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Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction and in patients who are critically ill. [2 ] [3 ]

Supplemental parenteral nutrition is used in a step-up approach when full enteral support is contra-indicated or fails to reach the required intake targets. [4 ]

Patient selection

The use of home enteral feeding is increasing worldwide. [5 ] Multidisciplinary primary care teams focused on home enteral nutrition can provide cost-effective care. [6 ]

Enteral feeding should be considered for malnourished patients or in those at risk of malnutrition who have a functional gastrointestinal tract but are unable to maintain an adequate or safe oral intake. [1 ] [7 ]

Enteral nutrition is often used for children as well as for adults. [8 ] Children may require enteral feeding for a wide range of underlying conditions, such as for malnutrition, for increased energy requirement (eg, cystic fibrosis), for metabolic disorders and also for children with neuromuscular disorders.

Although it is often a life-saving manoeuvre, the patient's quality of life may be adversely affected. [9 ]

Enteral feeding is particularly beneficial for:

Critically ill patients, in whom enteral feeding promotes gut barrier integrity and reduces rates of infection and mortality. [10 ]

Postoperative patients with limited oral intake. The complication rate and duration of hospital stay are reduced by early enteral feeding after:

Elective gastrointestinal surgery [11 ]

Gastrointestinal cancer surgery [12 ]

Early post-pyloric feeding (duodenal or jejunal) is useful as, although gastric and colonic function is impaired postoperatively, small bowel function is often normal. Feeding is usually introduced after 1 to 5 days. [11 ]

Patients with severe pancreatitis. without pseudocyst or fistula complication. Enteral feeding promotes the resolution of inflammation and reduces the incidence of infection. [13 ]

Low-flow enteral feeding may also be useful in combination with parenteral nutrition to maintain gut function and reduce the likelihood of cholestasis. [11 ]

Access

Short-term access is usually achieved using nasogastric (NG) or nasojejunal (NJ) tubes at an initial continuous feeding rate of 30 mls per hour. [11 ] Percutaneous endoscopic gastrotomy (PEG) or jejunostomy placement should be considered if feeding is planned for longer than one month:

NG tubes :

These are the most commonly used delivery routes but depend on adequate gastric emptying.

They allow the use of hypertonic feeds, high feeding rates and bolus feeding into the stomach reservoir.

Tubes are simple to insert but are easily displaced.

NJ tubes :

These reduce the incidence of gastro-oesophageal reflux and are useful in the presence of delayed gastric emptying.

Post-pyloric placement can be difficult but may be aided by intravenous prokinetics or fibre-optic observation.

PEG tubes :

Indications for gastrostomy include stroke, motor neurone disease, Parkinson's disease and oesophageal cancer. [14 ]

Relative contra-indications include reflux, previous gastric surgery, gastric ulceration or malignancy and gastric outlet obstruction.

They are inserted directly through the stomach wall endoscopically or surgically, under antibiotic cover.

Percutaneous jejunostomy tubes :

They permit early postoperative feeding and are useful in patients at risk of reflux.

They are inserted through the stomach into the jejunum, using a surgical or endoscopic technique.

This can be difficult and has more complications.

Feed preparations

Various nutritionally complete pre-packaged feeds are available:

Standard enteral feeds :

These contain all the carbohydrate, protein, fat, water, electrolytes, micronutrients (vitamins and trace elements) and fibre required by a stable patient.

'Pre-digested' feeds :

These contain nitrogen as short peptides or free amino acids and aim to improve nutrient absorption in the presence of pancreatic insufficiency or inflammatory bowel disease.

The fibre content of feeds is variable and some are supplemented with vitamin K, which may interact with other medications.

Nutrients such as glutamine, arginine and essential omega-3 fatty acids are able to modulate immune function. Enteral immunonutrition may decrease major infectious complications and length of hospital stay in surgical and some critically ill patients. Further research is ongoing. [15 ]

Complications of enteral feeding

General complications of feeding

Tube complications

NG tube:

This may cause nasopharyngeal discomfort and later nasal erosions, abscesses and sinusitis. [11 ]

Although acute complications such as pharyngeal or oesophageal perforation, intracranial or bronchial insertion are uncommon, they may be fatal.

Longer use may cause oesophagitis, oesophageal ulceration and stricture.

Fine-bore tubes should be used and replaced in the alternate nostril each month. Large stiff tubes are particularly unsafe in the presence of varices and insertion of any tube should be avoided for three days following acute variceal bleed.

Percutaneous gastrostomy or jejunostomy tubes:

These can lead to complications related to endoscopy plus bowel perforation and abdominal wall or intraperitoneal bleeding.

Post-insertion complications include stoma site infections, peritonitis, septicaemia, peristomal leaks, dislodgement and gastrocolic fistula formation.

All feeding tubes should be flushed with water before and after use, as they block easily. Blockages can sometimes be removed by flushing with warm water or an enzyme solution but some tubes may need to be replaced.

Infection

Bacterial contamination of enteral feed can cause serious infection. [11 ] Administration sets and feed containers should be discarded every 24 hours to minimise the risk of infection. Feeds should never be decanted and equipment should not be handled.

Gastro-oesophageal reflux and aspiration

Reflux occurs frequently with enteral feeding, particularly in patients with impaired consciousness, poor gag reflex and when fed in the supine position. [11 ] Patients should be propped up by at least 30° whilst feeding and should remain in that position for a further 30 minutes to minimise the risk of aspiration. Post-pyloric tubes should be used in unconscious patients who need to be nursed flat.

Reflux is more likely with accumulation of gastric residues. Gastric aspirates should be measured regularly and the feeding regimen altered or prokinetics added to reduce gastric pooling.

Gastrointestinal symptoms

Gut motility and absorption are promoted by hormones released during mastication, with co-ordinated stomach emptying and the in presence of intraluminal nutrients. [16 ]

As the usual physiological mechanisms are bypassed during enteral feeding, gastrointestinal symptoms such as abdominal bloating, cramps, nausea, diarrhoea and constipation are common.

Symptoms may respond to reduced feed administration rates, continuous rather than bolus feeding, alternative feed preparation or the addition of prokinetic agents. [11 ]

Re-feeding syndrome

This occurs in previously malnourished patients who are fed with high carbohydrate loads.

Carbohydrates (eg, glucose) in the feed can cause a large increase in the circulating insulin level. This results in a rapid and dramatic fall in phosphate, potassium and magnesium - with an increasing extracellular fluid (ECF) volume.

As the body tries to switch from catabolic (starvation mode) to using exogenous fuel sources, there is an increase in oxygen consumption, increased respiratory and cardiac workload (may precipitate acute heart failure and tachypnoea and make weaning from a ventilator difficult). Demand for nutrients and oxygen may outstrip supply. Both of the above can lead to multiple organ failure; respiratory and/or cardiac failure, arrhythmias, rhabdomyolysis, seizures or coma, red cell and/or leukocyte dysfunction.

The gut may have undergone some atrophy with starvation and, with the return of enteral feeding, there may be intolerance to the feed, with nausea and diarrhoea.

Feeds should be started slowly and the electrolytes closely monitored and adequately replaced to avoid these problems developing.

Monitoring

Monitoring should include the general observations and laboratory schedule recommended for all forms of nutritional support, particularly if the patient is at high risk of re-feeding syndrome. [1 ] Consideration should also be given to:

The position of nasally inserted tubes, which should be checked before each feed by obtaining tube aspirate of pH <5.5 on pH paper. [17 ]

The function of nasal tubes and the development of erosions, which should be assessed daily.

Gastrostomy and jejunostomy stoma sites, which should be checked each day for tube position and signs of infection.

Related discussions

Home therapy

The number of patients receiving home enteral feeding has increased considerably in recent years. [18 ] It is now estimated that more than twice as many patients receive enteral nutrition in the community compared with those in hospital.

Treatment is usually initiated in secondary care but GPs can also refer patients for elective home enteral nutrition with outpatient feeding tube placement. PEG tubes are the easiest feeding tubes to manage in the community.

Patients are managed by a co-ordinated multidisciplinary team, including a dietician and district nurse. They may also be invited to attend hospital PEG review clinics.

GPs are responsible for co-ordinating community services, so should be informed of all patients discharged on enteral feeding and any feeding regimen changes. Feed preparation and regimens are generally advised by dieticians and prescribed by GPs.

Manufacturing companies will deliver stock directly to patients' homes.

Patients and/or carers must be trained in the use of enteral feeding pumps and systems and how to deal with simple problems. Unfortunately, blocked tubes are still a common problem for nursing home residents.

Patients and/or carers should also be aware of the potential hazards of tube feeding and encouraged to contact a relevant health professional in emergency situations. [18 ]

Professionals should be aware of the potential negative impact of tube feeding on carers' own eating habits. [19 ]

Further reading & references

Caring for children and young people in the community receiving enteral tube feeding ; NHS Quality Improvement Scotland (September 2007)

Malnutrition Universal Screening Tool (MUST) ; British Association of Parenteral and Enteral Nutrition (BAPEN)

White H, King L ; Enteral feeding pumps: efficacy, safety, and patient acceptability. Med Devices (Auckl). 2014 Aug 19;7:291-8. doi: 10.2147/MDER. S50050. eCollection 2014.

NDR (Nutrition and Diet Resources) UK

Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition ; NICE (2006)

Blumenstein I, Shastri YM, Stein J ; Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014 Jul 14;20(26):8505-24. doi: 10.3748/wjg. v20.i26.8505.

Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, et al ; Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 2014 Jun 28;20(24):7739-51. doi: 10.3748/wjg. v20.i24.7739.

Bost RB, Tjan DH, van Zanten AR ; Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review. Ann Intensive Care. 2014 Oct 2;4:31. doi: 10.1186/s13613-014-0031-y. eCollection 2014.

Ojo O ; The Challenges of Home Enteral Tube Feeding: A Global Perspective. Nutrients. 2015 Apr 8;7(4):2524-2538.

Dinenage S, Gower M, Van Wyk J, et al ; Development and evaluation of a home enteral nutrition team. Nutrients. 2015 Mar 5;7(3):1607-17. doi: 10.3390/nu7031607.

Stroud M, Duncan H, Nightingale J ; Guidelines for enteral feeding in adult hospital patients. Gut. 2003 Dec;52 Suppl 7:vii1-vii12.

Braegger C, Decsi T, Dias JA, et al ; Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010 Jul;51(1):110-22. doi: 10.1097/MPG.0b013e3181d336d2.

Bozzetti F ; Quality of life and enteral nutrition. Curr Opin Clin Nutr Metab Care. 2008 Sep;11(5):661-5.

van der Voort PH, Zandstra DF ; Enteral feeding in the critically ill: comparison between the supine and prone positions: a prospective crossover study in mechanically ventilated patients. Crit Care. 2001 Aug;5(4):216-20. Epub 2001 May 25.

Stroud M, Duncan H, Nightingale J ; Guidelines for enteral feeding in adult hospital patients. Gut 2003;52:vii1

Bozzetti F, Braga M, Gianotti L, et al ; Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet. 2001 Nov 3;358(9292):1487-92.

Louie BE, Noseworthy T, Hailey D, et al ; 2004 MacLean-Mueller prize enteral or parenteral nutrition for severe pancreatitis: a randomized controlled trial and health technology assessment. Can J Surg. 2005 Aug;48(4):298-306.

Kurien M, McAlindon ME, Westaby D, et al ; Percutaneous endoscopic gastrostomy (PEG) feeding. BMJ. 2010 May 7;340:c2414. doi: 10.1136/bmj. c2414.

McCowen KC, Bistrian BR ; Immunonutrition: problematic or problem solving? Am J Clin Nutr. 2003 Apr;77(4):764-70.

Nutrition in critical illness ; Anaesthesia UK

Reducing the harm caused by misplaced nasogastric feeding tubes ; National Patient Safety Alert (#5), 2005

Collier J ; Enteral Feeding - An Overview

Morton KH, Goodacre L ; An exploration of the impact of home enteral tube feeding on the eating habits of the partners of adults receiving home enteral tube feeding. Journal of Human Nutrition and Dietetics, 21: 397. doi: 10.1111/j.1365-277X.2008.00881_33.x

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions .

Original Author: Dr Hayley Willacy



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Sertraline Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Sertral

sertraline

GENERIC NAME(S): SERTRALINE HCL

Warnings

Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression. other mental/mood symptoms, or suicidal thoughts/attempts. Therefore, it is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.

Tell the doctor right away if you notice worsening depression /other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety. panic attacks. trouble sleeping. irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

Uses

This medication may improve your mood, sleep. appetite, and energy level and may help restore your interest in daily living. It may decrease fear, anxiety. unwanted thoughts, and the number of panic attacks. It may also reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, and checking) that interfere with daily living. Sertraline is known as a selective serotonin reuptake inhibitor (SSRI). It works by helping to restore the balance of a certain natural substance (serotonin) in the brain .

How to use sertraline

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start using sertraline and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, usually once daily either in the morning or evening. The tablet form of this medication may be taken with or without food. The capsule form is usually taken with food after breakfast or after your evening meal.

If you are taking this medication for premenstrual problems, your doctor may direct you to take this drug every day of the month or for only the 2 weeks before your period until the start of your period.

The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

It is important to continue taking this medication as prescribed even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as mood swings, headache. tiredness, sleep changes, and brief feelings similar to electric shock. Your dose may need to be gradually decreased to reduce side effects. Report any new or worsening symptoms right away.

Tell your doctor if your condition persists or worsens.

Side Effects

See also Warning section.

Nausea. dizziness. drowsiness, dry mouth. loss of appetite, increased sweating. diarrhea. upset stomach. or trouble sleeping may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

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

Tell your doctor right away if any of these unlikely but serious side effects occur: easy bruising/bleeding, decreased interest in sex. decrease in sexual ability (ejaculation delay), muscle cramps /weakness. shaking (tremor), unusual weight loss .

Get medical help right away if any of these rare but serious side effects occur: black/bloody stools, vomit that looks like coffee grounds, eye pain /swelling/redness, vision changes (such as seeing rainbows around lights at night, blurred vision ).

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome /toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations. loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever. unusual agitation/restlessness.

Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.

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

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

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

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

Precautions

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

Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, liver disease, seizure disorder, thyroid disease, personal or family history of glaucoma (angle-closure type).

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

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

Older adults may be more sensitive to the side effects of this drug, especially bleeding, or loss of coordination. Older adults may also be more likely to develop a type of salt imbalance (hyponatremia), especially if they are taking "water pills" (diuretics). Loss of coordination can increase the risk of falling.

Children may be more sensitive to the side effects of the drug, especially loss of appetite and weight loss. Monitor weight and height in children who are taking this drug.

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Also, babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. If you notice any of these symptoms in your newborn, tell the doctor promptly.

Since untreated mental/mood problems (such as depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss the benefits and risks of using this medication during pregnancy with your doctor.

This drug passes into breast milk. Consult your doctor before breast-feeding.

Interactions

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

Some products that may interact with this drug include: pimozide, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, "blood thinners" such as warfarin).

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including other SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine). Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise.

This medication may interfere with certain medical/laboratory tests (including brain scan for Parkinson's disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting.

Notes

Do not share this medication with others.

Keep all regular medical and psychiatric appointments.

Missed Dose

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

Storage

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

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

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

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Co-Diovan 160, Co-Diovane

CO-DIOVAN 160/12.5MG TABLETS

UK PIL = Jan 2014. Add/amend to combine var 11 and var 9 correctly.

6. Further information

inflammation of blood vessels with symptoms such as rash, purplish-red spots, fever (vasculitis)

What Co-Diovan contains

rash, itching, hives, difficulty breathing or swallowing, dizziness (hypersensitivity reactions)

severe skin disease that causes rash, red skin, blistering of the lips, eyes or mouth, skin peeling, fever (toxic epidermal necrolysis)

Co-Diovan also contains the following inactive ingredients: microcrystalline cellulose, colloidal anhydrous silica, crospovidone, magnesium stearate, hypromellose, macrogol 8000, talc, titanium dioxide (E171) and red iron oxide (E172).

severe upper stomach pain (pancreatitis)

What Co-Diovan looks like and contents of the pack

difficulty breathing with fever, coughing, wheezing, breathlessness (respiratory distress including pneumonitis and pulmonary oedema)

Co-Diovan tablets are oval, brown orange coloured, imprinted with ‘HHH’ on one side and ‘CG’ on the other side.

fever, sore throat, more frequent infections (agranulocytosis) pale skin, tiredness, breathlessness, dark urine (haemolytic anaemia)

fever, sore throat or mouth ulcers due to infections (leucopenia)

confusion, tiredness, muscle twitching and spasm, rapid breathing (hypochloraemic alkalosis)

weakness, bruising and frequent infections (aplastic anemia)

severely decreased urine output (possible signs of renal disorder or renal failure)

decrease in vision or pain in your eyes due to high pressure (possible signs of acute angle-closure glaucoma)

rash, red skin, blistering of the lips, eyes or mouth, skin peeling, fever (possible signs of erythema multiforme)

if you have severe liver disease, destruction of the small bile ducts within the liver (biliary cirrhosis) leading to the build up of bile in the liver (cholestasis).

if you have severe kidney disease.

if you are unable to produce urine (anuria).

if you are treated with an artificial kidney.

Please note that information regarding other strengths 80mg/12.5mg and 160mg/25mg of Co-Diovan Tablets is also present in the below leaflet.

if the level of potassium or sodium in your blood is lower than normal, or if the level of calcium in your blood is higher than normal despite treatment.

if you have gout.

If you have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine called aliskiren.

Read all of this leaflet carefully before you start taking this medicine.

If any of the above apply to you, do not take this medicine and speak to your doctor.

CO-DIOVAN 160/12.5mg TABLETS (valsartan / hydrochlorothiazide)

Each film coated tablet contains 160mg of the active ingredient valsartan and 12.5mg of the active ingredient hydrochlorothiazide.

facial rash, joint pain, muscle disorder, fever (lupus erythematosus)

PACKAGE LEAFLET: INFORMATION FOR THE USER

S992 LEAFLET Co-Diovan 20140715

Co-Diovan tablets are available as calendar blister packs of 28 tablets. Product Licence holder Procured from within the EU and repackaged by the Product Licence holder: S&M Medical Ltd, Chemilines House, Alperton Lane, Wembley, HA0 1DX. Manufacturer

Your medicine is known as Co-Diovan 160/12.5mg Tablets but will be referred to as Co-Diovan throughout the following patient information leaflet.

Keep this leaflet. You may need to read it again.

If you have any further questions, ask your doctor or pharmacist.

This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

if you are taking potassium-sparing medicines, potassium supplements, salt substitutes containing potassium or other medicines that increase the amount of potassium in your blood such as heparin. Your doctor may need to check the amount of potassium in your blood regularly.

if you have low levels of potassium in your blood.

if you have diarrhoea or severe vomiting.

if you are taking high doses of water tablets (diuretics).

In this leaflet:

if you have severe heart disease.

1. What Co-Diovan is and what it is used for

if you are suffering from heart failure or have experienced a heart attack. Follow your doctor’s instruction for the starting dose carefully.

This product is manufactured by Novartis Farma S. p.A. Via Provinciale Schito 131, 80058 Torre Annunziata, Naples, Italy. POM

PL No: 19488/0992

2. Before you take Co-Diovan Leaflet revision date: 15 July 2014

3. How to take Co-Diovan

Co-Diovan is a registered trade mark of Novartis AG, Switzerland. S992 LEAFLET Co-Diovan 20140715

4. Possible side effects 5. How to store Co-Diovan

if you suffer from a narrowing of the kidney artery.

6. Further information

if you have recently received a new kidney.

if you suffer from hyperaldosteronism.

1. 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.

Your doctor may also check your kidney function. ?

Reporting of side effects

Take special care with Co-Diovan

Co-Diovan film-coated tablets contain two active substances called valsartan and hydrochlorothiazide. Both of these substances help to control high blood pressure (hypertension). ?

By reporting side effects, you can help provide more information on the safety of this medicine. 5. How to store Co-Diovan

Valsartan belongs to a class of medicines known as “angiotensin II receptor antagonists”, which help to control high blood pressure. Angiotensin II is a substance in the body that causes vessels to tighten, thus causing your blood pressure to increase. Valsartan works by blocking the effect of angiotensin II. As a result, blood vessels relax and blood pressure is lowered.

KEEP OUT OF THE SIGHT AND REACH OF CHILDREN.

Do not store above 30°C. Store in the original package to protect from moisture.

Do not use after the expiry date printed on the carton label or blister strip.

If your doctor tells you to stop using the medicine, please take it back to the pharmacist for safe disposal. Only keep the medicine if your doctor tells you to.

Co-Diovan is used to treat high blood pressure which is not adequately controlled by a single substance alone.

If the medicine becomes discoloured or shows any other signs of deterioration, you should seek the advice of your pharmacist who will tell you what to do.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

High blood pressure increases the workload of the heart and arteries. If not treated, it can damage the blood vessels of the brain, heart, and kidneys, and may result in a stroke, heart failure or kidney failure. High blood pressure increases the risk of heart attacks. Lowering your blood pressure to normal reduces the risk of developing these disorders.

This is a disease in which your adrenal glands make too much of the hormone aldosterone. If this applies to you, the use of Co-Diovan is not recommended.

What Co-Diovan is and what it is used for

Hydrochlorothiazide belongs to a group of medicines called thiazide diuretics (also known as “water tablets”). Hydrochlorothiazide increases urine output, which also lowers blood pressure.

if you have liver or kidney disease.

if you have ever experienced swelling of the tongue and face caused by an allergic reaction called angioedema when taking another drug (including ACE inhibitors), tell your doctor. If these symptoms occur when you are taking Co-Diovan, stop taking Co-Diovan immediately and never take it again. See also section 4, “Possible side effects”.

if you have fever, rash and joint pain, which may be signs of systemic lupus erythematosus (SLE, a so-called autoimmune disease).

if you have diabetes, gout, high levels of cholesterol or triglycerides in your blood.

if you have had allergic reactions with the use of other blood pressure-lowering agents of this class (angiotensin II receptor antagonists) or if you have allergy or asthma.

if you experience a decrease in vision or eye pain. These could be symptoms of an increase of pressure in your eye and can happen within hours to a week of taking Co-Diovan. This can lead to permanent vision loss, if not treated. If you earlier have had a penicillin or sulphonamide allergy you can be at higher risk of developing this.

it may cause increased sensitivity of the skin to sun.

the use of Co-Diovan in children and adolescents below the age of 18 years is not recommended.

you must tell your doctor if you think you are (or might become) pregnant. Co-Diovan is not recommended in early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used at that stage (see pregnancy section).

if you are taking any of the following medicines used to treat high blood pressure:

Before you take Co-Diovan

Do not take Co-Diovan: ?

if you are allergic (hypersensitive) to valsartan, hydrochlorothiazide, sulphonamide derivatives (substances chemically related to hydrochlorothiazide) or to any of the other ingredients of Co-Diovan.

if you are more than 3 months pregnant (it is also better to avoid Co-Diovan in early pregnancy – see pregnancy section).

“ACE inhibitors” such as enalapril, lisinopril, etc

o Aliskiren If any of these apply to you, talk to your doctor.

S992 LEAFLET Co-Diovan 20140715

Taking other medicines

Pregnancy and breast-feeding

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Ask your doctor or pharmacist for advice before taking any medicine.

Like all medicines, Co-Diovan can cause side effects, although not everybody gets them.

These side effects may occur with certain frequencies, which are defined as follows:

very common: affects more than 1 user in 10



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Diflucan Dosage Guide, Flucan

Diflucan Dosage

The recommended dosage of DIFLUCAN for vaginal candidiasis is 150 mg as a single oral dose.

Multiple Dose

SINCE ORAL ABSORPTION IS RAPID AND ALMOST COMPLETE, THE DAILY DOSE OF DIFLUCAN (FLUCONAZOLE) IS THE SAME FOR ORAL (TABLETS AND SUSPENSION) AND INTRAVENOUS ADMINISTRATION. In general, a loading dose of twice the daily dose is recommended on the first day of therapy to result in plasma concentrations close to steady-state by the second day of therapy.

The daily dose of DIFLUCAN for the treatment of infections other than vaginal candidiasis should be based on the infecting organism and the patient's response to therapy. Treatment should be continued until clinical parameters or laboratory tests indicate that active fungal infection has subsided. An inadequate period of treatment may lead to recurrence of active infection. Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis usually require maintenance therapy to prevent relapse.

Oropharyngeal candidiasis

The recommended dosage of DIFLUCAN for oropharyngeal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Clinical evidence of oropharyngeal candidiasis generally resolves within several days, but treatment should be continued for at least 2 weeks to decrease the likelihood of relapse.

Esophageal candidiasis

The recommended dosage of DIFLUCAN for esophageal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Doses up to 400 mg/day may be used, based on medical judgment of the patient's response to therapy. Patients with esophageal candidiasis should be treated for a minimum of three weeks and for at least two weeks following resolution of symptoms.

Systemic Candida infections

For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia, optimal therapeutic dosage and duration of therapy have not been established. In open, noncomparative studies of small numbers of patients, doses of up to 400 mg daily have been used.

Urinary tract infections and peritonitis

For the treatment of Candida urinary tract infections and peritonitis, daily doses of 50–200 mg have been used in open, noncomparative studies of small numbers of patients.

Cryptococcal meningitis

The recommended dosage for treatment of acute cryptococcal meningitis is 400 mg on the first day, followed by 200 mg once daily. A dosage of 400 mg once daily may be used, based on medical judgment of the patient's response to therapy. The recommended duration of treatment for initial therapy of cryptococcal meningitis is 10–12 weeks after the cerebrospinal fluid becomes culture negative. The recommended dosage of DIFLUCAN for suppression of relapse of cryptococcal meningitis in patients with AIDS is 200 mg once daily.

Prophylaxis in patients undergoing bone marrow transplantation

The recommended DIFLUCAN daily dosage for the prevention of candidiasis in patients undergoing bone marrow transplantation is 400 mg, once daily. Patients who are anticipated to have severe granulocytopenia (less than 500 neutrophils per cu mm) should start DIFLUCAN prophylaxis several days before the anticipated onset of neutropenia, and continue for 7 days after the neutrophil count rises above 1000 cells per cu mm.

Dosage and Administration in Children

The following dose equivalency scheme should generally provide equivalent exposure in pediatric and adult patients:

Experience with DIFLUCAN in neonates is limited to pharmacokinetic studies in premature newborns. (See CLINICAL PHARMACOLOGY .) Based on the prolonged half-life seen in premature newborns (gestational age 26 to 29 weeks), these children, in the first two weeks of life, should receive the same dosage (mg/kg) as in older children, but administered every 72 hours. After the first two weeks, these children should be dosed once daily. No information regarding DIFLUCAN pharmacokinetics in full-term newborns is available.

Oropharyngeal candidiasis

The recommended dosage of DIFLUCAN for oropharyngeal candidiasis in children is 6 mg/kg on the first day, followed by 3 mg/kg once daily. Treatment should be administered for at least 2 weeks to decrease the likelihood of relapse.

Esophageal candidiasis

For the treatment of esophageal candidiasis, the recommended dosage of DIFLUCAN in children is 6 mg/kg on the first day, followed by 3 mg/kg once daily. Doses up to 12 mg/kg/day may be used, based on medical judgment of the patient's response to therapy. Patients with esophageal candidiasis should be treated for a minimum of three weeks and for at least 2 weeks following the resolution of symptoms.

Systemic Candida infections

For the treatment of candidemia and disseminated Candida infections, daily doses of 6–12 mg/kg/day have been used in an open, noncomparative study of a small number of children.

Cryptococcal meningitis

For the treatment of acute cryptococcal meningitis, the recommended dosage is 12 mg/kg on the first day, followed by 6 mg/kg once daily. A dosage of 12 mg/kg once daily may be used, based on medical judgment of the patient's response to therapy. The recommended duration of treatment for initial therapy of cryptococcal meningitis is 10–12 weeks after the cerebrospinal fluid becomes culture negative. For suppression of relapse of cryptococcal meningitis in children with AIDS, the recommended dose of DIFLUCAN is 6 mg/kg once daily.

Dosage In Patients With Impaired Renal Function

Fluconazole is cleared primarily by renal excretion as unchanged drug. There is no need to adjust single dose therapy for vaginal candidiasis because of impaired renal function. In patients with impaired renal function who will receive multiple doses of DIFLUCAN, an initial loading dose of 50 to 400 mg should be given. After the loading dose, the daily dose (according to indication) should be based on the following table:

Creatinine Clearance (mL/min)

Percent of Recommended Dose



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Daparox E Sonnolenza, Daparox

Le risposte della psichiatra e psicoterapeuta alle domande online di consulenza psicologica

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daparox e sonnolenza

07/03/2014 ore: 17.13 - stefania vaccari ha scritto:

Buongiorno, assumo daparox 20 mg da 5 Settimane ( dopo un inizio molto graduale), sto molto meglio come ansia e agorafobia, e attacchi di panico, tuttavia presento una certa sonnolenza e stanchezza soprattutto al mattino. ( il farmaco lo assumo dopo pranzo); vorrei sapere se e un effetto tipico della paroxetina e quindi se fastidioso per me dovrei cambiare molecola, oppure se col tempo passera. Ho fatto molta fatica ad abituarmi, notevoli gli eff coll inziali, ma mi dispiacerebbe ora cambiare di nuovo. E' un sintomo che puo ancora ridursi da solo o no? Non prendo piu ansiolitici da due settimane. non ne sento piu il bisogno e di notte dormo bene senza niente. L'astenia che sento, e sempre dovuta al farmaco? grazie

07/03/2014 ore: 20.32 - Dr. Raffaella Salmoria ha scritto:

Gentile Stefania, La paroxetina si distingue dagli altri antidepressivi per il suo spiccato effetto ansiolitico, che la rende farmaco ideale nel trattamento del disturbo d'attacchi di panico con o senza agorafobia. Questo profilo clinico che la mecola ha evidenziato, si traduce in un senso di "rilassatezza" od "ovattamento", utizzando le parole dei pazienti che la assumono. La sonnolenza o addirittura una leggera sedazione. invece, rappresentano effetti collaterali tipici delle prime tre settimane dall'inizio del trattamento, e sono quindi destinati a scomparire. Proseguirei nel suo caso con tutta tranquillita ad assumere il farmaco, che rappresenta tuttora la prima scelta nella cura degli attacchi di panico, con una efficacia assai alta. Cordiali saluti Dr. Raffaella Salmoria

15/02/2016 ore: 16.49 - martinotti davide ha scritto:

sono 15g che assumo daparox 5gocce al mattino 4al pomeriggio e 3 alla sera sta andando meglio come ansia pero oggi non sono andato al lavoro e tutto il giorno mi viene da dormire e stanotte ho avuto ansia forte e tacchicardia cosa posso fare?

Lascia una risposta

Nome Scrivi qui la risposta Codice di verifica antispam

Inserisci il codice :



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Doxybene, Doxybene

Product Description Common use Doxycyline is a synthetic broad-spectrum antibiotic derived from tetracycline and used to treat many different bacterial infections, such as infections of urinary tract, acne, gonorrhea, chlamydiosis, periodontitis (gum disease), blemishes, bumps, and acne-like lesions caused by rosacea.

Dosage and directions This medication should be taken after a meal with a big glass of water to decrease irritation of esophagus. Daily dose should be taken as a single dose or divided in two (12 hours between each one). Do not take it in larger amounts or continue to take it after the administered period. Certain brands of this medication cannot be used with dairy products. Do not crush, break, or open a delayed-release capsule, eat the pill whole. If it is an oral suspension shake it before use and measure with special measuring spoon. Never take this drug if it is expired as it may damage your kidney.

Precautions Usage of Doxycycline during growth of teeth may result in their permanent color change. Avoid exposure of your body to prolonged UV radiation during treatment and 4-5 days after it. If long treatment with this medication is prescribed a regular monitoring of peripheral blood cell content, liver function tests and determination of nitrogen and urea in serum are required.

Contraindications Hypersensitivity to Doxycycline and tetracyclines, pregnancy (second half of the term), breastfeeding, infancy (for children younger than 9 y. o.), leucopenia, porphyria, severe liver failure.

Possible side effect Side effects caused by Doxycycline may appear as headache, dizziness, blurred vision, fever, chills, body aches, red skin rash, pale or yellowed skin, dark colored urine, severe pain in upper stomach, loss of appetite, jaundice, easy bruising or bleeding. Contact your doctor if you experience severe effects listed above.

Drug interaction Co-administration with aluminum, magnesium, or calcium based antacids is not recommended as Doxycyline absorption maybe slowered. Minerals (such as calcium or iron) or with bismuth subsalicylate have the same effect. Doxycycline is reported to enhance the activity of warfarin. Phenytoin (Dilantin), carbamazepine (Tegretol), and barbiturates (such as phenobarbital) may enhance the metabolism of Doxycycline.

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

Overdose In case of serious and persistent nausea, vomiting, and diarrhea consult your doctor.

Storage Store at room temperature between 59-77 degrees F (15-25 degrees C) away from light and moisture, kids and pets. Do not use after expiration term.

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.

Doxybene

Doxybene je lék, který patrí mezi antibiotika ze skupiny tetracyklinu . Jeho úcinnou slozkou je sloucenina doxycyklin .

Princip . Doxycyklin narušuje schopnost bakteriálních bunek tvorit své bílkoviny, tím blokuje jejich schopnost se mnozit a tak usnadnuje jejich likvidaci imunitním systémem.

Vyuzití . Doxybene lze uzít k lécbe chlamydiových infekcí. tezších forem akné a Lymské boreliózy. Celosvetove je významný i úcinek tetracyklinu proti bakterii moru .

Podávání . Zálezí na doporucení lékare, obvyklá dávka u dospelých lidí se pohybuje kolem 1-2 tabletek denne.

Nevýhody . Obecný text o nezádoucích úcincích antibiotik najdete v tomto odkazu. Speciálne u tetracyklinu existuje riziko poškození rustových plotének kostí u detí, coz muze mít za následek poruchy rustu kostí. Z toho duvodu by nemel být podáván tehotným a kojícím zenám a detem do osmi let veku. Pred a po uzití tablety preparátu by clovek nemel pít mléko a uzívat prípravky s vápníkem, protoze prudce snizují vstrebání antibiotika z trávícího traktu.



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Make Your Own Zanpakuto! Bleach Anime, Zanpeak

jadzter18 posted on Jan 01, 2009 at 06:06PM

enhance your imagination! If you were a shinigami what will your zanpakuto's name and abilities be?

share your thoughts and ideas of your ideal zanpakuto.

(note:please follow this format so that there will be a uniform ideas, and so that people would read this topic more interesting and more easy to read, thank you)

[zanpakuto's name/shikai name] [release command] [bankai name] - optional =description - optional

[shikai abilities] - limited only (3) =description

[bankai abilities] - limited only (3) =desciption - optional

=(then comments on your zanpakuto)

that's all we want to know!

last edited on Jan 02, 2009 at 05:48AM

over a year ago jadzter18 said…

here's an example (but this is really my ideal zanpakuto!)^^

zanpakuto/shikai: Kazerokumaru "six wind circles" release command: hireki "reveal"

description: which means "six wind circles", its hilt is black with red details and below it has a bleck ring holding six golden rings. The guard is a small square with a "T" like form in each of side of the square(looks somewhat like tensa zangetsu's guard)and it's blade is as of a normal black katana(like the zangetsu)

bankai name: Kazerokumaru Hatsugen "revelation of the six wind circles"

description: The form of the katana still retains its shikai form but the entire blade turns to black.(same as tensa zangetsu)

>nirokujuushin "six doppelgangers" - The user duplicates himself into six mirror images. the strenght and the mind of the images is as same as the original form, thus its just the same as fighting the six persons with just the same power as the original form.

>kudakero kaze "shattered wind" - the edge of the blade releases a powerful wind force which could cut anything that it encounters.(this ability is more likely of zangetsu's getsuga tenshou)

>muteki ken "the invincible blade" - since wind is invincible the user gains the ability to be invincible while attacking. But he can only be invincible only while attacking, thus making it almost impossible to counter.

>kuritikaru kougeki "critical strike" - because of the enhance force of wind when the blade is use, the user's attack doubles its normal damage, thus as the user attacks the opponent takes the damage twice or the opponent feels that the attack feels heavy. Normally the attack only doubles, but this also depends on how much spiritual pressure the user uses to his zanpakuto, so when the user puts more spiritual power to his zanpakuto the attack will be more powerful thus triples the damage the opponent receives.

= actually I had already this idea of zanpakuto long after ichigo's fight with byakuya. I was then started to imagining things like this. anyway, i got the idea of a wind base zanpakuto in senna's mirokumaru and kariya jin's doll. I got it so impressed that I base my ideal zanpkuto to be a wind base. The abilities was also planned out, each ability is base from wind, example the first ability is made from the wind, since the user moves as fast as the wind he is able to leave copies of himself and same goes to the other abilities. I made it fair and square. That's all i could say.

If you think that those japanese name are just made up, well your wrong I actually base it from a english to japanese dictionary in the net. If you wanna know the site just feel free to ask me.

please share your ideal zanpakuto, if you don't mind.

last edited over a year ago

over a year ago hime_sama said…

first thanx 4 the dic, but it doesn't work 4 me. and this: i sew ur bleach char. it's good. but shouldn't the spiritual pressure be light blue. and one more thing the hollow mask is a little well. err. emn. strange. and of course u didn't explain how u made it,

over a year ago annvie9 said…

PWEASE WEAD ME AWESOME POST ABOUT MAH IMAGINARY SOMEWHAT REALISTIC ZANPAKUTO

** OKai! I will make mee sort-of realistic zanpakutoh, now that I'm home xP

Zanapakuto/Shikai name: Samazamahi (Varying Fire) Release command: Hibana (Spark)

Shikai Description: When released, Samazamahi instantly sets fire. The true owner (mee!) is immune to the flames. To ignite, it needs reiatsu to burn up, so it takes some from the air, a bit from the wielder, and a portion of the opponent's reiatsu, when the opponent is cut/burned. It also stores 75% of the reiatsu it takes in and can submit them into the wielder if it's too full or if the wielder feels like it. Generally, Samazamahi takes the form of a sword when released into shikai, but Samazamahi can then change it's form, from weapons to defensive shields. The flames are red, and can evaporate water. They also can never stop (unless I call it off), as long as there is reiatsu to burn.

-->Shiroi Honoo (White Flame) Samazamahi's fire turns white, which is, of course, really hot. It's also slightly bigger. It will melt a zanpakuto on contact. Yes, it can still change form, and I, the wielder/owner, am still immune to it.

-->Reiatsu Kogeru (Reiatsu Burn) The selected reiatsu will instantly get set on fire by Samazamahi's RED flames.

-->Kiesaru (to vanish) All the flames caused by Samazamahi will disappear, and Samazamahi's shikai will turn into it's sealed form. I know it seems useless, but I feel like putting it on there xP

Bankai name: Kemono no Honoo (Beast of Flame) Description: Part of Samazamahi disconnects from it and quickly evolves into a big, white fire lion that can change it's form into another animal, legendary or real. It can also morph into mixes of animals, e. g. A tiger with big bat wings and a dragon's tail. Kemono no Honoo slowly feeds off the opponent's reiatsu. And yes, I've got Kemono no Honoo and also a weakened form of Samazamahi.

-->Bakuhatsu (Explosion) Kemono no Honoo explodes giganto-ly with white fire, and the explosion will destroy only the selected reiatsu.

-->Kyouka (Enchance) Kemono no Honoo defense and offense is huger, once it saps a ton of reiatsu from the opponent(s).

-->Kuro^n (Clone) Kemono no Honoo splits itself into equal portions of its reiatsu

Shew, finally done! Whoa! That took two hours! T_T I'm so happy I'm finished, though ^-^

OooOO! I even made a character to go with Samazamahi! Once I get it all done in mah head.

last edited over a year ago

over a year ago kofisius29 said…

Zanpakuto name: shiroi denkou Release: furasshu (flash) Appearance: transformed into gauntlets with claws which are one metre long, can extend up to 200 metres. White in appearance with yellow lightning patterns. Great for ranged and close combat.

Raiu (thunderstorm): lightning bolts rain down on opponent, opponent is trapped in a sphere and can’t get out. Eventually with a thought from bakuen the thunder bolts fall and they explode on contact.

Jigoku hibana(hells spark):a big ball of kinetic, electrical energy in a form of a cheetah is unleashed upon the opponent which also explodes with force.

kanzen seigyo(complete control)any conductive object (skin or metal)will either be paralyzed or manipulated with electric reiatsu .(zanpakutos real ability)

bankai: silver metal armour like this one(link )but with white crackling lightning wings and a cheetah tail.. also there is a massive axe with a spear head at the bottom of the handle.

axe=1.5 metres wide axe=2 metres high. Bottom spear =0.5 metre long Handle 1 metre long

Masuta raiu(master thunderstorm):countless weapons manipulated in the past are being called again today, hundreds of thousands of weapons full of reiatsu. with one word “rakka”(fall) they fall down and explode.

kemono yobidashi(beast call) shiroi denkou is called out as a crackling lightning cheetah. it is sent to bite, slash and claw the opponent. when the opponent lets his guard down bakuen says”katsu”(explode)and the opponent is left shellshocked.

denkou fukushuu(lightnings revenge) the opponent is trapped in a jail-like cage which is made of lightning and will explode if touched. the more the opponent moves the tighter the jail becomes until the fateful touch and then. BOOOM. the adversary is defeated.

note*=my zanpakuto is the strongest electric zanpakuto in the whole of soul society and can resist and absorb any electrical reiatsu or attack fired at him.

finally my ideal zanpakuto s finished i kept accidentally deleting my work so it finally makes me joyful now that i’ve finished. i kept it simple to speed things up but at least its finished! pleeeeez comment thanx. ^-^ ^_^

last edited over a year ago

i love it over a year ago

over a year ago annvie9 said…

Nice zanpakuto xP But it could never beat my Samazamahi! xPP My fictional Bleach character that represents myself is a very young shinigami with red hair like Renji's and yellow and orange highlights. xP Her name is Yumiko Mizuni. After she had died, her soul irregularly became into a shinigami. For days at a time, Yumiko just wandered around the town, not knowing what to do with her new zanpakuto. Then she met another shinigami, and he took her to Soul Society to enroll in the Shinigami Academy. She very quickly progressed. It only took her 2 years to pass the academy and go on and join the Gotei 13. In one try, she became the lieutenant of the 13th Division. In about 2 years time, she had mastered bankai. Finally, Yumiko became 9th Division Captain. Captain Mizuni facial expression always looked depressing no matter how much she laughed and smiled, but she was very cheery and playful. She also likes to give people nicknames that she thinks is cute. Yumiko is rather short. Actually, she's a bit bigger than half the size of Renji.

Yeah. that's all I could think of for now. xP

last edited over a year ago

lol. everyone wants to be their zanpakuto is the strongest. hahaha peace bro. I'm Kenji Takashi btw. D over a year ago

over a year ago kofisius29 said…

hmph, your flame samazamahi wouldnt stand a chance against my shiroi denkou annvie9. cus i am superior 2 u. bwa ha ha ha ha ha ha ha ha ha ha ha ha ha ha haaaaaaaaaaa. LOL!

over a year ago ShadowCodie1234 said…

Zanpakuto-Kumoriyaiba (Shadow-Blade) Release Command-Bakushin Zenpou (Rush Forward) Bankai-Kokuei Zetsubou (Dark Shadows of Despair)

Zanpakuto Ability 1-Controls all shadow and is able to produce swords out of shadow. Zanpakuto Ability 2-Produces illusion of the oppenent beating me with shadows while i kill them. Zanpakuto Ability 3-Shadows can heal cuts on anybody and become anything if i will them too. Zanpakuto Apearance-Curved blade with ridges in it. Pull apart to make two of them. Black blade with white edge.

Bankai Ability 3-Shadows swarm engulfing area. Unescapable. Also allows me to become shadow. This would enable me to be my own blade. Bankai Ability 2-Shadows become an armor around me and can change weight to make me faster or slower. Bankai Blade Apearance-Same as Zanpakuto

My apearance-Hair like Sephiroths, but black. I'm a captain in the 13 squads. I have Blue-Grey eyes. I am a loner and don't talk a lot. All the new soulreapers think I'm weak, but the captains fear me for my power. I am married to another captain. She is about as strong as me. I also have a hollow mask. You can see I would be a formidable opponent. He cannot go back to his first blade. Nobody else knows that he is a vizard. He does his best to hide this from the Soul Society. His best friend is Kenpachi. Kenpachi is also the one who trained him.

last edited over a year ago

Shikai - Tamashi (Soul) Release command - Gaido (Guide) similar to Ichigo's Shikai during most of the manga email for a sketch of the shikai and bankai. First Ability - Soru namida (Soul tear) Very similar to getsuga tenshou but travels a lot more quickly. Second ability - Hochiminririsu (Chi release) like a cero but much weaker and a lot more quick. It can become more powerful theblonger its charged. in is released at the tip of the sword. Bankai - Futago no tamashi ( Twin soul) very similar to tensa zangetsu but the the blade is jagged. has the same abilities as my shikai but gains a third ability. Third ability-Kuroi kukan (Black void) it engulfs the entire sky in darkness and black rain begins to fall slowly draining anyones reiatsu that has contact with the rain. then me and my zanpakuto absorbs the reiatsu and releases a final attack that appears to be a huge wave of darkness destroying anything in its path. over a year ago

over a year ago annvie9 said…

Kofisius, you can call me Mizuni-taichou lol xD Codie, you could elaborate more on your zanpakuto. It seems really interesting, though =3

I've built more character for Yumiko Mizuni ^-^, although you guys prolly wouldn't read it because it's kinda long =/ Oh well, I'll do it because I want her to be complete.

Yumiko Mizuni is very handy with kidou. She can do all the kido spells without the incantation up to 93. And thanks to Samazamahi, she has an absolutely huge reiatsu. Twice Zaraki's. Luckily, she can supress enough to the point where it is comepletely hidden. Fun Fact: Yumiko likes to bathe in Samazamahi's flames. Why? Because it "burns all the bad germs away and is just as good as bathing in water".

Okie, since Yumiko formed into a shinigami irregularly, she has an inner hollow. So obviously, she supressed the inner hollow so that it was almost completely gone. But no one knows that she is a Vizard.

Goals and Morals: One Captain Mizuni's morals is, "Anticipation of death is worse than death itself" She thinks that if you die, you should die honorably and with dignity. She doesn't always act upon her morals because of her carefreeness and disobidience to rules, but Yumiko usually tells her subordinates to follow their own morals and such.

Family/Friends: Yumiko's real family is still in the real world, because she died when she was 14 when a serial killer murdered her. What her mother and father never told her was that they were also shinigamis, but they were banished from Soul Society for some reason. But she has friends in Soul Society that could be called a "family". Renji would be her big brother and Rukia her big sister, because she had bumped into them in the 6th year corridor in the academy, and also beat them both during one of the exercises. Then Toshirou would be her twin, because Yumiko's kinda happy that there was someone else close to her age that was a captain. Captain Ukitake was like her dad, because she stayed at his place when she was a lieutenant, for she had no place to go. Captain Shunsui would be like her uncle, because he always offered Yumiko sake (especially when he was drunk).

Food (I'm kinda hungry, so I'll write about what she likes to eat xD): Yumiko loved buffalo wings, although there weren't any in Soul Society. That's why she always sent three subordinates to go buy 25 pounds of buffalo wings every few weeks. Eventually, they spread throughout Soul Society and became a common food to eat. That's why some of her subordinates called her Captain Buffalo Wing. Also, every weekend, she would go over to Toshirou's office and give him two watermelons, Byakuya's house to give him three bunches of bananas, Renji's place to give him coffee with a bunch of sugar cubes, and sometimes Ukitake's house to give him medicinal pills.

Well, I guess Yumiko Mizuni's character is somewhat complete <.< I'll just decide who she fights and people like that later xP.

jadzter18 im new to fanpop but i like bleach to (annoying about the cancellation) but how do i reply to your comment at the top over a year ago

shall i just do it as a reply to one of these over a year ago

oh im a it stupid lol. i found it over a year ago

over a year ago annvie9 said…

Oh yea. I forgot bout that xD Eh, being unfair's okay, as long as it seems realistic xP

Or maybe I'm so good, that I unlocked the fourth ability in my shikai! ;D

over a year ago The3rdL said…

Name: Yuujiin Shizuka

Zanpakuto Name: Tatetengoku “Heavens Shield”

Description: Tatetengoku exist as two Kodachi (short sword), both of which are worn across the lower back (like SoiFon) with one exiting on the left and the other on the right.

Scabbard - Both are white with black rope tied around them. Handle - The handle is made of onyx with a white braid cover. Guard - The Guard of the right Kodachi is made of onyx and resembles a triangle within a circle. The Guard of the left Kodachi is also onyx and resembles an X within a circle. Blade - The blades resemble white gold.

Shikai Release Command: Mamoru “Protect”

Description: Each Kodachi transforms into a glove instantly covering each hand. The material of the gloves resembles the same white gold as the blade but is flexible as leather. Onyx details cover the knuckles, wrist and finger nails of each. On both gloves there is a large onyx like semi-sphere on the back of each hand. The left glove has a glowing X within a circle on it; the right glove has a triangle within a circle on it.

Hansha “Reflect”- The Right glove (triangle), can reflect spirit energy (reiatsu) based attacks back at the opponent with twice the force.

Togameru “Rebuke”- The Left glove (X), can negate a physical attacks momentum when it comes into contact.

Bankai Name: Kyozetsu Tengoku “Heaven’s Refusal”

Description: The triangle and the X exit each glove and hover (5 inches/12.7 cm) over the palm of each glove leaving only the circle within the onyx. The colors of the gloves alternate, with the onyx becoming white gold and the white gold becoming onyx.

Migite Tamashi “Right Hand of the Spirit”- The triangle of the Right glove can absorb all spirit energy attacks and convert it to energy used to boost Spiritual Attributes: Kido. This allows for the use of Level 100 spells by reciting the name of the spell alone.

Hidarite Nikutai “Left Hand of the Flesh” - The X of the Left glove can absorb all force from physical attacks converts it into energy used to boost Physical Attributes: Agility (Shunpo), Strength (Hakudo), and Endurance.

Torikesu Tengoku “Heaven’s Revocation”: The circles exit the onyx sphere and all three shapes overlap combining both physical and spiritual energy absorbed along with my own reiatsu. A series of projectiles are then fired, first an X shaped blast is shot (with hand forming an X), if it connects all physical movement of the opponent is halted, this unlocks the next blast (the form of a triangle) which cancels all spirit energy, this unlocks the last shot (the circle) which shuts down the mind. This effectively revokes any form of movement or thought, leaving only the finishing blow to be administered, which is done with the unreleased form of the Zanpakuto (the Kodachi).

Strengths: Defense Maneuverability Enhances one’s own Skills

Weaknesses: Lack of Offensive attacks No Bladed Weapon

Character Profile Coming Soon!

last edited over a year ago

over a year ago annvie9 said…

Jadzter-chan, it would be better, but I tink my teenie little brain will overload xD Nice zanpakutou, Shihoin-san! =D I like how you're humble and put weaknesses on. You see, I couldn't think of any XD

I wanna make another zanapakutou now!

Name: Chore Sweeper Sealed Appearance: Just a regular old sponge. Release Command: Clean up!

Shikai Appearance: A super broom and a super sponge, complete with the super stove! Shikai Abilities:

-->Hands-free Dishwashing The dishes are automatically washed and put neatly in the pantry. MAGICALLY.

-->Housekeeper Every mess is cleaned up, unorganized desks are organized, the dust disappears, and the selected room(s) are now spotless.

-->Gasp! Free Meals! Free food is created just for you (and other peoples)! ^-^

Bankai Name: Super Cleanup time! Bankai Appearance: You get a giant feather duster. Bankai Abilities:

--> Super Duper Cleanup! All bad germs are eliminated, and sent to, like, the 6th dimension, and all previoius and current messes will be undone (like the stain from apple juice on the floor from when I was 4). And the dishes will be washed, the trash and dog poo sent to the 6th dimension, and your homework will be done, and you'll get an A+ :3

-->Yum Yum Healthy food is automatically put into your stomach, so you don't have to taste it =D But you can still eat that yummy chocolate and not gain weight.

over a year ago kimoy4321 said…

[zanpakuto's name/shikai name] = Hibana [release command]= electrify [bankai name] - optional = Bachiatari Hibana(cursed spark) = at its bankai form the lightning's or electricity's color will turn into black.

[shikai abilities] - looks like a normal zanpakuto with the exeption of the guard which is like a lightning bolt.

*lightning chase* = the user can control electricity, with equal power to lightning, from the blade and let it chase the opponent. After hitting the enemy, the body will be paralyzed leaving it vulnerable for any attack.

note * when released, electricity with equal power to lightning, will automatically protects the user without any orders from the latter.

[bankai abilities] - the sword's guard will extend into the lower part of the blade embracing it.

*curse of three lightnings* = this ability enables the user to put the enemy in a curse, hence the name. When the user is able to slash or injure the enemy by the use of his zanpakuto(sword) the user can activate the curse. When this ability is activated, the user is now able to electrify the opponent three times( electric power is equal to lightning. Every curse will last for a minute, example: when the user will electrify the enemy it will only last for a minute, enough to toast the latter, leaving the enemy paralyzed and vulnerable for any attack.

*dark lightning shoot* = the user can make millions of lightning needles shooting from above or the sky which can leave the opponent paralyzed and vulnerable.

*lightning Onslaught* this ability has two forms:

1)the first form enables the user to fire a very strong black lightning beam from the zanpakuto. The command for this form is "lightning Onslaught first assassination".

2) on its second form, the user will form a big black lightning ball. Anything on its path will surely be erased. the command for this form is " lightning Onslaught final assassination". *note = the user can also use the shikai abilities of the zanpakuto when in bankai form.

*note= when kim is blinded or trapped in an ability he can still locate enemy using his zanpakuto. when an enemy moves small amount of electricity, enough for hibana to locate it, is used by the body. due to this ability kim can still attack the enemy, with slight effort of course.

=alright i'm done. all i can say is. my zanpakuto is great. i just love bleach.

last edited over a year ago

over a year ago kimoy4321 said…

oh. my character's name is kim hiraishin. he can perform flash steps that is enhanced when his zanpakuto is released. kim is also a vizard, his hollow mask resembles a normal hollow mask with a horn on right side and some green markings on it. when he dons his hollow mask his strength and defense will increase. as well as his abilities and speed. meaning when he's using hollow powers it supplements his shinigami powers increasing everything.

kim died in an accident(not specify). his soul was sent to soul society by an unknown shinigami and made him enroll in the academy. he spent his time practicing and enhancing his abilities for 4 years and during at this time while practicing on his own a hollow attacked him. kim fought the hollow and in an unexplainable event their reiatsu combined causing a hollowification. kim was able to control his hollow powers in 2 days and kept this as a secret to the soul society. after graduating he was then promoted to vice-captain rank but his secret was revealed and was exiled.

kim then went to the real world and spent time their. he still has his loyalty to the soul society and even fought enemies that can cause damage to soul society and the real world. he even swore to protect the inhabitants of the two worlds.

*note= kim was able to learn his bankai in a week. he can also use kido spells up to 90 without incantations.

last edited over a year ago

over a year ago annvie9 said…

That's nice. I think I'm going to repost my character bio and my ideal zanpakutou here. I'll add a bit more to Yumiko's appearance too. *sigh* This is gonna be a really really long post.

Zanapakuto/Shikai name: Samazamahi (Varying Fire) Release command: Hibana (Spark)

Shikai Description: When released, Samazamahi instantly sets fire. The true owner (mee!) is immune to the flames. To ignite, it needs reiatsu to burn up, so it takes some from the air, a bit from the wielder, and a portion of the opponent's reiatsu, when the opponent is cut/burned. It also stores 75% of the reiatsu it takes in and can submit them into the wielder if it's too full or if the wielder feels like it. Generally, Samazamahi takes the form of a sword when released into shikai, but Samazamahi can then change it's form, from weapons to defensive shields. The flames are red, and can evaporate water. They also can never stop (unless I call it off), as long as there is reiatsu to burn.

-->Shiroi Honoo (White Flame) Samazamahi's fire turns white, which is, of course, really hot. It's also slightly bigger. It will melt a zanpakuto on contact. Yes, it can still change form, and I, the wielder/owner, am still immune to it.

-->Reiatsu Kogeru (Reiatsu Burn) The selected reiatsu will instantly get set on fire by Samazamahi's RED flames.

-->Kiesaru (to vanish) All the flames caused by Samazamahi will disappear, and Samazamahi's shikai will turn into it's sealed form. I know it seems useless, but I feel like putting it on there xP

Bankai name: Kemono no Honoo (Beast of Flame) Description: Part of Samazamahi disconnects from it and quickly evolves into a big, white fire lion that can change it's form into another animal, legendary or real. It can also morph into mixes of animals, e. g. A tiger with big bat wings and a dragon's tail. Kemono no Honoo slowly feeds off the opponent's reiatsu. And yes, I've got Kemono no Honoo and also a weakened form of Samazamahi.

-->Bakuhatsu (Explosion) Kemono no Honoo explodes giganto-ly with white fire, and the explosion will destroy only the selected reiatsu.

-->Kyouka (Enchance) Kemono no Honoo defense and offense is huger, once it saps a ton of reiatsu from the opponent(s).

-->Kuro^n (Clone) Kemono no Honoo splits itself into equal portions of its reiatsu

CHARACTER BIO My fictional Bleach character that represents myself is a very young shinigami with is Yumiko Mizuni.

Appearance: Yumiko is rather short. Actually, she's a bit bigger than half the size of Renji. They've got nearly the same hair color. It's red hair like Renji's and yellow and orange highlights. Her regular hair goes past her shoulders, but not past the elbows. It's sort of inbetween. But there's this one bunch of hair that is tied back, and it goes down to her waist. At the end of that bunch of hair, she tied a small dagger in it, which is full of powerful kidou. She likes to do pirouettes and slash her opponent with the small dagger. She has sidebangs that cover her right eye. She is constantly underestimated not only because she looks like 13-year old, but also because she looks skinny and underfed.

After she had died, her soul irregularly became into a shinigami. For days at a time, Yumiko just wandered around the town, not knowing what to do with her new zanpakuto. Then she met another shinigami (Urahara hehehe), and he took her to Soul Society to enroll in the Shinigami Academy. She very quickly progressed. It only took her 5 years to pass the academy and go on and join the Gotei 13. In one try, she became the lieutenant of the 13th Division. In about 3 years time, she had mastered bankai. Finally, Yumiko became 9th Division Captain.

Since Yumiko formed into a shinigami irregularly, she has an inner hollow. So obviously, she supressed the inner hollow so that it was almost completely gone. But no one knows that she is a Vizard, and she doesn't completely know how to control Vizard powers.

Captain Mizuni facial expression always looked depressed, no matter how much she laughed and smiled, but she was very cheery and playful. She also likes to give people nicknames that she thinks is cute. And she makes her subordinates go and get her 25 pounds of buffalo wings every couple of weeks.

Yumiko Mizuni is very handy with kidou. She can do all the kido spells without the incantation up to 93 (if there is 93, because I don't really know). And thanks to Samazamahi, she has an absolutely huge reiatsu. Twice Zaraki's. But she always supresses it to where it is below an average captain's reiatsu. She only releases it if she (or someone else) is in big trouble. Fun Fact: Yumiko likes to bathe in Samazamahi's flames. Why? Because it "burns all the bad germs away and is just as good as bathing in water".

last edited over a year ago

over a year ago VioletShingami said…

This is my Shinigami: Name:Lini Koummori Rank:The Lieutenant 4 Yumiko Mizuni(see above) Appearance: Hair Color:Long and Black Hair Style:Tied with a large red ribbon in a big spikey ponytail. Eye Color:a blood red Description:Lini is a spunky 13 year old, who looks like a 9 year old, who is very skinny. has a bow around her neck, and decorated the smallest size uniform into a unique school uniform. Personality:Lini likes to keep to herself. She is a sweet girl to those who get to know her like her Captain Yumiko. Shy but has major anger isues. She can make someone cry in less than 30 seconds. Has a issue with being cheery at the wrong times, and suprisingly makes friends easily with her looks, which also makes them do what ever she wants to avoid making her upset. Loves bitter things and enjoys picking on her bst friend Kiari. Enjoys buying new ribbons for her hair. History:Being a orphan ever since she can remember, She never had a real home. That was intill she met her soon to be captain Yumiko. Lini stayed with her till Yumiko went to the soul reaper acedmey, where Lini followed her with her buddy Kiari and became known as a prodigy with amazing intelligence, flexibilty, and offense skills!

And this is her Zanpakuto:

Zanpakuto name: Afutafaia chouchou(Afterfire butterfly) release command: maiodoru(dance)

Shikai description: When I release it, Afutafaia chouchou turns a deep red with black butterflys on it. To release the full potientiol power, the butterflys glow a bright white and the sword doubles in size. The sword is has a Jewel in the guard that allows it to turn into the jewel in the middle of the owners necklace and also into a sheild that is a dark ghost like butterfly with the jewel in the center.

takibi shuyoku(bonfire wing)- The sword get a neon orange color and any cut Afutafaia Chouchou makes on the opponent will take shape of a butterfly and explode.

nankin hanabi enbi(firecracker charm)- The sword gets a fire vine wrapped around it and anything that touches it get a charmed fire wrap on their sword making it crack.

hinotama hane tsubasa(fireball wings)- afutafaia Chouchou will hit the victum and the victim will be caught in a illousion where they are in a area that looks like outer space and will see a giant sun/comet looking thing with wings coming at them and will be caught on fire.

bankai name:chouchou maidoru(butterflys dance)- My girl Lini will have giant ghost wings appear on her back with her sword black with red butterflies marked on it, her hair also turns a ghostly white-purple. The top of her sword will disappear to show a large butterfly/angel with dark flame wings coming out of her back. The flames on the wings appear to dance like butterflys in the air.

kochou ishuu(butterfly swarm)- The butterfly-angel thing will turn into a glowing ball and millions of butterflies will hatch and eat the oppoents reiatsu.

ka^ringu kochou(curling butterfly)- The butterfly/angel will enlarge her wings of fire and the fire will turn into a spiral of doom(kinda like a tornado).

Kochou yubiwa(butterfly ring)- The butterfly swarm from before is the first attack. If it didn't work or Lini doesn't want to use it, She'll shout this out and it's kinda of like a circle in the sky that swirls around the opponent and squeezes till they pass out or die.

Comments: The sword at the begining is dark silver with a butterfly shaped gaurd.

last edited over a year ago

over a year ago RoseShingami said…

Here is my sword! I am soo happy I finished it! Oh and a shout out to all u bleach fans with characters! Me, VioletShingami, annive9,and my captian The3rdL, r starting a role playing game for bleach, and we need more people. If u want to join please message anyone of us for info and when it will start! Please join! Now here is my zanpakuto!

Zanpakuto Name: denkou shi neko(lightning kitten) Release commamd: tataku!(strike!)

Shikai Description: Denkou shi neko is a bright yellow. It has a gaurd the shaped of a cat head. It has a circle keychain that Kiari puts in her reiatsu in her sword and it turns into a giant spiked ball! It has a orange sash round it.

saiki hashiru(recovery run)- Using her reiatsu, her sword turns a bright white with a lightning bolt shaped like a huge cat goes around her and anyone she chooses and heals them. It takes a lot of reiatsu.

raikou supaiku(lightning spike)- I swing my sword toward the sky and clouds form and lightning strikes down leaving something that looks like spikes that when the opponent runs in them they get elecuted and faint if they don't die.

erekutorikku nawa(electric rope)- The sword strikes the opponent or/and sword and a electric rope goes over them and ties them tightly with a damanging stactic shock every 2 minutes.

sutateikku odoriko(static dancer)- a flowing bolt of energy envolves the sword and Kiari will spin the sword in a full circle and the glow will disappear from the sword to the circle and the circle will burst and turn into a burst of stactic energy. The static will appear to dance while parazlying every opponent within a 2 mile radius!

Bankai Name: shouryou neko(Holy ghost cat) The sword turns a blinding white and a ghostly lightning cat comes out and she grows cat ears and her hair is still orange but can appear a rose pink. When she travels with it, she hides it with a purple hat.

Koneko aikyou(kitten charms)- The cat will sparkle making the opponent hyponotized, seeing the illusion of a angel, the angel, or actually the cat, will kill them in this illusion, giving them a holy feeling death.

neko negai(cat wishes)- The cat grows in size and unleashes a bright glow inside. Kiari goes into a prayer form and wishes for the enimes to be gone. The banki goes crazy and fufills her wishes by killing them all. after it, Kiari almost or she does pass out because it uses a lot of reiatsu.

neko tengoku(cats heaven)- The cats will burst into sparkle, making a bunck of minature cats that prowl the opponent, making Kiari the hunter. The cats all have wing and make the hunter parazlyzed and then charm his sword to seal the power within. The big sphere at the end of the sword will attack the opponent by making him passout and breaking the sword the cats have put a spell on.

middonaito yamaneko(midnight wildcat)- the cat will claw the opponent, sending him/her into a sate of madness. They will be sent to a space like area. Slowly, looking like a star, a cat will approch. Looking like a tiger with huge angel wings, and sharp fangs the wildcat will pounce and kill them.

Comments: Specializes in defense. The orange sash is a ribbon that she carries tied on her wrist. She can release it to turn her reiatsu trapped in the ribbon into the sword and the ribbon ties on the sword.



Buy Online Make Your Own Zanpakuto! Bleach Anime, Zanpeak

Metformin Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Miformin

metformin

GENERIC NAME(S): METFORMIN HCL

Warnings

Metformin can rarely cause a serious (sometimes fatal) condition called lactic acidosis. Stop taking metformin and get medical help right away if you develop any of the following symptoms of lactic acidosis: unusual tiredness, dizziness. severe drowsiness, chills, blue/cold skin. muscle pain. fast/difficult breathing, slow/irregular heartbeat. stomach pain with nausea. vomiting. or diarrhea .

Lactic acidosis is more likely to occur in patients who have certain medical conditions, including kidney or liver disease, recent surgery, a serious infection, conditions that may cause a low level of oxygen in the blood or poor circulation (such as congestive heart failure. recent heart attack. recent stroke ), heavy alcohol use, a severe loss of body fluids (dehydration ), or X-ray or scanning procedures that require an injectable iodinated contrast drug. Tell your doctor right away if any of these conditions occur or if you notice a big change in your overall health. You may need to stop taking this medication temporarily. The elderly are also at higher risk, especially those older than 80 years who have not had kidney tests. (See also Side Effects and Precautions sections.)

Uses

Metformin is used with a proper diet and exercise program and possibly with other medications to control high blood sugar. It is used in patients with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke. Metformin works by helping to restore your body's proper response to the insulin you naturally produce. It also decreases the amount of sugar that your liver makes and that your stomach /intestines absorb.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Metformin may be used with lifestyle changes such as diet and exercise to prevent diabetes in people who are at high risk for becoming diabetic. It is also used in women with a certain disease of the ovaries (polycystic ovarian syndrome ). Metformin may make menstrual cycles more regular and increase fertility .

How to use metformin

Read the Patient Information Leaflet if available from your pharmacist before you start taking metformin and each time you get a refill. If you have any questions, consult your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, usually 1-3 times a day with meals. Drink plenty of fluids while taking this medication unless otherwise directed by your doctor.

The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). To reduce your risk of side effects (such as upset stomach), your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.

Take this medication regularly in order to get the most benefit from it. Remember to use it at the same times each day.

If you are already taking another anti-diabetic drug (such as chlorpropamide ), follow your doctor's directions carefully for stopping/continuing the old drug and starting metformin.

Check your blood sugar regularly as directed by your doctor. Keep track of the results, and share them with your doctor. Tell your doctor if your blood sugar measurements are too high or too low. Your dosage/treatment may need to be changed.

Side Effects

Nausea, vomiting, stomach upset, diarrhea, weakness. or a metallic taste in the mouth may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. If stomach symptoms return later (after taking the same dose for several days or weeks), tell your doctor right away. Stomach symptoms that occur after the first days of your treatment may be signs of lactic acidosis.

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.

Metformin does not usually cause low blood sugar (hypoglycemia). Low blood sugar may occur if this drug is prescribed with other anti-diabetic medications. Talk with your doctor or pharmacist about whether the dose of your other diabetic medication(s) needs to be lowered.

Symptoms of low blood sugar include sudden sweating. shaking, fast heartbeat, hunger. blurred vision. dizziness, or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor about the reaction right away. Low blood sugar is more likely if you drink large amounts of alcohol, do unusually heavy exercise. or do not consume enough calories from food. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Check with your doctor or pharmacist to find out what you should do if you miss a meal.

Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, and fruity breath odor. If these symptoms occur, tell your doctor right away. Your doctor may need to adjust your diabetes medication(s).

Stop taking this medication and tell your doctor right away if this very serious side effect occurs: lactic acidosis (see Warning section).

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

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

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

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

Precautions

See also Warning section.

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

Before using this medication, tell your doctor or pharmacist your medical history, especially of: severe breathing problems (such as obstructive lung disease, severe asthma), blood problems (such as anemia, vitamin B12 deficiency), kidney disease, liver disease.

Before having surgery or any X-ray/scanning procedure using injectable iodinated contrast material, tell your doctor that you are taking this medication. You will need to temporarily stop this medication before the time of your surgery/procedure. Consult your doctor for further instructions.

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

You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar levels. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely.

Limit alcohol while using this medication because it can increase your risk of lactic acidosis and developing low blood sugar.

High fever, "water pills" (diuretics such as hydrochlorothiazide), too much sweating, diarrhea, or vomiting may cause loss of too much body water (dehydration) and increase your risk of lactic acidosis. Stop taking this medication and tell your doctor right away if you have prolonged diarrhea or vomiting. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.

It may be harder to control your blood sugar when your body is stressed (such as due to fever, infection, injury, or surgery). Consult your doctor because increased stress may require a change in your treatment plan, medications, or blood sugar testing.

Older adults may be at greater risk for side effects such as low blood sugar or lactic acidosis.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Your doctor may direct you to use insulin instead of this product during your pregnancy. Follow your doctor's instructions carefully.

Metformin can cause changes in the menstrual cycle (promote ovulation) and increase the risk of becoming pregnant. Consult your doctor or pharmacist about the use of reliable birth control while using this medication.

Metformin passes into breast milk in small amounts. Consult your doctor before breast-feeding.

Interactions

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

Beta-blocker medications (such as metoprolol, propranolol, glaucoma eye drops such as timolol) may prevent the fast/pounding heartbeat you would usually feel when your blood sugar level falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness, hunger, or sweating, are unaffected by these drugs.

Many drugs can affect your blood sugar levels, making it more difficult to control your blood sugar. Before you start, stop, or change any medication, talk with your doctor or pharmacist about how the medication may affect your blood sugar. Check your blood sugar levels regularly as directed by your doctor. Tell your doctor about the results and of any symptoms of high or low blood sugar. (See also Side Effects section.) Your doctor may need to adjust your anti-diabetic medication, exercise program, or diet.

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Overdose can cause lactic acidosis. Symptoms of overdose may include: severe drowsiness, severe nausea/vomiting/diarrhea, rapid breathing, slow/irregular heartbeat.

Notes

Do not share this medication with others.

You should attend a diabetes education program to learn more about diabetes and all the important aspects of its treatment, including meals/diet, exercise, personal hygiene, medications, and getting regular eye/foot/medical exams.

Keep all medical appointments. Laboratory and/or medical tests (such as liver/kidney function tests, blood glucose, hemoglobin A1c, complete blood counts) should be performed periodically to check for side effects and monitor your response to treatment. Check your blood sugar levels regularly as directed.

Missed Dose

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

Storage

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

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

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

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

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Human Resources Trovix Recruit Introduces A New Paradigm In Candidate Search Technology, Triovix

trovix WINS Human Resource Executive ® Magazine´s TOP HR PRODUCT OF THE YEAR AWARD

MOUNTAIN VIEW, Calif. - October 3, 2006 - Trovix Inc. a leading provider of intelligent search technology, today announced that its full-featured intelligent search and applicant tracking solution, Trovix Recruit TM. has been selected by Human Resource Executive ® magazine as a Top

HR Product of the Year.

"Trovix has rapidly made its mark as an innovator in the HR industry through the company´s incorporation of cutting-edge search technology into its ATS," stated David Shadovitz, chairman of the HR Technology Conference & Exposition, and editor and publisher of Human Resource Executive . "By adding this twist to traditional recruiting, Trovix Recruit is changing the way recruiters find top candidates. As the war for talent heats up, finding the best candidates quickly is more business-critical than ever."

Trovix CEO and Founder Jeff Benrey said, "We´re thrilled to be recognized by Human Resource Executive as an innovator in the HR industry less than one year after the launch of Trovix Recruit. Winning the Top HR Product of the Year award is further validation that Trovix Recruit is and will continue to have a major impact on the way organizations recruit top talent. To get and stay at the top, organizations are dependent upon the accomplishments of their workforce. We´re extremely proud of the successes that our clients have been able to achieve through the power of Trovix Recruit."

About Trovix Recruit

Trovix Recruit is a Web-based application that combines Trovix´s Intelligent Search Technology with a full-featured applicant tracking system (ATS) to manage the entire candidate selection process: from requisition and offer approvals to career site hosing and customized reports. Trovix Intelligent Search is a powerful tool for recruiters and hiring managers because it learns based on their preferences and identifies the best qualified candidates for them.

Trovix Recruit expedites the hiring process, improves the quality of hires, reduces recruiting cost, and streamlines the overall process by quickly ranking the best candidates for each position. Designed with input from industry experts and end-users, Trovix Recruit is not only a comprehensive, easy-to-use solution, it also incorporates essential features and benefits for successful recruiting, such as automatic data capture for compliance requirements, a communications module, and custom reports.

About Trovix Inc.

Trovix Inc. is a leading provider of intelligent search technology. Its first product, Trovix Recruit, combines intelligent, personalized search technology with a full-featured applicant tracking system to help companies recruit the best talent available faster. reduce their cost-per-hire, and streamline their workflow. Trovix customers include successful and growing ventures such as Palm, Stanford University, Linksys, Juniper Networks, VMware and Rambus. Headquartered in Silicon Valley, Trovix is backed by top-tier venture capital firms including 3i, Granite Ventures and USVP. For more information, visit www. trovix. com.

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Coreg - Heart Disease, Avernol

Coreg is used for treating high blood pressure or certain types of heart failure. It may also be used after a heart attack to improve survival in certain patients. It may be used along with other medicines. Coreg is an alpha - and beta-blocker. It works by relaxing the blood vessels, slowing down the heart, and decreasing the amount of blood it pumps out. This decreases blood pressure, helps the heart pump more efficiently, and reduces the workload on the heart.

Use Coreg as directed by your doctor.

Take Coreg by mouth with food.

Take Coreg on a regular schedule to get the most benefit from it. Taking Coreg at the same time each day will help you remember to take it.

Continue to take Coreg even if you feel well. Do not miss any doses.

Do not suddenly stop taking Coreg. You may have an increased risk of side effects. If you need to stop Coreg or add a new medicine, your doctor will gradually lower your dose.

If you miss a dose of Coreg, 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 Coreg.

Store Coreg below 86 degrees F (30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Coreg out of the reach of children and away from pets.

Active Ingredient: Carvedilol.

Do NOT use Coreg if:

you are allergic to any ingredient in Coreg

you have a very slow heartbeat, certain types of irregular heartbeat (eg, moderate to severe heart block, sick sinus syndrome), or very severe heart failure (eg, requires treatment in a hospital)

you have asthma or other severe breathing problems

you have severe liver problems

you are taking mibefradil.

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

Some medical conditions may interact with Coreg. 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 or are taking medicine for allergies

if you have a history of other heart problems (eg, heart failure, slow or irregular heartbeat, angina) or low blood pressure

if you have a history of liver or kidney problems, blood vessel disease, blood flow problems (eg, in the legs or feet), lung or breathing problems (eg, chronic bronchitis emphysema, chronic obstructive pulmonary disease), diabetes, low blood sugar, thyroid problems, or glaucoma

if you have an adrenal gland tumor (pheochromocytoma)

if you will be having surgery.

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

Mibefradil because the risk of serious heart side effects may be increased

Many prescription and nonprescription medicines (eg, used for infections, inflammation, aches and pains, high blood pressure, heart problems, irregular heartbeat, diabetes, depression, mental or mood problems, immune system suppression, allergic reactions, asthma, high cholesterol, seizures), multivitamin products, and herbal or dietary supplements (eg, herbal teas, coenzyme Q10, garlic, ginseng, ginkgo, St. John's wort) may interact with Coreg, increasing the risk of side effects.

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

Coreg may cause dizziness, fainting, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Coreg with caution. Do not drive or perform other possibl unsafe tasks until you know how you react to it.

Coreg may cause dizziness, lightheadedness, or fainting. These effects may occur within the first hour after you take your dose. They may be more likely when you start taking Coreg or if your dose is increased. 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. Tell your doctor if these effects occur.

Do not take more than the recommended dose without checking with your doctor.

Do not suddenly stop taking Coreg. Sharp chest pain, irregular heartbeat, and sometimes heart attack may occur if you suddenly stop Coreg. The risk may be greater if you have certain types of heart disease. Your doctor should slowly lower your dose over several weeks if you need to stop taking it. This should be done even if you only take Coreg for high blood pressure. Heart disease is common and you may not know you have it. Limit physical activity while you are lowering your dose. If new or worsened chest pain or other heart problems occur, contact your doctor right away. You may need to start taking Coreg again.

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.

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

If you have a history of any severe allergic reaction, talk with your doctor. You may be at risk for an even more severe allergic reaction if you come into contact with the substance that caused your allergy. Some medicines used to treat severe allergies may also not work as well while you are using Coreg.

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

Diabetes patients - Coreg may hide signs of low blood sugar, such as a rapid heartbeat. Be sure to watch for other signs of low blood sugar. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your vision change; give you a headache, chills, or tremors; or make you more hungry. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.

Lab tests, including blood pressure and heart function, may be performed while you use Coreg. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Use Coreg with caution in the elderly; they may be more sensitive to its effects, especially dizziness.

Coreg should be used with extreme caution in children younger 18 years; 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 Coreg while you are pregnant. It is not known if Coreg is found in breast milk. Do not breast-feed while taking Coreg.

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; dry eyes; fatigue; headache; lightheadedness; nausea; numbness or tingling of the hands or feet; vomiting; weakness.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); change in the amount of urine produced; chest pain; disorientation; fainting; fever; irregular or unusually slow heartbeat; persistent or severe vision changes; severe dizziness; shortness of breath; sudden, unusual weight gain; swelling of the hands, ankles, or feet; unusual bruising or bleeding.

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



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Aleve (naproxen) is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen works by reducing hormones that cause inflammation and pain in the body. It commonly used for the reduction of pain, fever, inflammation and stiffness caused by conditions such as:

osteoarthritis

kidney stones

rheumatoid arthritis

psoriatic arthritis

gout

ankylosing spondylitis

menstrual cramps

tendinitis

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Aleve is commonly used for the reduction of pain, fever, inflammation and stiffness caused by conditions such as:

osteoarthritis

kidney stones

rheumatoid arthritis

psoriatic arthritis

gout

ankylosing spondylitis

menstrual cramps

tendinitis

bursitis

Take Aleve exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts, or use it for longer than recommended. Do not crush, chew, or break an extended-release or enteric-coated tablet. Swallow the pill whole. The extended-release pill is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating. Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you take Aleve for a long period of time, your doctor may want to check you on a regular basis to make sure this medication is not causing harmful effects. Do not miss any scheduled visits to your doctor.

Since Aleve is sometimes taken only when needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time.

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Many medicines available over the counter contain aspirin or other medicines similar to Aleve (such as ibuprofen or ketoprofen). If you take certain products together you may accidentally take too much of this type of medication. Read the label of any other medicine you are using to see if it contains aspirin, ibuprofen, or ketoprofen. Do not drink alcohol while taking Aleve. Alcohol can increase the risk of stomach bleeding caused by Aleve. Avoid prolonged exposure to sunlight.

Aleve can make your skin more sensitive to sunlight, and a sunburn may result. Wear protective clothing and use sunscreen (SPF 15 or higher) when you are outdoors.

Store Aleve at room temperature away from moisture and heat.

Before taking Aleve:

Taking an NSAID can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use an NSAID. Do not use Aleve just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

NSAIDs can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking an NSAID. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Do not use this medication if you are allergic to Aleve, or if you have a history of allergic reaction to aspirin or other NSAIDs.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use Aleve:

a history of heart attack, stroke, or blood clot;

heart disease, congestive heart failure, high blood pressure;

a history of stomach ulcers or bleeding;

liver or kidney disease;

asthma;

polyps in your nose;

a bleeding or blood clotting disorder; or

if you smoke.

FDA pregnancy category C. Before using Aleve, tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking Aleve during the last 3 months of pregnancy may result in birth defects. Do not take Aleve during pregnancy unless your doctor has told you to. Aleve can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medicine to a child younger than 2 years old without the advice of a doctor.

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Many medicines available over the counter contain aspirin or other medicines similar to Aleve (such as ibuprofen or ketoprofen). If you take certain products together you may accidentally take too much of this type of medication. Read the label of any other medicine you are using to see if it contains aspirin, ibuprofen, or ketoprofen. Do not drink alcohol while taking Aleve. Alcohol can increase the risk of stomach bleeding caused by Aleve. Avoid prolonged exposure to sunlight. Aleve may increase the sensitivity of the skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking Aleve and seek medical attention or call your doctor at once if you have any of these serious side effects:

chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance;

black, bloody, or tarry stools;

coughing up blood or vomit that looks like coffee grounds;

swelling or rapid weight gain;

urinating less than usual or not at all;

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

fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;

bruising, severe tingling, numbness, pain, muscle weakness; or

fever, headache, neck stiffness, chills, increased sensitivity to light, purple spots on the skin, and/or seizure (convulsions).

Less serious Aleve side effects may include:

upset stomach, mild heartburn or stomach pain, diarrhea, constipation;

bloating, gas;

dizziness, headache, nervousness;

skin itching or rash;

blurred vision; or

ringing in your ears.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.



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Omeprazole Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Aprazole

omeprazole

GENERIC NAME(S): OMEPRAZOLE

Uses

Omeprazole is used to treat certain stomach and esophagus problems (such as acid reflux. ulcers). It works by decreasing the amount of acid your stomach makes. It relieves symptoms such as heartburn. difficulty swallowing, and persistent cough. This medication helps heal acid damage to the stomach and esophagus, helps prevent ulcers, and may help prevent cancer of the esophagus. Omeprazole belongs to a class of drugs known as proton pump inhibitors (PPIs).

If you are self-treating with this medication, over-the-counter omeprazole products are used to treat frequent heartburn (occurring 2 or more days a week). Since it may take 1 to 4 days to have full effect, these products do not relieve heartburn right away.

For over-the-counter products, carefully read the package instructions to make sure the product is right for you. Check the ingredients on the label even if you have used the product before. The manufacturer may have changed the ingredients. Also, products with similar brand names may contain different ingredients meant for different purposes. Taking the wrong product could harm you.

How to use omeprazole

Read the Patient Information Leaflet if available from your pharmacist before you start taking omeprazole and each time you get a refill.

Take this medication by mouth as directed by your doctor, usually once daily, before a meal. If you are self-treating, follow all directions on the product package. Dosage and length of treatment are based on your medical condition and response to treatment. In children, the dosage is also based on weight. Do not increase your dose or take this drug more often than directed. If you have any questions, ask your doctor or pharmacist.

Do not crush, break, or chew the tablets. Swallow this medication whole with a glass of water.

If needed, antacids may be taken along with this medication. If you are also taking sucralfate, take omeprazole at least 30 minutes before sucralfate.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Continue to take this medication for the prescribed length of treatment even if you are feeling better. If you are self-treating with the over-the-counter product, do not take it for more than 14 days unless directed by your doctor.

Tell your doctor if your condition persists or worsens. If you are self-treating, tell your doctor if your heartburn persists after 14 days or if you need to use this medication more than once every 4 months. If you think you may have a serious medical problem, get medical help right away.

Side Effects

See also Precautions section.

Headache or abdominal pain may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

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

Tell your doctor right away if you have any serious side effects, including: symptoms of a low magnesium blood level (such as unusually fast/slow/irregular heartbeat. persistent muscle spasms. seizures ).

This medication may rarely cause a severe intestinal condition (Clostridium difficile - associated diarrhea ) due to a type of bacteria. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Tell your doctor right away if you develop: persistent diarrhea, abdominal or stomach pain/cramping, fever, blood /mucus in your stool.

Rarely, proton pump inhibitors (such as omeprazole) have caused vitamin B-12 deficiency. The risk is increased if they are taken every day for a long time (3 years or longer). Tell your doctor right away if you develop symptoms of vitamin B-12 deficiency (such as unusual weakness. sore tongue. or numbness/tingling of the hands/feet).

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

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

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

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

Precautions

Before taking omeprazole, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as esomeprazole. lansoprazole. pantoprazole ); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease.

Some symptoms may actually be signs of a more serious condition. Get medical help right away if you have: heartburn with lightheadedness/sweating /dizziness, chest/jaw/arm/shoulder pain (especially with shortness of breath, unusual sweating ), unexplained weight loss .

In addition, before you self-treat with this medication, get medical help right away if you have any of these signs of a serious condition: trouble/pain swallowing food, bloody vomit, vomit that looks like coffee grounds, bloody/black stools, heartburn for over 3 months, frequent chest pain. frequent wheezing (especially with heartburn), nausea /vomiting. stomach pain.

Proton pump inhibitors (such as omeprazole) may increase your risk for bone fractures. especially with longer use, higher doses, and in older adults. Talk with your doctor or pharmacist about ways to prevent bone loss /fracture, such as by taking calcium (such as calcium citrate ) and vitamin D supplements .

Children may be more sensitive to the side effects of this drug, especially fever, cough, and infections of the nose/throat/airways.

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

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

This medication passes into breast milk. The effects on a nursing infant are unknown. Consult your doctor before breast-feeding.

Interactions

See also How to Use section.

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

Some products that may interact with this drug include: cilostazol, clopidogrel, methotrexate (especially high-dose treatment), rifampin, St John's wort.

Some products need stomach acid so that the body can absorb them properly. Omeprazole decreases stomach acid, so it may change how well these products work. Some affected products include atazanavir, erlotinib, nelfinavir, pazopanib, rilpivirine, certain azole antifungals (itraconazole, ketoconazole, posaconazole), among others.

Omeprazole is very similar to esomeprazole. Do not use any medications containing esomeprazole while using omeprazole.

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

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: confusion, unusual sweating, blurred vision, unusually fast heartbeat.

Notes

If your doctor has prescribed this medication for you, do not share it with others.

If your doctor instructs you to use this medication regularly for a long time, laboratory and medical tests (such as a magnesium blood test, vitamin B-12 levels) may be performed periodically to monitor your progress or check for side effects. Keep all regular medical and laboratory appointments.

Missed Dose

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

Storage

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

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

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

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WOMIBAN TABLET

It is used to treat infections caused by worms.

How does Albendazole work:

Albendazole works to harm the worms and fight the infection.

How should Albendazole be used:

Take this exactly as directed by your doctor. Do not take more or less than instructed by your doctor. Take Albendazole at regular intervals as instructed. Do not skip any doses. Continue to take it even when you feel better. You must complete the entire course unless otherwise directed. If you do not complete the course, the infection may not clear completely. Depending on the type of infection, you may need to take Albendazole for any length of time, ranging from 1 day to 1 month. Follow your doctors instructions. Take Albendazole together with or immediately after a full meal.

Common side effects of Albendazole :

Stomach pain, nausea, vomiting, headache, dizziness, reversible hair loss.

What do I do if I miss a dose

Take a missed dose as soon as you think about it. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. - Do not take 2 doses at the same time or extra doses.

What precautions should I take when taking Albendazole :

Alert your doctor if you are pregnant. Do not take Albendazole if you are pregnant. - It is important that you do not get pregnant while being treated with Albendazole. - You may wish to discuss birth control methods with your doctor or pharmacist, especially if you are taking Albendazole for a longer period, such as for a month. - Avoid pregnancy for at least 1 month after you stop taking Albendazole. - Alert your doctor if you are breastfeeding.

When do I need to seek medical help

Seek help if you think there was an overdose or signs of a very bad reaction to the drug. These include wheezing, chest tightness, fever, itching, bad cough, blue or gray skin color, seizures, or swelling of face, lips, tongue, or throat. - Signs of infection. These include a fever of 100.5?F (38?C) or higher, chills, very bad sore throat, ear or sinus pain, cough, more sputum or change in color of sputum, pain with passing urine, mouth sores, wound that will not heal, or anal itching or pain. - Feeling very tired or weak. - Very bad belly pain. - Very bad headache. - Very upset stomach or throwing up. - Any bruising or bleeding. - Dark urine or yellow skin or eyes. - Not able to eat. - Any rash. - Side effect or health problem is not better or you are feeling worse.

Can I take Albendazole with other medicines:

Let your doctor know if you are taking a gastric medicine called cimetidine. - Always inform your doctor and pharmacist if you are taking any other medicines, including herbal tonics, supplements and medicines that you buy without a prescription.

Are there any food restrictions

How do I store Albendazole :

Store in a cool, dry place away from the reach of children. - Medicines must not be used past the expiry date.

Pregnancy Category

Category D. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Therapeutic Classification



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piroxicam

Piroxicam is a nonsteroidal anti-inflammatory drug (NSAID). This medicine works by reducing substances in the body that cause pain and inflammation.

Piroxicam is used to treat pain or inflammation caused by osteoarthritis or rheumatoid arthritis.

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

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

Piroxicam can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Piroxicam may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using piroxicam, especially in older adults.

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

You should not use piroxicam if you are allergic to it, or if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID.

Piroxicam can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Even people without heart disease or risk factors could have a stroke or heart attack while taking this medicine.

Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Piroxicam may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using piroxicam, especially in older adults.

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

heart disease, high blood pressure, high cholesterol, diabetes, or if you smoke;

a history of heart attack, stroke, or blood clot;

a history of stomach ulcers or bleeding;

liver or kidney disease; or

Taking piroxicam during the last 3 months of pregnancy may harm the unborn baby. Tell your doctor if you are pregnant.

Ovulation (release of an egg from your ovary) could be delayed while you are taking piroxicam. This effect is usually not permanent. You should not take piroxicam while you are trying to get pregnant.

Piroxicam can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

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

How should I take piroxicam?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger amounts or for longer than recommended. Use the lowest dose that is effective in treating your condition.

It may take up to 2 weeks before your symptoms improve. Keep using the medicine as directed and tell your doctor if your symptoms do not improve.

If you use this medicine long-term, you may need frequent medical tests.

Store at room temperature away from moisture and heat.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include nausea, vomiting, stomach pain, black or bloody stools, or coughing up blood.

What should I avoid while taking piroxicam?

Avoid drinking alcohol. It may increase your risk of stomach bleeding.

Avoid taking aspirin while you are taking piroxicam.

Ask a doctor or pharmacist before using any cold, allergy, or pain medicine. Many medicines available over the counter contain aspirin or other medicines similar to piroxicam. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.

Piroxicam side effects

Get emergency medical help if you have signs of an allergic reaction: sneezing, runny or stuffy nose; wheezing or trouble breathing; hives; swelling of your face, lips, tongue, or throat.

Get emergency medical help if you have signs of a heart attack or stroke: chest pain spreading to your jaw or shoulder, sudden numbness or weakness on one side of the body, slurred speech, feeling short of breath.

Stop using piroxicam and call your doctor at once if you have:

changes in your vision;

shortness of breath (even with mild exertion);

swelling or rapid weight gain;

the first sign of any skin rash, no matter how mild;

signs of stomach bleeding--bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

liver problems--nausea, upper stomach pain, itching, tired feeling, flu-like symptoms, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

kidney problems--little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath;

low red blood cells (anemia)--pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; 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.

Common side effects may include:

abnormal liver function tests;

upset stomach, heartburn, loss of appetite, stomach pain, nausea, vomiting;

gas, diarrhea, constipation;

itching, rash; or

ringing in your ears.

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.

Piroxicam dosing information

Usual Adult Dose for Rheumatoid Arthritis:

Recommended dose: 20 mg orally once a day

Comments: - The lowest effective dose for the shortest duration possible should be used based on individual patient treatment goals. - Due to the long half-life, there is a progressive response to treatment over several weeks; the effect of therapy should not be assessed for 2 weeks.

Use: For the relief of signs and symptoms of rheumatoid arthritis.

Usual Adult Dose for Osteoarthritis:

Recommended dose: 20 mg orally once a day

Comments: - The lowest effective dose for the shortest duration possible should be used based on individual patient treatment goals. - Due to the long half-life, there is a progressive response to treatment over several weeks; the effect of therapy should not be assessed for 2 weeks.

Use: For the relief of signs and symptoms of osteoarthritis.

What other drugs will affect piroxicam?

Ask your doctor before using piroxicam if you take an antidepressant such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed easily.

Ask a doctor or pharmacist if it is safe for you to use piroxicam if you are also using any of the following drugs:

a blood thinner (warfarin, Coumadin, Jantoven);

heart or blood pressure medication, including a diuretic or "water pill"; or

steroid medicine (such as prednisone).

This list is not complete. Other drugs may interact with piroxicam, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

More about piroxicam

Consumer resources

Professional resources

Related treatment guides

Where can I get more information?

Your pharmacist can provide more information about piroxicam.

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

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

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.01. Revision Date: 2015-08-27, 4:44:05 PM.

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Fda Warning Reumofan Supplements Contain Dangerous Drugs - Abc News, Reumafen

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Arthritis Supplement Draws FDA Warning

Consumers searching for a miracle cure for the aches and pains of arthritis should beware: The FDA has issued a new warning about the potential health risks of Reumofan and Reumofan Plus, two products marketed as natural dietary supplements for treating arthritis, muscle pain, osteoporosis, bone cancer, and other conditions.

The FDA said it found both supplements contain several potentially dangerous ingredients that are not listed on the label. Since the first warning was issued in June, consumers have begun to speak up.

"The FDA has received dozens of additional adverse event reports, including death and stroke, associated with the use of Reumofan Plus," said Sarah Clark-Lynn, an FDA spokesperson. "Other reports include liver injury, severe bleeding, sudden worsening of glucose (sugar) control, weight gain, swelling, leg cramps and withdrawal syndrome, and adrenal suppression."

FDA lab analysis of the products revealed the presence of several prescription drugs that are linked to serious side effects, the agency said.

Dexamethasone, a corticosteroid commonly used to treat inflammatory conditions, can weaken the immune system, elevate blood sugar levels and increase the risk of bone and muscle injuries. It's also been associated with psychiatric problems.

When taken over long periods of time or in high doses, the drug may damage the adrenal glands, impairing their ability to produce hormones. Sudden discontinued use, especially when the drug has been taken long-term or in high doses, may lead to withdrawal syndrome, with users experiencing fatigue, nausea, low blood pressure, low blood sugar levels, fever, dizziness, and muscle and joint pain.

Diclofenac sodium, a non-steroidal anti-inflammatory drug (NSAID) also detected in the supplements, increases the risk of cardiovascular events, such as heart attack and stroke, as well as serious gastrointestinal problems including bleeding, ulceration, and fatal perforation of the stomach and intestines. Additionally, the analysis found the muscle relaxant methocarbamol, which can cause drowsiness, dizziness, low blood pressure, and impair mental or physical abilities to perform tasks, such as driving a motor vehicle or operating machinery.

Tests on samples of Reumofan Plus found it contained diclofenac sodium and methocarbamol, the FDA said.

"The hidden drug ingredients in Reumofan Plus and Reumofan Plus Premium can lead to serious, even life-threatening, health consequences. The longer you take the products, the higher the risk," Clark-Lynn said. "Because of the hidden corticosteroid, consumers taking these products are urged to immediately consult with their doctor to safely discontinue use of the product."

Dr. Stephen Dahmer, an integrated medicine family physician in private practice at the Continuum Center for Health and Healing, Beth Israel Medical Center, said supplements can be as dangerous as medications. "Anyone can have an adverse or allergic reaction to almost any supplement so you do need to be careful about what you take and make sure you only buy reputable, high quality brands," he said.

None of his patients has taken Reumofan but he urged anyone with osteoarthritis to steer clear. And he said he's on the lookout for symptoms in patients who suffer from arthritis in case they've taken the pills without telling him.

The supplements are manufactured in Mexico by the company Riger Naturals. They are usually labeled in Spanish but may also be labeled in English. In the U. S. GNC, Vitamin Shoppe and other large national retailers don't appear to be carrying the products either on the shelves or on their websites, but they can easily be purchased on supplement websites or eBay.

The Mexican Ministry of Health issued its own health warning to the public about Reumofan and has ordered Riger Naturals to recall the products. The FDA is asking doctors and consumers to report any side effects related to the two supplements to the FDA's MedWatch Safety Information and Adverse Event Reporting Program.



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Evaluation Of The Safety Profile Of Zolafren®, A Generic Olanzapine Formulation, In Patients With Bi

Evaluation of the Safety Profile of Zolafren ®. a Generic Olanzapine Formulation, in Patients with Bipolar Disorder: A Post-Authorization Safety Study

Fountoulakis KN, Kelsoe JR, Akiskal H. Receptor targets for antidepressant therapy in bipolar disorder: an overview. J Affect Disord. 2012;138:222–38. CrossRef PubMed

McCormack PL, Wiseman LR. Olanzapine: a review of its use in the management of bipolar I disorder. Drugs. 2004;64:2709–26. CrossRef PubMed

Kennedy JS, Bymaster FP, Schuh L, et al. A current review of olanzapine’s safety in the geriatric patient: from pre-clinical pharmacology to clinical data. Int J Geriatr Psychiatry. 2001;16(Suppl 1):S33–61. CrossRef PubMed

The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines. Wold Health Organization, Geneva; 1992. http://www. who. int/classifications/icd/en/bluebook. pdf .

Obesity: preventing and managing the global epidemic. Report of WHO Consultation on Obesity. Geneva, 3–5 June 1997 WHO/NUT/NCD, Geneva; 1998.

The International Diabetes Federation (IDF) consensus worldwide definition of the metabolic syndrome. Berlin; 2005. www. idf. org .

Gomez JC, Sacristan JA, Hernandez J, et al. The safety of olanzapine compared with other antipsychotic drugs: results of an observational prospective study in patients with schizophrenia (EFESO Study). Pharmacoepidemiologic Study of Olanzapine in Schizophrenia. J Clin Psychiatry. 2000;61:335–43. CrossRef PubMed

Tohen M, Calabrese JR, Sachs GS, et al. Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. Am J Psychiatry. 2006;163:247–56. CrossRef PubMed

Olszanecka-Glinianowicz M. Safety and tolerance of generic olanzapine formulation (Zapilux ® ) in therapy of patients with schizophrenia—results of a post-marketing, non-randomized, non-interventional, multicenter survey in outpatient treatment. Problemy Medycyny Rodzinnej. 2012;14:5–16.

Parsons B, Allison DB, Loebel A, et al. Weight effects associated with antipsychotics: a comprehensive database analysis. Schizophr Res. 2009;110:103–10. CrossRef PubMed

Dittmann RW, Meyer E, Freisleder FJ, et al. Effectiveness and tolerability of olanzapine in the treatment of adolescents with schizophrenia and related psychotic disorders: results from a large, prospective, open-label study. J Child Adolesc Psychopharmacol. 2008;18:54–69. CrossRef PubMed

Moteshafi H, Zhornitsky S, Brunelle S, Stip E. Comparing tolerability of olanzapine in schizophrenia and affective disorders: a meta-analysis. Drug Saf. 2012;35:819–36. CrossRef PubMed

Zajecka JM, Weisler R, Sachs G, Swann AC, Wozniak P, Sommerville KW. A comparison of the efficacy, safety, and tolerability of divalproex sodium and olanzapine in the treatment of bipolar disorder. J Clin Psychiatry. 2002;63:1148–55. CrossRef PubMed

Niufan G, Tohen M, Qiuqing A, et al. Olanzapine versus lithium in the acute treatment of bipolar mania: a double-blind, randomized, controlled trial. J Affect Disord. 2008;105:101–8. CrossRef PubMed

Milano W, Grillo F, Del Mastro A, et al. Appropriate intervention strategies for weight gain induced by olanzapine: a randomized controlled study. Adv Ther. 2007;24:123–34. CrossRef PubMed

Hagg S, Joelsson L, Mjorndal T, Spigset O, Oja G, Dahlqvist R. Prevalence of diabetes and impaired glucose tolerance in patients treated with clozapine compared with patients treated with conventional depot neuroleptic medications. J Clin Psychiatry. 1998;59:294–9. CrossRef PubMed

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Copyright information

© Springer Healthcare 2015

Authors and Affiliations

Jerzy Chudek

1

Email author

Magdalena Olszanecka-Glinianowicz

2

Agnieszka Almgren-Rachtan

3

Tomasz Gabryelewicz

4

1. Pathophysiology Unit, Department of Pathophysiology, Medical Faculty in Katowice Medical University of Silesia Poland

2. Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice Medical University of Silesia Poland

3. Department of Pharmacovigilance Europharma Rachtan Co. Ltd. Poland

4. Department of Neurodegenerative Disorders Mossakowski Medical Research Centre Polish Academy of Sciences Poland

About this article



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There - S No Such Thing As Free Will - The Atlantic, Infree S

The Atlantic

There’s No Such Thing as Free Will

F or centuries. philosophers and theologians have almost unanimously held that civilization as we know it depends on a widespread belief in free will—and that losing this belief could be calamitous. Our codes of ethics, for example, assume that we can freely choose between right and wrong. In the Christian tradition, this is known as “moral liberty”—the capacity to discern and pursue the good, instead of merely being compelled by appetites and desires. The great Enlightenment philosopher Immanuel Kant reaffirmed this link between freedom and goodness. If we are not free to choose, he argued, then it would make no sense to say we ought to choose the path of righteousness.

Today, the assumption of free will runs through every aspect of American politics, from welfare provision to criminal law. It permeates the popular culture and underpins the American dream—the belief that anyone can make something of themselves no matter what their start in life. As Barack Obama wrote in The Audacity of Hope . American “values are rooted in a basic optimism about life and a faith in free will.”

So what happens if this faith erodes?

The sciences have grown steadily bolder in their claim that all human behavior can be explained through the clockwork laws of cause and effect. This shift in perception is the continuation of an intellectual revolution that began about 150 years ago, when Charles Darwin first published On the Origin of Species . Shortly after Darwin put forth his theory of evolution, his cousin Sir Francis Galton began to draw out the implications: If we have evolved, then mental faculties like intelligence must be hereditary. But we use those faculties—which some people have to a greater degree than others—to make decisions. So our ability to choose our fate is not free, but depends on our biological inheritance.

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Galton launched a debate that raged throughout the 20th century over nature versus nurture. Are our actions the unfolding effect of our genetics? Or the outcome of what has been imprinted on us by the environment? Impressive evidence accumulated for the importance of each factor. Whether scientists supported one, the other, or a mix of both, they increasingly assumed that our deeds must be determined by something .

In recent decades, research on the inner workings of the brain has helped to resolve the nature-nurture debate—and has dealt a further blow to the idea of free will. Brain scanners have enabled us to peer inside a living person’s skull, revealing intricate networks of neurons and allowing scientists to reach broad agreement that these networks are shaped by both genes and environment. But there is also agreement in the scientific community that the firing of neurons determines not just some or most but all of our thoughts, hopes, memories, and dreams.

We know that changes to brain chemistry can alter behavior—otherwise neither alcohol nor antipsychotics would have their desired effects. The same holds true for brain structure: Cases of ordinary adults becoming murderers or pedophiles after developing a brain tumor demonstrate how dependent we are on the physical properties of our gray stuff.

Many scientists say that the American physiologist Benjamin Libet demonstrated in the 1980s that we have no free will. It was already known that electrical activity builds up in a person’s brain before she, for example, moves her hand; Libet showed that this buildup occurs before the person consciously makes a decision to move. The conscious experience of deciding to act, which we usually associate with free will, appears to be an add-on, a post hoc reconstruction of events that occurs after the brain has already set the act in motion.

The 20th-century nature-nurture debate prepared us to think of ourselves as shaped by influences beyond our control. But it left some room, at least in the popular imagination, for the possibility that we could overcome our circumstances or our genes to become the author of our own destiny. The challenge posed by neuroscience is more radical: It describes the brain as a physical system like any other, and suggests that we no more will it to operate in a particular way than we will our heart to beat. The contemporary scientific image of human behavior is one of neurons firing, causing other neurons to fire, causing our thoughts and deeds, in an unbroken chain that stretches back to our birth and beyond. In principle, we are therefore completely predictable. If we could understand any individual’s brain architecture and chemistry well enough, we could, in theory, predict that individual’s response to any given stimulus with 100 percent accuracy.

This research and its implications are not new. What is new, though, is the spread of free-will skepticism beyond the laboratories and into the mainstream. The number of court cases, for example, that use evidence from neuroscience has more than doubled in the past decade—mostly in the context of defendants arguing that their brain made them do it. And many people are absorbing this message in other contexts, too, at least judging by the number of books and articles purporting to explain “your brain on” everything from music to magic. Determinism, to one degree or another, is gaining popular currency. The skeptics are in ascendance.

This development raises uncomfortable—and increasingly nontheoretical—questions: If moral responsibility depends on faith in our own agency, then as belief in determinism spreads, will we become morally irresponsible? And if we increasingly see belief in free will as a delusion, what will happen to all those institutions that are based on it?

In 2002, two psychologists had a simple but brilliant idea: Instead of speculating about what might happen if people lost belief in their capacity to choose, they could run an experiment to find out. Kathleen Vohs, then at the University of Utah, and Jonathan Schooler, of the University of Pittsburgh, asked one group of participants to read a passage arguing that free will was an illusion, and another group to read a passage that was neutral on the topic. Then they subjected the members of each group to a variety of temptations and observed their behavior. Would differences in abstract philosophical beliefs influence people’s decisions?

Yes, indeed. When asked to take a math test, with cheating made easy, the group primed to see free will as illusory proved more likely to take an illicit peek at the answers. When given an opportunity to steal—to take more money than they were due from an envelope of $1 coins—those whose belief in free will had been undermined pilfered more. On a range of measures, Vohs told me, she and Schooler found that “people who are induced to believe less in free will are more likely to behave immorally.”

It seems that when people stop believing they are free agents, they stop seeing themselves as blameworthy for their actions. Consequently, they act less responsibly and give in to their baser instincts. Vohs emphasized that this result is not limited to the contrived conditions of a lab experiment. “You see the same effects with people who naturally believe more or less in free will,” she said.

In another study, for instance, Vohs and colleagues measured the extent to which a group of day laborers believed in free will, then examined their performance on the job by looking at their supervisor’s ratings. Those who believed more strongly that they were in control of their own actions showed up on time for work more frequently and were rated by supervisors as more capable. In fact, belief in free will turned out to be a better predictor of job performance than established measures such as self-professed work ethic.

Another pioneer of research into the psychology of free will, Roy Baumeister of Florida State University, has extended these findings. For example, he and colleagues found that students with a weaker belief in free will were less likely to volunteer their time to help a classmate than were those whose belief in free will was stronger. Likewise, those primed to hold a deterministic view by reading statements like “Science has demonstrated that free will is an illusion” were less likely to give money to a homeless person or lend someone a cellphone.

Further studies by Baumeister and colleagues have linked a diminished belief in free will to stress, unhappiness, and a lesser commitment to relationships. They found that when subjects were induced to believe that “all human actions follow from prior events and ultimately can be understood in terms of the movement of molecules,” those subjects came away with a lower sense of life’s meaningfulness. Early this year, other researchers published a study showing that a weaker belief in free will correlates with poor academic performance.

The list goes on: Believing that free will is an illusion has been shown to make people less creative, more likely to conform, less willing to learn from their mistakes, and less grateful toward one another. In every regard, it seems, when we embrace determinism, we indulge our dark side.

Few scholars are comfortable suggesting that people ought to believe an outright lie. Advocating the perpetuation of untruths would breach their integrity and violate a principle that philosophers have long held dear: the Platonic hope that the true and the good go hand in hand. Saul Smilansky, a philosophy professor at the University of Haifa, in Israel, has wrestled with this dilemma throughout his career and come to a painful conclusion: “We cannot afford for people to internalize the truth” about free will.

Smilansky is convinced that free will does not exist in the traditional sense—and that it would be very bad if most people realized this. “Imagine,” he told me, “that I’m deliberating whether to do my duty, such as to parachute into enemy territory, or something more mundane like to risk my job by reporting on some wrongdoing. If everyone accepts that there is no free will, then I’ll know that people will say, ‘Whatever he did, he had no choice—we can’t blame him.’ So I know I’m not going to be condemned for taking the selfish option.” This, he believes, is very dangerous for society, and “the more people accept the determinist picture, the worse things will get.”

Determinism not only undermines blame, Smilansky argues; it also undermines praise. Imagine I do risk my life by jumping into enemy territory to perform a daring mission. Afterward, people will say that I had no choice, that my feats were merely, in Smilansky’s phrase, “an unfolding of the given,” and therefore hardly praiseworthy. And just as undermining blame would remove an obstacle to acting wickedly, so undermining praise would remove an incentive to do good. Our heroes would seem less inspiring, he argues, our achievements less noteworthy, and soon we would sink into decadence and despondency.

Smilansky advocates a view he calls illusionism—the belief that free will is indeed an illusion, but one that society must defend. The idea of determinism, and the facts supporting it, must be kept confined within the ivory tower. Only the initiated, behind those walls, should dare to, as he put it to me, “look the dark truth in the face.” Smilansky says he realizes that there is something drastic, even terrible, about this idea—but if the choice is between the true and the good, then for the sake of society, the true must go.

When people stop believing they are free agents, they stop seeing themselves as blameworthy for their actions.

Smilansky’s arguments may sound odd at first, given his contention that the world is devoid of free will: If we are not really deciding anything, who cares what information is let loose? But new information, of course, is a sensory input like any other; it can change our behavior, even if we are not the conscious agents of that change. In the language of cause and effect, a belief in free will may not inspire us to make the best of ourselves, but it does stimulate us to do so.

Illusionism is a minority position among academic philosophers, most of whom still hope that the good and the true can be reconciled. But it represents an ancient strand of thought among intellectual elites. Nietzsche called free will “a theologians’ artifice” that permits us to “judge and punish.” And many thinkers have believed, as Smilansky does, that institutions of judgment and punishment are necessary if we are to avoid a fall into barbarism.

Smilansky is not advocating policies of Orwellian thought control. Luckily, he argues, we don’t need them. Belief in free will comes naturally to us. Scientists and commentators merely need to exercise some self-restraint, instead of gleefully disabusing people of the illusions that undergird all they hold dear. Most scientists “don’t realize what effect these ideas can have,” Smilansky told me. “Promoting determinism is complacent and dangerous.”

Yet not all scholars who argue publicly against free will are blind to the social and psychological consequences. Some simply don’t agree that these consequences might include the collapse of civilization. One of the most prominent is the neuroscientist and writer Sam Harris, who, in his 2012 book, Free Will . set out to bring down the fantasy of conscious choice. Like Smilansky, he believes that there is no such thing as free will. But Harris thinks we are better off without the whole notion of it.

“We need our beliefs to track what is true,” Harris told me. Illusions, no matter how well intentioned, will always hold us back. For example, we currently use the threat of imprisonment as a crude tool to persuade people not to do bad things. But if we instead accept that “human behavior arises from neurophysiology,” he argued, then we can better understand what is really causing people to do bad things despite this threat of punishment—and how to stop them. “We need,” Harris told me, “to know what are the levers we can pull as a society to encourage people to be the best version of themselves they can be.”

According to Harris, we should acknowledge that even the worst criminals—murderous psychopaths, for example—are in a sense unlucky. “They didn’t pick their genes. They didn’t pick their parents. They didn’t make their brains, yet their brains are the source of their intentions and actions.” In a deep sense, their crimes are not their fault. Recognizing this, we can dispassionately consider how to manage offenders in order to rehabilitate them, protect society, and reduce future offending. Harris thinks that, in time, “it might be possible to cure something like psychopathy,” but only if we accept that the brain, and not some airy-fairy free will, is the source of the deviancy.

Accepting this would also free us from hatred. Holding people responsible for their actions might sound like a keystone of civilized life, but we pay a high price for it: Blaming people makes us angry and vengeful, and that clouds our judgment.

“Compare the response to Hurricane Katrina,” Harris suggested, with “the response to the 9/11 act of terrorism.” For many Americans, the men who hijacked those planes are the embodiment of criminals who freely choose to do evil. But if we give up our notion of free will, then their behavior must be viewed like any other natural phenomenon—and this, Harris believes, would make us much more rational in our response.

Although the scale of the two catastrophes was similar, the reactions were wildly different. Nobody was striving to exact revenge on tropical storms or declare a War on Weather, so responses to Katrina could simply focus on rebuilding and preventing future disasters. The response to 9/11, Harris argues, was clouded by outrage and the desire for vengeance, and has led to the unnecessary loss of countless more lives. Harris is not saying that we shouldn’t have reacted at all to 9/11, only that a coolheaded response would have looked very different and likely been much less wasteful. “Hatred is toxic,” he told me, “and can destabilize individual lives and whole societies. Losing belief in free will undercuts the rationale for ever hating anyone.”

Whereas the evidence from Kathleen Vohs and her colleagues suggests that social problems may arise from seeing our own actions as determined by forces beyond our control—weakening our morals, our motivation, and our sense of the meaningfulness of life—Harris thinks that social benefits will result from seeing other people’s behavior in the very same light. From that vantage point, the moral implications of determinism look very different, and quite a lot better.

What’s more, Harris argues, as ordinary people come to better understand how their brains work, many of the problems documented by Vohs and others will dissipate. Determinism, he writes in his book, does not mean “that conscious awareness and deliberative thinking serve no purpose.” Certain kinds of action require us to become conscious of a choice—to weigh arguments and appraise evidence. True, if we were put in exactly the same situation again, then 100 times out of 100 we would make the same decision, “just like rewinding a movie and playing it again.” But the act of deliberation—the wrestling with facts and emotions that we feel is essential to our nature—is nonetheless real.

The big problem, in Harris’s view, is that people often confuse determinism with fatalism. Determinism is the belief that our decisions are part of an unbreakable chain of cause and effect. Fatalism, on the other hand, is the belief that our decisions don’t really matter, because whatever is destined to happen will happen—like Oedipus’s marriage to his mother, despite his efforts to avoid that fate.

Most scientists “don’t realize what effect these ideas can have,” Smilansky told me. It is “complacent and dangerous” to air them.

When people hear there is no free will, they wrongly become fatalistic; they think their efforts will make no difference. But this is a mistake. People are not moving toward an inevitable destiny; given a different stimulus (like a different idea about free will), they will behave differently and so have different lives. If people better understood these fine distinctions, Harris believes, the consequences of losing faith in free will would be much less negative than Vohs’s and Baumeister’s experiments suggest.

Can one go further still? Is there a way forward that preserves both the inspiring power of belief in free will and the compassionate understanding that comes with determinism?

Philosophers and theologians are used to talking about free will as if it is either on or off; as if our consciousness floats, like a ghost, entirely above the causal chain, or as if we roll through life like a rock down a hill. But there might be another way of looking at human agency.

Some scholars argue that we should think about freedom of choice in terms of our very real and sophisticated abilities to map out multiple potential responses to a particular situation. One of these is Bruce Waller, a philosophy professor at Youngstown State University. In his new book, Restorative Free Will . he writes that we should focus on our ability, in any given setting, to generate a wide range of options for ourselves, and to decide among them without external constraint.

For Waller, it simply doesn’t matter that these processes are underpinned by a causal chain of firing neurons. In his view, free will and determinism are not the opposites they are often taken to be; they simply describe our behavior at different levels.

Waller believes his account fits with a scientific understanding of how we evolved: Foraging animals—humans, but also mice, or bears, or crows—need to be able to generate options for themselves and make decisions in a complex and changing environment. Humans, with our massive brains, are much better at thinking up and weighing options than other animals are. Our range of options is much wider, and we are, in a meaningful way, freer as a result.

Waller’s definition of free will is in keeping with how a lot of ordinary people see it. One 2010 study found that people mostly thought of free will in terms of following their desires, free of coercion (such as someone holding a gun to your head). As long as we continue to believe in this kind of practical free will, that should be enough to preserve the sorts of ideals and ethical standards examined by Vohs and Baumeister.

Yet Waller’s account of free will still leads to a very different view of justice and responsibility than most people hold today. No one has caused himself: No one chose his genes or the environment into which he was born. Therefore no one bears ultimate responsibility for who he is and what he does. Waller told me he supported the sentiment of Barack Obama’s 2012 “You didn’t build that” speech, in which the president called attention to the external factors that help bring about success. He was also not surprised that it drew such a sharp reaction from those who want to believe that they were the sole architects of their achievements. But he argues that we must accept that life outcomes are determined by disparities in nature and nurture, “so we can take practical measures to remedy misfortune and help everyone to fulfill their potential.”

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Understanding how will be the work of decades, as we slowly unravel the nature of our own minds. In many areas, that work will likely yield more compassion: offering more (and more precise) help to those who find themselves in a bad place. And when the threat of punishment is necessary as a deterrent, it will in many cases be balanced with efforts to strengthen, rather than undermine, the capacities for autonomy that are essential for anyone to lead a decent life. The kind of will that leads to success—seeing positive options for oneself, making good decisions and sticking to them—can be cultivated, and those at the bottom of society are most in need of that cultivation.

To some people, this may sound like a gratuitous attempt to have one’s cake and eat it too. And in a way it is. It is an attempt to retain the best parts of the free-will belief system while ditching the worst. President Obama—who has both defended “a faith in free will” and argued that we are not the sole architects of our fortune—has had to learn what a fine line this is to tread. Yet it might be what we need to rescue the American dream—and indeed, many of our ideas about civilization, the world over—in the scientific age.

The Death of 'He Said, She Said' Journalism

The New York Times responds to a candidate who breaks all the rules by discarding some of its own.

Last Saturday, The New York Times published an extraordinary story. What made the story extraordinary wasn’t the event the Times covered. What made it extraordinary was the way the Times covered it.

On its front page, top right—the most precious space in American print journalism—the Times wrote about Friday’s press conference in which Donald Trump declared that a) he now believed Barack Obama was a US citizen, b) he deserved credit for having established that fact despite rumors to the contrary and c) Hillary Clinton was to blame for the rumors. Traditionally, when a political candidate assembles facts so as to aggrandize himself and belittle his opponent, “objective” journalists like those at the Times respond with a “he said, she said” story.

The Free-Time Paradox in America

The rich were meant to have the most leisure time. The working poor were meant to have the least. The opposite is happening. Why?

"Every time I see it, that number blows my mind.”

Erik Hurst, an economist at the University of Chicago, was delivering a speech at the Booth School of Business this June about the rise in leisure among young men who didn’t go to college. He told students that one “staggering” statistic stood above the rest. "In 2015, 22 percent of lower-skilled men [those without a college degree] aged 21 to 30 had not worked at all during the prior twelve months,” he said.

"Think about that for a second,” he went on. Twentysomething male high-school grads used to be the most dependable working cohort in America. Today one in five are now essentially idle. The employment rate of this group has fallen 10 percentage points just this century, and it has triggered a cultural, economic, and social decline. "These younger, lower-skilled men are now less likely to work, less likely to marry, and more likely to live with parents or close relatives,” he said.

Donald Trump Doesn’t Understand Food

What we eat may be the most important issue before the country.

Last week The New York Times reported, “Donald Trump Checkup Said to Reveal He Is Overweight.”

This revelation was a prelude to the Republican candidate's appearance on The Dr. Oz Show on Thursday. There Trump appeared surprised by one question about obesity. The question was not about Trump’s own body mass, but rather what he planned to do about the metabolic health of American children.

It was a sobering moment, a reminder that concerns about Donald Trump or Hillary Clinton’s health should be dwarfed by concerns about how the candidates would affect everyone else’s health. The fundamental way that will happen is by affecting the leading cause of poor health in the country: the food we eat. On that topic the two candidates could not be more different.

What America Lost as Women Entered the Workforce

Civic organizations were built on the voluntary labor of women. As the demands on women's time increase, communities are suffering.

It’s a shame that Phyllis Schlafly had a corner on skepticism about women’s liberation. “Why should we trade in our special privileges and honored status for the alleged advantage of working in an office or assembly line?” the conservative crusader, perhaps best known for her successful campaign against the Equal Rights Amendment, asked in 1972. “Most women would rather cuddle a baby than a typewriter or a factory machine.”

Schlafly masterfully sold the narrative that women’s rights, including those which would enable their greater participation in the workforce, would hurt women. In the process, she polarized the debate, making conservatives loath to recognize women’s gains, and liberals equally reluctant to acknowledge that progress might entail trade-offs. As more women have joined the workforce and become leaders in traditionally male spheres, gender roles have shifted, and women have lost their exclusive hold over traditionally female spheres. One of these is the home, as Schlafly argued. But women’s dominion over another part of public life has also declined: civil society.

The People Behind The Apprentice Owe America the Truth About Donald Trump

The reality-television show gave millions a misleading impression of the billionaire. NBC has a special obligation to make that clear to voters.

Why do tens of millions of Americans believe that Donald Trump, who has no experience in domestic or foreign policy, is qualified to lead the United States government?

One major reason is The Apprentice .

The popular reality-television show portrayed its host in a favorable but contrived light. He would sit at a big, wooden conference table, reviewing business tasks that two teams competed to carry out. The winning team would often get his circumspect praise. With the losing team, Trump usually seemed able to pinpoint a clear performance failure and to accurately identify the person most responsible for it.

Aren’t those precisely the attributes a good president would possess?

The problem, of course, is that “reality television” shows are elaborately constructed lies. Many “real housewives” are not actually housewives. Trump’s boardroom scenes were no more “reality” than his time in the ring with Vince McMahon:

Millennial Voters May Cost Hillary Clinton the Election

The Democratic nominee hasn't matched the support Barack Obama garnered during his presidential campaigns. Can she turn that around before November?

When Hillary Clinton delivers a speech aimed at Millennials in Philadelphia on Monday, she will be confronting perhaps the most persistent weakness in her career as a national candidate.

Clinton struggled among Millennial voters in her 2008 primary campaign, her 2016 primary campaign, and in the 2016 general election. Against Donald Trump, Clinton has two big advantages—a policy agenda that polls show largely matches Millennials’ own preferences, and an opponent even more unpopular with them than with the public overall. But she also must overcome her own long history of failing to connect with this growing group of voters—a failure that is increasingly worrying Democrats as the overall race tightens.

When Donald Meets Hillary

Who will win the debates? Trump’s approach was an important part of his strength in the primaries. But will it work when he faces Clinton onstage?

The most famous story about modern presidential campaigning now has a quaint old-world tone. It’s about the showdown between Richard Nixon and John F. Kennedy in the first debate of their 1960 campaign, which was also the very first nationally televised general-election debate in the United States.

The story is that Kennedy looked great, which is true, and Nixon looked terrible, which is also true—and that this visual difference had an unexpected electoral effect. As Theodore H. White described it in his hugely influential book The Making of the President 1960 . which has set the model for campaign coverage ever since, “sample surveys” after the debate found that people who had only heard Kennedy and Nixon talking, over the radio, thought that the debate had been a tie. But those who saw the two men on television were much more likely to think that Kennedy—handsome, tanned, non-sweaty, poised—had won.

‘Women Atheists Are Genuinely Considered Monsters’

Americans have long been suspicious of nonbelievers. Misogyny, nativism, and racism have often been tied up in their fear.

In general, Americans do not like atheists. In studies, they say they feel coldly toward nonbelievers; it’s estimated that more than half of the population say they’d be less likely to vote for a presidential candidate who didn’t believe in God.

This kind of deep-seated suspicion is a long-standing tradition in the U. S. In his new book. Village Atheists . the Washington University in St. Louis professor Leigh Eric Schmidt writes about the country’s early “infidels”—one of many fraught terms nonbelievers have used to describe themselves in history—and the conflicts they went through. While the history of atheists is often told as a grand tale of battling ideas, Schmidt set out to tell stories of “mundane materiality,” chronicling the lived experiences of atheists and freethinkers in 19th - and 20th-century America.

Pit Bulls Are Chiller Than Chihuahuas

New evidence suggests that in many situations, America’s most feared dog is as docile as other breeds.

The Irish Examiner called Rottweilers “time bombs on legs.” The Supreme Court of Kansas called pit bulls “a public-health hazard.” Dostoyevski called the bloodhound “a terrible beast.” But new data suggests that stereotypes of breeds and aggression might warrant a closer look.

My website, Dognition. gathers data on dog behavior by leading paid subscribers through games designed to test their pets’ cognition. Recently, a random sample of people who played the games was asked how aggressive their dogs were in various situations—toward people who were new or familiar, children who were new or familiar, and dogs who were either new, familiar, bigger, or smaller. More than 4,000 dog owners responded.

Why New Yorkers Received a Push Alert About a Manhunt

The city has never before used the emergency system the way it did Monday morning.

Updated on September 19 at 3:15 p. m.

Just before 8 in the morning on Monday, cellphones chimed in unison across New York City. It wasn’t the sound of text messages: It was a dissonant siren, repeated six times, accompanied by a short note. “WANTED: Ahmad Khan Rahami, 28-yr-old male. See media for pic. Call 9-1-1 if seen.”

New Yorkers have received emergency alerts before. In extreme weather, like Jonas earlier this year. the jarring tones have instructed people to move indoors and stay there. AMBER alerts, which use the same system, occasionally ask people to look out for abducted children in their area.

But the city never has sent an alert like this. Typically used only to keep people safe, the Monday alert asked New Yorkers to join the police’s search for a wanted man.

The Origin of Dogs

How and when wild wolves transformed into domestic pets has always been mysterious—until now.

What Happens Inside a Dying Mind?

Science cannot fully explain near-death experiences. What makes people believe they visited heaven?

The Pimps and Prostitutes of 1970s Times Square

A bartender's camera captures the seedy street life of retro New York.

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Betapred, Betapred

Metformin is used for treating type 2 diabetes. It is used along with diet and exercise. It may be used alone or with other anti-diabetic medicines.

Use Metformin as directed by your doctor.

Take Metformin by mouth with food. Take Metformin on a regular schedule to get the most benefit from it. Taking Metformin at the same time each day will help you remember to take it. Continue taking Metformin even if you feel good. Do not miss any doses. Ask your health care provider any questions you may have about its usage.

Drug Class and Mechanism

Metformin is a biguanide antidiabetic. It works by decreasing the amount of sugar that the liver produces and the intestines absorb. It also helps to make your body more sensitive to the insulin that you naturally produce.

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

Store Metformin between 68 and 77 degrees F (20 and 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 Metformin out of the reach of children and away from pets.

Do not use Metformin if:

you are allergic to any ingredient in Metformin; you have congestive heart failure that is treated by medicine; you have a severe infection, low blood oxygen levels, kidney or liver problems, high blood ketone or acid levels (e. g. diabetic ketoacidosis), or severe dehydration; you have had a stroke or a recent heart attack, or you are in shock; you are 80 years old or older and have not had a kidney function test; you will be having surgery or certain lab procedures. Contact your doctor or health care provider right away if any of these apply to you.

Important : Dizziness may occur while you are taking Metformin. This effect may be worse if you take it with alcohol or certain medicines. Use Metformin with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Follow the diet and exercise program given to you by your health care provider. Do not drink large amounts of alcohol while you use Metformin. Talk to your doctor or health care provider before you drink alcohol while you use Metformin. Tell your doctor or dentist that you take Metformin before you receive any medical or dental care, emergency care, or surgery. Be careful not to become dehydrated, especially during hot weather or while you are being active. Dehydration may increase the risk of Metformin 's side effects. Carry an ID card at all times that says you have diabetes. Check your blood sugar levels as directed by your doctor. If they are often higher or lower than they should be and you take Metformin exactly as prescribed, tell your doctor. This medicine does not usually lower your blood sugar levels. Low blood sugar may be more likely to occur if you skip a meal, exercise heavily, or drink alcohol. It may also be more likely if you take Metformin along with certain medicines for diabetes (e. g. sulfonylureas, insulin). It is a good idea to carry a reliable source of glucose (e. g. tablets or gel) to treat low blood sugar. If this is not available, you should eat or drink a quick source of sugar like table sugar, honey, candy, orange juice, or non-diet soda. This will raise your blood sugar level quickly. Tell your doctor right away if this happens. To prevent low blood sugar, eat meals at the same time each day and do not skip meals. Fever, infection, injury, or surgery may increase your risk for high or low blood sugar levels. If any of these occur, check your blood sugar closely and tell your doctor right away. Metformin may commonly cause stomach upset, indigestion, nausea, vomiting, or diarrhea at the beginning of treatment. If you develop unusual or unexpected stomach problems, or if you develop stomach problems later during treatment, contact your doctor at once. This may be a sign of lactic acidosis. Lab tests, including kidney function, fasting blood glucose, hemoglobin A1c, and blood counts, may be performed while you use Metformin. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Use Metformin with caution in the elderly; they may be more sensitive to its effects. Low blood sugar levels may also be more difficult to recognize in the elderly. Metformin should not be used in children younger than 10 years old; safety and effectiveness in these children have not been confirmed. Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Metformin while you are pregnant. It is not known if Metformin is found in breast milk. Do not breast-feed while taking Metformin.

Possible Side Effects

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

Diarrhea; gas; headache; indigestion; nausea; stomach upset; temporary metallic taste; vomiting. Seek medical attention right away if any of these severe side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain or discomfort; dizziness or lightheadedness; fast or difficult breathing; feeling of being unusually cold; fever, chills, or persistent sore throat; general feeling of being unwell; muscle pain or weakness; slow or irregular heartbeat; unusual drowsiness; unusual or persistent stomach pain or discomfort; unusual tiredness or weakness.

If you have any questions about Hydrochlorothiazide, please talk with your doctor, pharmacist, or other health care provider. Metformin is to be used only by the patient for whom it is prescribed. Do not share it with other people.



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Apraxin, Apraxin

Apraxin

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

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

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Eurasia Gas Summit In Abu Dhabi, Movlan

The Managing Partner of PwC Azerbaijan Movlan Pashayev will be discussing "Economical and Social Impact of Gas projects to Azerbaijan" on Eurasia Gas Summit in Abu Dhabi

In February 25-26, 2014 the Managing Partner of PwC Azerbaijan is to speak at “Eurasia Gas” Summit presented by Academy & Finance in partnership with Kazenergy Eurasian Forum in Abu Dhabi. The ultimate goal of this high profile business summit is discussion of future significant increase in exports of vast gas resources of Azerbaijan, Turkmenistan and Kazakhstan to Europe, China and India.

Summit will also cover new export capacities of Azerbaijan and Turkmenistan; future prespectives of the major gas projects currently operating in Azerbaijan including Shah Deniz and Galkynysh, as well as other significant topics related to Central Asia gas routes and strategic opportunities.

By supporting this strategically important global function, PwC Azerbaijan is embracing its knowledge and expertise to raise the awareness of global community on the envisaged economical and social impact of gas projects to our country.

The summit will feature a number of top level government authorities, leading oil and gas companies, public faces and other statesmen of different countries including the Minnister of Oil and Gas of Kazakhstan Republic - Uzakbay Karabalin, Chairman of KazTransOil - Kairgeldy Kabyldin, representative of SOCAR, Former US Ambassador to Azerbaijan - Matthew Bryza, Ambassador of the European Union – Roland, representative of Ministry of Oil of Iran - Hossein Esmaeili Shahmirzadi, Managing Director of Turkish Petroleum - Murat Karcy, representative of BOTAS Company - Ibrahim Said Arinch.

For information and registration, please contact Piero Ventura, Head Energy & Water Department, Secretary, Swiss National Committee, World Petroleum Council at:

tel: +41 22 849 01 11 cell: +41-79-537-3231 address: Academy & Finance SA, PO Box 6069, CH-1211 Geneva 6 Switzerland email: info@academyfinance. ch web: www. academyfinance. ch



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Stevencillin, Stevencillin

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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Nevotek

World-class Award-winning NEVOTEK V/IP Suite delivered to Arraya Project in Kuwait City

NEVOTEK delivers solutions which complement and extend the Cisco AVVID IP Communications network with business applications that improve customer care, lower costs, and increase workforce productivity. The Arraya Project in Kuwait City turned out to be an excellent implementation of the Cisco AVVID convergence architecture. The owners of the Arraya Building complex wished to install a state-of-the-art smart-building infrastructure which would enable them to introduce many free and fee based services which would attract tenants and differentiate them from other new up-market building complexes.

The Arraya Complex contains a shopping mall with multiple tenants, a commercial office complex and a 304 bed Marriott Courtyard Hotel. A redundant network infrastructure was constructed using Cisco components, and onto the network was added a Cisco IP telephony system in a dual redundant cluster configuration supporting a total of 900 IP phones. High speed Internet services are offered to all tenants and hotel guests using the same network, and on top of this, an Interactive TV service uses the same network infrastructure. This is a true example of integration of Voice, Video and Data services across a single network.

The solution would not have been possible without Nevotek products. V/IP Suite delivered to the Hotel guest easy-to-use Wake-up call, Guest Information, Billing, Voice messaging and a powerful e-mail facility through the use of a simple menu prompt on the IP phone. Adagio provided multi-tenant voice, fax and e-mail integration on to the IP phones for the many tenants of the shopping mall. Sigma-5 was able to take the call accounting records from Cisco Call Manager, calculate call pricing, and pass the pricing information through to either the Fidelio Hotel Management System for the hotel guests or through to the Oracle based Property Management System for the tenants. Although Cisco BBSM was used to account for the Internet usage, Sigma 5 was also used to pass the Internet billing across to the respective Property management systems.

New Age Telecommunication Solution for Hospitality Industry

Advanced IP Telephony Guest and Staff Services

This IT project was part of a building construction project and would not have happened without the vision and foresight of the owner to employ an IT Consultant. The IT Consultant created a separate IT infrastructure and Integration Package, something virtually unknown in the Middle East. The common practice in the construction industry is to place components such as building automation, telephony, AV, data cabling, computer room build all into different packages with no architecture for integration.

The total IT infrastructure and Integration project which included cabling, computer room build, networking, telephony, Internet services, TV services, Help Desk software, MS Exchange e-mail, network and systems management and 13 IBM servers was undertaken by Khorafi Business Machines (KBM), located in Kuwait, a member of the GBM group of companies who are sole IBM distributors in the Arabian Gulf. GBM is a Cisco Gold Partner and Nevotek SI Partner.

We extend out congratulations to KBM and GBM for performing a remarkable job in delivering such a complex project on-time, and almost without hitch from day 1. The mall went live in September 2003, and the hotel in December 2003.

It is a first in the Middle East, a first for the Courtyard by Marriott, and possible a first In the world! In such a short time, there is already an interest to exploit the intelligence and convenience of the IP phone. The tenants are asking for value-add IP phone applications such as advertising and simple fast food ordering, and the hotel is keen to explore how guests can interface to the Loyalty program on the IP phones. Nevotek is engaged in these initiatives.

The Nevotek Partner Programme was created to develop strong strategic relationships with our Channel Partners. The program provides the highest level of support as well as the tools you need to ensure total customer satisfaction with the Nevotek solutions you sell. It also provides the foundation to ensure a successful partnership that is tailored to work within your business model and add additional resources to help you maximize your success and profitability.

NEVOTEK was founded in 2001 as a dynamic high-tech company focusing on the development of i ndustry specific IP applications. As a Strategic Software Development Partner of Cisco Systems. Nevotek has offices in Istanbul, Turkey and Amsterdam, the Netherlands. For more information about Nevotek Services and products:

Buyukdere Cad. ITU Ayazaga Kampusu Teknokent Binasi 34469 Maslak Istanbul, Turkey

Tel. +90-212-286 75 76 Fax. +90-212-286 74 76

Burg. Amersfoordtlann 82, 1171 DR Badhoevedorp, The Netherlands

Tel. +31-64-831 77 16 Fax. +31-84-863 59 78



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Santa Rita High School Eagles Alumni - Tucson Arizona Az, Ritaalumin

Home Of The Eagles!

Snow is falling and Christmas is right around the corner! Many of us begin to reflect on what we have done this past year and start to list what we wish we had done. Don’t let reconnecting with your Santa Rita High School Eagles be on that list? Reconnect with our fellow Eagles right here on our alumni site!

If you attended your class reunion this year be sure to post your photos in your reunion photo album or share your favorite memories in the Alumni Stories section for the rest of our Santa Rita High School alumni!

Don’t forget to start planning your Santa Rita High School reunion today! Our free reunion planning tools make it easier than ever to plan and announce your event! With our tools you can post your reunion event(s), manage your own Santa Rita High School reunion website, schedule meetings and sell tickets online. We also offer the option to open a free class reunion store to sell reunion merchandise and raise funds for your event! Remember it is up to each class to plan their own reunion, anybody can start the process and we can help make it a success! Click the Plan Reunion link at the top of our Santa Rita High School Alumni Site to get started!

Our Santa Rita High School Alumni apparel makes the perfect gift for the holidays! Don’t forget to visit the school apparel section for all of your gift giving needs this holiday season.

Copyright © 2016 AlumniClass, Inc. All rights reserved. Santa Rita High School, Tucson, Arizona (AZ) AlumniClass. com (2811) - 10019 E Knox Ave, Spokane Valley WA, 99206.

AlumniClass. com is not affiliated with and is independent of any school, school district, alumni association or any other sites.



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