CMS had identified that they were going to pay $10+ billion every year for this program. Theoretically, it created a much bigger total adjustable market per year, $16 billion in 2015 and 2016. That number actually increases to a possible addressable market to $20+ billion because now they’ve given three new codes out to incentivize the market. One is an enrollment code and the other two are to address complex chronic care.

It’s not going away. It was a slow-starting process, but it’s being addressed from many different areas. The inevitability of chronic care management programs throughout healthcare has pretty much been set in stone and will just continue to grow as other new things have been introduced in healthcare over the last several decades, like HMOs and PCMHs and others. This is just another one in the fold that will continue to mature.

If I’m a physician and I think you’re a candidate to participate in CCM, what is your obligation as a patient?

It’s really quite simple. There is the consent process, which CMS wanted to know that there was written confirmation that a patient was elected to participate in something that they were eligible for. In this case, two or more chronic conditions. The chronic conditions, though, were very liberally interpreted by CMS, meaning that they were not going to actually put edits on what a provider thought was a chronically ill condition for the patient. If you look at ICD-9 alone, there are over 4,500 conditions which are marked or flagged chronic in nature.

From a patient’s perspective, it really is how you design the program. Patients need to have access to information, electronically or written, and have access to those that can access that information and are clinically trained or licensed 24/7. It’s more of an access from the vendor or the provider’s perspective. The patient, outside of them consenting to the program, just needs to make themselves available. The program  is designed to give back more time and resources to where patients need it and that’s in the consumption of the treatment plans that various providers are administering to them, a reconciliation of that.

We’ve found that variability of patient engagement is as wide as any that you could imagine. Some just like to be called once a month and talked to. Others will have inbound calls and want to talk extensively about their progress. We have patients that will be a few minutes a month or it could literally be in the several hundred minutes per month. Patient requirements are still low, other than their co-insurance or co-pay responsibilities.

Otherwise, it’s intended to be a service that is aggregating information, creating a comprehensive care plan that the patient can then consume and can be collaborated and administered, and then lastly, creating a health summary that can be provided back to the patient or anyone who is seeing the patient. Overall, patient requirements are still low, but it’s incumbent on the provider to maximize the value to the patient of the program as prescribed under CMS.

How does Medicare verify or monitor that services were provided and not just billed?

In the CMS program, you bill Medicare and they pay based upon whatever edits they can run through a computer system. They don’t verify until they actually audit.

This code is really no different. They’ve said at least initially in the first couple of years that they weren’t going to put edits on their claims, meaning that they weren’t going to necessarily determine whether a chronic condition had met some criteria that Medicare would feel is not chronic enough or chronic in the right way. They’ve left that up to the physicians’ discretion.

What we’ve found is we have hundreds of chronic diseases that are on our lists for the patients who we serve. As you know, there are even several thousand rare diseases that meet the chronic definition. As it stands right now, we’ve not seen any claims denied as it relates to the diagnosis that has been tied to the CPT code 99490.

How did CareSync’s recent $20 million in new funding come about and how has it changed what you do?

We were very fortunate to have a lot of venture capitalists and strategics already having conversations with as it related back to our legacy product, CareSync Plus. Many people felt that there needed to be a connective tissue, if you will, for patients where they’re in the space that we call the dark space, which is where you are when you’re not at an appointment or a hospital setting. This dark space is like trying to navigate between airports without a radar system or air traffic control. The thesis was that surely some entity or some party would benefit if patients were better monitored and/or had the opportunities to help themselves adhere to what was prescribed.

When the code came out, it was the match that lit the fire. We were setting ourselves up with people who thought that there were problems in healthcare that could be solved with a combination of nurses and technology. Having those things in place when the code came about allowed us to execute on closing financing rounds from those players. They have since then recommitted to continuing to fund CaresSync.

We feel that the chronic care management market will continue to grow significantly, especially under the new codes in MACRA. We have 18 months of solid data that shows that providers are getting paid. We’re seeing real tangible benefits for clinical outcomes as well. Nine percent of our patients that come into the system have a severe drug-to-drug interaction that no one knew about. That’s nearly one in 10, which is pretty significant because it’s the severe drug-to-drug interactions that potentially are lethal. Sixty-four percent of our patients avoided a duplicate test because they had the results with them. A provider avoided re-prescribing another test because they felt that they had the results that they needed at the time of care.

There are many things that illustrate the advantages of the program. Those things obviously matriculate back to value when you look at an investment community. The key thing in pairing up investments from the investment community and being an entity in this space is the ability to execute at scale. We have found that it is much easier to have a chronic care management program at 30 nurses than it is 300. There are natural elements of growing and scaling that process and learning a lot of things along the way.

I think that what you’ll see overall in the market is that there will be a continued interest from the investment community in supporting this dark space and the vendors that emerge from this innovation opportunity.

Are you seeing any improvement in the ability and willingness of hospitals to provide patients with their electronic records in whatever form they request?

They’re getting a little bit better, but we’re getting a lot smarter. It’s the combination of the two that has created the net result that we are getting better, faster results from the data.

There has been an implementation of these HIT systems lag, in terms of those professionals who are running these systems even knowing that there are features to share the information. There’s still the HIPAA cloud of death and despair that hangs over all of these institutions. They feel that they need to protect this data, even from those who originated it, like the patient. That becomes primarily an education step. There’s still also a lot of medical-legal sensitivity. Why does a person want their data? Do they think we did something wrong?

That’s still a case-by-case process that we have to go through at CareSync. It’s still far easier for a provider to request information than it is a vendor. A vendor is always suspect. It is slowly changing. I wouldn’t say that we have a marked increase in the amount of freedom of information posture of these institutions that hold large amounts of it, but at least we’re seeing some incremental changes in a direction for the positive.

You were selling EHRs in the heady days. Are you glad you aren’t still in the EHR business?

Yes. [laughs] I am glad that I’m not there. In retrospect, the advent of EMRs bogged down the efficiency of a visit.

Having some medical training acted as the foundation for creating our EMR program and helped me. Technology took away from a lot of the observation skills. A  good portion of medical school training is spent in diagnostics and observations of patients. Those just can’t be done simultaneously while also working through documentation requirements.

Hopefully, programs like chronic care management and other things that try to reintroduce an experience that the patient feels comfortable in talking and sharing information and how that’s captured — I’m hoping that we can blunt some of the negative impacts that EMRs had. But I would say that if I ever had to be reincarnated, I would not go back into building any piece of software for ambulatory healthcare. That was a very painful pioneering pathway to walk.

Do EHR vendors get blamed for too many clicks and too much pointless information collection instead of those parties on the back end who require collecting that information before paying providers?

Yes. I would have to side with the EMR vendors on this one. It’s not their fault. It’s Washington, DC that creates the product road maps for vendors now. It’s not what users want.

Users want a certain amount of clicking so that they can document, recall, and have that information available for the next visit or for other providers. There’s real fundamental and foundational value to EMRs. But the direction they’ve taken in terms of usability, unfortunately, was hijacked by those that were writing the checks for them in the first place. Under ARRA,  the government was paying for them, but as a result of them paying for them, they were able to create what they were going to be under Meaningful Use.

There’s always a balance here. We are better off that we now have EMRs, undeniably. You’re in a far better place in being able to record this information a way that we can learn it more rapidly off the science of healthcare and treating those that have disease.

The disadvantage is that we’ve made the billing system on par with the IRS tax code. We’ve made it so complicated that it’s very difficult to do an effective visit with the necessary amount of documentation in a way that demonstrates what took place such that it could be reimbursed on par for what happened. I’m hoping that we’ll eventually get through this, but I’m worried about the overall physician dissatisfaction with their job as we go through this lonely period of transition.

Are consumers really gaining power, demanding their data, and becoming involved as participants in their own care or are we just wishfully thinking that was the case?

I think it’s slowly happening. The best chance that we have in terms of developing technologies for patients is that patients are becoming more consumer aware. That to me is probably the biggest weapon that we have. The patient is probably the greatest sleeping giant in all of healthcare. When you go through Uber or a good banking scenario or a good restaurant experience, you understand how brands compete for your business, your attention, and the right to serve you. They see that as a privilege. That’s how good businesses become great businesses.

Healthcare has had the patient lag, where they’ve been more passive and they’ve not really felt like they’re in an empowered position. I think a lot of things will start to accumulate to hit a tipping point where the patient will be more in a position of a consumer. When that light bulb goes off, the technology that they’re experiencing healthcare in needs to be more on par with other things that they experience in their lives.

The biggest advantage to the payer, the provider, and the patient is that when you look at where healthcare falls down, it doesn’t fall down in a science problem. It falls down in to an adherence and data-sharing problem. It’s not like we need better cures — we just really need to implement more effectively the ones we’ve already discovered.

Where do you see the company and the industry in the next 5-10 years?

We’ll be making more decisions in real time. Things like IBM Watson and other types of analytics that will be under the hood … we’ll  see like a TurboTax for health. These things have happened, so you need to do these things.

The problem with healthcare that we’re going to finally get our hands around over the next 10 years is, how do I go do those things? If somebody tells me to get an MRI, who’s going to do that for me? Innovation is going to start to fill in this last mile of putting the things that need to get done to actually getting done and being tracked. That will start to figure its way out over the next 10 years, principally because it’s being funded against something that is challenging our economy, where 86 percent of the dollars are being spent out there to manage chronic disease. If we don’t get our hands around it, we will end up breaking both the legs of the US economy.

What will change is that vendors, payers, and providers will figure out how to play nicely with the patient who ultimately is writing a big part of the check, whether in taxes or insurance premiums. They will start to find an experience to where they’re now more engaged. Not in vendor classic term of engaged, but making them a more efficient component of the healthcare equation.

Top News

Appalachian Regional Healthcare brings the computer systems of its Kentucky and West Virginia hospitals, pharmacies, and clinics back online after nearly three weeks of downtime caused by an attack of unspecified malware. At least one hospital source says the attack involved ransomware, but the hospital declined to confirm citing an ongoing federal investigation.

ARH says its IT department took its systems and network down to stop the spread of the virus, causing downtime it described as causing “some inconvenience for a few weeks.”

Reader Comments

From Follow the Money . “Re: Mayers Memorial Hospital District (CA). Their EHR was down for two weeks at a cost of $100,000.” The forwarded board of directors meeting agenda did not indicate the source of the downtime, but says half of the $100,000 was spent on “equipment to mitigate future issues.” I don’t know which system was down, but an earlier board meeting agenda mentions Paragon. It’s fun to read a small hospital’s simply written meeting information, which includes such interesting thoughts as an upcoming chocolate festival fundraiser, the poor attitudes of the ED doctors, a sticky ED door that unintentionally left the department open to the public, and the development of an IT disaster backup solution that might need to be revisited.

From HTCGLOBAL . “Re: CareTech Solutions. Jim Giordano is no longer president and CEO as of this past Friday. Seven top executives have resigned in the past six months. HTC Global continues to offshore work.” Unverified, but the company’s executive page and Giordano’s LinkedIn profile are unchanged. HTC Global Services, which offers IT and BPO services, bought the company in December 2014.

From Ex-PwC Consultant . “Re: PricewaterhouseCoopers Advisory Services. Has been quietly laying off workers all summer, with rumors of 20-25 percent let go.” Unverified.

HIStalk Announcements and Requests

Nearly half of poll respondents think the most important healthcare issue in the presidential election is healthcare costs. New poll to your right or here. who would you vote for if the presidential election were held today?

I’m excited to offer (below) the first of an ongoing series I’m calling Decisions. I’ve been talking with the folks at Definitive Healthcare about getting fresh updates about hospital software decisions and the company graciously offered to share what they learn with HIStalk readers. They didn’t even ask for anything in return, not even a plug, but it’s only fair to credit them as the source.

Last Week’s Most Interesting News

HHS awards $87 million in EHR improvement grants to 1,310 safety net health centers.

Altos announces that it will acquire Anthelio Healthcare Solutions for $275 million.

McKesson withdraws its participation in the independent InSight user group conference after Meditech and Cerner are invited to present alternatives to McKesson Paragon.

Russian backers breach the World Anti-Doping Agency’s systems and publish the medical records of Olympic athletes.

Apple releases iOS 10, which includes C-CDA support via HealthKit.

In England, NHS awards $13 million each to 12 health IT global exemplars to establish best practices.

Dartmouth-Hitchcock Medical Center (NH) will lay off 460 employees, blaming its financial losses on billing-related expenses and implementing of new IT systems.

Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models .” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia .” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia ,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Money-losing, for-profit hospital operator Community Health Systems is rumored to be exploring the sale of its business, although the company’s massive debt may limit interest. Shares are down 76 percent since June 2015 even after a 16 percent jump Friday when word of the possible sale leaked out. The company operates 158 hospitals.

Sales

The Healthix HIE (NY) chooses Verato’s identity management technology, which claims to deliver up to 98 percent matching accuracy by comparing known information to that contained in commercially available databases. The VA is another customer. Verato raised $12.5 million in a single funding round in January 2015 under its original name Araxid.

Decisions

Blue Mountain Hospital District (OR) will change time and attendance software from Healthland to ADP on October 1, 2016.

Valley Hospital (WA) will switch from Meditech to Cerner in 2017.

Lakes Regional General Hospital (NH) will move from NextGen to Cerner in December 2016.

Saint Clare’s Hospital – Denville (NJ) will replace Cerner with Epic in early 2018.

These provider-reported updates are provided by Definitive Healthcare. which offers powerful intelligence on hospitals, physicians, and healthcare providers.

Announcements and Implementations

In England, Cambridge University Hospital NHS Foundation Trust will outsource its IT infrastructure services for an estimated $182 million over seven years. HPE provides those services now via a 10-year agreement signed when the trust chose Epic in 2012. The trust’s growing financial deficit and significant quality problems triggered the resignation of its CEO and finance director in September 2015.

Government and Politics

The National Institutes of Health will require drug and medical device companies to post the results of all NIH-funded clinical studies – not just the favorable ones – to ClinicalTrials. gov starting January 18, 2017.

Oracle will pay $25 million in cash and provide products worth another $75 million to settle lawsuits over its performance in the failed Cover Oregon insurance exchange, for which Oracle was originally paid $240 million. The state had sought $6 billion in damages, but wasn’t willing to take the case to trial since legal fees alone would have run $1.5 million per month and it had already paid lawyers $20 million in the several lawsuits each party filed against the other.

Privacy and Security

Forward Health Group’s security expert Ed Skaife is named Up and Comer Runner-Up in an international security leadership award competition.

Other

The three big drug companies that manufacture insulin have increased average prices more than tenfold in the past 20 years in lockstep, with all three companies expressing indignation that anyone would look at list prices since insures get big discounts. The chart above shows the price of Humalog and Novolog, but you would notice that only with sharp eyesight since the prices remained identical while rapidly increasing over 20 years.

Vince and Elise offer Part 7 of their “Rating the Ratings” series, this time looking at physician practice EHRs.

Sponsor Updates

Experian Health will exhibit at the RBMA Fall Educational Conference September 25-27 in New Orleans.

PatientMatters will exhibit at the Minnesota Hospital Association Annual Meeting September 21-23 in Brainerd.

Qpid Health. Sagacious Consultants. Versus Technology. and Zynx Health will exhibit at Epic’s UGM September 21-23 in Verona, WI.

Red Hat announces plans for new facility in Boston.

The SSI Group will exhibit at the AMSURG Connections Cafe September 28 in Lake Buena Vista, FL.

Sunquest Information Systems will exhibit at CAP’16 – The Pathologists Meeting September 25-28 in Las Vegas.

Surescripts will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.

Audacious Inquiry is sponsoring the SHIEC Annual Conference in Scottsdale, AZ this week.

Meditech will attend the 2016 InSight Annual Conference September 27-30 in San Antonio, TX.

TeleTracking sponsors The DAISY Award for Extraordinary Nurses.

Tierpoint will host Techpalooza September 22 at its facility in Durham, NC.

Valence Health will exhibit at the ASHHRA annual conference September 24-27 in Grapevine, TX.

Verscend will host its annual conference September 27-30 in Palm Desert, CA.

Consulting Magazine includes Huron on its list of 2016 Best Firms to Work For.

Healthwise is included in Fortune’s “100 Best Workplaces for Women.”

ZeOmega launches the ZeExchange e-newsletter.

ZirMed will exhibit at HBMA The Healthcare Revenue Cycle Conference September 21-23 in Atlanta.

Contacts

HHS will provide $87 million to 1,310 safety net health centers for purchasing or upgrading EHRs, supported by the ACA’s Community Health Center Fund that was extended under MACRA.

HHS reports that 98 percent of health centers use EHRs. Nearly three-fourths of the patients they serve are insured.

Reader Comments

From Lana Retentive . “Re: Charleston Area Medical Center (WV). Goes live this week in the first prominent Soarian to Millennium conversion that was supposed to have been completed in June. The go-live vendor has been asked to bring in SMEs in charging and patient accounting, but no word on whether they’re using a charge validation vendor.” Unverified.

From Xander Steel . “Re: startups. You told the would-be CEO that HIStalk readers won’t be interested in companies until they reach either $1 million in funding or $5 million in revenue. I’m not really interested in stories about capital raised when there’s no existing demand. Any chance when you disclose investment funding that you can also mention whether the company has actual revenue? I know it’s easier said than done since the companies aren’t publicly traded.” I don’t know how to get revenue information since those small companies rarely want to disclose it (which tells you that it’s likely minimal) and their numbers would be self-reported and unaudited anyway. My newsworthiness threshold of $1 million in funding is low enough that many companies can raise that much without having any paying customers, which doesn’t necessarily mean you would be wise to become one. Significant funding suggests that investors with access to inside information bought in for good reason, but that might be based on future opportunity rather than present revenue (much less profit).

From Doughboy . “Re: Epic. Can you believe that a publication ‘reported’ that the company’s R&D spending exceeds Silicon Valley companies without doing any type of verification?” I believe it. The obviously star-struck publication ran Judy Faulkner’s claim that Epic spends 50 percent of operating expenses on R&D without validating that number, then compared it to the SEC-filed data of Epic’s publicly traded competitors in trying and failing to make a point without letting those companies respond. The goal was obviously to earn clicks, not to provide useful information.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor InMediata. The Charlotte, NC-based company‘s InBanking payment reconciliation solution eliminates manual ERA payment and patient payment reconciliation to bank deposits; automates complex billing scenarios by splitting ANSI 835 files into separate billing systems; and converts paper payments to electronic files for posting and reconciliation. CEO and industry long-timer John Marron explained the “banking as the last mile” problem well when I interviewed him a few months ago, pointing out that while front-end RCM functions are mostly automated and clearinghouses have become commoditized, the back-end work (payments, reconciliation, and payment analytics) is mostly inefficiently manual. Thanks to InMediata for supporting HIStalk.

This week on HIStalk Practice: Medical associations weigh in on new MACRA options. The Maine Medical Association endorses DrFirst eRx solutions. AMD Global Telemedicine expands Massachusetts headquarters. Mediware adds PQRS reporting capabilities to its rehab EHR. Lynchburg, VA-area practices join Privia Medical Group. CompuLink gets into telemedicine.

This week on HIStalk Connect: Sanofi and Verily Life Sciences launch diabetes management company. Chrono Therapeutics raises a $47.6 million Series B. Frost & Sullivan recognizes Validic with an innovation leadership award. Samsung-backed smart belt startup raises more than double its Kickstarter goal.

I’m beginning to think that a significant percentage of health IT executives sport disfiguring facial injuries or were raised in Amish families considering that their graven image is nowhere to be found on the Internet, including on their LinkedIn profiles. I frankly distrust people whose photos aren’t available online. It’s only slightly better when someone shrinks their LinkedIn photo in failing to understand that the right process is to use a full-sized image and let LinkedIn thumbnail it automatically, which doesn’t seem too far beyond the understanding of technology executives.

Webinars

September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements .” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia .” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia ,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Huron Consulting Group renames itself to Huron.

Team messaging vendor Klara, which describes itself as “a professional WhatsApp for medicine,” raises $3 million, increasing its total to $5.5 million. The company pivoted from teledermatology software to messaging just a few weeks back. It did not inspire my confidence that the company’s website was down all day Thursday as I tried to learn more.

In Germany, officials reportedly raid the offices of eight drug wholesalers, including McKesson, to determine if they illegally conspired to avoid stealing each other’s customers.

A federal judge allows Cave Consulting Group’s antitrust lawsuit against OptumInsight to continue. CCG says OptumInsight, owned by UnitedHealth Group, controls 90 percent of the claims grouper software market only because the company it acquired in 2003, Symmetry Health Data Systems, lied on its patent application. UHG agreed in April 2015 to pay CCG $12 million for infringing on its patents.

A Network World review of the 500 largest publicly traded companies finds that 25 of them disclose CIO pay. On their list is former Kaiser Permanente CIO Phil Fasano, who joined insurer AIG in the newly created position of EVP/CIO in late 2014 and was paid $8.4 million in 2015 as the #3 top earner. Walgreens Boots Alliance CIO Tim Theriault took the #1 spot with $13.6 million.

Sales

Vigilance Health (CA) chooses population health management technology from EQHealth Solutions for chronic care management and care coordination programs in 51 California counties.

Nebraska Medicine chooses and implements Nuance Dragon Medical One for clinical documentation in Epic, with 94 percent of its surveyed doctors saying it helps them practice better medicine, 71 percent reporting that their documentation has improved, and 50 percent saying Nuance saved them at least 30 minutes per day.

People

Julie Boughn (Cognasante) joins Audacious Inquiry as senior director.

CTG promotes Angela Rivera and Robert Barras to vice president.

Announcements and Implementations

The Department of Defense approves the participation of Fort Drum Medical Department Activity (NY) with the HIE of HealtheConnections, which will combine the military’s medical records of soldiers and families with those contributed by 300 connected civilian facilities to create a single overall view.

Harvard Medical School launches Library of Evidence, which offers free, evidence-based imaging clinical decision support that can be embedded in EHRs to help clinicians choose the most appropriate imaging tests.

Lenovo Health and LifeMed ID partner to offer an identity management solution that includes a trusted patient ID token that links to medical records. According to Lenovo Health’s website, providers can “achieve 100% accurate.”

National Decision Support Company will offer cardiac imaging appropriate use criteria from the American College of Cardiology.

Government and Politics

Eight Republican senators that include HELP committee chair Lamar Alexander (R-TN) introduce emergency, one-year legislation that would eliminate ACA-mandated penalties for those who don’t buy health insurance and would allow consumers who are covered by exchange-issued plans to use their federal government premium subsidies to buy plans elsewhere.

Privacy and Security

A dental practice whose patient information was exposed to the Internet explains the odd situation: (a) the practice gave live patient data to a vendor whose system it was considering; (b) the practice decided that same year not to buy that system; (c) the vendor took the server offline in 2004; and (d) somehow the server (now unsecured) was brought back online 10 years later for a two-week period in 2014 during which the practice’s patient information was exposed.

The Dark Overlord (or other hacker claiming to be him) threatens to publish patient information from St. Francis Health System (OK) unless it pays $15,000 by Sunday.

A single ransomware author claims to have made $94 million in profit during the first half of 2016.

A legal preview of patient and provider class action lawsuits brought against Banner Health (AZ) following a breach of its food service point-of-sale systems that exposed the information of 3.7 million people raises these issues:

The plaintiffs don’t know whether hackers actually accessed or used the information, only that they might at some point.

The suit does not claim breach of contract, which doesn’t always work in breach lawsuits, and instead argues that Banner made an enforceable promise without consideration (promissory estoppel).

The plaintiffs argue that Banner didn’t notify them promptly.

The case uses recent FTC enforcement actions to claim that Banner violated the FTC act that says lax cybersecurity constitutes “unfair or deceptive acts.”

Technology

Accenture announces a health IT innovation challenge tied to its venture fund.

BSX Athletics launches a Kickstarter campaign to fund its LVL wearable hydration monitor. It has raised $200,000 vs. a goal of $50,000 and is a smart idea that apparently actually works, although Kickstarter projects are notorious for failing and not everybody wants to wear a one-trick wristband 24/7.

Other

An HHS OIG report finds that for-profit hospices are aggressively recruiting patients who aren’t terminally ill and who may not know that choosing palliative care means they won’t receive other treatment. Medicare paid $15 billion for hospice care in 2013 and is trying to recover $1 billion from for-profit hospices in which one in three patients leave the service without dying, double the rate of non-profit hospices. In Mississippi, 41 percent of hospice patients were discharged alive. 

Former New York City Mayor Michael Bloomberg donates another $300 million to the Johns Hopkins Bloomberg School of Public Health, saying the US should lead the world in life expectancy instead of placing 31st. Bloomberg has donated $1.5 billion to Hopkins, of which the School of Public health received $684 million, explaining, “It’s a lot cheaper to prevent than to cure, and it’s certainly a lot more humane.”

A man who had been hospitalized for 22 years with spinal muscular atrophy dies at 54, to the consternation of employees who had grown attached to him. It would be interesting to see the final bill and to know who’s paying it.

Sponsor Updates

Impact Advisors and NTT Data make Consulting Magazine’s list of “Best Small Firms to Work For.”

InterSystems and Intelligent Medical Objects will exhibit at the Epic UGM September 21-23 in Verona, WI.

PDR Network CMO Sal Volpe, MD receives the 2016 Patient-Centered Medical Home Practice Award.

Live Process will exhibit at California Hospital Association Disaster Planning 2016 September 19-21 in Sacramento.

Nordic is named one of Madison Magazine’s best places to work.

Vyne President and CEO Lindy Benton presents at the HERe Conference in Nashville.

AlleyWatch spotlights MedCPU in its coverage of New York City startups that have raised the most amount of money.

Meditech and Nvoq will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.

Navicure will exhibit at Kansas MGMA September 21-23 in Overland Park.

Netsmart will exhibit at the Kansas Public Health Association conference September 20 in Wichita.

Nordic will host an open house September 19 in Madison, WI.

Obix Perinatal Data System will exhibit at the Georgia Perinatal Conference September 21-23 on St. Simon’s Island.

Infor Healthcare will exhibit at ASHHRA 2016 September 25 in Grapevine, TX.

Clockwise. MD will exhibit at the UCAOA Fall conference in Nashville September 29 – October 1.

Christy Kaplan and Susan Tolan of The Chartis Group presented “Transforming Care Coordination: Keys to Operationalizing Your Pop Health Strategy” at the HIMSS Population Health Forum this week.

Contacts

I was reminded today that this year marks the 20th anniversary of the Health Insurance Portability and Accountability Act of 1996, affectionately known as HIPAA (or HIPPA, as the case often is). As much as we lamented its beginning, most of us had no idea how much more regulation we would see in the healthcare space during the subsequent decades. Physicians and other healthcare providers are now more regulated than they have ever been, which has contributed significantly to physician burnout and early retirement in many communities.

Regulations are often nested within other policy and regulatory documents. A recent example of this is a requirement in the proposed 2017 Medicare fee schedule that would require surgeons and other procedural physicians to report a series of G codes during the postoperative period. The codes vary based on place of service, patient complexity, and time. They don’t match cleanly with existing bundled services. The fee schedule also proposes changes to the quality measures used for Accountable Care Organizations, which also met with resistance.

Sometimes CMS announces plans which benefit physicians, which feels like a rarity. The recent announcement of a “pick your pace” approach to MACRA implementation was welcomed due to the apparent flexibility of the approach. There are a few options for MIPS reporting in 2017:

Providers can simply test their ability to report data, doing so at least once at some point during the year. Completion of testing allows providers to avoid penalties and ensures that systems are functioning prior to greater participation in subsequent years.

Providers can also consider reporting for part of the calendar year. However, they must report performance in all three Composite Performance Score (CPS) categories. This approach could result in a small bonus in 2019.

Providers can report the full calendar year (again in all three categories) to achieve what CMS describes as a “modest” bonus in 2019.

Providers participating in certain Advanced Alternative Payment Models can qualify for a five percent bonus.

Selecting the third option will depend on the ability of vendors to quickly become compliant with the requirements of the final rule, which is expected to be released by early November. This means that they have very little time to achieve software readiness and upgrade thousands of providers. Depending on vendor resources and how much prep work has been done in anticipation of the release of the final rule, full-year reporting may be little more than a pipe dream.

For those of us who live and breathe this on a daily basis, having some flexibility in reporting seems refreshing. But for the large numbers of physicians and practices who have no idea what MACRA even is, let alone that these regulations are coming, the flexibility won’t be very comforting.

I recently received a blast letter from the Drug Enforcement Administration letting me know I would have to upgrade my browser in order to access DEA resources and renew my registration. That’s insignificant to many physicians, yet the DEA felt it was important enough to mail paper correspondence to every registered physician across the country. MACRA and the associated penalties and incentives are a big deal. Where is the letter to all Medicare providers? CMS is expecting physicians to follow blogs and tweets and webcasts that many physicians don’t even know exist.

I’m not absolving physicians from being responsible for what is going on in the world around them, but merely commenting on the reality of many physicians out there, which has also been reflected in various surveys and articles. Ultimately if a physician is going to contract with a payer, he or she is responsible for knowing the rules, but it certainly could be easier.

What’s also not easy is figuring out how to actually achieve savings under Alternative Payment Models. Recently CMS released performance data for 2015. The numbers show that of 404 Medicare ACOs, only 125 of them qualified for shared savings. Of the 392 Shared Savings Program ACOs, only 119 qualified for shared savings. Participation in Pioneer ACOs continues to shrink, with only 12 remaining.

I don’t think those statistics make Alternative Payment Models look appealing to the average physician. Of course the “appeal” is different for providers employed by hospitals and large health systems who are simply forced to participate. Those that weren’t successful based on the metrics are still doing the extra work required of ACO members but just not getting the shared savings payments at the end.

I do feel that CMS is listening and trying to respond. Recently they changed the rules for the Medicare Chronic Care Management services code to remove a requirement that providers have 24/7 access to patient records. The code allows providers to bill for coordination of care for patients who have chronic conditions. However, I’m not sure what kind of burden the 24/7 rule really was.

The bigger barrier in my experience is the fact that patients have to pay a portion of the charge, and many don’t see the benefit because the services performed on their behalf are often done behind the scenes – phone calls to consultants, review of personal health log data, etc. There’s also a process required to obtain patient consent for participation which adds to challenges in adopting the service. I find it funny that people who will pay for a maintenance/protection program for their phone will balk at paying for something similar to help safeguard their health.

I’m mentoring some medical students and several are out on ambulatory clinical clerkships, working with practicing community physicians. They always have questions about how regulations are going to impact them in practice. Sometimes I have answers and sometimes there are no good answers. What they see, however, is definitely driving them away from primary care, where it seems that providers feel a greater burden. We’re getting thousands of new Medicare beneficiaries each day, so the need for processes and policies is real in order to successfully manage the demands. I think many of us wish that there was just a better way.

What are you doing to celebrate the 20th anniversary of HIPAA? Email me.

The Surgeon General’s Rallying Cry Against the Opioid Epidemic Must Also Be a Call to Arms for Healthcare IT By Thomas Sullivan, MD

In a rare open letter to the nation’s doctors, US Surgeon General Vivek Murthy, MD, MBA sounded a rallying cry to engage their greater participation in the opioid-abuse crisis afflicting our country. Missing from the USSG’s commendable call to arms, though, was mention of the role technology plays in reducing drug diversion and doctor shopping and providing ready access to services to support patients.

Those of us in healthcare IT know that we are critical to this cause. The USSG is talking to our customers, and we know our customers aren’t adopting as quickly as they could the substance abuse-fighting technologies that are widely available to them. This includes a variety of technology solutions such as:

E-prescribing technology, particularly EPCS to support the electronic prescribing of controlled substances, which is key to helping providers more efficiently deploy and monitor prescription medicines being prescribed or over-prescribed across a practice.

Medication adherence monitoring technology that lets providers gauge in real time, at the point of encounter, a patient’s level of compliance with drug therapy and provide patients with evidence-based support and services for self-management.

Clinical decision support that helps doctors avoid adverse drug events and medication errors.

State-run prescription drug monitoring programs (PDMPs) designed to help law enforcement track the use of controlled substances and help prescribers identify doctor shoppers and others seeking illicit access to controlled substances.

Specific to the opioid abuse epidemic, the most important next step is for physicians to be able to check PDMPs within their normal workflow. Simply said, the integration and availability of PDMP data within e-medication management solutions — e-prescribing, medication history services, medication adherence tools and the like — will result in the greatest use of PDMP data and the best one-two tech-assisted punch we have in the opioid battle.

Over the past two years, policymakers have begun to take action in using EPCS to address this crisis. This past March, New York State took a major step toward this goal when it began requiring e-prescriptions for all controlled substances as well as all non-controlled substances, frequently referred to as “legend drugs.” Known as I-STOP, the Internet System for Tracking Over-Prescribing act, originally passed in 2012, New York’s experience now serves as a case study for other states that wish to modernize their prescribing infrastructure and address opioid abuse.

Maine as well now will require opioid medications to be prescribed electronically via Drug Enforcement Agency-certified EPCS solutions beginning in July 2017. Several other states including Massachusetts, Missouri and Maryland are also considering or working to pass mandatory EPCS requirements for prescribers.

Unfortunately, neither New York nor Maine PDMP data is currently accessible to health IT vendors for integration into the prescribing workflow of providers.

E-prescribing – the direct digital transfer of patient prescriptions from provider to pharmacy – is broadly recognized as an important tool in helping promote patient safety, convenience, and overall efficiency for all stakeholders in the prescription process. E-prescribing is well understood to assist prescribers by allowing patients and doctors to better guard against medication errors, such as drug-to-drug interactions, reduce common errors inherent in paper-based prescribing — including illegible handwriting, misinterpreted abbreviations, and unclear dosages, — and provide critical decision support tools.

Despite the fact that, nationwide, more than 70 percent of doctors transmit most prescriptions electronically, the vast majority of these prescriptions are only for legend drugs. In comparison, less than 10 percent are using EPCS solutions to e-prescribe controlled substances. However, in New York, the I-STOP legislation has driven adoption of EPCS to over an estimated 70 percent. As such, all indications are that the laws passed in New York and Maine mandating use of EPCS and PDMPs will almost certainly prove helpful in curbing opioid abuse, fraud, and diversion and help prevent possible addiction down the line.

However, full adoption of PDMPs will likely never be achieved until the PDMP information is accessible in the doctor’s technology workflow. Ultimately, the opioid-abuse battle needs to be fought through states enabling their respective PDMP data to flow through doctors’ own workflows, as opposed to requiring that physicians and clinicians go outside their familiar software tool and interact with a separate portal in order to access their respective state PDMP databases.

In the case of New York State, the Medical Society of the State of New York conducted a survey that found a large percentage of prescribers believed that forcing mandatory compliance was placing an undue burden on their practices. No doubt, physicians feel overburdened with IT mandates. Improving integration between PDMPs and electronic health records will alleviate some of these burdens and allow for better compliance.

States must work more closely with the healthcare community to remove obstacles that will allow as close to 100 percent compliance as possible. Every state has the opportunity to learn from New York to smooth implementation and drive adoption to make a meaningful impact on the growing opioid abuse epidemic. Leadership in healthcare IT companies must be more vocal about our role and responsibilities in enabling doctors on the ground.

With the US Surgeon General weighing in, those of us in the healthcare IT community must rise up to make our voices heard. The importance of integrating e-medication management tools and EPCS solutions with PDMP data cannot be overestimated. It is the best path toward helping our customers — the doctors — make the right decision, at the right time, with the right data, on the right platforms.

Thomas Sullivan, MD is chief strategy and privacy officer of DrFirst of Rockville, MD.

The Electronic Health Record and The Golden Spike By Frank D. Byrne, MD

On May 10, 1869, at a ceremony in Utah, Leland Stanford drove the final spike to join the first transcontinental railroad across the US. Considered one of the great technological feats of the 19th century, the railroad would become a revolutionary transportation network that changed the young country.

For the past few years, the healthcare industry and the patients in its care have experienced a similar “Golden Spike Era” through the deployment of the electronic health record (EHR). Others have used this analogy, including author Robert Wachter, MD at a recent excellent presentation at the American College of Healthcare Executives 2016 Congress on Healthcare Leadership.

Why is this comparison relevant? While the Utah ceremony marked the completion of a transcontinental railroad, it did not actually mark the completion of a seamless coast-to-coast rail network. Key gaps remained and a true coast-to-coast rail link was not achieved until more than a year later and required ongoing further improvements.

Similarly, while a recent study indicated that 96 percent of hospitals possessed a certified EHR technology and 84 percent had adopted at least a basic EHR system in 2015, there is still much more needed to achieve optimized deployment of the EHR to make healthcare better, safer, more efficient, and to improve the health of our communities.

Nonetheless, the EHR is one of the major advances in healthcare in my professional lifetime. It is an essential tool in progress toward the Institute for Healthcare Improvement’s “Triple Aim for Healthcare”– better patient experience, lower per-capita cost, and improved population health. We cannot achieve those laudable goals without mining and analyzing the data imbedded in the EHR to generate useful information to guide our actions. Advances in data science are enabling the development of meaningful predictive analytics, clinical decision support, and other tools that will advance quality, safety, and efficiency.

But there is much work to do. Christine Sinsky, MD, vice president of professional satisfaction for the American Medical Association, and others have written with concern about dissatisfied physicians, nurses, and other clinicians who feel the EHR is distracting them from patients care and meaningful interactions with their patients.

“Contemporary medical records are used for purposes that extend beyond supporting patient and caregiver … the primary purpose, i. e. the support of cognition and thoughtful, concise communication, has been crowded out,” Sinsky and co-author Stephen Martin, MD note in a recent article.

Perhaps you’ve also seen the sobering drawing by a seven-year-old girl depicting a doctor focused on the computer screen with his back to her, his patient.

Some of the EHR’s shortcomings may be the result of lack of end user input prior to implementation, possibly due to the implementing organization not incorporating the extensive research gathered by the EHR providers. Further, even if one gets end-user input prior to implementation, there’s always challenges prior to go-live, and it seems to me that op

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Central nervous system: Nervousness, restlessness

Gastrointestinal: Nausea, vomiting

<1% (Limited to important or life-threatening): Insomnia, irritability, seizure, tremor

Overdosage/Toxicology

Symptoms of overdose include nausea, vomiting, insomnia, irritability, tachycardia, seizures, tonic-clonic seizures, insomnia, and circulatory failure. If seizures have not occurred, induce vomiting; ipecac syrup is preferred. Do not induce emesis in the presence of impaired consciousness. Repeated doses of charcoal have been shown to be effective in enhancing the total body clearance of theophylline. Do not repeat charcoal doses if an ileus is present. Charcoal hemoperfusion may be considered if serum theophylline levels exceed 40 mcg/mL, the patient is unable to tolerate repeat oral charcoal administrations, or if severe toxic symptoms are present. Clearance with hemoperfusion is better than clearance from hemodialysis. Administer a cathartic, especially if sustained release agents were used. Phenobarbital administered prophylactically may prevent seizures.

Drug Interactions

Substrate of CYP1A2 (major), 2C8/9 (minor), 2D6 (minor), 2E1 (major), 3A4 (major); Inhibits CYP1A2 (weak)

CYP1A2 inducers: May decrease the levels/effects of theophylline. Example inducers include aminoglutethimide, carbamazepine, phenobarbital, and rifampin.

CYP1A2 inhibitors: May increase the levels/effects of theophylline. Example inhibitors include amiodarone, ciprofloxacin, fluvoxamine, ketoconazole, norfloxacin, ofloxacin, and rofecoxib.

CYP2E1 inhibitors: May increase the levels/effects of theophylline. Example inhibitors include disulfiram, isoniazid, and miconazole.

CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of theophylline. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.

CYP3A4 inhibitors: May increase the levels/effects of theophylline. Example inhibitors include azole antifungals, ciprofloxacin, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, quinidine, and verapamil.

Ethanol/Nutrition/Herb Interactions

Food: Food does not appreciably affect the absorption of liquid, fast-release products, and most sustained release products; however, food may induce a sudden release (dose-dumping) of once-daily sustained release products resulting in an increase in serum drug levels and potential toxicity. Avoid excessive amounts of caffeine. Avoid extremes of dietary protein and carbohydrate intake. Changes in diet may affect the elimination of theophylline; charbroiled foods may increase elimination, reducing half-life by 50%.

Compatibility

Y-site administration: Compatible: Acyclovir, ampicillin, ampicillin/sulbactam, aztreonam, cefazolin, cefotetan, ceftazidime, ceftriaxone, cimetidine, cisatracurium, clindamycin, dexamethasone sodium phosphate, diltiazem, dobutamine, dopamine, doxycycline, erythromycin lactobionate, famotidine, fluconazole, gatifloxacin, gentamicin, haloperidol, heparin, hydrocortisone sodium succinate, lidocaine, linezolid, methyldopate, methylprednisolone sodium succinate, metronidazole, midazolam, milrinone, nafcillin, nitroglycerin, penicillin G potassium, piperacillin, potassium chloride, ranitidine, remifentanil, sodium nitroprusside, ticarcillin, ticarcillin/clavulanate potassium, tobramycin, vancomycin. Incompatible: Hetastarch, phenytoin

Compatibility when admixed: Compatible: Cefepime, chlorpromazine, deslanoside, fluconazole, furosemide, hydrocortisone hemisuccinate, lidocaine, methylprednisolone sodium succinate, papaverine, verapamil Incompatible: Ascorbic acid injection, ceftriaxone, cimetidine

Mechanism of Action

Causes bronchodilatation, diuresis, CNS and cardiac stimulation, and gastric acid secretion by blocking phosphodiesterase which increases tissue concentrations of cyclic adenine monophosphate (cAMP) which in turn promotes catecholamine stimulation of lipolysis, glycogenolysis, and gluconeogenesis and induces release of epinephrine from adrenal medulla cells

Pharmacodynamics/Kinetics

Absorption: Oral: Dosage form dependent

Distribution: 0.45 L/kg based on ideal body weight

Metabolism: Children >1 year and Adults: Hepatic; involves CYP1A2, 2E1 and 3A4; forms active metabolites (caffeine and 3-methylxanthine)

Half-life elimination: Highly variable and dependent upon age, liver function, cardiac function, lung disease, and smoking history

Time to peak, serum:

Oral: Liquid: 1 hour; Tablet, enteric-coated: 5 hours; Tablet, uncoated: 2 hours

I. V. Within 30 minutes

Neonates: 50% unchanged

Children >3 months and Adults: 10% unchanged

Dosage

Use ideal body weight for obese patients

I. V. Initial: Maintenance infusion rates:

6 weeks to 6 months: 0.5 mg/kg/hour

6 months to 1 year: 0.6-0.7 mg/kg/hour

Children >1 year and Adults:

Acute bronchospasm: See table.

Approximate I. V. maintenance dosages are based upon continuous infusions

Approximate I. V. Theophylline Dosage for Treatment of Acute Bronchospasm

Dosage for Next 12 h 1

Increasing dose: The dosage may be increased in approximately 25% increments at 2- to 3-day intervals so long as the drug is tolerated or until the maximum dose is reached

Maintenance dose: In children and healthy adults, a slow-release product can be used; the total daily dose can be divided every 8-12 hours

Administration

Oral: Long-acting preparations should be taken with a full glass of water, swallowed whole, or cut in half if scored. Do not crush. Extended release capsule forms may be opened and the contents sprinkled on soft foods; do not chew beads.

Dietary Considerations

Should be taken with water 1 hour before or 2 hours after meals. Premixed injection may contain corn-derived dextrose and its use is contraindicated in patients with allergy to corn-related products.

Patient Education

Take exactly as directed; do not exceed recommended dosage. Avoid smoking (smoking may interfere with drug absorption as well as exacerbate condition for which medication is prescribed). If you are smoking when dosage is prescribed; inform prescriber if you stop smoking (dosage may need to be adjusted to prevent toxicity). Preferable to take on empty stomach, 1 hour before or 2 hours after meals, with a full glass of water. Do not chew of crush sustained release forms; capsules may be opened and contents sprinkled on soft food (do not chew beads). Avoid dietary stimulants (eg, caffeine, tea, colas, or chocolate - may increase adverse side effects). Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. You may experience nausea, vomiting, or lose of appetite (small, frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help). Report acute insomnia or restlessness, chest pain or rapid heartbeat, emotional lability or agitation, muscle tremors or cramping, acute headache, abdominal pain and cramping, blackened stool, or worsening of respiratory condition. Pregnancy precaution: Inform prescriber if you are or intend to become pregnant.

Nursing Implications

Monitor heart rate, CNS effects (insomnia, irritability); respiratory rate (COPD patients often have resting controlled respiratory rates in low 20s), serum theophylline level, arterial or capillary blood gases (if applicable)

Additional Information

Theophylline salt / theophylline content (percent)

Theophylline anhydrous (eg, most oral solids): 100% theophylline

Theophylline monohydrate (eg, oral solutions): 91% theophylline

Aminophylline (theophylline) (eg, injection): 80% (79% to 86%) theophylline

Oxtriphylline (choline theophylline) (eg, Choledyl ® ): 64% theophylline

Cardiovascular Considerations

Theophylline results in significant tachycardia and, at higher doses, may impair ventricular rate control in patients with atrial fibrillation. This is particularly a concern since patients with underlying chronic obstructive lung disease often have coexisting atrial fibrillation. Aminophylline can be used to treat patients who have adverse hemodynamic responses to adenosine or dipyridamole, when used during cardiovascular stress testing.

Dental Health: Effects on Dental Treatment

Prescribe erythromycin products with caution to patients taking theophylline products. Erythromycin will delay the normal metabolic inactivation of theophyllines leading to increased blood levels; this has resulted in nausea, vomiting, and CNS restlessness. Azithromycin does not cause these effects in combination with theophylline products.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May cause nervousness and restlessness; may rarely cause insomnia and irritability

Mental Health: Effects on Psychiatric Treatment

Barbiturates and carbamazepine may decrease serum levels while disulfiram, propranolol, and fluvoxamine may increase theophylline levels

Dosage Forms

[DSC] = Discontinued product

Capsule, extended release (Theo-24 ® ): 100 mg, 200 mg, 300 mg, 400 mg [24 hours]

Elixir (Elixophyllin ® ): 80 mg/15 mL (480 mL) [contains alcohol 20%; fruit flavor]

Infusion [premixed in D5W]: 0.8 mg/mL (500 mL, 1000 mL); 1.6 mg/mL (250 mL, 500 mL); 2 mg/mL (100 mL); 3.2 mg/mL (250 mL); 4 mg/mL (50 mL, 100 mL)

Solution, oral: 80 mg/15 mL (15 mL, 18.75 mL, 500 mL) [dye free, sugar free; contains alcohol 0.4% and benzoic acid; orange flavor]

Tablet, controlled release:

T-Phyl ®. 200 mg [12 hours; contains cetostearyl alcohol]

Uniphyl ®. 400 mg, 600 mg [24 hours; contains cetostearyl alcohol]

Tablet, extended release: 100 mg, 200 mg, 300 mg, 450 mg

Theochron ®. 100 mg, 200 mg, 300 mg [12-24 hours]

Tablet, immediate release:

Quibron ® - T: 300 mg

Theolair™: 125 mg, 250 mg

Tablet, sustained release (Quibron ® - T/SR): 300 mg [8-12 hours]

Tablet, timed release (Theolair™-SR [DSC]): 300 mg, 500 mg

References

"American Academy of Pediatrics Committee on Drugs. The Transfer of Drugs and Other Chemicals Into Human Milk," Pediatrics . 2001, 108(3):776-89.

Mokhlesi B, Leikin JB, Murray P, et al, "Adult Toxicology in Critical Care: Part II: Specific Poisonings," Chest . 2003, 123(3):897-922.

International Brand Names

Aerobin ® (DE); Aerobin ® [inj.] (DE); Aerobin Mite ® (TH); Aerodyne ® (AT); Aerodyne retard ® (AT); Afonilum ® (CZ, DE, PL); Afonilum SR ® (PL, RO); afpred forte-Theo ® (DE); Almarion ® (TH); Aminofilin ® (AR); Aminofilin Forte ® (AR); Aminomal Elisir ® (IT); Apo-Theo LA ® (CA, SG); Asmafilina ® (EC); Asmanyl ® (BD); Asmasolon ® (TH); Asthma-T ® (IL); Austyn ® (AU); Bronchoparat ® (DE); Bronchophylin ® (ID); Bronchoretard ® (DE); Bronkolin ® (TR); Bronsolvan ® (ID); Contiphyllin ® (DE); Crisasma ® (AR); Cronasma ® (DE); Diffumal ® (IT); Dilatrane ® (FR); Ditenate ® (DE); Drilyna ® (AR); Drilyna forte ® (AR); Duraphyllin ® (DE); Durofilin ® (RU, YU); Egifilin ® (HU); Elixifilin ® (ES); Elixine ® (CL); Elixofilina ® (DO); Eufilina ® (PT); Euphyllina ® (IT); Euphyllin ® (BE, CH, CZ, PL); Euphylline L. A. ® (FR); Euphyllin Quick ® (RO); Euphyllin Retard ® (AT, EG, FI, ID, JO, KW, LB, PL, ZA); Euphyllin retard N ® (CH); Euphylong ® (DE, EG, HU, JO, KW, LB, RU, SE, YU); Franol ® (TH); Frivent ® (IT); Glyphyllin ® (IL); G-Theophylline ® (BD); Histafilin ® (ES); Jasonphylin ® (BD); Kalbron ® (ID); Lasma ® (IE); Liopect ® (AR); Med-Phylline ® (TH); Nefoben ® (AR); Novo-Theophyl SR (CA); Nuelin ® (CR, DK, DO, FI, GB, GT, HK, HN, NO, NZ, PA, SG, SV, TH); Nuelin SA ® (GB, IE); Paidomal ® (IT); Pediaphyllin PL ® (BE, LU); Pharphylline ® (HK); Phylobid ® (IN, ZA); Phyloday ® (IN); Pirasmin ® (TR); PMS-Theophylline (CA); Pneumogeine ® (MC); Pro-Vent ® (IE); Pulmeno ® (ES); Pulmidur ® (AT); PulmiDur ® (DE); Pulmophylline (CA); Pulmo-Timelets ® (DE, DK); Quibron ® (ID); Quibron ® - T/SR (CA); Ramaphyllin ® (IL); ratio-Theo-Bronc (CA); Respicur ® (AT, IT); Retafyllin ® (FI, HU, SG, TH); Retafyl ® (RU); Retaphy SRl ® (ID); Sedacris ® (AR); Sinasmal ® (AR); Slo-Bid ® (HK, MX); Slo-Phyllin ® (GB, IE); Sodip-phylline Aquasol ® (CH); Solosin ® (DE); Solucao de Teofilina Berm&aacute;cia ® (BR); Spophyllin ® [compr.] (CZ, RU, SK); Spophyllin ® (CZ); Spophyllin ® [liqu. oral] (CZ); Talotren ® (TR); Tedralan ® (MC); Tefamin Elisir ® (IT); Temaco ® (TH); Teobid ® (CO, GT, PA, SV); Teoficol ® (BE); Teofilina Bermacia ® (BR); Teofilina Biocrom ® (AR); Teofilina ® (BR); Teofilina Ecar ® (CO); Teofilina Fabra ® (AR); Teofilina Genfar ® (EC); Teofilina Lafedar ® (AR); Teofilina Northia ® (AR); Teofilina Northia ® [compr.] (AR); Teofilina Ratiopharm ® (ES); Teofilinar ® (CO); Teofilina Retard ® (RO); Teokap ® (TR); Teolin ® (HR, SI); Teolixir ® (CO, ES); Teolong ® (BR, CR, DO, GT, HN, MX, PA, SV); Teosona ® (AR); Teotard ® (CZ, HR, PL, RO, SI); Teovent ® (PT); Terizol ® (AR); Teromol ® (ES); Thenglate ® (BD); Theo-2 ® (BE, LU); Theo-24 ® (IT); Theobilong ® (AT); Theobron ® (ID); Theo-Caps ® (PL); Theochron ® SR (CA); Theo-Dur ® (AR, AU, BE, CA, CZ, DK, ES, FI, GB, HK, IE, IT, LU, NO, NZ, PL, SE); Theofol ® (FI); Theofylamin "Medic" ® (DK); Theojap ® (BD); Theolair ® (BE); Theolair™ (CA); Theolair ® (CH, DE, ES, IT, LU, NL); Theolin ® (JO, NL, RO, SG); Theolong ® (JP); Theo Max ® (ES); Theomol ® (DE); Theonate ® (BD); Theo Pa ® (IN); Theophtard ® (HU); Theophyllin AL ® (DE); Theophyllin AZU ® (DE); Theophylline Bruneau ® (LU); Theophylline ® (IL); Theophyllin Heumann ® (DE); Theophyllin Ratiopharm ® (DE, LU); Theophyllin Sandoz ® (DE); Theophyllin Stada ® (DE); Theophyllinum ® (PL); Theophyllinum prolongatum ® (PL); Theoplus ® (AT, CR, CZ, DO, ES, GT, HN, PA, PL, SV, ZA); Theospirex ® (AT); Theospirex ® [caps./compr.] (AT, HU); Theospirex retard ® (PL); Theo-SR ® (RO); Theostat ® (FR); Theostat ® (LU, RU); Theotard ® (IL, RU); Theotrim ® (IL, TH); Theovent ® (HK, PL); theo von ct ® [caps.] (DE); theo von ct ® [inj.] (DE); Tromphyllin ® (DE); Unicontin ® (BD, IN); Uni-Dur ® (HR); Unidur ® (ID); Uni-Dur ® Ltec (RO); Uni-Dur ® (MX, PL, RO); Unifyl ® (AT); Unifyl Continus ® (CH); Unilair ® (DE); Unilong ® (ES); Uniphyl ® (HK); Uniphyllin Continus ® (GB, IE); Uniphyllin ® (DE, IE); Uniphyl ® SRT (CA); UniXan ® (DK); Uno-Lin ® (DK); Vent retard ® (ES); Xanthium ® (BE, FR, LU, SG, TH, TR); Zepholin ® (IE)



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Comprimidos 750 mg:

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Comprimidos dispersables 1000 mg:

cada comprimido dispersable contiene: Amoxicilina 1000 mg.

Suspension 250 mg:

cada 5 ml de suspension reconstituida contiene: Amoxicilina 250 mg.

Suspension 500 mg:

cada 5 ml de suspension reconstituida contiene: Amoxicilina 500 mg.

Suspension BID 1 g:

cada 5 ml de suspension reconstituida contiene: Amoxicilina 1000 mg.

Contraindicaciones:

Hipersensibilidad a las penicilinas.

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Comprimidos 500 mg:

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Suspension 250 mg:

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Posologia:

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Contraindicaciones:

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The risk of serious side effects for taking this medicine can be different if you take other medicines or if you suffer from a condition. Get your Risk Rating by creating a profile in a few steps.

Benefits:

We monitor your health and alert you to any safety updates and recalls.

You get to talk directly to other members about their experience.

You can create profiles for you and your loved ones.

Create my Profile Learn more about Risk Ratings

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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.

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Buy Generic For Clorprax Sr 150mg, Clorprax

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Generic Name: Bupropion

What is Generic for Clorprax* used for?

Generic for Clorprax* (Bupropion) is an antidepressant medication used to treat major depressive disorder. It is also used to treat seasonal affective disorder. Besides, this medicine is used as a smoking cessation aid to help people stop smoking. This medicine may also be used to treat other conditions as determined by your doctor.

What is the recommended dosage of Generic for Clorprax*?

The dosage of Generic for Clorprax* prescribed to each patient will vary. Always follow your physician? s instructions and/or the directions on the prescription drug label.

Generic for Clorprax* can be taken with or without food. Do not crush, chew, or break this medicine. Swallow the pill whole.

What if you miss a dose of Generic for Clorprax*?

If your physician has instructed or directed you to use Generic for Clorprax* medication in a regular schedule and you have missed a dose of this medicine, take it as soon as you remember. However, if it is almost time for your next dose, then skip the missed dose and go back to your regular dosing schedule. Do not double the doses unless otherwise directed.

What if you overdose on Generic for Clorprax*?

Any medication taken in excess can have serious consequences. If you suspect an overdose of Generic for Clorprax*, seek medical attention immediately.

What other drugs could interact with Generic for Clorprax*?

It may be noted that drugs other than those listed above may also interact with Generic for Clorprax*

Usually drug interactions occur when it is taken with another drug or with food. Before you take a medication for a particular ailment, you should inform the health expert about intake of any other medications including non-prescription medications, over-the-counter medicines that may increase the effect of Generic for Clorprax*, and dietary supplements like vitamins, minerals and herbal, so that the doctor can warn you of any possible drug interactions.

Generic for Clorprax* can interact with antipsychotics, anticoagulants, MAO inhibitors, antihistamines, and diet pills.

Do let your doctor know if you smoke, consume alcohol or caffeinated drinks, or use illegal drugs as these may interfere with the action of your medication. Make sure to inform your doctor of any medical conditions you may have, or any family history of medical problems. Do not start or stop using any medicine without consulting your doctor.

What are the side effects of Generic for Clorprax*?

Like other medicines, Generic for Clorprax* can cause some side effects. If they do occur, the side effects of Generic for Clorprax* are most likely to be minor and temporary. However, some may be serious and may require the individual to inform the doctor or visit the nearest hospital immediately.

It is pertinent to note that side effects of Generic for Clorprax* cannot be anticipated. If any side effects of Generic for Clorprax* develop or change in intensity, the doctor should be informed as soon as possible.

Generic for Clorprax* can cause side effects such as anxiety, trouble sleeping, weight loss or gain, nausea, vomiting, headache, dry mouth, confusion, dizziness, and tremors. This is not a complete list of all side effects. Do concur with your doctor and follow his directions completely when you are taking Generic for Clorprax*

What are the questions to ask your doctor before taking Generic for Clorprax*?

Is it possible for me to take Generic for Clorprax* with other drugs? Should certain beverages, foods and other products be avoided when I take Generic for Clorprax*? What are the possible drug interactions of Generic for Clorprax*? How will Generic for Clorprax* work in my body? How should Generic for Clorprax* be taken? How to reduce the risk of Generic for Clorprax* drug interactions and side effects?

Note

The health and medical information provided here is intended to supplement and not substitute for the expertise and judgment of your physician, pharmacists or other health care professional. It should not be understood to indicate that the use of Generic for Clorprax* is safe, appropriate or effective for you. Always consult your health care professional before using this, or any other, drug.



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Buy Lamivir Online, Lamivur

Lamivir - 100 mg

Description of the drug:

Lamivudine is the active ingredient present in Lamivir 100 mg. It is an anti-viral medicine that prevents the human immunodeficiency virus (HIV) or hepatitis B virus from growing in the body. You can buy Lamivir 100 mg online.

Indications and Usage:

The drug is used to treat HIV/AIDS. Keep in mind, the medicine will not cure the body of the condition. HIV/AIDS is typically treated with a combination of drugs. Keep in mind to take the medicines as advised by your doctor.

Dosage and Administration

Recommended dose:

Take the medicine as per the advice of your doctor or according to the instructions on the medicine label. Stick to your doses until the doctor advises otherwise. Make sure also to avoid taking the medicine after the prescribed time is over. Your medicine packet would have a patient leaflet, which you can refer to know more about the medication. The medicine must be taken with or without food.

The medicine dosage may depend on several factors including sex, age, allergy to drugs and severity of condition among many other factors. The dosage will be prescribed by your doctor after examining you properly. Keep in mind to adhere to your doctor's advice for the best results.

Method of Administration:

The medicine is to be taken orally.

Missed dose:

In case of missed dose, take the medicine as soon as you remember it. However, skip the missed dose if it is too close to the time for your next dosage. Avoid taking a double dosage.

Overdose:

In case of overdose, seek

medical help immediately.

Forms and Strengths:

Form - Tablet

Strength – Lamivir 100 mg

Contraindications:

The medicine is contraindicated in people who are allergic to the ingredients.

Warnings and precautions:

Avoid the medicine if you are allergic to any of the ingredients.

Make sure to inform your doctor in advance if you have a history of pancreatitis, kidney or liver disease, or if have used a similar medicine (similar to Lamivudine) in the past such as didanosine, abacavir, stavudine, emtricitabine, or zidovudine.

Do not take the medicine also if you are already taking medicine that contains Emtricitabine or Lamivudine.

It has been observed that some people who took the medicine developed lactic acidosis. The initial symptoms of the condition can worsen over time and can even prove to be fatal. Therefore, it is important that you seek medical attention the moment you start noticing symptoms of lactic acidosis including stomach pain, muscle pain, breathing trouble, numb or cold feeling in the limbs, or nausea with vomiting.

The medicine can lead to life threatening damage to your pancreas or liver. Make sure to consult your doctor if you have any of the symptoms of pancreas or liver damage such as severe pain in upper stomach, nausea and vomiting, itching, fast heartbeats, dark urine, loss of appetite, clay colored stools, or jaundice.

It is a FDA pregnancy category C medicine, which means that it is not yet proven if it can harm an unborn baby if taken while at the time of pregnancy. There is a risk of the virus getting transmitted to the baby if the mother does not undergo proper treatment at the time of pregnancy. The drug can get into breast milk and cause harm to a nursing baby. It is advised that you stay away from the medicine if you are breast feeding. Breast feeding is generally not recommending for HIV positive mothers as the virus can pass on to the baby. Make sure to let your doctor now if you are planning to become pregnant soon or are pregnant currently or are breast feeding.

It is crucial that you keep all the precautions in mind before you begin your treatment. Make sure to discuss your condition with your doctor and clear any doubts that you may have.

Side effects:

Some common side effects of the medicine are headache, nausea, dizziness, vomiting, drowsiness, or diarrhea. If any of the side effects persist or becomes worse, it is important to seek medical attention as soon as possible.

In some cases, there may be a deterioration of a previous medial ailment or a new one may develop due to changes in the immune system. Inform your doctor immediately if any such thing happens.

These are not the only side effects of the medicine. There may be other side effects too. In case you notice any symptoms, inform your doctor right away.

Drug Interactions:

Certain medicines including interferons (Betaseron, Intron, Avonex, Extavia, Rebif, Rebetron, Alferon, and others) can interact with Lamivudine. These are however not the only drugs that can interact with the drug. There can be many others as well. Make sure to inform your doctors about the medicines that you may be taking.

Ingredients:

Lamivudine is the active ingredient present in the medicine.

Storage information:

Keep this medicine in a cool and dry place.

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Aceon - Blood Pressure, Teraxans

Blood Pressure - Teraxans (Brand name: aceon)

Aceon is used for treating high blood pressure. Aceon is an angiotensin-converting enzyme (ACE) inhibitor. It works by blocking ACE, an enzyme involved in narrowing blood vessels and causing sodium and fluid retention by the kidneys. This causes blood vessels to relax, allowing blood to flow more freely and at a lower pressure, and increasing the heart's ability to pump blood in some types of heart failure.

Use Aceon as directed by your doctor.

You may take Aceon with or without food.

Take Aceon regularly to receive the most benefit from it. Taking Aceon at the same time each day will help you to remember to take it. Continue taking Aceon even if you feel well.

If you miss a dose of Aceon, 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 Aceon.

Active Ingredient: Perindopril erbumine.

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

Do NOT use Aceon if:

you are allergic to any ingredient in Aceon

you are in the second or third trimester of pregnancy

you have a history of giant hives or skin inflammation caused by ACE inhibitors

you are taking or have taken dextran sulfate within the past 3 days.

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

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

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

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

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

if you have a history of giant hives or skin inflammation, or hardening of the skin or organs

if you have bone marrow depression, blood vessel problems in the brain (including stroke), or severe immune system disease

if you are undergoing dialysis

if you have high blood potassium, low blood sodium, or are on a sodium-restricted diet

if you have ischemic heart disease, liver or kidney problems (including transplant), or lupus, or you are dehydrated.

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

Indomethacin, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), or salicylates (eg, aspirin) because the effectiveness of Aceon may be decreased

Clozapine, cyclosporine, dextran sulfate, HMG-CoA reductase inhibitors (eg, simvastatin), indomethacin, mannitol, NSAIDs (eg, ibuprofen), pergolide, phenothiazines (eg, chlorpromazine), potassium, potassium-sparing diuretics (eg, triamterene), thiazide-type diuretics (eg, hydrochlorothiazide), or trimethoprim because the actions and side effects of Aceon and these medicines may be increased.

Iron, lithium, sulfonylureas (eg, glyburide), or thiopurines (eg, azathioprine) because the actions and side effects of these medicines may be increased.

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

Aceon may cause dizziness or lightheadedness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Aceon. Using Aceon alone, with other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.

Dizziness or lightheadedness may occur if you stand up too fast from a lying or sitting position. Avoid sudden changes in posture.

Drink plenty of fluids while taking Aceon and avoid engaging in activities that cause excessive sweating. Dehydration, excessive sweating, vomiting, or diarrhea may lead to a fall in blood pressure. Contact your health care provider at once if any of these occur.

A persistent, unproductive cough may occur. Tell your doctor if this occurs. Recovery is rapid when the medicine is stopped.

Patients being treated for high blood pressure often feel tired or run down for a few weeks after beginning therapy. Continue taking our medicine even though you may not feel quite "normal." Contact your doctor or pharmacist about any new symptoms.

Black patients are at higher risk for certain side effects, and may not respond as well to Aceon as patients of other races.

Before you have any medical or dental treatments, emergency care, or surgery, tell your doctor or dentist that you are taking Aceon.

Aceon may lower your resistance to infection. Prevent infection by avoiding contact with people with colds or other infections. Do not touch you eyes or the inside of your nose unless you have thoroughly washed your hands first.

Do not use salt substitutes containing potassium without first talking with your health care provider.

It may take several weeks for Aceon to work. Do not stop taking Aceon without checking with your health care provider.

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

Caution is advised when using Aceon in the elderly because they may be more sensitive to its effects, especially dizziness and rash.

Children should use Aceon with extreme caution. Safety and effectiveness have not been confirmed.

Pregnancy and breast-feeding: Aceon has been shown to cause harm to the fetus. If you become pregnant, discuss with your doctor the benefits and risks of using Aceon during pregnancy. It is unknown if Aceon is excreted in breast milk. Do not breast-feed while taking Aceon.

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 skin sensation; arm or leg pain; back pain; cough; depression; diarrhea; dizziness; drowsiness; headache; lightheadedness; nausea; runny nose; weakness.

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

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); change in the amount of urine; chest pain; darkening of urine; difficulty swallowing; fainting; fast or irregular heartbeat; fever; hoarseness; pounding in the chest; prolonged nausea, vomiting, or diarrhea; severe lightheadedness or fainting; sore throat; swelling of the hands, legs, face, lips, eyes, throat, tongue, or trunk; unusual joint pain; unusual muscle pain, cramps, or weakness; unusual stomach pain; 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.

Aceon is used for treating high blood pressure. Aceon is an angiotensin-converting enzyme (ACE) inhibitor. It works by blocking ACE, an enzyme involved in narrowing blood vessels and causing sodium and fluid retention by the kidneys. This causes blood vessels to relax, allowing blood to flow more freely and at a lower pressure, and increasing the heart's ability to pump blood in some types of heart failure.

Use Aceon as directed by your doctor.

You may take Aceon with or without food.

Take Aceon regularly to receive the most benefit from it. Taking Aceon at the same time each day will help you to remember to take it. Continue taking Aceon even if you feel well.

If you miss a dose of Aceon, 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 Aceon.

Active Ingredient: Perindopril erbumine.

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

Do NOT use Aceon if:

you are allergic to any ingredient in Aceon

you are in the second or third trimester of pregnancy

you have a history of giant hives or skin inflammation caused by ACE inhibitors

you are taking or have taken dextran sulfate within the past 3 days.

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

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

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

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

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

if you have a history of giant hives or skin inflammation, or hardening of the skin or organs

if you have bone marrow depression, blood vessel problems in the brain (including stroke), or severe immune system disease

if you are undergoing dialysis

if you have high blood potassium, low blood sodium, or are on a sodium-restricted diet

if you have ischemic heart disease, liver or kidney problems (including transplant), or lupus, or you are dehydrated.

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

Indomethacin, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), or salicylates (eg, aspirin) because the effectiveness of Aceon may be decreased

Clozapine, cyclosporine, dextran sulfate, HMG-CoA reductase inhibitors (eg, simvastatin), indomethacin, mannitol, NSAIDs (eg, ibuprofen), pergolide, phenothiazines (eg, chlorpromazine), potassium, potassium-sparing diuretics (eg, triamterene), thiazide-type diuretics (eg, hydrochlorothiazide), or trimethoprim because the actions and side effects of Aceon and these medicines may be increased.

Iron, lithium, sulfonylureas (eg, glyburide), or thiopurines (eg, azathioprine) because the actions and side effects of these medicines may be increased.

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

Aceon may cause dizziness or lightheadedness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Aceon. Using Aceon alone, with other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.

Dizziness or lightheadedness may occur if you stand up too fast from a lying or sitting position. Avoid sudden changes in posture.

Drink plenty of fluids while taking Aceon and avoid engaging in activities that cause excessive sweating. Dehydration, excessive sweating, vomiting, or diarrhea may lead to a fall in blood pressure. Contact your health care provider at once if any of these occur.

A persistent, unproductive cough may occur. Tell your doctor if this occurs. Recovery is rapid when the medicine is stopped.

Patients being treated for high blood pressure often feel tired or run down for a few weeks after beginning therapy. Continue taking our medicine even though you may not feel quite "normal." Contact your doctor or pharmacist about any new symptoms.

Black patients are at higher risk for certain side effects, and may not respond as well to Aceon as patients of other races.

Before you have any medical or dental treatments, emergency care, or surgery, tell your doctor or dentist that you are taking Aceon.

Aceon may lower your resistance to infection. Prevent infection by avoiding contact with people with colds or other infections. Do not touch you eyes or the inside of your nose unless you have thoroughly washed your hands first.

Do not use salt substitutes containing potassium without first talking with your health care provider.

It may take several weeks for Aceon to work. Do not stop taking Aceon without checking with your health care provider.

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

Caution is advised when using Aceon in the elderly because they may be more sensitive to its effects, especially dizziness and rash.

Children should use Aceon with extreme caution. Safety and effectiveness have not been confirmed.

Pregnancy and breast-feeding: Aceon has been shown to cause harm to the fetus. If you become pregnant, discuss with your doctor the benefits and risks of using Aceon during pregnancy. It is unknown if Aceon is excreted in breast milk. Do not breast-feed while taking Aceon.

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 skin sensation; arm or leg pain; back pain; cough; depression; diarrhea; dizziness; drowsiness; headache; lightheadedness; nausea; runny nose; weakness.

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

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); change in the amount of urine; chest pain; darkening of urine; difficulty swallowing; fainting; fast or irregular heartbeat; fever; hoarseness; pounding in the chest; prolonged nausea, vomiting, or diarrhea; severe lightheadedness or fainting; sore throat; swelling of the hands, legs, face, lips, eyes, throat, tongue, or trunk; unusual joint pain; unusual muscle pain, cramps, or weakness; unusual stomach pain; 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.

Aceon is used for treating high blood pressure. Aceon is an angiotensin-converting enzyme (ACE) inhibitor. It works by blocking ACE, an enzyme involved in narrowing blood vessels and causing sodium and fluid retention by the kidneys. This causes blood vessels to relax, allowing blood to flow more freely and at a lower pressure, and increasing the heart's ability to pump blood in some types of heart failure.

Use Aceon as directed by your doctor.

You may take Aceon with or without food.

Take Aceon regularly to receive the most benefit from it. Taking Aceon at the same time each day will help you to remember to take it. Continue taking Aceon even if you feel well.

If you miss a dose of Aceon, 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 Aceon.

Active Ingredient: Perindopril erbumine.

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

Do NOT use Aceon if:

you are allergic to any ingredient in Aceon

you are in the second or third trimester of pregnancy

you have a history of giant hives or skin inflammation caused by ACE inhibitors

you are taking or have taken dextran sulfate within the past 3 days.

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

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

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

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

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

if you have a history of giant hives or skin inflammation, or hardening of the skin or organs

if you have bone marrow depression, blood vessel problems in the brain (including stroke), or severe immune system disease

if you are undergoing dialysis

if you have high blood potassium, low blood sodium, or are on a sodium-restricted diet

if you have ischemic heart disease, liver or kidney problems (including transplant), or lupus, or you are dehydrated.

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

Indomethacin, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), or salicylates (eg, aspirin) because the effectiveness of Aceon may be decreased

Clozapine, cyclosporine, dextran sulfate, HMG-CoA reductase inhibitors (eg, simvastatin), indomethacin, mannitol, NSAIDs (eg, ibuprofen), pergolide, phenothiazines (eg, chlorpromazine), potassium, potassium-sparing diuretics (eg, triamterene), thiazide-type diuretics (eg, hydrochlorothiazide), or trimethoprim because the actions and side effects of Aceon and these medicines may be increased.

Iron, lithium, sulfonylureas (eg, glyburide), or thiopurines (eg, azathioprine) because the actions and side effects of these medicines may be increased.

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

Aceon may cause dizziness or lightheadedness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Aceon. Using Aceon alone, with other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.

Dizziness or lightheadedness may occur if you stand up too fast from a lying or sitting position. Avoid sudden changes in posture.

Drink plenty of fluids while taking Aceon and avoid engaging in activities that cause excessive sweating. Dehydration, excessive sweating, vomiting, or diarrhea may lead to a fall in blood pressure. Contact your health care provider at once if any of these occur.

A persistent, unproductive cough may occur. Tell your doctor if this occurs. Recovery is rapid when the medicine is stopped.

Patients being treated for high blood pressure often feel tired or run down for a few weeks after beginning therapy. Continue taking our medicine even though you may not feel quite "normal." Contact your doctor or pharmacist about any new symptoms.

Black patients are at higher risk for certain side effects, and may not respond as well to Aceon as patients of other races.

Before you have any medical or dental treatments, emergency care, or surgery, tell your doctor or dentist that you are taking Aceon.

Aceon may lower your resistance to infection. Prevent infection by avoiding contact with people with colds or other infections. Do not touch you eyes or the inside of your nose unless you have thoroughly washed your hands first.

Do not use salt substitutes containing potassium without first talking with your health care provider.

It may take several weeks for Aceon to work. Do not stop taking Aceon without checking with your health care provider.

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

Caution is advised when using Aceon in the elderly because they may be more sensitive to its effects, especially dizziness and rash.

Children should use Aceon with extreme caution. Safety and effectiveness have not been confirmed.

Pregnancy and breast-feeding: Aceon has been shown to cause harm to the fetus. If you become pregnant, discuss with your doctor the benefits and risks of using Aceon during pregnancy. It is unknown if Aceon is excreted in breast milk. Do not breast-feed while taking Aceon.

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 skin sensation; arm or leg pain; back pain; cough; depression; diarrhea; dizziness; drowsiness; headache; lightheadedness; nausea; runny nose; weakness.

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

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); change in the amount of urine; chest pain; darkening of urine; difficulty swallowing; fainting; fast or irregular heartbeat; fever; hoarseness; pounding in the chest; prolonged nausea, vomiting, or diarrhea; severe lightheadedness or fainting; sore throat; swelling of the hands, legs, face, lips, eyes, throat, tongue, or trunk; unusual joint pain; unusual muscle pain, cramps, or weakness; unusual stomach pain; 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.



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Comprar Clocardigel (Plavix) Sin Receta, Clocardigel

compra Clocardigel (Plavix) en linea sin receta

Clocardigel (Plavix) Explicacion

Clocardigel se centran en que sea la reparacion de los ataques cardiovasculares, asi como a traves de cambios de detener la formacion de coagulos en el torrente sanguineo. Ademas se entrega a evitar algunos otros problemas cardiovasculares o incluso torrente sanguineo.

Clocardigel esta realmente llevando a cabo a traves de detener la formacion de coagulos en el torrente sanguineo. Es realmente agentes inmobiliarios antiplaquetarios.

Clocardigel tambien puede ser referido como clopidogrel, Clopitab, Caplor, Iscover, Clopilet, Ceruvin.

titulo general asociada con Clocardigel clopidogrel es en realidad.

Marca asociada con Clocardigel Clocardigel es en realidad.

Clocardigel (Plavix) Dosis

Clocardigel viene en:

75 mg material de friccion dosis regular

Obtener Clocardigel simultaneamente cada dia, con o sin comidas.

Obtener pildoras Clocardigel por via oral junto con el agua potable.

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

Clocardigel (Plavix) Careciendo asocia con dosis

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

Clocardigel (Plavix)

En el caso de una sobredosis Clocardigel y que tambien se evita gran usted necesita comprobar hacia fuera su medico o incluso el medico de inmediato. Asociado con Clocardigel sobredosis: vomitos, perdida de sangre irregular o incluso golpes, problemas con la inhalacion y la exhalacion.

Clocardigel (Plavix) Espacio de almacenamiento

Tienda en temperaturas de espacio entre 10 y 30 niveles de D (59, asi como ochenta y seis niveles F) de humedad, asi como la temperatura. Fortalecer cualquier tipo de medicamento sin tocar a partir del dia de vencimiento. Mantener desde el lograr de los ninos dentro de un cuadro de texto que los ninos pequenos no puedan abrir.

Clocardigel (Plavix) Efectos negativos

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

material de friccion zona nasal congestionada o incluso nasal

Material vientre molestias friccion

dolorido amigdalas material de friccion

material de friccion tos

material de friccion dolor de cabeza

material de friccion diarrea

material de friccion fatiga

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

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

debilucho, alquitranadas o incluso material de friccion taburetes oscuro

problemas con la ingestion o incluso inhalar y exhalar material de friccion Material

problemas cardiacos friccion

material de friccion perdida de sangre unstopping

cabeza inesperado material de friccion dolor

tono ronco de material de friccion de voz

nauseas o vomitos material de friccion

un poco de material de friccion debilidad

material de friccion de la transpiracion

problemas con pis material de friccion

problemas con la vision, habla, o material de friccion incluso la estabilidad

sangrado simple o material de friccion moretones

material de friccion caliente

material de friccion malentendidos

material de friccion ictericia

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

Clocardigel (Plavix) Contraindicaciones

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

Por lo general no reciben Clocardigel si usted esta esperando otra manera tiene la intencion de tener un hijo, si no que realmente eres una mama medica.

Tenga cuidado junto con Clocardigel en caso de que se ven afectados y tienen una breve historia asociada con ataque al corazon, ulcera vientre o la colitis ulcerosa, incluso; organo higado o enfermedad renal incluso, la hemofilia.

Tenga cuidado junto con Clocardigel en caso de que usted esta usando este tipo de medicamentos porque la aspirina o incluso algunos otros AINE (medicamentos antiinflamatorios no esteroideos, por ejemplo, naproxeno (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofeno (Ansaid), indometacina (Indocin), ibuprofeno (Motrin, Advil), (Toradol), ketoprofeno (Orudis), nabumetona (Relafen), piroxicam (Feldene), ketorolaco acidez mefenamico ( El Relafen), meloxicam (Mobic) y tambien los otros), fenitoina (Dilantin tales porque); torsemide (tal porque Demadex); medicina utiliza para evitar coagulos de sangre (alteplasa (tales porque Activase), anistreplasa (tales porque Eminase), dipiridamol (tales porque Persantine), estreptoquinasa (tales porque Kabikinase, Streptase), ticlopidina (Ticlid), asi como la uroquinasa (por ejemplo, porque Abbokinase) ; fluvastatina (Lescol porque tales); el torrente sanguineo mas delgado (warfarina (por ejemplo porque Coumadin), heparina, ardeparin (por ejemplo porque Normiflo), dalteparina (tales porque Fragmin), danaparoid (por ejemplo porque Orgaran), enoxaparina (Lovenox porque tales), o incluso tinzaparina (tales porque Innohep); tamoxifeno (Nolvadex porque tales);. tolbutamida (tales porque Orinase)

Esta lejos de ser propuesto para llevar a cabo la actividad deportiva durante el uso de Clocardigel, ya que puede causar la perdida de sangre o incluso golpes lesiones.

Si quieres poseer un tratamiento quirurgico que necesita para dejar de usar Clocardigel con respecto a cinco veces antes del tratamiento quirurgico.

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

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

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

Clocardigel (Plavix) Preguntas comunes

Queen: ?Cuales son exactamente los efectos negativos Clocardigel?

El: Clocardigel ofrece los tipicos efectos negativos, por ejemplo, la zona de congestion o incluso nasal nasal, malestar del vientre, dolor de amigdalas, tos, dolor de cabeza, diarrea, fatiga. Sin embargo en la situacion que se asocia con ser rechazado asociado con componentes Clocardigel que son capaces de encontrar mas graves efectos negativos: debil, alquitranadas o incluso taburetes oscuros, problemas con ingestion o incluso inhalar y exhalar, problemas cardiacos, perdida de sangre, dolor de cabeza unstopping inesperado, fornido tono de voz, nauseas o vomitos, alguna debilidad, sudoracion, problemas con orinar, problemas con la vision, habla, o incluso la estabilidad; sangrado o moretones sencillo, calido, malentendidos, la respuesta de reaccion alergica, ictericia. La probabilidad de efectos negativos a aparecer depende de la posicion de bienestar, asi como, naturalmente, en la receta Clocardigel posterior correcta medications. A

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

El: titulo general asociada con Clocardigel clopidogrel es en realidad. Marca asociada con Clocardigel es en realidad Clocardigel. A ??

Queen: Exactamente como debo conseguir Clocardigel?

El: Clocardigel viene en pastillas (75 mg). Obten Clocardigel simultaneamente cada dia, con o sin comidas. Obten pildoras Clocardigel por via oral junto con el agua potable. Si usted desea lograr mejores resultados por lo general no dejar de usar Clocardigel todos un sudden. A

Queen: Exactamente ?que debo FAG situacion asociada con sobredosis?

El: Por lo general no reciben pildoras de Clocardigel en grandes cantidades. En el caso de Clocardigel mas de la dosis, usted tiene que comprobar hacia fuera medico o incluso medico instantly. A

Reina: ?Se puede realmente consumir alcohol?

El: Por supuesto que no, lo que realmente es inaceptable aprecian alcoholica beverages. A

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ARTELAC 0.32 % W/V EYE DROPS SINGLE DOSE UNIT

Transcript

Assessed against UK PIL dated March 2011

By Carthika Kanagasabai at

PACKAGE LEAFLET: INFORMATION FOR THE USER

Artelac® 0.32% w/v Eye Drops Single Dose Unit (hypromellose)

The usual dose is to apply one drop in the corner of the eye, nearest the nose, 3 to 5 times each day or as required to give enough lubrication. Dry eye is a condition that varies from person to person. Use the drops as often as you think necessary.

The name of your medicine is Artelac 0.32% w/v Eye Drops Single Dose Unit but it will be referred to as Artelac 0.32% throughout this leaflet. Please read all of this leaflet carefully because it contains important information for you. This medicine is available without prescription, as an over the counter item only in a pharmacy. However, you still need to use Artelac 0.32% carefully to get the best results from it. • Keep this leaflet. You may need to read it again. • Ask your pharmacist if you need more information or advice. • You must contact a doctor if your symptoms worsen or do not improve. • If any of the side effects gets serious, or if you notice any side effect not listed in this leaflet, please tell your doctor or pharmacist.

Directions for use

this leaflet: What Artelac 0.32% is and what it is used for Before you use Artelac 0.32% How to use Artelac 0.32% Possible side effects How to store Artelac 0.32% Further information

sit down in front of a mirror so that you can see what you are doing wipe your eyes to clear any residual wateriness or discharge holding the unit by the label end, remove a single-dose unit from the pack twist the cap off the single-dose unit pull your lower eyelid gently down, and then carefully place one drop inside the lower eyelid, in the corner nearest the nose • release the lower eyelid, and blink a few times to make sure the eye is covered by the liquid • repeat the procedure for your other eye • when you have finished, throw away the single-dose unit Always read the label before using this medicine.

WHAT ARTELAC 0.32% IS AND WHAT IT IS USED FOR

Your drops contain hypromellose as the active ingredient, which is a form of cellulose. Your drops are used as a tear substitute and lubricant when applied to the eye. The hypromellose in these drops increases the thickness of the solution which has a moisturising effect and helps the solution to stay in contact with the eye for a longer period of time. These drops work by soothing the eye and giving tear-like lubrication to the eyes and eye lids. They are used to treat the symptoms of "dry eye", which is a dehydration of the surface of the eye because no natural tears are being produced. Dry eye can also be caused if it is not possible to close your eyelids partly or completely.

If you use more Artelac 0.32% than you should

If you accidentally use a larger dose than recommended, this may cause some blurring of vision, which will soon pass. Make sure you know how and when to use your medicine. If you are not sure about using your drops, ask your pharmacist.

BEFORE YOU USE ARTELAC 0.32%

Do not use these drops •

if you have been told, or know, that you are allergic (hypersensitive) to any of its ingredients (see section 6).

Take special care with these drops •

HOW TO USE ARTELAC 0.32%

Always use your drops exactly as your doctor or pharmacist has told you to. You should check with your doctor or pharmacist if you are not sure. The medicine is to be used only as drops applied into one or both eye(s).

if you wear soft contact lenses – take out your lenses before using Artelac 0.32% and then wait for at least 15 minutes after using these drops before putting your lenses back in.

POSSIBLE SIDE EFFECTS

Like all medicines, Artelac 0.32% can cause some side effects, although not everybody gets them. If you experience any difficulty stop using your drops and talk to your doctor or pharmacist. Like all eye drops you may briefly have blurred vision or a slight stinging feeling after using your drops. There is also a slight possibility that irritation or itching of the eye may occur in a very small number of people.

Reporting of side effects:

Using other medicines

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www. mhra. gov. uk/yellowcard.

Pregnancy and breast-feeding

By reporting side effects, you can help provide more information on the safety of this medicine.

You should wait 5 minutes before using any other eye medication.

These drops can be used if you are pregnant or breast-feeding.

Driving and using machines •

All eye drops can cause a short term blurring of vision when first used so you should wait until your eyes are clear before driving or using machines.

HOW TO STORE ARTELAC 0.32%

Keep out of the sight and reach of children. Do not use this medicine after its expiry date. Check the expiry date on the label before you begin to use your medicine. The expiry date refers to the last day of that month. If the expiry date has passed, take the medicine back to your pharmacist. Do not store above 25?C. Keep container in the outer carton. Protect from light. Your eye drops are sterile until first opened. It is important to keep the drops as clean as possible during use. Your drops come in single-dose, single-use units, which should be thrown away immediately after use. If your medicine appears to be discoloured or show any other signs of deterioration please return to your pharmacist who will advise you further. If your doctor tells you to stop using the medicine, please take them back to the pharmacist. Only keep the medicine if your doctor tells you to. Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

What Artelac 0.32% contains

The active ingredient is hypromellose 0.32% w/v. Each ml contains 3.2mg hypromellose. The other ingredients are sorbitol, disodium phosphate dodecahydrate, sodium dihydrogen phosphate dihydrate and purified water.

What Artelac 0.32% looks like and contents of the pack Artelac 0.32% is a clear, colourless solution.

Your medicine is supplied in plastic single-dose units in pack sizes of 30 and 60. Each single dose unit has a volume of 0.6ml. Your drops contain no preservative, therefore each unit is for single-use only. Your drops do not contain a preservative and can be used by patients who are hypersensitive to preservatives or who wear contact lenses. This medicine is for you, never give it to anyone else, even if they appear to have the same symptoms as you. Return any unused medicine to your pharmacist.

Your medicine is manufactured by: Dr Gerhard Mann Chem-pharm Fabrik GmbH, 13581 Berlin, Germany. Procured from within the EU and repackaged by: Doncaster Pharmaceuticals Ltd. Kirk Sandall, Doncaster, DN3 1QR. Product Licence holder: Landmark Pharma Ltd. 7 Regents Drive, Prudhoe, Northumberland, NE42 6PX. PL No: 21828/0422

Leaflet issue and revision date (Ref.): 03.03.15 Artelac® is a registered trademark of Dr. Gerhard Mann, Chem-pharm Fabrik GmbH.

PACKAGE LEAFLET: INFORMATION FOR THE USER

Artelac® Preservative Free Single Dose Unit 3.2mg/ml eye drops, solution (hypromellose) The name of your medicine is Artelac Preservative Free Single Dose Unit 3.2 mg/ml eye drops, solution, but it will be referred to as Artelac throughout this leaflet. Please read all of this leaflet carefully because it contains important information for you. This medicine is available without prescription, as an over the counter item only in a pharmacy. However, you still need to use Artelac carefully to get the best results from it. • Keep this leaflet. You may need to read it again. • Ask your pharmacist if you need more information or advice. • You must contact a doctor if your symptoms worsen or do not improve. • If any of the side effects gets serious, or if you notice any side effect not listed in this leaflet, please tell your doctor or pharmacist.

this leaflet: What Artelac is and what it is used for Before you use Artelac How to use Artelac Possible side effects How to store Artelac Further information WHAT ARTELAC IS AND WHAT IT IS USED FOR

Your drops contain hypromellose as the active ingredient, which is a form of cellulose. Your drops are used as a tear substitute and lubricant when applied to the eye. The hypromellose in these drops increases the thickness of the solution which has a moisturising effect and helps the solution to stay in contact with the eye for a longer period of time. These drops work by soothing the eye and giving tear-like lubrication to the eyes and eye lids. They are used to treat the symptoms of "dry eye", which is a dehydration of the surface of the eye because no natural tears are being produced. Dry eye can also be caused if it is not possible to close your eyelids partly or completely.

BEFORE YOU USE ARTELAC

Do not use these drops •

if you have been told, or know, that you are allergic (hypersensitive) to any of its ingredients (see section 6).

Take special care with these drops •

if you wear soft contact lenses – take out your lenses before using Artelac and then wait for at least 15 minutes after using these drops before putting your lenses back in.

Using other medicines •

You should wait 5 minutes before using any other eye medication.

Pregnancy and breast-feeding •

These drops can be used if you are pregnant or breast-feeding.

The usual dose is to apply one drop in the corner of the eye, nearest the nose, 3 to 5 times each day or as required to give enough lubrication. Dry eye is a condition that varies from person to person. Use the drops as often as you think necessary.

Directions for use

sit down in front of a mirror so that you can see what you are doing wipe your eyes to clear any residual wateriness or discharge holding the unit by the label end, remove a single-dose unit from the pack twist the cap off the single-dose unit pull your lower eyelid gently down, and then carefully place one drop inside the lower eyelid, in the corner nearest the nose • release the lower eyelid, and blink a few times to make sure the eye is covered by the liquid • repeat the procedure for your other eye • when you have finished, throw away the single-dose unit Always read the label before using this medicine.

If you use more Artelac than you should

If you accidentally use a larger dose than recommended, this may cause some blurring of vision, which will soon pass. Make sure you know how and when to use your medicine. If you are not sure about using your drops, ask your pharmacist.

POSSIBLE SIDE EFFECTS

Like all medicines, Artelac can cause some side effects, although not everybody gets them. If you experience any difficulty stop using your drops and talk to your doctor or pharmacist. Like all eye drops you may briefly have blurred vision or a slight stinging feeling after using your drops. There is also a slight possibility that irritation or itching of the eye may occur in a very small number of people.

Reporting of side effects:

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www. mhra. gov. uk/yellowcard. By reporting side effects, you can help provide more information on the safety of this medicine.

Driving and using machines •

HOW TO USE ARTELAC

Always use your drops exactly as your doctor or pharmacist has told you to. You should check with your doctor or pharmacist if you are not sure. The medicine is to be used only as drops applied into one or both eye(s).

All eye drops can cause a short term blurring of vision when first used so you should wait until your eyes are clear before driving or using machines.

HOW TO STORE ARTELAC

Keep out of the sight and reach of children. Do not use this medicine after its expiry date. Check the expiry date on the label before you begin to use your medicine. The expiry date refers to the last day of that month. If the expiry date has passed, take the medicine back to your pharmacist. Do not store above 25?C. Keep container in the outer carton. Protect from light. Your eye drops are sterile until first opened. It is important to keep the drops as clean as possible during use. Your drops come in single-dose, single-use units, which should be thrown away immediately after use. If your medicine appears to be discoloured or show any other signs of deterioration please return to your pharmacist who will advise you further. If your doctor tells you to stop using the medicine, please take them back to the pharmacist. Only keep the medicine if your doctor tells you to. Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

What Artelac contains

The active ingredient is hypromellose 3.2mg/ml. The other ingredients are sorbitol, disodium phosphate dodecahydrate, sodium dihydrogen phosphate dihydrate and purified water.

What Artelac looks like and contents of the pack Artelac is a clear, colourless solution.

Your medicine is supplied in plastic single-dose units in pack sizes of 30 and 60. Each single dose unit has a volume of 0.6ml. Your drops contain no preservative, therefore each unit is for single-use only. Your drops do not contain a preservative and can be used by patients who are hypersensitive to preservatives or who wear contact lenses. This medicine is for you, never give it to anyone else, even if they appear to have the same symptoms as you. Return any unused medicine to your pharmacist.

Your medicine is manufactured by: Dr Gerhard Mann Chem-pharm Fabrik GmbH, 13581 Berlin, Germany. Procured from within the EU and repackaged by: Doncaster Pharmaceuticals Ltd. Kirk Sandall, Doncaster, DN3 1QR. Product Licence holder: Landmark Pharma Ltd. 7 Regents Drive, Prudhoe, Northumberland, NE42 6PX. PL No: 21828/0422

Leaflet issue and revision date (Ref.): 03.03.15 Artelac® is a registered trademark of Dr. Gerhard Mann, Chem-pharm Fabrik GmbH.

Source: Medicines and Healthcare Products Regulatory Agency

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



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Losachlor, Losachlor

Diabetes - Losachlor (Brand name: cozaar)

Cozaar is used for treating high blood pressure alone or with other medicines. It is used in certain patients to decrease the risk of stroke. It is used in certain patients to treat kidney problems caused by diabetes (diabetic nephropathy). Cozaar is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps to lower blood pressure.

Use Cozaar as directed by your doctor.

Take Cozaar by mouth with or without food.

Take Cozaar on a regular schedule to get the most benefit from it. Taking Cozaar at the same time each day will help you remember to take it.

Continue to take Cozaar even if you feel well. Do not miss any dose.

If you miss a dose of Cozaar, 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 Cozaar.

Store Cozaar at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Cozaar out of the reach of children and away from pets.

Active Ingredient: Losartan potassium.

Do NOT use Cozaar if:

you are allergic to any ingredient in Cozaar

you are in your second or third trimester of pregnancy

the patient is a child with severe kidney problems.

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

Some medical conditions may interact with Cozaar. 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, or are breast-feeding

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

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

if you are able to become pregnant

if you have a history of angioedema (swelling of the hands, face, lips, eyes, throat, or tongue; difficulty swallowing or breathing; or hoarseness), including angioedema caused by treatment with an angiotensin-converting enzyme (ACE) inhibitor (eg, lisinopril)

if you have a history of heart problems (eg, heart failure), blood vessel problems, blood flow problems, liver or kidney problems, or diabetes

if you have a history of stroke or recent heart attack

if you are dehydrated or have low blood volume

if you have electrolyte problems (eg, high blood potassium levels, low blood sodium levels) or are on a low-salt (sodium) diet

if you are on dialysis or are scheduled to have major surgery.

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

Diuretics (eg, furosemide, hydrochlorothiazide) because the risk of low blood pressure may be increased

Potassium-sparing diuretics (eg, spironolactone, triamterene) or potassium supplements because the risk of high blood potassium levels may be increased

Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, indomethacin, celecoxib) or rifampin because they may decrease Cozaar's effectiveness

Lithium because the risk of its side effects may be increased by Cozaar.

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

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

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

Cozaar may cause a serious side effect called angioedema. Contact your doctor at once if you develop swelling of the hands, face, lips, eyes throat, or tongue; difficulty swallowing or breathing; or hoarseness.

Cozaar may not work as well to reduce the risk of stroke in black patients. Discuss any questions or concerns with your doctor.

Dehydration, excessive sweating, vomiting, or diarrhea may increase the risk of low blood pressure. Contact your health care provider at once if any of these occur.

Check with your doctor before you use a salt substitute or a product that has potassium in it.

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

Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal." Tell your doctor if you develop any new symptoms.

If you have high blood pressure, do not use nonprescription products that contain stimulants. These products may include diet pills or cold medicines. Contact your doctor if you have any questions or concerns.

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

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

Cozaar should not be used in children younger 6 years; safety and effectiveness in these children have not been confirmed.

Pregnancy and breast-feeding: Cozaar may cause birth defects or fetal death if you take it while you are pregnant. If you think you may be pregnant, contact your doctor right away. It is not known if Cozaar is found in breast milk. Do not breastfeed while taking Cozaar.

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; dizziness; tiredness.

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; hoarseness); change in the amount of urine produced; chest pain; dark urine; difficulty swallowing; fast, slow, or irregular heartbeat; muscle pain or cramps; severe or persistent stomach pain (with or without nausea or vomiting); symptoms of low blood pressure (eg, fainting, severe dizziness, lightheadedness); unusual bruising or bleeding; vision changes; yellowing of the eyes or skin.

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



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Gabapentin Uses, Dosage - Safety Information, Gabantin

Gabapentin

What is gabapentin?

Gabapentin is an anti-epileptic medication, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain.

Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles (herpes zoster).

The Horizant brand of gabapentin is also used to treat restless legs syndrome (RLS).

The Neurontin brand of gabapentin is also used to treat seizures in adults and children who are at least 3 years old.

Use only the brand and form of gabapentin that your doctor has prescribed. Check your medicine each time you get a refill at the pharmacy, to make sure you have received the correct form of this medication.

Important information

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use gabapentin if you are allergic to it.

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

kidney disease (or if you are on dialysis);

epilepsy or other seizure disorder;

a history of depression, mood disorder, drug abuse, or suicidal thoughts or actions;

heart disease; or

(for patients with RLS) if you are a day sleeper or work a night shift.

Some people have thoughts about suicide while taking this medicine. Your doctor will need to check your progress at regular visits while you are using gabapentin. Your family or other caregivers should also be alert to changes in your mood or symptoms.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Gabapentin can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I take gabapentin?

Take gabapentin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

The Horizant brand of gabapentin should not be taken during the day. For best results, take Horizant with food at about 5:00 in the evening.

Both Gralise and Horizant should be taken with food.

Neurontin can be taken with or without food.

If you break a Neurontin tablet and take only half of it, take the other half at your next dose. Any tablet that has been broken should be used as soon as possible or within a few days.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

If your doctor changes your brand, strength, or type of gabapentin, your dosage needs may change. Ask your pharmacist if you have any questions about the new kind of gabapentin you receive at the pharmacy.

Do not stop using gabapentin suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose.

Wear a medical alert tag or carry an ID card stating that you take gabapentin. Any medical care provider who treats you should know that you take seizure medication.

Gabapentin can cause you to have a false positive urine protein screening test. If you provide a urine sample for testing, tell the laboratory staff that you are taking gabapentin.

Store tablets and capsules at room temperature away from light and moisture.

Store the liquid medicine in the refrigerator. Do not freeze.

What happens if I miss a dose?

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

What happens if I overdose?

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

What should I avoid while taking gabapentin?

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

Avoid taking an antacid within 2 hours before or after you take gabapentin. Antacids can make it harder for your body to absorb gabapentin.

Drinking alcohol with this medicine can cause side effects.

Gabapentin side effects

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

Seek medical treatment if you have a skin rash with symptoms of a serious allergic reaction that can affect other parts of your body, including: fever, dark urine, blood in your urine, swollen glands, sore throat, extreme weakness or tiredness, unusual bruising or bleeding, muscle pain, or jaundice (yellowing of the skin or eyes).

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, depression, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

severe weakness or tiredness;

upper stomach pain;

chest pain, new or worsening cough with fever, trouble breathing;

severe tingling or numbness;

rapid back and forth movement of your eyes;

kidney problems--little or no urination, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath; or

severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Some side effects are more likely in children taking gabapentin. Contact your doctor if the child taking this medication has any of the following side effects:

changes in behavior;

trouble concentrating; or

acting restless, hostile, or aggressive.

Common gabapentin side effects may include:

dizziness, drowsiness; or

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

Gabapentin dosing information

Usual Adult Dose for Epilepsy:

Initial dose: 300 mg orally on day one, 300 mg orally twice a day on day two, then 300 mg orally 3 times a day on day three. Maintenance dose: 900 to 1800 mg orally in 3 divided doses. If necessary, the dose may be increased using 300 mg or 400 mg capsules three times a day up to 1800 mg/day. Dosages up to 2400 mg/day have been well tolerated in long-term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. The maximum time between doses in the three times a day schedule should not exceed 12 hours.

The safety and effectiveness of gabapentin available under the trade name Gralise (R) or Horizant (R) in patients with epilepsy has not been studied.

Usual Adult Dose for Postherpetic Neuralgia:

Initial dose: 300 mg orally on day one, 300 mg orally twice a day on day two, then 300 mg orally 3 times a day on day three.

The dose may be titrated up as needed for pain relief to a daily dose of 1800 mg. Maintenance dose: 900 to 1800 mg orally in 3 divided doses.

Efficacy was demonstrated in clinical studies over a range of 1800 mg/day to 3600 mg/day. However, no additional benefit was demonstrated from the use of doses over 1800 mg/day.

Gabapentin available under the trade name Gralise (R):

Maintenance dose: Gralise (R) should be titrated to 1800 mg orally once daily with the evening meal.

Recommended titration schedule: Day 1: 300 mg orally with the evening meal Day 2: 600 mg orally with the evening meal Days 3 through 6: 900 mg orally with the evening meal Days 7 through 10: 1200 mg orally with the evening meal Days 11 through 14: 1500 mg orally with the evening meal Day 15: 1800 mg orally with the evening meal

Gralise (R) is not interchangeable with other gabapentin products because of differing pharmacokinetic profiles that affect the frequency of administration.

Gabapentin enacarbil extended release tablets available under the trade name Horizant (R):

The recommended dosage is 600 mg orally twice daily. Therapy should be initiated at a dose of 600 mg orally in the morning for 3 days of therapy, then increased to 600 mg twice daily (1,200 mg/day) on day four.

Gabapentin enacarbil extended release tablets available under the trade name Horizant (R) and gabapentin are not interchangeable.

Usual Adult Dose for Restless Legs Syndrome:

Gabapentin enacarbil available under the trade name Horizant (R): 600 mg orally once daily with food at about 5 PM

Usual Pediatric Dose for Epilepsy:

Less than 3 years: Effectiveness has not been established.

Greater than or equal to 3 and less than 12 years: Starting Dose: ranges from 10 to 15 mg/kg/day in 3 divided doses. Effective Dose: reached by upward titration over a period of approximately 3 days. The effective dose of gabapentin in patients 5 years of age and older is 25 to 35 mg/kg/day and given in divided doses (three times a day). The effective dose in pediatric patients ages 3 and 4 years is 40 mg/kg/day and given in divided doses (three times a day). Gabapentin may be administered as the oral solution, capsule, or tablet, or using combinations of these formulations. Dosages up to 50 mg/kg/day have been well tolerated in a long term clinical study. The maximum time interval between doses should not exceed 12 hours.

Greater than 12 years: Initial dose: 300 mg orally on day one, 300 mg orally twice a day on day two, then 300 mg orally 3 times a day on day three. Maintenance dose: 900 to 1800 mg orally in 3 divided doses. If necessary, the dose may be increased using 300 mg or 400 mg capsules three times a day up to 1800 mg/day. Dosages up to 2400 mg/day have been well tolerated in long term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. The maximum time between doses in the three times a day schedule should not exceed 12 hours.

What other drugs will affect gabapentin?

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking gabapentin with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with gabapentin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

More about gabapentin

Consumer resources

Professional resources

Related treatment guides

Where can I get more information?

Your pharmacist can provide more information about gabapentin.

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

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

Copyright 1996-2016 Cerner Multum, Inc. Version: 13.01. Revision Date: 2015-11-09, 12:57:33 PM.

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Common Side Effects Of Nolvadex (Tamoxifen Citrate) Drug Center, Tamoxifen Citrate

For Patients

Last reviewed on RxList 7/23/2015

Nolvadex (tamoxifen citrate) is a nonsteroidal antiestrogen used to treat breast cancer that has spread to other parts of the body (metastatic breast cancer), to treat breast cancer in certain patients after surgery and radiation therapy, and to reduce the chances of breast cancer in high-risk patients. Common side effects of Nolvadex include hot flashes, flushing, changes in menstrual periods, nausea, leg cramps, abdominal cramps, bone pain, muscle pain, cough, swelling, fatigue, hair thinning, headache, depression, and loss of sexual ability/interest in men.

The recommended daily dose of Nolvadex for patients with breast cancer is 20-40 mg per day, in tablet form. Patients taking anastrozole or letrozole should not take Nolvadex as serious interactions could occur. SSRI antidepressants and cimeditdine may affect how Nolvadex works. Patients taking coumarin-type anticoagulants should be closely monitored. There may be risks to the fetus if Nolvadex is taken by pregnant women, however the benefit of the drug may warrant its use despite the potential risks. Nolvadex has been reported to inhibit lactation. It is not known whether the medication is passed through breast milk, but because of the potential risks for the fetus, women who are taking Nolvadex should not breast feed.

Our Nolvadex Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

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

What is Patient Information Overview?

A concise overview of the drug for the patient or caregiver from First DataBank.

Nolvadex Overview - Patient Information: Side Effects

SIDE EFFECTS: See also Warning section.

Hot flashes, nausea, leg cramps, muscle aches, hair thinning, headache, and numb/tingling skin may occur. A loss of sexual ability/interest may occur in men. If these effects persist or worsen, notify your doctor promptly.

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

Tell your doctor immediately if any of these unlikely but serious side effects occur: vision changes (e. g. blurred vision), eye pain, easy bruising/bleeding, mental/mood changes, swelling of ankles/feet, unusual tiredness.

Tell your doctor immediately if any of these rare but very serious side effects occur: stomach/abdominal pain, persistent nausea/vomiting, dark urine, yellowing eyes/skin, signs of infection (e. g. fever, persistent sore throat).

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

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

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

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

Read the entire patient information overview for Nolvadex (Tamoxifen Citrate)

What is Prescribing information?

The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.

Nolvadex FDA Prescribing Information: Side Effects (Adverse Reactions)

SIDE EFFECTS

Adverse reactions to NOLVADEX (tamoxifen citrate) are relatively mild and rarely severe enough to require discontinuation of treatment in breast cancer patients.

Continued clinical studies have resulted in further information which better indicates the incidence of adverse reactions with NOLVADEX (tamoxifen citrate) as compared to placebo.

Metastatic Breast Cancer

Increased bone and tumor pain and, also, local disease flare have occurred, which are sometimes associated with a good tumor response. Patients with increased bone pain may require additional analgesics. Patients with soft tissue disease may have sudden increases in the size of preexisting lesions, sometimes associated with marked erythema within and surrounding the lesions and/or the development of new lesions. When they occur, the bone pain or disease flare are seen shortly after starting NOLVADEX (tamoxifen citrate) and generally subside rapidly.

In patients treated with NOLVADEX (tamoxifen citrate) for metastatic breast cancer, the most frequent adverse reaction to NOLVADEX (tamoxifen citrate) is hot flashes .

Other adverse reactions which are seen infrequently are hypercalcemia. peripheral edema. distaste for food, pruritus vulvae, depression. dizziness, light-headedness, headache, hair thinning and/or partial hair loss. and vaginal dryness.

Premenopausal Women

The following table summarizes the incidence of adverse reactions reported at a frequency of 2% or greater from clinical trials (Ingle, Pritchard, Buchanan) which compared NOLVADEX (tamoxifen citrate) therapy to ovarian ablation in premenopausal patients with metastatic breast cancer.

NOLVADEX (tamoxifen citrate) All Effects % of Women n=104

OVARIAN ABLATION All Effects % of Women n =100

Male Breast Cancer

NOLVADEX (tamoxifen citrate) is well tolerated in males with breast cancer. Reports from the literature and case reports suggest that the safety profile of NOLVADEX (tamoxifen citrate) in males is similar to that seen in women. Loss of libido and impotence have resulted in discontinuation of tamoxifen therapy in male patients. Also, in oligospermic males treated with tamoxifen, LH, FSH, testosterone and estrogen levels were elevated. No significant clinical changes were reported.

Adjuvant Breast Cancer

In the NSABP B-14 study, women with axillary node-negative breast cancer were randomized to 5 years of NOLVADEX (tamoxifen citrate) 20 mg/day or placebo following primary surgery. The reported adverse effects are tabulated below (mean follow-up of approximately 6.8 years) showing adverse events more common on NOLVADEX (tamoxifen citrate) than on placebo. The incidence of hot flashes (64% vs. 48%), vaginal discharge (30% vs. 15%), and irregular menses (25% vs. 19%) were higher with NOLVADEX (tamoxifen citrate) compared with placebo. All other adverse effects occurred with similar frequency in the 2 treatment groups, with the exception of thrombotic events; a higher incidence was seen in NOLVADEX (tamoxifen citrate) - treated patients (through 5 years, 1.7% vs. 0.4%). Two of the patients treated with NOLVADEX (tamoxifen citrate) who had thrombotic events died.

NSABP B-14 Study

*Defined as a platelet count of < 100,000/mm 3

In the Eastern Cooperative Oncology Group (ECOG) adjuvant breast cancer trial, NOLVADEX (tamoxifen citrate) or placebo was administered for 2 years to women following mastectomy. When compared to placebo, NOLVADEX (tamoxifen citrate) showed a significantly higher incidence of hot flashes (19% vs. 8% for placebo). The incidence of all other adverse reactions was similar in the 2 treatment groups with the exception of thrombocytopenia where the incidence for NOLVADEX (tamoxifen citrate) was 10% vs. 3% for placebo, an observation of borderline statistical significance.

In other adjuvant studies, Toronto and NOLVADEX (tamoxifen citrate) Adjuvant Trial Organization (NATO), women received either NOLVADEX (tamoxifen citrate) or no therapy. In the Toronto study, hot flashes were observed in 29% of patients for NOLVADEX (tamoxifen citrate) vs. 1% in the untreated group. In the NATO trial, hot flashes and vaginal bleeding were reported in 2.8% and 2.0% of women, respectively, for NOLVADEX (tamoxifen citrate) vs. 0.2% for each in the untreated group.

Anastrozole Adjuvant Trial - Study of Anastrozole compared to NOLVADEX (tamoxifen citrate) for Adjuvant Treatment of Early Breast Cancer (see CLINICAL PHARMACOLOGY - Clinical Studies ).

At a median follow-up of 33 months, the combination of anastrozole and NOLVADEX (tamoxifen citrate) did not demonstrate any efficacy benefit when compared to NOLVADEX (tamoxifen citrate) therapy given alone in all patients as well as in the hormone receptor positive subpopulation. This treatment arm was discontinued from the trial. The median duration of adjuvant treatment for safety evaluation was 59.8 months and 59.6 months for patients receiving anastrozole 1 mg and NOLVADEX (tamoxifen citrate) 20 mg, respectively.

Adverse events occurring with an incidence of at least 5% in either treatment group during treatment or within 14 days of the end of treatment are presented in the following table.

Adverse events occurring with an incidence of at least 5% in either treatment group during treatment, or within 14 days of the end of treatment

Body system and adverse event by COSTART-preferred term*

Anastrozole 1 mg (N = 3092)

NOLVADEX 20 mg (N = 3094)

COSTART Coding Symbols for Thesaurus of Adverse Reaction Terms. N = Number of patients receiving the treatment. *A patient may have had more than 1 adverse event, including more than 1 adverse event in the same body system. † Vaginal Hemorrhage without further diagnosis. ** The combination arm was discontinued due to lack of efficacy benefit at 33 months of follow-up.

Certain adverse events and combinations of adverse events were prospectively specified for analysis, based on the known pharmacologic properties and side effect profiles of the two drugs (see the following table).

Number (%) of Patients with Pre-Specified Adverse Event in the Anastrozole Adjuvant Trial 1

NOLVADEX (tamoxifen citrate) N=3094 (%)

Musculoskeletal Events 2

Nausea and Vomiting

Fractures of Spine, Hip, or Wrist

Ischemic Cardiovascular Disease

Venous Thromboembolic events

Deep Venous Thromboembolic

Ischemic Cerebrovascular Event

Endometrial Cancer 3

1 Patients with multiple events in the same category are counted only once in that category. 2 Refers to joint symptoms, including joint disorder, arthritis, arthrosis and arthralgia. 3 Percentages calculated based upon the numbers of patients with an intact uterus at baseline. 4 The odds ratios < 1.00 favor Anastrozole and those > 1.00 favor NOLVADEX (tamoxifen citrate)

Patients receiving anastrozole had an increase in joint disorders (including arthritis, arthrosis and arthralgia) compared with patients receiving NOLVADEX (tamoxifen citrate). Patients receiving anastrozole had an increase in the incidence of all fractures (specifically fractures of spine, hip and wrist) [315 (10%)] compared with patients receiving NOLVADEX (tamoxifen citrate) [209 (7%)]. Patients receiving anastrozole had a decrease in hot flashes, vaginal bleeding, vaginal discharge, endometrial cancer, venous thromboembolic events and ischemic cerebrovascular events compared with patients receiving NOLVADEX (tamoxifen citrate) .

Patients receiving NOLVADEX (tamoxifen citrate) had a decrease in hypercholesterolemia (108 [3.5%]) compared to patients receiving anastrozole (278 [9%]). Angina pectoris was reported in 71 [2.3%] patients in the anastrozole arm and 51 [1.6%] patients in the NOLVADEX (tamoxifen citrate) arm; myocardial infarction was reported in 37 [1.2%] patients in the anastrozole arm and in 34 [1.1%] patients in the NOLVADEX (tamoxifen citrate) arm.

Results from the adjuvant trial bone substudy, at 12 and 24 months demonstrated that patients receiving anastrozole had a mean decrease in both lumbar spine and total hip bone mineral density (BMD ) compared to baseline. Patients receiving NOLVADEX (tamoxifen citrate) had a mean increase in both lumbar spine and total hip BMD compared to baseline.

Ductal Carcinoma in Situ (DCIS)

The type and frequency of adverse events in the NSABP B-24 trial were consistent with those observed in the other adjuvant trials conducted with NOLVADEX (tamoxifen citrate) .

Reduction in Breast Cancer Incidence in High Risk Women

In the NSABP P-1 Trial, there was an increase in five serious adverse effects in the NOLVADEX (tamoxifen citrate) group: endometrial cancer (33 cases in the NOLVADEX (tamoxifen citrate) group vs. 14 in the placebo group); pulmonary embolism (18 cases in the NOLVADEX (tamoxifen citrate) group vs. 6 in the placebo group); deep vein thrombosis (30 cases in the NOLVADEX (tamoxifen citrate) group vs. 19 in the placebo group); stroke (34 cases in the NOLVADEX (tamoxifen citrate) group vs. 24 in the placebo group); cataract formation (540 cases in the NOLVADEX (tamoxifen citrate) group vs. 483 in the placebo group) and cataract surgery (101 cases in the NOLVADEX (tamoxifen citrate) group vs. 63 in the placebo group) (See WARNINGS and Table 3 in CLINICAL PHARMACOLOGY ).

The following table presents the adverse events observed in NSABP P-1 by treatment arm. Only adverse events more common on NOLVADEX (tamoxifen citrate) than placebo are shown.

NSABP P-1 Trial: All Adverse Events % of Women

1 Number with Quality of Life Questionnaires 2 Number with Treatment Follow-up Forms 3 Number with Adverse Drug Reaction Forms

In the NSABP P-1 trial, 15.0% and 9.7% of participants receiving NOLVADEX (tamoxifen citrate) and placebo therapy, respectively withdrew from the trial for medical reasons. The following are the medical reasons for withdrawing from NOLVADEX (tamoxifen citrate) and placebo therapy, respectively: Hot flashes (3.1% vs. 1.5%) and Vaginal Discharge (0.5% vs. 0.1%).

In the NSABP P-1 trial, 8.7% and 9.6% of participants receiving NOLVADEX (tamoxifen citrate) and placebo therapy, respectively withdrew for non-medical reasons.

On the NSABP P-1 trial, hot flashes of any severity occurred in 68% of women on placebo and in 80% of women on NOLVADEX (tamoxifen citrate). Severe hot flashes occurred in 28% of women on placebo and 45% of women on NOLVADEX (tamoxifen citrate). Vaginal discharge occurred in 35% and 55% of women on placebo and NOLVADEX (tamoxifen citrate) respectively; and was severe in 4.5% and 12.3% respectively. There was no difference in the incidence of vaginal bleeding between treatment arms.

Pediatric Patients - McCune-Albright Syndrome

Mean uterine volume increased after 6 months of treatment and doubled at the end of the one-year study. A causal relationship has not been established; however, as an increase in the incidence of endometrial adenocarcinoma and uterine sarcoma has been noted in adults treated with NOLVADEX (see BOXED WARNING ), continued monitoring of McCune-Albright patients treated with NOLVADEX (tamoxifen citrate) for long-term effects is recommended. The safety and efficacy of NOLVADEX (tamoxifen citrate) for girls aged two to 10 years with McCune-Albright Syndrome and precocious puberty have not been studied beyond one year of treatment. The long-term effects of NOLVADEX (tamoxifen citrate) therapy in girls have not been established.

Postmarketing experience

Less frequently reported adverse reactions are vaginal bleeding, vaginal discharge, menstrual irregularities, skin rash and headaches. Usually these have not been of sufficient severity to require dosage reduction or discontinuation of treatment. Very rare reports of erythema multiforme. Stevens-Johnson syndrome. bullous pemphigoid, interstitial pneumonitis, and rare reports of hypersensitivity reactions including angioedema have been reported with NOLVADEX (tamoxifen citrate) therapy. In some of these cases, the time to onset was more than one year. Rarely, elevation of serum triglyceride levels, in some cases with pancreatitis, may be associated with the use of NOLVADEX (tamoxifen citrate) (see PRECAUTIONS - Drug/Laboratory Testing Interactions section).

Read the entire FDA prescribing information for Nolvadex (Tamoxifen Citrate)



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Ixidor - Magic The Gathering Wiki, Xidor

Ixidor

He lived in Dominaria during the events after the destruction of Cabal City involving the First. Kamahl and Chainer.

Ixidor made his living as a pit fighter in the colosseum of the Cabal alongside his beloved Nivea. a talented summoner. Ixidor and Nivea lived this life betting on each other in the pits with the hopes of earning enough money to quit their career as pit fighters. As powerful as they were, they wouldn't see their dream fulfilled, as Nivea was killed in a fight at the hands of Phage the Untouchable.

Weak, physically and mentally, and with no money to pay his debts, Ixidor was cast to the desert, abandoning all hope of life. Ixidor in fact died in the desert, but then his body was inhabited by the spirit of the Numena Llowalyn, an ancient spirit of Dominaria. With renewed strength and the power to bend reality, Ixidor started to craft his perfect world, using his artistic gifts as a way to create a new realm from his imagination.

One of such creations was Akroma. a white angel with the face of his deceased Nivea. Remembering during a dream the root of all his suffering, Ixidor bent himself to one purpose: the destruction of Phage the Untouchable.

Akroma would try to help Ixidor in this task multiple times, but would fail to finish off Phage thanks to the intervention of Kamahl. now a druid of the Krosan forest.

Later Ixidor faced Phage's army, casting an unlimited amount of illusions and finally a devastating horde of massive, uncontrollable deathwurms. Faced with the consequences of such a reckless act, Ixidor vanished into a pocket dimension. Kamahl of Krosa convinced him to return. Ixidor was now fully aware of Llowalyn and joined his two brother Numena, Kuberr and Averru, in an attempt to take Karona's magic for themselves. When that failed, Ixidor advised Kamahl in how to destroy Karona, thus helping in the birth of the planeswalker Jeska. Ixidor and the other Numena were killed in the duel. Some of Ixidor's spawn yet walk over Dominaria.



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Zinopril (Lisinopril) Drug, Zinopril

Zinopril

NOTICE: This Consumer Medicine Information (CMI) is intended for persons living in Australia. This page contains answers to some common questions about Zinopril. It does not contain all the information that is known about Zinopril. It does not take the place of talking to your doctor or pharmacist. All medicines have risks and benefits. Your doctor has weighed the risk of you using this medicine against the benefits he/she expects it will have for you. If you have any concerns about using this medicine, ask your doctor or pharmacist. Bookmark or print this page, you may need to read it again.

What ZINOPRIL is used for

ZINOPRIL lowers high blood pressure, called hypertension. It is also used to treat heart failure and patients who have just had a heart attack.

Everyone has blood pressure. This pressure helps get your blood all around your body.

Your blood pressure may be different at different times of the day, depending on how busy or worried you are. You have hypertension (high blood pressure) when your blood pressure stays higher than is needed, even when you are calm and relaxed. There are usually no symptoms of hypertension. The only way of knowing that you have hypertension is to have your blood pressure checked on a regular basis. If high blood pressure is not treated it can lead to serious health problems. You may feel fine and have no symptoms, but eventually hypertension can cause stroke, heart disease and kidney failure.

ZINOPRIL helps to lower your blood pressure.

Heart failure means that the heart muscle cannot pump blood strongly enough to supply all the blood needed throughout the body. Heart failure is not the same as heart attack and does not mean that the heart stops working.

Heart failure may start off with no symptoms, but as the condition progresses, patients may feel short of breath or may get tired easily after light physical activity such as walking. Some patients may wake up short of breath at night. Fluid may collect in different parts of the body, often first noticed as swollen ankles and feet.

ZINOPRIL helps to treat heart failure and may improve your symptoms. One of the ways ZINOPRIL helps heart failure is that it widens the blood vessels, so that the heart does not have to pump as hard to move the blood around the body. This also means that when you place extra demands on your heart, such as during exercise, the heart may cope better so you may not get short of breath as easily.

When used to treat heart failure, ZINOPRIL is almost always used with other medicines called diuretics or fluid tablets. These medicines help the kidney to get rid of excess fluid from the body.

A heart attack occurs when one of the major blood vessels supplying blood to the heart muscle becomes blocked. As a result of the blockage, the heart does not receive the oxygen it needs and the heart muscle is damaged. This damage may lead to further complications such as heart failure, irregular heart rhythms and blood clots.

In some patients, ZINOPRIL may help to prevent some complications of heart attack, such as heart failure.

ZINOPRIL belongs to a group of medicines called angiotensin converting enzyme (ACE) inhibitors.

Your doctor may prescribe ZINOPRIL for another reason. Ask your doctor if you have any questions about why ZINOPRIL has been prescribed for you.

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

ZINOPRIL is not addictive.

Before you take ZINOPRIL

When you must not take it

Do not take ZINOPRIL if:

you have taken any medicines called 'ACE-inhibitor' before and have had allergic reactions with swelling of the hands, feet, or ankles, the face, lips, tongue and/or throat with difficulty in swallowing or breathing or if you or a member of your family have had a similar reaction

If you or a family member has had an allergic reaction to an ACE inhibitor before, you may be allergic to ZINOPRIL.

you have an allergy to lisinopril or any of the ingredients in ZINOPRIL listed at the end of this leaflet

Some of the symptoms of an allergic reaction to ZINOPRIL may include skin rash, itchiness, difficulty breathing or swallowing, or swelling of the face, lips, tongue or throat.

you are pregnant or breast-feeding

Your baby may absorb this medicine in the womb or from breast milk and therefore there is a possibility of harm to the baby.

you or a member of your family has a history of swelling of the face, lips, tongue, throat, hands or feet, for no apparent reason

you are undergoing haemodialysis

you are taking a blood pressure medicine containing aliskiren and you have diabetes mellitus

you are taking a blood pressure medicine containing aliskiren and you have kidney problems

the package is torn or shows signs of tampering

the expiry date (EXP) printed on the pack has passed. If you take this medicine after the expiry date has passed, it may not work as well

Before you start to take it

Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.

Tell your doctor or pharmacist if you have or have had any of the following medical conditions:

kidney disease or are undergoing dialysis

low blood pressure (you may notice this as faintness or dizziness, especially when standing)

aortic stenosis (narrowing of the aorta), renal stenosis (narrowing of the renal artery) or hypertrophic cardiomyopathy (an increase in the thickness of the heart muscle)

diarrhoea or vomiting

any other medical condition.

Tell your doctor if you are following a very low-salt diet.

Tell your doctor if you are going to receive desensitization treatment for an allergy, e. g. insect bites etc.

The desensitisation treatment reduces the effects of the allergy (e. g. bee or wasp stings) but sometimes it can cause a more severe allergic reaction if you are taking an ACE inhibitor during the desensitisation treatment.

Tell your doctor if you are pregnant or intend to become pregnant.

ZINOPRIL is not recommended for use during pregnancy.

Tell your doctor if you are breastfeeding or plan to breastfeed.

ZINOPRIL should not be used while breastfeeding or if planning to breastfeed.

If you have not told your doctor about any of the above, tell him/her before you start taking ZINOPRIL.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any that you get without a prescription from a pharmacy, supermarket or health food shop.

Some medicines and ZINOPRIL may interfere with each other.

medicines used to treat high blood pressure or heart problems called angiotensin II receptor blockers, such as candesartan, valdesartan, telmisartan, olmesartan or irbesartan.

other medicines used to treat high blood pressure including any that contain aliskiren

diuretic tablets - also called fluid or water tablets

lithium, a medicine used to treat some types of mental disorders

potassium tablets, salt substitutes containing potassium or other medicines which can increase potassium in your body

non-steroidal anti-inflammatory medicines used to treat arthritis and muscle pain, such as indomethacin. naproxen or ibuprofen

heparin, a medicine used to prevent blood clots

a medicine used to treat infection containing sulfamethoxazole and trimethoprim, also known as co-trimoxazole

gold injections (such as sodium aurothiomalate) usually used to treat rheumatoid arthritis

insulin or other medicines used to treat diabetes

medicines used to break down blood clots such as alteplase or reteplase

These medicines may be affected by ZINOPRIL or may affect how well it works. You may need different amounts of your medicines, or you may need to take different medicines.

Your doctor and pharmacist have more information on medicines to be careful with or avoid while taking this medicine.

If you have not told your doctor about any of the above, tell them before you take any ZINOPRIL.

How to take ZINOPRIL

Follow all directions given to you by your doctor and pharmacist carefully.

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

Your doctor will tell you how many tablets you need to take each day. This depends on your condition and whether you are taking other medicines.

Take ZINOPRIL only when prescribed by your doctor.

For high blood pressure:

For most patients, the usual starting dose is 5 mg to 10 mg taken once a day.

Some patients may need a lower starting dose. The dose may need to be increased depending on your blood pressure.

Most patients take between 10 mg to 20 mg each day, taken once a day.

For heart failure:

The usual starting dose is 2.5 mg taken once a day.

Depending on your response, this dose may need to be increased.

The usual dose is between 5 mg to 20mg each day, taken once a day.

For heart attack:

ZINOPRIL may be started within 24 hours of the onset of the symptoms of heart attack. The usual starting dose is 5 mg, which is followed 24 hours later by another 5 mg dose.

This is then followed 48 hours later by a 10 mg dose, and then 10 mg taken once a day thereafter. Some patients may need a lower starting and maintenance dose.

Follow all directions given to you by your doctor carefully. They may differ from the information contained in this leaflet.

If you do not understand the instructions on the pack, ask your doctor or pharmacist for help.

How to take it

Swallow the tablets whole with a full glass of water or other fluid.

Do not crush or chew the tablets.

When to take it

ZINOPRIL is usually taken once a day.

Take your ZINOPRIL 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.

It does not matter if you take ZINOPRIL before or after food.

How long to take it for

Continue taking ZINOPRIL for as long as your doctor tells you to.

ZINOPRIL helps control your high blood pressure and helps improve your heart failure, but does not cure it. Therefore ZINOPRIL must be taken every day. It is important to keep taking your medicine even if you feel well.

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, and then go back to taking your medicine as you would normally.

Do not take a double dose to make up for the dose you missed.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering your dose, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your doctor or the Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much ZINOPRIL. Do this even if there are no signs of discomfort or poisoning.

If you take too many tablets you will probably feel light-headed or dizzy, or you may faint.

You may need urgent medical attention.

If you are not sure what to do, contact your doctor or pharmacist.

While you are taking ZINOPRIL

Things you must do

Have your blood pressure checked when your doctor says to make sure ZINOPRIL is working.

Tell your doctor immediately if you feel any light-headedness or dizziness after you take your first dose of ZINOPRIL of if your dose is increased.

This is especially important if you are taking ZINOPRIL for heart failure.

If you feel light-headed, dizzy or faint, get up slowly when getting out of bed or standing up.

You may feel light-headed or dizzy, especially if you are also taking a diuretic (fluid tablet). This is because your blood pressure is falling suddenly.

Standing up slowly, especially when you get up from bed or chairs, will help your body get used to the change in position and blood pressure. If this problem gets worse or continues, talk to your doctor.

If you become pregnant while taking ZINOPRIL, tell your doctor immediately.

If you are about to be started on any new medicine, tell your doctor and pharmacist that you are taking ZINOPRIL.

If you plan to have surgery (even at the dentist) that needs a general anaesthetic, tell your doctor or dentist that you are taking ZINOPRIL.

Your blood pressure may drop suddenly during surgery.

Make sure you drink enough water during exercise and hot weather when you are taking ZINOPRIL, especially if you sweat a lot.

If you do not drink enough water while taking ZINOPRIL, you may faint or feel light-headed or sick. This is because your blood pressure is dropping suddenly. If you continue to feel unwell, tell your doctor.

If you have excessive vomiting and/ or diarrhoea while taking ZINOPRIL, tell your doctor.

This can result in you losing too much water and may drop your blood pressure too much.

Go to your doctor regularly for a check-up.

Your doctor may occasionally do a blood test to check your potassium level in the blood and see how your kidneys are working.

Things you must not do

Do not stop taking ZINOPRIL or change the dose without first checking with your doctor.

If you stop taking it suddenly, your condition may worsen or you may have unwanted side effects.

If possible, your doctor will gradually reduce the amount you take each day before stopping the medicine completely.

Do not let yourself run out of medicine over the weekend or on holidays.

Do not give ZINOPRIL to anyone else even if they have the same condition as you.

Do not use ZINOPRIL to treat other complaints unless your doctor says to.

Do not take any other medicines whether they require a prescription or not without first telling your doctor or consulting a pharmacist.

Things to be careful of

Be careful driving or operating machinery until you know how ZINOPRIL affects you.

This medicine may cause dizziness (light-headedness) or tiredness in some people, especially after the first dose or if the dose is increased. Make sure you know how you react to ZINOPRIL before you drive a car, operate machinery, or do anything else that could be dangerous if you are dizzy or light-headed. If you drink alcohol, dizziness or light - headedness may be worse.

Things that would be helpful for your blood pressure or heart failure

Some self help measures suggested below may help your condition. Talk to your doctor or pharmacist about these measures and for more information.

Alcohol - your doctor may advise you to limit your alcohol intake.

Diet - eat a healthy diet, which includes plenty of fresh vegetables, fruit, bread, cereals and fish. Also eat less fat and sugar.

Exercise - regular exercise helps to reduce blood pressure and helps the heart get fitter, but it is important not to overdo it. Walking is good exercise, but try to find a route that is fairly flat. Before starting any exercise, ask your doctor about the best kind of programme for you.

Salt - your doctor may advise you to watch the amount of salt in your diet. To reduce your salt intake you should avoid using salt in cooking or at the table.

Smoking - your doctor may advise you to stop smoking or at least cut down.

Weight - your doctor may suggest losing some weight to help lower your blood pressure and help lessen the amount of work your heart has to do. Some people may need a dietician's help to lose weight.

Know warning signs of heart attack and what to do:

Tightness, fullness, pressure, squeezing, heaviness or pain in your chest, neck, jaw, throat, shoulders, arms or back.

You may also have difficulty breathing, or have a cold sweat or feel dizzy or light headed or feel like vomiting (or actually vomit).

If you have heart attack warning signs that are severe, get worse or last for 10 minutes even if they are mild, call triple zero (000). Every minute counts.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking ZINOPRIL

This medicine helps most people with heart failure or hypertension, but it may have unwanted side effects in some people.

All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.

Do not be alarmed by the following list of side effects.

You may not experience any of them.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor or pharmacist if you notice any of the following and they worry you:

light-headedness or dizziness

mild stomach upsets such as feeling sick, diarrhoea, or stomach pains

hair loss or thinning



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Recall of a single lot of Donnatal Elixir Safecor Health, LLC has recalled a single lot of Phenobarbital/Hyoscyamine/Atropine/Scopolamine 16.2/0.1037/0.019 4/0.0065 mg DONNATAL ELIXIR. Lot number 914227 is being recalled because the label.

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Zocor (Simvastatin) Side Effects, Dosage, Uses - More, Simvastan

Simvastatin

Highlights

Simvastatin is used to help lower cholesterol and triglyceride levels. It can also reduce the risk of heart disease.

This drug comes as a tablet you take by mouth.

Simvastatin is available as the brand-name drug Zocor. It’s also available as a generic drug.

IMPORTANT INFORMATION

May cause myopathy and rhabdomyolysis Simvastatin and other statin drugs can sometimes cause muscle disease (myopathy). They can even cause severe muscle breakdown (rhabdomyolysis). Rhabdomyolysis can lead to kidney failure. You have an increased risk of each condition if you:

are elderly

are female

have kidney disease

have low thyroid function

have diabetes

Tell your doctor right away if you experience:

unexplained muscle weakness or tenderness

persistent muscle pain

diarrhea

fever

dark-colored urine

Warning for liver disease and alcohol abuse People with active liver disease shouldn’t use simvastatin. People with a history of alcohol abuse and risk of liver disease should also not take the drug. For these groups, simvastatin can increase the risk of serious liver injury.

Drug features

Simvastatin is a prescription drug. It comes as a tablet and suspension that you take by mouth.

Simvastatin is available as the brand-name drug Zocor. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

Why it's used

Simvastatin is used to:

lower bad cholesterol (low-density lipoprotein [LDL]) and triglycerides in the body

increase good cholesterol (high-density lipoprotein [HDL])

slow the development of heart disease and reduce the risk of stroke

How it works

Simvastatin belongs to the drug class known as HMG-CoA reductase inhibitors, also called statins. A class of drugs refers to medications that work similarly in your body. They have a similar chemical structure and are often used to treat similar conditions.

Statins work to reduce the body’s cholesterol production. They also reduce the amount of cholesterol and triglycerides moving through the body. High cholesterol and triglycerides are associated with increased risk of:

Statins are usually taken in combination with lifestyle changes, such as changes to diet and exercise.

Simvastatin Side Effects

More common side effects

Most people don’t experience too many uncomfortable side effects from simvastatin. However, side effects are possible.

Common side effects include:

headache

nausea

stomach pain

constipation

diarrhea

muscle pain or weakness

joint pain

Serious side effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life-threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

muscle breakdown (rhabdomyolysis)

severe muscle pain or weakness

muscle spasms

kidney failure

liver toxicity

jaundice (yellowing of the skin)

severe anemia

symptoms associated with severe allergic reaction, such as fever and difficulty breathing

rash of any kind

extreme sensitivity to the sun

diarrhea

feeling weak or very tired

severe stomach pain

severe nausea or vomiting

blood in the stool or black stools

blood in the urine

unusual bleeding or bruising

severe swelling of the hands, feet, and ankles

Simvastatin does not cause drowsiness.

To reduce the likelihood of feeling side effects, take this drug exactly as prescribed at a regularly scheduled time each night.

Simvastatin and diabetes

You Asked, We Answered

Can taking simvastatin increase my risk of diabetes?

There is a small risk of increased blood sugar levels and even diabetes from taking simvastatin. Your doctor should occasionally check your blood sugar levels while you take simvastatin. If you already have diabetes, your doctor should regularly check your blood sugar level. Your doctor should also regularly check your hemoglobin A1C level, which can indicate if your average blood sugar level has been high over an extend period (2–3 months).

- Healthline Pharmacist Review Team

Simvastatin may interact with other medications

Simvastatin can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Food interactions

Avoid grapefruit juice while taking simvastatin. Grapefruit juice can increase simvastatin levels in your body and increase the risk for side effects.

Medications that might interact with this drug

CYP3A4 Inhibitors These drugs block the breakdown of simvastatin. They can lead to very high levels of the drug in your body. They can also increase side effects, including severe muscle breakdown (rhabdomyolysis). These drugs include:

ketoconazole

itraconazole

voriconazole

erythromycin

clarithromycin

telithromycin

cyclosporine

danazol

nefazodone

boceprevir

telaprevir

ritonavir

tipranavir

indinavir

fosamprenavir

darunavir

atazanavir

nelfinavir

cobicistat

People taking simvastatin should not drink grapefruit juice, which is also a CYP3A4 inhibitor.

Other Cholesterol-Lowering Drugs When used with simvastatin, some cholesterol drugs can increase side effects such as muscle weakness (myopathy) or rhabdomyolysis. These drugs include:

gemfibrozil (Lopid)

fenofibrate (Tricor)

Calcium Channel Blockers & Other Drugs that Increase Risk for Myopathy or Rhabdomyolysis Using simvastatin with these drugs can increase the risk of myopathy or rhabdomyolysis. Your doctor may discuss other medication options or lower your dose of simvastatin. Calcium channel blockers include:

amlodipine (Norvasc)

diltiazem (Cardizem, Dilacor, Taztia, Tiazac)

verapamil

Other drugs that increase risk for myopathy or rhabdomyolysis include:

Lomitapide (Juxtapid) Lomitapide is a drug used to lower cholesterol. Using it with simvastatin can cause large increases in simvastatin levels. If you use these two medications together, your doctor may lower your dose of simvastatin.

Digoxin Digoxin is a drug used to treat heart failure and arrhythmias. Simvastatin can increase levels of digoxin in some people. If you’re taking both drugs, your doctor may want to more closely monitor your digoxin level.

Colchicine and Niacin Colchicine is a drug used to treat gout. Niacin is sometimes used to lower cholesterol (either alone or in combination with other drugs). Combining simvastatin with colchicine or niacin can increase the risk of both myopathy and rhabdomyolysis. The risk with niacin is higher when taking larger doses and in people of Chinese descent.

Warfarin (Blood Thinners): Simvastatin can increase the blood thinning effects of warfarin. This can lead to an increased risk of bleeding. Your doctor may want to more closely monitor your warfarin level if you’re taking these two drugs at the same time.

AMLODIPINE WARNINGS

Low Thyroid Function (Hypothyroidism) or Diabetes Simvastatin and other statin drugs can sometimes cause severe muscle breakdown called rhabdomyolysis. Having hypothyroidism or diabetes raises your risk for this condition. Other risk factors include:

being elderly

being female

having kidney disease

unexplained muscle weakness or tenderness

continuous muscle pain

diarrhea

fever

dark-colored urine

Tell your doctor right away if you experience:

Liver Disease People with active liver disease, such as cirrhosis or hepatitis, shouldn’t use simvastatin.

Alcohol Abuse People with a history of alcohol abuse and risk of liver disease should also not take the drug. For these groups, simvastatin can increase the risk of serious liver injury.

Pregnant women Simvastatin is a category X pregnancy drug. Category X drugs should never be used during pregnancy .

Simvastatin blocks the production of cholesterol, which is important for the developing baby.

If you’re pregnant and need treatment for high cholesterol or triglycerides, talk to your healthcare provider. They can discuss other treatment options during pregnancy.

Women who are breast-feeding It isn’t known if simvastatin enters the breast milk. But, because of the risk of severe side effects, it shouldn’t be used during breastfeeding. Talk to your healthcare provider about other treatment options while breastfeeding.

How to take simvastatin

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

your age

the condition being treated

how severe your condition is

other medical conditions you have

how you react to the first dose

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages and forms. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

What are you taking this medication for?

Generic: Simvastatin Form: Oral tablet Strengths: 5 mg, 10 mg, 20 mg, 40 mg, 80 mg

strong>Form: Oral suspension Strengths: 20 mg/5 mL, 40 mg/5 mL

Adult Dosage (ages 18 years and older)

Simvastatin is often started at 10–20 mg per day. However, the dose may range from 5 mg to 40 mg.

You can take it once a day in the evening.

• The dose is gradually adjusted if needed.

Child Dosage (ages 0-9 years) This medicine has not been studied in children below age 10 years.

Child Dosage (ages 10-17 years) Doses above 40 mg per day have not been studied in this age group:

Kidney disease: Having kidney disease may affect your dose. People with advanced kidney disease usually require a lower dose. Speak with your healthcare provider about your treatment with simvastatin if you have kidney disease. Liver disease: The recommended dose is 2.5 mg taken by mouth once per day. Amlodipine is processed by your liver. If your liver isn’t working well, more of this drug may stay in your body longer. This puts you at risk for side effects. If you have severe liver problems, you may need a lower dose or a different dosing schedule.

Reduce the risk of heart disease and heart attack and stroke in people with heart disease

Generic: Simvastatin Form: Oral tablet Strengths: 5 mg, 10 mg, 20 mg, 40 mg, 80 mg

Adult Dosage (ages 18 years and older)

Simvastatin is often started at 10–20 mg per day. However, the dose may range from 5 mg to 40 mg.

You can take it once a day in the evening.

• The dose is gradually adjusted if needed.

Child Dosage (ages 0-9 years) This medicine has not been studied in children below age 10 years.

Child Dosage (ages 10-17 years) Doses above 40 mg per day have not been studied in this age group:

Kidney disease: Having kidney disease may affect your dose. People with advanced kidney disease usually require a lower dose. Speak with your healthcare provider about your treatment with simvastatin if you have kidney disease. Liver disease: The recommended dose is 2.5 mg taken by mouth once per day. Amlodipine is processed by your liver. If your liver isn’t working well, more of this drug may stay in your body longer. This puts you at risk for side effects. If you have severe liver problems, you may need a lower dose or a different dosing schedule.

Simvastatin comes with serious risks if you don’t take it as prescribed.

If you don’t take it at all or stop taking it If you have high cholesterol and don’t take your simvastatin, you risk: having increased cholesterol levels, developing heart disease, and having a heart attack or a stroke.

If you don't take it on schedule Not taking simvastatin every day, skipping days, or taking doses at different times of the day may also increase your risk for high cholesterol levels, heart attack, or stroke.

If you miss a dose If you miss a dose, take the next dose as scheduled. Don’t double your dose.

How can I tell if the drug is working You can tell this drug is working if your cholesterol and triglyceride levels are within healthy levels while taking it.

Important considerations for taking this drug

You can take simvastatin with or without food Taking it with food may reduce nausea.

Cholesterol production in the body is highest at nighttime Take simvastatin in the evening to maximize its effects.

Though most simvastatin pills don’t have a score, you may cut or crush them A score is an indented line down the middle of a tablet. Scoring helps pills to be cut in half evenly.

Store this drug carefully.

Store the tablets between 41°F and 86°F (5°C to 30°C).

Keep the tablets in a tightly closed, light-resistant container.

Store the suspension between 68°F and 77°F (20°C to 25°C). Protect the suspension from heat. Don’t freeze or refrigerate it. Use it within one month of opening it.

A prescription for this medication is not refillable. You or your pharmacy will have to contact your doctor for a new prescription if you need this medication refilled.

Your doctor will want to make sure that simvastatin isn't affecting your liver and kidneys They may perform a baseline liver function test (an initial liver function test that is repeated in a few months). They may also do additional liver and kidney function tests during treatment.

Though rare, simvastatin may increase risk of sunburn Use these steps to avoid sunburn:

Avoid the sun if possible.

Keep skin covered with protective clothing/hat.

Use high a sunscreen with a sun protection factor (SPF) of 30 higher.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives. Options include:

atorvastatin

lovastatin

rosuvastatin

fluvastatin

pravastatin

pitavastatin

Simvastatin professional information

Brand Name

Indications for use

Reduce the risk of total mortality by reducing CHD deaths and reduce the risk of non-fatal myocardial infarction, stroke, and the need for revascularization procedures in patients at high risk of coronary events.

Reduce elevated total-C, LDL-C, Apo B, TG and increase HDL-C in patients with primary hyperlipidemia (heterozygous familial and nonfamilial) and mixed dyslipidemia.

Reduce elevated TG in patients with hypertriglyceridemia and reduce TG and VLDL-C in patients with primary dysbetalipoproteinemia.

Reduce total-C and LDL-C in adult patients with homozygous familial hypercholesterolemia.

Reduce elevated total-C, LDL-C, and Apo B in boys and postmenarchal girls, 10 to 17 years of age with heterozygous familial hypercholesterolemia (HFH) after failing an adequate trial of diet therapy.

Contraindications

Concomitant administration of strong CYP3A4 inhibitors (e. g. itraconazole, ketoconazole, posaconazole, voriconazole, HIV protease inhibitors, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin, nefazodone, and cobicistat-containing products).

Concomitant administration of gemfibrozil, cyclosporine, or danazol .

Hypersensitivity to any component of this medication.

Active liver disease, which may include unexplained persistent elevations in hepatic transaminase levels.

Women who are pregnant or may become pregnant. Serum cholesterol and triglycerides increase during normal pregnancy, and cholesterol or cholesterol derivatives are essential for fetal development. Because HMG-CoA reductase inhibitors (statins) decrease cholesterol synthesis and possibly the synthesis of other biologically active substances derived from cholesterol, simvastatin may cause fetal harm when administered to a pregnant woman. Atherosclerosis is a chronic process and the discontinuation of lipid-lowering drugs during pregnancy should have little impact on the outcome of long-term therapy of primary hypercholesterolemia. There are no adequate and well-controlled studies of use with simvastatin during pregnancy; however, in rare reports congenital anomalies were observed following intrauterine exposure to statins. In rat and rabbit animal reproduction studies, simvastatin revealed no evidence of teratogenicity.

Simvastatin should be administered to women of childbearing age only when such patients are highly unlikely to conceive.

If the patient becomes pregnant while taking this drug, simvastatin should be discontinued immediately and the patient should be apprised of the potential hazard to the fetus.

Nursing mothers. It is not known whether simvastatin is excreted into human milk; however, a small amount of another drug in this class does pass into breast milk. Because statins have the potential for serious adverse reactions in nursing infants, women who require treatment with simvastatin should not breastfeed their infants.

Warnings/precautions

The risk of myopathy, including rhabdomyolysis, is greater in patients on simvastatin 80 mg compared with other statin therapies with similar or greater LDL-C-lowering efficacy and compared with lower doses of simvastatin. Therefore, the 80-mg dose of simvastatin should be used only in patients who have been taking simvastatin 80 mg chronically (e. g. for 12 months or more) without evidence of muscle toxicity. If, however, a patient who is currently tolerating the 80-mg dose of simvastatin needs to be initiated on an interacting drug that is contraindicated or is associated with a dose cap for simvastatin, that patient should be switched to an alternative statin with less potential for the drug-drug interaction. Patients should be advised of the increased risk of myopathy, including rhabdomyolysis, and to report promptly any unexplained muscle pain, tenderness or weakness. If symptoms occur, treatment should be discontinued immediately.

Persistent increases (to more than 3X the ULN) in serum transaminases have occurred in approximately 1% of patients who received simvastatin in clinical studies. It is recommended that liver function tests be performed before the initiation of treatment, and thereafter when clinically indicated.

Increases in HbA1c and fasting serum glucose levels have been reported with HMG-CoA reductase inhibitors, including simvastatin.

Mechanism of action

Simvastatin is a prodrug and is hydrolyzed to its active beta-hydroxyacid form, simvastatin acid, after administration. Simvastatin is a specific inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, the enzyme that catalyzes the conversion of HMG-CoA to mevalonate, an early and rate limiting step in the biosynthetic pathway for cholesterol. In addition, simvastatin reduces VLDL and TG and increases HDL-C.

Dosing in adults

The usual dosage range is 5 to 40 mg/day. In patients with CHD or at high risk of CHD, simvastatin can be started simultaneously with diet. The recommended usual starting dose is 10 or 20 mg once a day in the evening. For patients at high risk for a CHD event due to existing CHD, diabetes, peripheral vessel disease, history of stroke or other cerebrovascular disease, the recommended starting dose is 40 mg/day.

Dosing in children

Adolescents (10-17 years of age with HFH): The recommended usual starting dose is 10 mg once a day in the evening. The recommended dosing range is 10 to 40 mg/day; the maximum recommended dose is 40 mg/day.

Dosing in elderly

Dosing in renal impairment

Because simvastatin does not undergo significant renal excretion, modification of dosage should not be necessary in patients with mild to moderate renal impairment. However, caution should be exercised when simvastatin is administered to patients with severe renal impairment; such patients should be started at 5 mg/day and be closely monitored.

Dosing in hepatic impairment

Drug interactions

Strong CYP3A4 inhibitors, cyclosporine, or danazol

Strong CYP3A4 inhibitors: Simvastatin, like several other inhibitors of HMG-CoA reductase, is a substrate of CYP3A4. Simvastatin is metabolized by CYP3A4 but has no CYP3A4 inhibitory activity; therefore it is not expected to affect the plasma concentrations of other drugs metabolized by CYP3A4.

Elevated plasma levels of HMG-CoA reductase inhibitory activity increases the risk of myopathy and rhabdomyolysis, particularly with higher doses of simvastatin.

Concomitant use of drugs labeled as having a strong inhibitory effect on CYP3A4 is contraindicated . If treatment with itraconazole, ketoconazole, posaconazole, voriconazole, erythromycin, clarithromycin or telithromycin is unavoidable, therapy with simvastatin must be suspended during the course of treatment.

Cyclosporine or danazol: The risk of myopathy, including rhabdomyolysis is increased by concomitant administration of cyclosporine or danazol. Therefore, concomitant use of these drugs is contraindicated.

Lipid-lowering drugs that can cause myopathy when given alone

Gemfibrozil: Contraindicated with simvastatin.

Other fibrates: Caution should be used when prescribing with simvastatin.

Amiodarone, dronedarone, ranolazine, or calcium channel blockers

The risk of myopathy, including rhabdomyolysis, is increased by concomitant administration of amiodarone, dronedarone, ranolazine, or calcium channel blockers such as verapamil, diltiazem, or amlodipine.

Cases of myopathy/rhabdomyolysis have been observed with simvastatin coadministered with lipid-modifying doses (?1 g/day niacin) of niacin-containing products. In particular, caution should be used when treating Chinese patients with simvastatin doses exceeding 20 mg/day coadministered with lipid-modifying doses of niacin-containing products. Because the risk for myopathy is dose-related, Chinese patients should not receive simvastatin 80 mg coadministered with lipid-modifying doses of niacin-containing products.

In one study, concomitant administration of digoxin with simvastatin resulted in a slight elevation in digoxin concentrations in plasma. Patients taking digoxin should be monitored appropriately when simvastatin is initiated.

In two clinical studies, one in normal volunteers and the other in hypercholesterolemic patients, simvastatin 20-40 mg/day modestly potentiated the effect of coumarin anticoagulants: the prothrombin time, reported as international normalized ratio (INR), increased from a baseline of 1.7 to 1.8 and from 2.6 to 3.4 in the volunteer and patient studies, respectively. With other statins, clinically evident bleeding and/or increased prothrombin time has been reported in a few patients taking coumarin anticoagulants concomitantly. In such patients, prothrombin time should be determined before starting simvastatin and frequently enough during early therapy to ensure that no significant alteration of prothrombin time occurs.

Once a stable prothrombin time has been documented, prothrombin times can be monitored at the intervals usually recommended for patients on coumarin anticoagulants. If the dose of simvastatin is changed or discontinued, the same procedure should be repeated. Simvastatin therapy has not been associated with bleeding or with changes in prothrombin time in patients not taking anticoagulants.

Cases of myopathy, including rhabdomyolysis, have been reported with simvastatin coadministered with colchicine. Use this combination with caution.

Adverse drug reactions

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

In the pre-marketing controlled clinical studies and their open extensions (2,423 patients with median duration of follow-up of approximately 18 months), 1.4% of patients were discontinued due to adverse reactions. The most common adverse reactions that led to treatment discontinuation were: gastrointestinal disorders (0.5%), myalgia (0.1%), and arthralgia (0.1%). The most commonly reported adverse reactions (incidence ?5%) in simvastatin controlled clinical trials were: upper respiratory infections (9.0%), headache (7.4%), abdominal pain (7.3%), constipation (6.6%), and nausea (5.4%).

Monitoring parameters

Check liver enzyme tests before initiating therapy and as clinically indicated thereafter.

Pregnancy risk factor

Simvastatin is contraindicated in women who are or may become pregnant. Lipid lowering drugs offer no benefit during pregnancy, because cholesterol and cholesterol derivatives are needed for normal fetal development. Women of childbearing potential, who require treatment with simvastatin for a lipid disorder, should be advised to use effective contraception. For women trying to conceive, discontinuation of simvastatin should be considered. If pregnancy occurs, simvastatin should be immediately discontinued.

Preparation of suspension

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. The drug information contained herein is for informational purposes only. Data sources include the drug manufacturer’s prescribing information and package insert.

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DRUG DESCRIPTION

The active ingredient in CANASA 1000 mg rectal suppositories is mesalamine, also known as mesalazine or 5-aminosalicylic acid (5-ASA). Chemically, mesalamine is 5-amino-2-hydroxybenzoic acid, and is classified as an anti-inflammatory drug. Each CANASA rectal suppository contains 1000 mg of mesalamine (USP) in a base of Hard Fat, NF.

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What are the possible side effects of mesalamine rectal (Canasa, Canasa Pac, Rowasa)?

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What are the precautions when taking mesalamine (Canasa)?

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Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, pancreas problems (pancreatitis), inflammation of the sac around the heart (pericarditis).

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Last reviewed on RxList: 1/6/2014 This monograph has been modified to include the generic and brand name in many instances.



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