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Teva-Spironolactone - Uses, Side Effects, Interactions, Spirolon

Teva-Spironolactone

How does this medication work? What will it do for me?

Spironolactone belongs to the class of medications known as diuretics (water pills). It is used to treat edema (fluid retention) that occurs with congestive heart failure, cirrhosis of the liver, and nephrotic syndrome. It is also used to treat high blood pressure and to diagnose and treat primary hyperaldosteronism (a condition where too much aldosterone is produced by the adrenal glands).

Spironolactone can also be used to treat or prevent hypokalemia (too little potassium in the body) when other methods are not appropriate. Spironolactone works by making the body lose excess water and salt but reduces the loss of potassium from the body.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

25 mg Each cream-coloured, round, biconvex, compressed tablet, and with a peppermint aroma, engraved "N" on one side and "2|5" on the reverse, contains spironolactone 25 mg. Nonmedicinal ingredients: D&C Yellow No. 10 Lake, FD&C Yellow No. 6 Lake, lactose, magnesium stearate, natural peppermint flavour, sodium lauryl sulfate, and sodium starch glycolate. Gluten - and tartrazine-free.

100 mg Each cream-coloured, round, biconvex tablet, and with a peppermint aroma, engraved "N|N" on one side and "100" on the reverse, contains spironolactone 100 mg. Nonmedicinal ingredients: D&C Yellow No. 10 Lake, FD&C Yellow No. 6 Lake, lactose, magnesium stearate, natural peppermint flavour, sodium lauryl sulfate, and sodium starch glycolate. Tartrazine-free.

How should I use this medication?

The recommended dose of spironolactone for adults ranges from 25 mg to 400 mg daily depending on the condition being treated. It may be taken in single or divided doses.

For children with edema (fluid retention) associated with congestive heart failure, cirrhosis of the liver, or nephrotic syndrome, the daily dose is based on body weight and is given in single or divided doses.

Since this medication increases urine output, it is better to take it early in the day (with breakfast if you are taking a once-daily dose, or with breakfast and lunch if you are taking divided doses). Spironolactone may be taken with or without food. If stomach upset occurs, take the medication with food.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from heat and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e. g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

are allergic to spironolactone or any ingredients of the medication

are unable to produce urine

have Addison's disease

have high blood levels of potassium

have rapidly worsening kidney function

have significantly reduced kidney function

are using eplerenone, heparin, or a low molecular weight heparin

are pregnant

are breast-feeding

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

abdominal pain

diarrhea

dizziness or lightheadedness, especially when rising from a lying or sitting position

drowsiness

dry mouth

fatigue

fever

frequent urination

headache

nausea

thirst

vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

confusion

enlarged or painful breasts

fast, slow, or irregular heartbeat

fever

increased infections

irregular menstrual period

muscle weakness or cramps

rapid weight loss

signs of anemia (low red blood cells; e. g. dizziness, pale skin, unusual tiredness or weakness, shortness of breath)

signs of bleeding (e. g. unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)

signs and symptoms of imbalance of water, sodium or potassium in the body (e. g. muscle pain or cramps, weakness, irregular heart beat)

signs of kidney problems (e. g. increased urination at night, decreased urine production, blood in the urine, swelling, fatigue, abdominal pain)

signs of liver problems (e. g. nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)

signs of pancreatitis (e. g. abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)

skin rash

symptoms of high blood sugar (e. g. frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)

Stop taking the medication and seek immediate medical attention if any of the following occur:

chest pain

signs of a severe allergic reaction such as difficulty breathing; hives; or swelling of the face, tongue, or throat

signs of a severe skin reaction (e. g. blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort)

signs of stomach bleeding such as vomiting of blood, stomach pain, black and tarry stools

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Breast enlargement in men: Men may develop breast enlargement with the use of spironolactone. If this occurs, tell your doctor. In the great majority of cases, breast enlargement disappears once the medication is stopped.

Drowsiness and dizziness: Spironolactone may cause drowsiness or dizziness, affecting your ability to drive or operate machinery.

Avoid these and other hazardous tasks until you have determined how this medication affects you. This medication may also cause dizziness or lightheadedness when moving from a lying or sitting to an upright position.

Alcohol can add to the drowsiness caused by this medication.

Potassium: This medication may cause high potassium levels if potassium intake is too high. Do not take potassium supplements, follow a diet rich in potassium, or use salt substitutes containing potassium while taking spironolactone. People with reduced kidney function, seniors, and people with diabetes are more at risk of developing high potassium levels.

Fluid and electrolyte balance: Spironolactone may cause the levels of electrolytes such as potassium, sodium, and chloride in the blood to change while taking this medication. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible. Your doctor will do blood tests regularly to monitor the levels of these electrolytes in your blood while you are taking this medication.

Liver function: Small changes to electrolytes and fluid in the body can cause large changes to liver function. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Pregnancy: Spironolactone crosses the placenta and may affect the developing baby if taken by a woman when she is pregnant. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication talk to your doctor about the potential benefits and risks of taking this medication during pregnancy.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking spironolactone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

What other drugs could interact with this medication?

There may be an interaction between spironolactone and any of the following:

abiraterone

aldesleukin

alcohol

alpha/ beta agonists (e. g. epinephrine, norepinephrine)

alpha agonists (e. g. clonidine, methyldopa)

alpha blockers (e. g. alfuzosin, doxazosin, tamsulosin)

amifostine

amphetamines (e. g. dextroamphetamine, lisdexamphetamine)

angiotensin II antagonists (e. g. candesartan, valsartan)

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barbiturates (e. g. phenobarbital, butalbital)

beta-adrenergic blockers (e. g. atenolol, propranolol, sotalol)

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canagliflozin

cholestyramine

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corticosteroids (e. g. prednisone, dexamethasone)

cyclosporine

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digoxin

other diuretics (water pills; e. g. amiloride, furosemide, hydrochlorothiazide)

dropspirenone

duloxetine

eplerenone

guanfacine

heparin

levodopa

lithium

low molecular weight heparins (e. g. dalteparin, enoxaparin, tinzaparin)

methylphenidate

minoxidil

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nitrates (e. g. nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)

nitrofurantoin

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potassium-containing medications, supplements, or salt-substitutes (e. g. potassium chloride, potassium citrate, potassium gluconate, potassium iodide, potassium phosphate)

quetiapine

quinidine

salicylates (e. g. ASA, salsalate)

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rituximab

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If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,

change one of the medications to another,

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leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.



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NOOTROPIL® 800mg TABLETS / PIRACETAM 800mg TABLETS (piracetam) This product is available using any of the above names but will be referred to as Nootropil Tablets throughout the remainder of this leaflet. Read all of this leaflet carefully before you start taking this medicine. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor or pharmacist. • This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. In this leaflet: 1. What Nootropil Tablets are for 2. Before you take Nootropil Tablets 3. How to take Nootropil Tablets 4. Possible side effects 5. How to store Nootropil Tablets 6. Further information. 1. WHAT NOOTROPIL TABLETS ARE FOR Nootropil Tablets belongs to a group of medicines known as GABA analogues. Nootropil Tablets contains the active ingredient Piracetam. It acts on the brain and nervous system and is thought to protect it against a shortness of oxygen. Nootropil Tablets are used in combination with other medicines to treat myoclonus. This is a condition in which the nervous system causes muscles, particularly in the arms and legs, to start to jerk or twitch uncontrollably. 2. BEFORE YOU TAKE NOOTROPIL TABLETS Do not take Nootropil Tablets if: • You are allergic to the active ingredient piracetam • You are allergic to any of the other ingredients of Nootropil (these are listed in Section 6) • You have ever had serious kidney problems • You suffer from Huntington‘s Disease (also known as Huntington‘s Chorea) • You have ever experienced a brain haemorrhage If any of the above applies to you, do not take Nootropil Tablets and talk to your doctor or pharmacist. Check with your doctor before taking Nootropil Tablets if: • You think your kidneys may not be working perfectly. (Your doctor may need to start you on a lower dose.) • You have ever had any kind of bleeding problem. Tell your doctor if you are taking any of the following medicines: • Thyroid extract or thyroxine • Anticoagulants such as warfarin or aceno-coumarol • Low dose aspirin • Any other medicines, including medicines obtained without a prescription. Pregnancy and breast-feeding If you are pregnant, trying to become pregnant or breast-feeding ask your doctor or pharmacist for advice before taking Nootropil Tablets. If you are taking this medicine, use contraception to avoid becoming pregnant. If you are taking Nootropil Tablets and you think you may be pregnant, consult your doctor immediately. Driving and using machines Nootropil Tablets may cause drowsiness and shakiness. If this happens to you, do not drive or use machinery. Warning about some of the ingredients in Nootropil Tablets This medicine contains 46 mg sodium per dose. To be taken into consideration by patients on a controlled sodium diet. This medicine contains the colouring agent sunset yellow (E110) which may cause allergic reactions. 3. HOW TO TAKE NOOTROPIL TABLETS Always take Nootropil Tablets exactly as your doctor has told you. Important: Your doctor will choose the dose that is right for you. Your dose will be shown clearly on the label that your pharmacist puts on your medicine. If it does not, or you are not sure, ask your doctor or pharmacist. Adults How much medicine to take and when to take it • The normal starting dose is 7.2 g each day (nine tablets). • It is best to split the dose so that the tablets are taken on two or three separate occasions during the day (3 tablets in the morning, 3 at midday and 3 in the evening). • When you start taking this medicine your doctor may tell you to gradually increase the dose to ensure that you receive the best dose to treat your condition. • Follow your doctor’s instructions carefully. How to take your medicine • Swallow the tablets whole with a glass of water. • Do not break or chew the tablets as piracetam has a very bitter taste. • If you find it difficult to swallow the tablets tell your doctor as soon as possible as they can prescribe piracetam in the form of a solution. Elderly and patients with kidney problems If you are elderly or have kidney problems your doctor may reduce your dose. If you take more Nootropil Tablets than you should If you accidentally take too much, immediately go to the nearest hospital casualty department or your doctor.

If you forget to take Nootropil Tablets Do not take a double dose to make up for a missed dose. Simply take the next dose as planned. Stopping Nootropil Tablets Do not stop taking Nootropil Tablets without first talking to your doctor. Abruptly stopping your medicine may cause twitching and jerking. If you have any further questions about the use of this medicine, ask your doctor or pharmacist. 4. POSSIBLE SIDE EFFECTS Like all medicines Nootropil Tablets can cause side effects, although not everybody gets them. You may notice the following side effects: • An allergic reaction and experience difficulty breathing, swelling, fever • Spontaneous bleeding caused by defects in your blood clotting mechanism • Worse fits • Hallucinations • Difficulty balancing and unsteadiness when standing • Anxiety and agitation • Confusion • Restlessness • Nervousness • Sleepiness • Depression • Weakness • Vertigo • Weight increase • Stomach pain • Diarrhoea • Feeling or being sick • Headache • Being unable to sleep • Swelling of the skin, particularly around the face • Skin rash and itching. Reporting of side effects If you get any side effects talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly on the Yellow Card Scheme website: www. mhra. gov. uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine. 5. HOW TO STORE NOOTROPIL TABLETS • Keep out of the sight and reach of children. • Do not use after the expiry date shown on the end panel of the carton. The expiry date refers to the last day of that month. • If the tablets becomes discoloured or shows any other signs of deterioration, you should seek the advice of your pharmacist. • Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment. 6. FURTHER INFORMATION What Nootropil Tablets contain Each pack of Nootropil Tablets contains 60 orange capsule shaped tablets marked N breakline N on one side and breakline on the reverse. The tablets have the letters N breakline N on one side and breakline on the reverse marked on them to allow them to be easily identified. Each tablet contains 800mg of piracetam as the active ingredient. Each tablet also contains macrogol 6000. macrogol 400, colloidal anhydrous silica, magnesium stearate, hypromellose, titanium dioxide (E171), sunset yellow (E110), talc. PL No: 15814/0572

Manufactured by J. Uriach y Cia, S. A. Avda. Cami Reial 51-57, 08184 Palau-Solita i Plegamans (Barcelona), Spain and is procured from within the EU and repackaged by the Product Licence holder: OPD Laboratories Ltd, Unit 6 Colonial Way, Watford, Herts WD24 4PR. Leaflet revision and issue date (Ref.) 30.04.2015. ® Nootropil is a registered Trade Mark of UCB, Belgium. To request a copy of this leaflet in Braille, large print or audio please call 01923 332 796.

Source: Medicines and Healthcare Products Regulatory Agency

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Darkness At Sunset And Vine, Dasav

After attending our production of Darkness at Sunset and Vine at UNT, Ginger Mayerson had the following comments on the adaptation and on her motivations for writing her novella:

I'd like to thank Kelly Taylor for bringing my very angry novella to life and commend her and her squad, because they're performance commandos, really, for breathing life into my work as if with a flamethrower. That said, I can only add that Nellie Gail is considerably grander when she's standing three feet in front of one than smoldering on the page. I thoroughly commend Messrs. Calvert, Wood, Thompson, Wilkerson, Badger, and Notebloom for the massive amounts of thoughts, charm and brute force energy they put into the production.

And a special salute to Andrea Baldwin, who fearlessly took on the role of the most genial sociopath in all of dystopian Los Angeles and powerfully portrayed the bleak wry weary minimalist humanity I wrote into Nellie Gail that could have been lost so easily in all the blood and horror of the story. Andrea portrayed Nellie as a woman who could stare down genocide with ruthless and fearless intelligence. As that man said, more or less, whoever fights monsters should take care they become a monster. Of course Nellie, via Andrea, stands that on its head by becoming less of a monster when she decides to start fighting them. A hearty thank you to all of you for blasting Darkness at Sunset and Vine off the page and into the wider world.

Andrew Calvert, Adam Wood, Chandler Thompson, Jay Wilkinson, as actors, and Kevin Badger, and Kris Noteboom in more technical roles, did an exceptional job supporting the story and keeping things moving. I know very little about co-operative directing, but I do know a good ensemble when I see it. The lads ran rings around the stage, being wherever they needed to be to support the story or add a dash of color, with Kevin Badger neatly demarcating the sections, giving the actors a moment to catch their breath and then be off like rockets again. If they were in a jazz ensemble, they'd be a saxophone choir: soloing here and there, but usually supporting the harmonic structure and each other in the middle ground. An example of that in the performance was that every time Nellie goes to her place, there's a new permutation of weirdoes waiting for her and Drew, Adam, Chandler, and Jay completely made each weirdo weirdly distinct and then some. The ensembles and solos came together, dispersed, reformed, and the cycle was repeated again and again with discreet tones, textures and rhythms that were rich in variety and saturated with powerful semiotics. I never felt that I was looking at the same guy twice, or gal, as in Sara Lee's case.

Sara Lee's character was devised in haste and partly for a throw away joke, but she really came alive with Adam Wood's homicidal budding linguist camp performance. He only has her up for less than a minute, and yet she was as fully formed as if she'd sprung like Athena. But earlier in the show, Adam plays the second villain, Mr. Glen, with a drawl and a snarl which ought to be a word like, dranarl or snrawl or something, and he gets more syllables than I ever thought possible out of words like bullshit, which is bu-ul-shi-eet by the time he finally gets through with it. Impressive, most impressive. As I recall, he gives an amazing performance sitting down, merely twisting his body up at Nellie while twisting his words and human decency as well. When he does spring up, it's to shoot S. Crow in a way that looks like two teenagers humping in the backseat of a car. Really; it's on video and everything. I don't know what that blocking started out as, but that's what it looked like by the last show. Too bad there couldn't have been a few more performances, like a dozen, to see how far those moves could have gone. But, oh well, what might have been, saddest words, etc.

The character of S. Crow flies by in the novella, but he gets a star turn and an over-the-top death in this production. Andrew Calvert is, from the first moment he speaks to Nellie, the jittery emaciated heavily armed scarecrow of a man I wrote. I only saw two nights, but, as I mention above, when Glen kills him, it becomes more and more lewd with the two of them bumping around on the floor. It's one of the funnier deaths in the whole show, if you can wrap your mind around that.

Andrew also rocks the house as Dr. Max, the exiled economist freedom fighter who lays it on the line with Nellie about Fydor Chandler and the good of the many vs. the good of the one and how that might be the same thing in this instance. Andrew plays Max as the only person in the story who really realizes how dangerous and amoral Nellie is, and yet he is also the only person who finds some finer feelings in Nellie to appeal to. He takes a tremendous risk in asking her to do the right thing in all the insanity that surrounds them both. In the novella, Max's cohort stays passively in the background. In the production they are nervously circling the unarmed Nellie and being reminded by Max that they're all on the same side. Andrew plays Max as a man with a larger purpose than just his survival, one of the few characters with any vision, but as a man who is going to survive to see his vision realized. He explains to Nellie the danger she's in and then mocks her gently, goading her into the right frame of mind without preaching, something she'd kill him with her bare hands and acid irony for. Andrew put Max's shrewd wisdom across the footlights with a combination of the power in his voice and a certain air of nervousness that worked better than the confident sneer he'd had on paper. Andrew played Max as a guy who can't fail, because if he does, nothing much will matter anymore. He has to make sure Nellie knows that, and Andrew really got that message across to all of us.

Jay Wilkinson aced putting some fire and dimension in Rush, just call me Rush, one of the colder, flatter villains in the story. A man so sure of his lofty status he can't be bothered to give anyone his real name. As a villain, Rush must project entitlement, condescension, rage and arrogance at the same time. Jay managed to do all those things while almost dancing to the rhythm of his delivery. Rush is a desperate man under the expensive tailoring, as if his WASP male privilege was eating him from the inside out while he is trying to hold onto the last vestiges of it. Much of what Jay had to do as Rush, and did very well, was project menace and cruelty with his voice and posture without wrinkling the suit one could almost see he was wearing. It was eerie how much ghostly sartorial semiology was going on in that performance. Some actors let their costumes do their acting. Somehow Jay got the audience to imagine his costume, which was a very sharp ensemble, but didn't let it get in the way of his acting. Weird, deeply weird it was, but effective if I'm still thinking about it.

Chandler Thompson gets a double-wide gold star for playing two Mayersonian villains. He played Sara Lee's father, Mr. James, with exactly the right mix of sick fatherly concern and menace. With Mr. James, Chandler set the tone for what's left of the debased US government and the sleazy characters yet to come. His second villain was Kevin, whom he played as a demented drooling monster. I thought his portrayal was effective and humorous, but not what I had thought it would be. The Kevin in my head is an icy, soulless bureaucrat, the kind of guy who signs a requisition for mass murder, terror, and pillage as easily as he orders lunch. Actually all my villains are, on paper, a little colder and deader than they were in this production, but what goes on in my head wouldn't make good theater even on a good day. I laughed very much at the interaction between Kevin and Rush, who is justifiably terrified of him. Chandler also portrayed the Tiny Gun Man who works for Dr. Max. TGM's job is to keep his tiny gun on Nellie, who menaces him and smacks his gun away repeatedly. Chandler's wordless performance is brilliant as a man with one job, however silly, that he's going to do well or die in the effort.

There are too many good moments to pick out of this production and obsess on. I've hit the ones that have stayed with me nearly two months later, which says a lot about their impact and staying power. Everyone in this cast did an outstanding job of soloing and supporting and they did it with more grace and brio than I could have imagined possible in the blood-soaked nihilist wasteland of Darkness at Sunset and Vine .

I can't really express how moved I was seeing my writing come to life before my very eyes and ears. Moved, touched, pleased, frightened, startled, delighted, and occasionally a little freaked out only touches on part of what I felt in Denton last April. I think I should mentions the one thing that freaked me out the most and has stayed with me in many ways was the suicide bomber scene. It was a perfect fit into the visual narrative of this production, absolutely letter-perfect. But I didn't write it and I didn't realize how much I'd subconsciously shied away from that particular idea until I saw it. In fact, my mind refused to see it until the second performance when what I thought I saw in the first and didn't ask about afterwards was, well, really what I saw. An American Suicide Bomber in pantomime, which didn't make it any less disturbing for me. I'm here to tell ya, it was a very powerful theatrical device, maybe too powerful. Our own people resorting to suicide bombing as the ultimate protest against an unjust government would be the end for the United States as we know, even the fucked up version we have now, it would really be over. Even I have some hope the will to revive the Constitution, that piece of paper of ideas so many have died for, even I have some faith that our country can pull itself together again and become a place where life gets better, or at least not worse, every generation. Even though I believe the best future is for the United States to break up regionally and ideologically, I deeply hope this can happen without the horror of homegrown suicide bombers in the streets. And, frankly, I hope I'm dead before my county reaches the level of despair, desperation and hopelessness that sends young men and women into the streets to kill as many people as possible and themselves with a bomb strapped to their body. The United States as we know it and hope for it to be again, will truly be finished when suicide bombing becomes the only means, however futile and tragic, of striking back at the power structure. When terror, terror by the State or by citizenry, replaces all mechanisms of dissent, dialogue and change, (I'm sure democracy will be long gone by then) there will be no place for people like me in the United States. There will be nothing that resembles what the United States once was or could be or even dreamed it could be. And I suspect that historians will date the beginning of the dream's end in the last month of the last year of the last century.

My life changed rather unpleasantly on December 12, 2000. I had, up until that moment, really thought that what was good about our political process was unshakable, or at least had some merit. Perhaps only my faith in it was unshakable. When the Supreme Court stopped the Florida recount in a vote strictly on partisan lines, is was disgusted that they'd not only disenfranchised Florida voters, they'd disenfranchised the entire country. Whey they tell you "your vote matters" they're not talking about the 526 votes Gore didn't get due to the butterfly ballot, Nader, voter intimidation, sunspots, gremlins, Katherine Harris, whatever. What they mean is your vote matters. if you're a Supreme Court Justice. Yes, I was bitter, I was outraged, I argued with anyone who'd take me on, I was reading the papers, the blogs, and Vincent Bugliosi's most excellent book None Dare Call It Treason. where the future of Bushco lawlessness is subtly predicted in the explanation of the majority Court's psychotic reactionary disregard for the Democratic process by stopping the recount. (Dear God, we just wanted all the votes counted properly so we could know, really know, but no, 5-4 gets to decide, and now look at us.) But I still thought our government had enough checks and balances, or enough goodness left in it to honor those checks and balances, to plod along with four years of the bush junta. Of course all that changed on September 11, 2001 when, with the notable exception of Congresswoman Barbara Lee of Oakland, California, our Congress handed 200+ years of more or less democracy into the keeping of the spoiled scion of an amoral family headed by a guy who was born on 3rd base but thought he'd hit a triple, as a witty Texan once said. Alas, I was not laughing: I had never been afraid of my government. until then.

I am not a conspiracy theorist, I really cannot stand those people. But in the shock of events on September 11, 2001, two things went through my mind: 1) something designed to get our minds off what a fuck-up Bush II was/is, something to scare us a little, shake us up a bit got away from the Bush family and its mafia and scared us a lot; and 2) Jesus, we got the fucking worst possible government in DC at this moment for this to have happened. And when we had the sympathy and support of most of the world, when a meaningful and concerted effort to rid the world of terrorism could have been put into action, GW Bush told the world to fuck off: he was doing it his way and his way involved bombs, bombs, bombs, more bombs, and getting the Bin Laden family out of the US on special planes when everything else was grounded. And if anything in this whole perverted mess makes me weep, it's the lost opportunity that evil idiot threw away.

By 2003, I was blogging as fast as I could if only to verify what I knew was true and right before it disappeared down the memory hole. Blogging might be a joke now, but in 2003 in was a way to stay sane in all the war madness. I know I was against and I know why and it's all on my blog. Being an amateur historian has its ups and downs, but only a complete idiot could possibly think invading Iraq was a good idea. And only sick, demented monsters like GW Bush, Cheney, and Rumsfeld could call murdering civilians Shock and Awe. Yes, murdering civilians, blowing the limbs off young boys, wiping out entire families, and all from the safety of their offices where they made the worst decision in the history of the United States. My country, my people, my history will never get the blood off its hands in my lifetime, if ever.

I wish I had been being overly dramatic. I had no idea just how bad it was going to get.

On September 7, 2003 President Bush lied to us again:

"Our strategy in Iraq will require new resources. We have conducted a thorough assessment of our military and reconstruction needs in Iraq, and also in Afghanistan. I will soon submit to Congress a request for $87 billion. The request will cover ongoing military and intelligence operations in Iraq, Afghanistan and elsewhere, which we expect will cost $66 billion over the next year. This budget request will also support our commitment to helping the Iraqi and Afghan people rebuild their own nations, after decades of oppression and mismanagement. We will provide funds to help them improve security. And we will help them to restore basic services, such as electricity and water, and to build new schools, roads, and medical clinics. This effort is essential to the stability of those nations, and therefore, to our own security. Now and in the future, we will support our troops and we will keep our word to the more than 50 million people of Afghanistan and Iraq."

That night in 2003, as I read to this speech on my computer, I could not know that over 100K Iraqis would die, that Abu Ghraib would question my faith in our military and humanity, that billions would go missing somewhere between Halliburton and, well, Halliburton. I could not know over four thousand American soldiers would die in the service of a government that was unworthy of their sacrifice, I could not know the America I was raised to love would promote torture, despotism, fear, greed, slavery, rape, murder, and more murder for the goals of one small group of men who'd come to power, legally or not, but who'd taken the tragic opportunity of September 11 to sweep away any moral or legal obstacles to their plans to rule through fear, because they cannot govern through consent. And so they did. And so they continue to do so. Monstrous men - Cheney, Bush and Rumsfeld - and their minions not much less monstrous than themselves.

But that night in September 2003 I could not know any of this, I could only go cold with rage and fury that the moral and fiscal consequences of Bush's murderous Iraq invasion were going to sow horror in my country for generations and that it was so fucking unnecessary. I was too angry to cry, to furious to move, and the only thing I could do was open a word processing window and pound out the first five thousand words of Darkness at Sunset and Vine. DASAV is 20K words. I wrote it in five days and somehow managed to work my 9-5 job as well. This story poured out of me in a torrent of fury and sorrow in between bouts of pounding on my desk and howling with rage. I am not a patriot. I love my country because its mine. I hadn't realized how much I love it and writing a story might not seem like much of a fight for something one loves, but it was the only fight I had in me at that moment. Even a California girl will turn and fight with whatever is at hand when her back is against the surf. And this is how I felt in September 2003. Five years later, I've calmed down a little, but I've only banked my fire with hope and sadness, it could flare up again with the right provocation (and, yes, I am looking at the White House as I write that, and will be looking at it, hard, until Jan 20, 2009 supposing there isn't another "terrorist" event and Bush doesn't declare himself President for Life).

At the time I was writing DASAV. my beloved California, for various insane and greedy reasons, was in the throes of recalling Governor Gray Davis, an unlucky and mediocre bureaucrat. Maybe I was just kidding myself, but at the time it seemed like the recall could go either way and DASAV was written as if Davis had won the recall, but the Bush family sent troops into California to install Schwarzenegger as governor. Would Californians fight this kind of invasion? For the purposes of fiction, I said yes, but looking around at the suckers like Darryl Issa and the clowns who elected Schwarzenegger, twice yet, I wonder. At one point in the second novella, The End of History at Sunset and Vine. Nellie's dinner date (yeah, I know, Nellie on a date, laugh riot, right?) opines that he didn't like what happened to his State. Nellie politely refrains from saying out loud that she thinks her State got what it deserved. It's too long and complicated to go into in this screed, but through overuse of the referendum mechanism, which means we vote more than Switzerland, a manipulative, if not malevolent business culture and media, and just being stupid and greedy, California has bankrupted its government, painted itself into a corner, tied its hands, and knocked over a candle to set the house on fire, which the under-funded emergency services aren't going to get to in time. But, hey, dude! Arnold Schwarzenegger is our governor, and the only thing that stands between our citizenry and complete moral, physical and financial collapse is the California Nurses Association and a couple of unions. But, hey, dude! Arnold Schwarzenegger is our governor, and - oh, just fucking, never mind.

The Enron scandal was also a factor in Governor Davis' downfall, that wasn't clear to most people until after he was ousted. Most people still think he was a big loser because he couldn't control energy prices and, in truth, he couldn't control them under the deregulated system most of California adopted in the mid 90s, led by Republican governor Pete Wilson, who governed under some kind of powerful curse so that California experienced nothing but catastrophe after disaster, including, but not limited to, earthquakes, weeks of wildfires, urban rioting, and energy deregulation, during his terms in Sacramento. Although Dr. Taylor's production did not feature my concept of power, who had it and why, in post-Occupation Los Angeles, I wrote quite a bit on how LA and parts of the State I liked might survive through the good management of a few farsighted individuals and the brute force and street smarts of the rest of the citizens determined to stay in town. The fate of Los Angeles and California were very much on my mind in the aftermath of the Enron free-market assault on my foolish State. During the 90s energy deregulation madness in California, the head of the Los Angeles Department of Water and Power, Mr. David Freeman, refused to deregulate our utilities. It was not mandatory and, being an intelligent man who could remember longer than last week and might have done some reading on the history of unrestrained capitalism, he could see deregulating a vital service was not just a bad idea, it was a really fucking stupid idea. So he refused to do it. Our DWP has flaws, but deregulation is not one of them. This is why the DWP is keeping the lights on and the water flowing and raking a percentage off the top of every dollar circulating on the net in the City of Angels in 2016. How would they do it? They'd hire thugs like Nellie to protect their aqueducts and power stations, as well as dig up alternative energy sources that were getting dusty through disuse. The original El Pueblo de Nuestra Se?ora la Reina de Los Angeles de Porci?ncula founded in 1781 had (and likely still has) enough water to support about 14,000 souls. The Los Angeles Nellie lives in is about that number or less, and I surmised that the DWP could find a way to support that many paying customers with electricity and water. In the later novellas, I expound on the Metropolitan Transit Authority's role in policing their bus routes and how AT&T keeps the internet working, but nearly destroys everything in a further grab for power.

DASAV is set in Los Angeles after the Federal Occupation which resulted in Der Terminator, sorry, Der Schwarzenegger, being installed as Gov for Life. I was discussing this with a friend in Michigan, who said LA would be impossible to occupy. This is likely true, but, courtesy of Bush 1, we have had US Marines patrolling the streets of South Central LA after the 1992 Rodney King Rebellion, so troops on the street isn't just a possibility in America, it has been a reality in Los Angeles. You see, here in Hollywood, we don't just live our dreams, we live our nightmares, too.

Much of the novella DASAV concerns how things got so messed up. That the goals of the Bush family and their mafias was to create a passive slave society (through drugs, terror, and starvation, physical and spiritual) in which their looting could go unimpeded. Most of the American intelligencia has fled. Philanthropic George Soros and opportunistic Bill Gates have essentially purchased Mexico as a haven for anyone smart enough to get there in time. (Canada has sensibly closed and mined their border with the US, but do help out in the third novella.) It is in Mexico, as brilliantly administered by economists Paul Krugman and Jeffery Sacks, that economists, scientists, linguists, and other such brainy and advanced-degrees types have been formulating plans to retake their country. The technology sector that has fled with the brain trust has been manufacturing and exporting the sexy ti-tandex outfits Nellie wears for protection and the titanium Colt she packs for action. Within the United States, Nellie's former colleague, the brilliant linguist and vicious urban tactician (or vicious linguist and brilliant urban tactician, either way) Fydor Chandler, has been leading a guerilla resistance, but the strain is driving him mad. Nellie's idol, Dr. Max of Dr. Max's Live Nude Economics - the best show on the Internet Broadcast - currently exiled in Mexico, comes to Nellie to ask her to convince Fydor to lead his people to join forces with Max in Mexico. It is Nellie's history with Fydor that leads Max to believe she might be able to convince him with emotion where mere reason would fail. Among Fydor's followers is the fantastically idealistic and tragically young Sara Lee, who has shrewdly taken a member of the Bush family hostage in a serious blow against their authority. It's Sara Lee's action that triggers all the events that ultimately lead to Nellie ending up if not on the right side of history, at least on the right side of what's left of her conscience.

Okay, I get this question a lot: Why are all the freedom fighters linguists?

Oh, why not? Just because one never sees a linguist with a rocket launcher doesn't mean it couldn't happen. Why should rhetoricians have all the fun?

There are two more novellas in the trilogy: The End of History at Sunset and Vine. wherein Chelsea Clinton is coming to LA to lead the revolution. Yay? The Greens, the Christian Right, and Kevin, the evil functionary from part 1 are trying to destroy what's left of the US, starting with Nellie and Los Angeles. In part 3, A New American Century at Sunset and Vine. the bad guys this time are working directly for the Bush family and their mafias using Fundamentalist Christian Rightwing refugees as human shields to get the Bush family and their money out of the US before the whole mess implodes. Also in this final story, Nellie and Fydor learn some important things about LA infrastructure, spend some quality time in a underground library cum bunker, Chinatown, and Nellie meets the followers of the cult of Santa Gloria Molina, who are not quite what they seem to be. Also in the last story, Nellie and Fydor, in their own inimitable way, launch the second American Revolution with style, wit and a little more than the usual level of mayhem. All this fun fun fun is merely a mouseclicky away at http://dasav. com

However clever these novellas might sound now, five years later, at the time I was writing them it was painful. These novellas are my plea to my country, which seems hell bent on destroying everything that's ever been good about it, to stop, please stop, before it's too late. Why, America, why does it even seem possible that such things as happen in Darkness at Sunset and Vine could ever occur, but with a less happy ending? Why have you handed yourself to the monsters of the Bush family and their mafias? Why? Are we too numb, too stupid, to beaten down to fight for the only things that mean anything in this crazy mixed up world? To fight for our freedom, our future, and the ideals Americans have been willing to die for for over 200 years? Have we forgotten that it's better to die on our feet than live on our knees? Or did we never really know it? Or will we just not care? Until it really is too late.

Students in my and some of my colleagues' classes attended our production of Darkness at Sunset and Vine. Here is a sampling of the one page reviews they submitted:

I attended Dr. Kelly Taylor's performance of Darkness at Sunset and Vine. I think everyone did very well. Every character was very well thought out. I think the characters were brilliant, and the actors who portrayed them were genius. For example, all of the male characters were playing more than one role. Throughout the play they were constantly switching roles as the scenes changed. I can only imagine how hard that must have been, not only to try and capture the personality of one character, but to multiple characters. I also enjoyed the comedy behind all the madness going on. I really liked the chalkboard walking across; I felt that added more humor and understanding to the piece. All the actors and actress did amazing at staying in character even through distractions. For example, many people walked in late and the noisy door was creeping they still kept in character, and even when the back board nearly fell down and Andrea saved it, nobody even laughed. That was so well played by Andrea I would have never know that it wasn't supposed to happen. I also think the music added a little bit of pop culture to the mix. The different types of songs played fit each scene nicely. Even though the guns were fake sometimes I felt like it was real. The characters did a great job at acting dead, and using the handkerchief as fake blood.

Overall, I really enjoyed watching the performance. I can tell that there was a lot of time and heart put into that performance. I think every actor and actress should will an Oscar, and Dr. Kelly Taylor should receive best director. I can't wait to see the next Communication Studies performance!

Darkness at Sunset and Vine contained numerous elements of surprise, intrigue, and confusion which exploded onto the audience in the form of flailing body parts, splattering blood, and a Sin City - like trance. The males in the play possessed an almost acrobatic/circus-like ability to quickly morph into the required roles of any given scene, whether it be a disturbing zombie or quintessential thug. Andrea nailed the lead role as Nellie Gail in her bad-ass tone and apparel, most likely because she is already a CPS bad-ass. I found parallel qualities between the play and Garrison Keillor's Guy Noir: Private Eye. except Andrea composed both the villain, heroine, and detective making her the ultimate Femme Fatale as described in the program. Andrea's descriptive narrator style seemed to model Garrison Keillor's suave detective, although sparked with more flare. The location of Sunset and Vine seemed ironic to me, seeing as how this area is infamous for boisterous and bright nightclubs that rarely see darkness, even though the metaphoric tones of the play undoubtedly utilized the stark contrast to set the mood of the scene. Mayerson's use of actual places in LA weighed the current surface situation to a plausible future scenario that reeked of subverted issues that now plague our society. Mayerson evidently hates Bush and Republicans in general, seen in her choice to use Schwarzenegger and Jenna Bush's cloned baby, Millie, as the coveted child. The entire play seemed to exude irony; from Andrea's "Vegan" diet, to the explosion at the end that killed both Sara Lee and Millie who had encompassed the focal purpose of the play.

The collaborative cast equally utilized Performance Art in their choice of colors, music, and repetitive motions such as shooting someone to death. The cast demonstrated excellent cohesion in their portrayal of parody and other performance qualities. This cohesion was most pointedly observed in the final explosion where Nellie picked up a "motorcycle" (Adam) and, mimicking a Die Hard IV move, drove the motorcycle into the "helicopter" (the rest of the cast). I did not know whether to laugh or clap seeing as how the already confusing play only became more confounding. The blur of blood and crashing parts caught me by surprise seeing as how the entire cast had not yet been completely involved in an all out catastrophe comprising humans on other humans meant to be machines. The cast's use of space and props perfectly suited the fluid scene changes and overall feeling of entertaining horror and resembled a warming combination between the Goodfellas. Tom Raider. and Resident Evil .

I attended Darkness at Sunset and Vine on Thursday, the first showing. The show was hard for me to understand, but I know that the show was based on a book written by Ginger Mayerson. Our fellow classmates did a fabulous job sending the message across about their feelings towards the U. S. government. This show used many elements that helped create the reality of the story. I am going to talk about the use of characters, props, and space which made this a unique performance to watch. The use of characters in this performance demonstrated four men and one girl. They dressed as if they were ready to fight anytime. The girl, Andrea was the overall narrator and acted like the boss of everyone. She was extremely witty and tough, but at the same time she made the performance have humor. The guys played multiple roles which made the performance confusing to follow, but I could see what was going on based on their use of actions.

The props the characters used were very creative. I loved how the characters incorporated the guns and the red handkerchiefs to represent blood. I also thought that Kevin carrying across the sign to show how many people were dead gave a huge visual effect on the audience. The props overall helped me understand the message the characters were sending.

The characters had to work in an extremely small performance space and I think they did a great job using every inch of space. With all the shootings going on, the characters had to fly everywhere to act like they were dead. I am sure they practiced a lot so they knew where to land dead. Overall, I really enjoyed this performance and it was extremely creative.

I loved this post-apocalyptic bloodbath that featured a strong, steamy lead character portrayed by Andrea Baldwin. She was magnificent. The entire cast was great, but her performance in particular was fearless.

Darkness at Sunset and Vine gave the audience a glimpse of a grim, dirty world in the not so distant future. This production was certainly meant to be enjoyed and to entertain, but the strong rhetoric was also intended to provoke thought and warn the audience of a slope this country is sliding down at a rapid pace. They masterfully used references to current policy in the United States to illustrate the possible catastrophic results that seem only a baby step away if policy does not change dramatically. I am sure this production was a cold bucket of water thrown down on the sleeping audience forcing them to wake from their slumber of ignorance.

I had a great time watching this performance of heroes and villains where the line between the two is obscured by the need to survive. Our hero, Miss Baldwin, was also a mass murdering lone sociopath who claimed, I believe, sixty victims. She can victimize me any day.

I attended the first showing of Darkness at Sunset and Vine. It is based on the novel by Ginger Mayerson. The play was set in Los Angeles, after the fall of the U. S. government. Since the play itself was a little confusing to me, I am going to write about how it used the elements of space, characters and props to produce a very interesting performance.

The space the cast had to work with was very small, but they utilized every inch of it. During certain scenes, like when the main character was being chased by hitmen, or when she was chasing them, they would use almost the entire space. They would also use the space to change scenes. When the main character would be outside of her apartment, buying food, she would walk a few steps to another part of the "stage" and she was in her apartment.

The cast was made up of five members. Andrea always played the same character, but the four guys played multiple roles. This sometimes made it a little confusing to follow. One minute, they were lying dead on the floor, the next minute they would be up playing another character. They would change characters by changing the sounds of their voices.

There were few props used in the play, but they were very effective. The main props were the toy guns. They were used in almost every single scene. If they were not being used, they were always visible on Andrea. Another effective prop was the red rags. Every time someone was shot, they would throw out red rags, depicting blood.

Darkness at Sunset is a performance involving students from the University of North Texas. The director is Kelly Taylor along with the cast traveled to Arkansas to perform in front of a body of students from other schools. The sunset play was an instant hit. Each individual watching only reported positive things about the play. First, the play was unique bringing in minimal staging techniques. For example, the stage consisted of the cast, one chair and four or five toy guns. This helped to keep the focus on the characters. The lack of staging really helped the audience focus on the words as well, and each person was able to create his or her own seen of what is going on. This is great because some members of the audience felt the play was poking fun at the President and secret service men, while others felt this play was more of movie and this one person was in a world full of zombies.

A second feature positively seen in the play took place during the transitions of scenes. We knew a change was occurring because a person representing a sexy ring girl holding a cardboard sign walked across the stage. However, instead of having numbers on the sign, a special make up of words were written to keep the audience entertained. For each transition, funny sayings were thrown on to stage, For example, during one scene a number of different people were supposed to be killed or injured. A woman was the killer, so the sign said, "Killing them softly with her gun." Clearly the saying is from a popular nineties song.

While the language is mature and many elements display negative views geared toward democracy I find this performance to be very funny and for anyone who needs a good laugh.



Buy Online Darkness At Sunset And Vine, Dasav

Moxetin 20 Mg, Moxetin

MOXETIN 20 MG Tabletas recubiertas PAROXETINA

COMPOSICIÓN Cada Tableta recubierta contiene: Paroxetina clorhidrato hemihidratado Equivalente a paroxetina base 20 mg Excipientes c. s.p

ACCIÓN FARMACOLÓGICA: Paroxetina es un inhibidor potente y selectivo de la recaptación de la serotonina. Su acción antidepresiva, antiobsesional y antipanico se relaciona a la potenciación de la actividad serotonergica en el Sistema Nervioso Central (SNC). Paroxetina inhibe la membrana activa en el mecanismo de transporte para la recaptación de la serotonina, aumenta la concentración del neurotransmisor en la hendidura sináptica y prolonga su actividad en los sitios sinápticos del receptor. La inhibición de la recaptación de la serotonina realza la neurotrasmisión serotonergica reduciendo el volumen del neurotransmisor, vía un mecanismo negativo de la regeneración. Paroxetina inhibe a la serotonina in vitro más selectivamente y potentemente que la fluoxetina, sertralina, fluvoxamina, zimeldina o clomipramina. Paroxetina inhibe débilmente la recaptación de la norepinefrina y dopamina. Los estudios de la captación del receptor han demostrado que la paroxetina no obra directamente con los sitios centrales del receptor del neurotransmisor, incluyendo receptores alfa o beta adrenoreceptores, dopamina D2, serotonina (5-Hidroxitriptamina) 5-HT1 o 5-HT2, histamina H. Paroxetina tiene baja afinidad por los receptores colinérgicos-muscarínicos y no inhibe la monoaminooxidasa.

INDICACIONES Tratamiento de desorden depresivo . Paroxetina se indica para el tratamiento de desorden depresivo. El tratamiento de episodios depresivos agudos requiere típicamente de 6 a 12 meses de la terapia del antidepresivo. Los pacientes con la depresión recurrente o crónica pueden requerir el tratamiento a largo plazo. Paroxetina ha demostrado el mantenimiento eficaz de la respuesta del antidepresivo por hasta 52 semanas del tratamiento en un ensayo placebo-controlado. Tratamiento de desorden generalizado: Paroxetina se indica para el tratamiento del desorden generalizado de la ansiedad (DGA). Tratamiento de desorden obsesivo-compulsivo: Paroxetina se indica para el tratamiento de desorden obsesivo-compulsivo. Tratamiento de desorden de pánico: Paroxetina se indican para el tratamiento del desorden del pánico, con o sin agorafobia. Tratamiento de desorden disfórico premenstrual: Paroxetina se indica para el tratamiento de desorden disfórico premenstrual (DDPM). Tratamiento de desorden de tensión Postraumatica: Paroxetina se indica para el tratamiento del desorden de tensión postraumática (DTPS). Tratamiento de desorden de ansiedad: Paroxetina se indica para el tratamiento de desorden de la ansiedad o fobia social.

INTERACCIONES: Las siguientes interacciones de la droga y/o problemas relacionados se han seleccionado en base de su significancia clínica potencial. Nota: Paroxetina es un potente inhibidor del citocromo P450 2D6 (CYP2D6), pero inhibidor muy débil de CYP3A4. La precaución debe ser ejercitada cuando la paroxetina coadministrada con las medicaciones que son metabolizadas por CYP2D6, tal como antidepresivos tricíclicos, fenotiazinas (p. ej. tioridazina) o antiarrítmicos del IC de tipo (p. ej. encainida, flecainida o propafenona) o medicaciones que inhiben CYP2D6, tal como quinidina. Las reducciones de la dosificación de la paroxetina y/o de la otra medicación pueden ser necesarias. Las interacciones con las medicaciones metabolizadas por el isoenzima CYP3A4 son inprobables. Las combinaciones que contiene cualquiera de las medicaciones siguientes, dependiendo de la cantidad, pueden también obrar recíprocamente con esta medicación. • Alcohol: Aunque la paroxetina no se ha demostrado que altere el metabolismo del alcohol, uso concomitante no se recomiendan. • Antidepresivos tricíclicos (ATCs), la paroxetina puede inhibir el metabolismo de los ATCs. • Ácido acetilsalicílico o antiinflamatorios no esteroideos (AINEs) u otras drogas que afectan la coagulación: El uso concomitante produce el riesgo de sangría; debe ser utilizada con precaución. • Atomoxetina: El uso concomitante de la paroxetina y atomoxetina puede dar lugar a un incremento de la atomoxetina; se recomienda la reducción de la dosificación de la atomoxetina. • Cimetidina: En un estudio, las concentraciones de paroxetina en el plasma fueron aumentadas en 50% aproximadamente durante la administración concurrente del cimetidina, aunque la significación clínica de esta interacción no se ha establecido. CYP2D6 substratos, por ejemplo: • Flecainida, fluoxetina, fenotiazinas, propafenona, quinidina o risperidona: Usar con precaución; el uso concomitante del paroxetina y de otras drogas metabolizados por CYP2D6 puede requerir dosis más bajas de paroxetina o de otras drogas. • Risperidona: Usar con precaución; el uso concomitante de paroxetina y de otras drogas metabolizados por CYP2D6 puede requerir dosis más bajas de paroxetina o de otras drogas. • Digoxina: La administración concurrente debe ser usada con precaución, puesto que hay poca experiencia clínica con esta combinación. • Litio: Como hay experiencia limitada en pacientes, usar con precaución. • Metoprolol: El uso concomitante de paroxetina y del metoprolol puede dar lugar a la hipotensión severa. • Moclobemida: El uso concurrente no se recomienda. • Inhibidores monoaminaoxidasa (MAO), incluyendo furazolidona, procarbazina y selegilina: El uso concurrente de los inhibidores de MAO con paroxetina puede dar lugar potencialmente a fatales reacciones, que pueden incluir confusión, agitación, inquietud y síntomas gastrointestinales o posiblemente episodios hiperpiréticos, convulsiones severas, crisis hipertensas o el síndrome de la serotonina; el uso concurrente está contraindicado y por lo menos 14 días deben transcurrir entre la discontinuación de una medicación con la iniciación de la otra. • Fenobarbital o primidona: La primidona metaboliza parcialmente al fenobarbital, que induce muchas enzimas del citocromo P450; la administración de cualquiera de estos agentes concomitante con paroxetina puede reducir la disponibilidad sistémica de la paroxetina, no se recomienda ningún ajuste inicial de la dosis, cualquier ajuste subsecuente debe ser guiado por el efecto clínico. • Fenitoina: La administración concomitante con paroxetina puede disminuir la disponibilidad sistemica de cualquier agente; no se recomienda ningún ajuste inicial de la dosis, cualquier ajuste subsecuente debe ser guiado por el efeco clínico. El uso concomitante de la paroxetina y de la fenitoína puede dar lugar a concentraciones crecientes de fenitoína. • Pimozida: La administración concomitante con paroxetina puede aumentar la disponibilidad sistémica del pimozida. • Prociclidina: El uso concurrente puede aumentar la disponibilidad sistémica de la prociclidina; si ocurren los efectos anticolinérgicos, la dosificación de la prociclidina debe ser reducida. • Serotonérgicos u otras medicaciones con actividad serotonérgicos: Si se requiere administración concomitante con estos fármacos, se recomienda proceder con precaución. El uso concurrente del triptófano y la paroxetina no se recomienda. • Sumatriptan: La terapia concomitante de sumatriptan y paroxetina puede aumentar el riesgo de reacciones adversas. • St. John’s Wort: El uso concomitante con esta planta antidepresiva puede aumentar efectos indeseables. • Teofilina: Durante el uso concurrente se han encontrado concentraciones elevadas de teofillina. • Tioridazina: La administración del paroxetina y tioridazina está contraindicado. • Warfarina: Se aconseja precaución cuando estos agentes se utilizan concomitantemente.

CONTRAINDICACIONES Excepto bajo circunstancias especiales, esta medicación no debe ser utilizada cuando existe el problema médico siguiente: Hipersensibilidad a paroxetina o sus componentes. Riesgo-beneficio debe ser considerado cuando existen los problemas médicos siguientes: Desorden o riesgo bipolar puede aumentar la probabilidad de un episodio maniaco mixto en estos pacientes; antes de iniciar el tratamiento de la paroxetina, el paciente debe ser observado adecuadamente para determinar si está en el riesgo del desorden bipolar; tal investigación debe incluir una historia psiquiátrica detallada, incluyendo antecedentes familiares de suicidio, desorden bipolar y depresión. • Enfermedades que afectan el metabolismo o respuestas hemodinámicas: La precaución es recomendable. • Epilepsia: Al igual que con otros antidepresivos, la paroxetina se debe usar con precaución. • Debilitación de la funcion hepática. • Historia de manía: La activación de la hipomanía o de la manía se ha manifestado en pacientes tratados con paroxetina. • Infarto del miocardio o historia reciente de enfermedad cardiaca: La paroxetina no se ha evaluado en pacientes con estas condiciones; se aconseja precaución. • Glaucoma: La paroxetina infrecuentemente causa midriasis y debe usarse con precaución en pacientes con glaucoma de angulo estrecho. • La debilitación neurológica: El riesgo puede ser aumentado. • Debilitación de la funcion renal severa: Iniciar con 10 mg una vez al día y los intervalos de la dosificación deben ser alargados.

PRECAUCIONES: Recientes estudios han demostrado que la paroxetina no es eficaz en niños y adolescentes menores de 18 años, ya que incluso los ensayos clínicos han encontrado que la paroxetina se asocia a riesgo creciente del comportamiento y de la hostilidad suicida. Carcinogenicidad: En estudios de dos años de carcinogenicidad, un número mayor en ratas machos en el grupo que recibía 3,9 veces la dosis humana máxima recomendada (DHMR) de 50 mg para el desorden depresivo importante, desorden social de la ansiedad, desorden general de la ansiedad y el desorden postraumatico de la tensión; (3,2 veces el DHMR de 60 mg para el desorden obsesivo-obligatorio) en un mg por metro cuadrado de área superficial del cuerpo (sarcomas exhibidos base de la célula del retículo de mg/m 2) que las ratas que recibían dosis más bajas. También, había una tendencia lineal perceptiblemente creciente a través de los grupos de la dosis para la ocurrencia de tumores linforreticular en ratas machos. Las ratas hembras eran inafectadas. En los ratones que reciben hasta 2,4 veces el DHMR para el desorden depresivo importante, desorden social de la ansiedad, desorden general de la ansiedad y desorden postraumático de la tensión (2 veces el DHMR para el desorden obsesivo-obligatorio) sobre una base de mg/m2, había un aumento relativo a la dosis en el número de tumores en ratones, pero ningún aumento droga-relacionado en el número de ratones con los tumores. La importancia de estos resultados a los seres humanos no se sabe. Mutagenicidad: Paroxetina no demostró ningún efecto genotóxico, en una batería de cinco análisis in vitro y dos in vivo, incluyendo el análisis bacteriano de la mutación, análisis de la mutación del linfoma del ratón, análisis no programado de la síntesis del ADN, pruebas para las aberraciones citogenéticas in vivo en médula del ratón e in vitro en linfocitos humanos y una prueba mortal dominante en ratas. Embarazo/Reproducción • Fertilidad: Paroxetina administrado en ratas en 2,9 veces el DHMR, mide el tiempo para el desorden depresivo importante, desorden social de la ansiedad, desorden general de la ansiedad y desorden postraumatico de la tensión (2,4 veces el DHMR para el desorden obsesivo-obligatorio) sobre una base de mg/m2, había reducido tarifas del embarazo. En estudios de toxicidad de duración de 2 a 52 semanas, ocurrieron lesiones reproductivas irreversibles en rata machos. Estas lesiones abarcaron cambios atrofico en los túbulos seminíferos de las pruebas con espermatogénesis arrestada en las dosis 4,9 veces del MRHD, por el desorden depresivo principal, desorden social de la ansiedad y el desorden general de la ansiedad (4,1 veces el MRHD para el desorden obsesivo-obligatorio y el desorden del pánico) sobre una base de mg/m2. La vacuolación del epitelio tubular epididimal en dosis 9,8 mide el tiempo de la DHRM, para el desorden depresivo importante, desorden social de la ansiedad, y el desorden general de la ansiedad (8,2 veces el MRHD para el desorden obsesivo-obligatorio y el desorden del pánico) sobre una base de mg/m2 y la vacuolación del epitelio tubular epididimal en las dosis 9,8 mide el tiempo del MRHD para el desorden depresivo importante, el desorden social de la ansiedad, y el desorden general de la ansiedad (8,2 veces el MRHD para el desorden obsesivo-obligatorio y el desorden del pánico) sobre una base de mg/m2. • Embarazo: No hay estudios adecuados y bien controlados en mujeres embarazadas. Sin embargo la paroxetina se debe utilizar durante el embarazo solamente si la ventaja potencial justifica al riesgo. • Efectos no teratogénicos: Al tratar a una mujer embarazada con paroxetina durante el tercer trimestre, el médico debe considerar cuidadosamente los riesgos y las ventajas potenciales del tratamiento. El médico puede considerar el prescribir paroxetina en el tercer trimestre. Categoría C del embarazo del FDA. Lactancia: Paroxetina se distribuye en la leche materna. Pediatría: La seguridad y eficacia no han sido establecidos. Geriatría: No había diferencias totales en acontecimientos adversos entre los pacientes mayores y más jóvenes, y la eficacia era similar en pacientes más jóvenes y mayores. En estudios la paroxetina, el 17% de los pacientes tenían 65 años de edad o mayores. Estos estudios demostraron que la separación está reducida en los ancianos; la paroxetina se asocia a los niveles crecientes del plasma y a la prolongación de los adultos más jóvenes en relación con el periodo de la eliminación. La dosificación reducida del paroxetina se recomienda para los pacientes mayores en bajas dosis diarias que debe ser iniciada y ser mantenida. Un estudio controlado de pacientes mayores con desorden depresivo importante. demostró que la paroxetina puede ser seguro y eficaz en el tratamiento de pacientes mayores de 60 años de edad.

INCOMPATIBILIDADES: No se han reportado incompatibilidades.

REACCIONES ADVERSAS: Los efectos siguientes se han seleccionado en base de su significancia clínica potencial: Las que indican necesidad de atención médica • Incidencia menos frecuente – Agitación, dolor de pecho, mialgia, miastenia o miopatia: Dolor o debilidad del músculo. – Palpitación: Latido del corazón rápido o irregular. – Hipotensión postural. – Desorden respiratorio. – Erupción de piel. – Taquicardia. • Incidencia rara – Sangría anormal. – Síntomas extrapiramidales. – Hiponatremia. – Manía o hipomanía. – Midriasis. – Síndrome de la serotonina. Nota: Los informes de la sangría anormal han incluido los informes publicados del caso que documentaban la ocurrencia de los episodios de la sangría en los pacientes tratados con los agentes psicotrópicos que interfieren con la recaptación de la serotonina. Los estudios epidemiológicos adicionales han confirmado la asociación entre el uso de los agentes psicotrópicos que interfieren con la recaptación de la serotonina y la ocurrencia de la sangría gastrointestinal superior. En ambos estudios, el uso concurrente de una droga antiinflamatoria no esteroidal [AINEs] o al ácido acetilsalicílico reforzó el riesgo de la sangría. Aunque estos estudios se centraron en la sangría gastrointestinal superior, es posible que sangrando en otros sitios sería reforzado semejantemente. • Incidencia no determinada observada durante la práctica clínica: – Agranulocitosis. – Acatisia. – Anafilaxis. – Anemia aplástica. – Aveolitis alérgica. – Bradicinesia. – Aplasia de la médula. – Eclampsia. – Galactorrea. – Síndrome de la Guillain-Barré: Entumecimiento y debilidad repentinos en los brazos y las piernas; inhabilidad de mover los brazos y las piernas. – Hematopoyesis. – Anemia hemolítica. – Púrpura de Henoch-Schonlein. – Hipertonía. – Laringismos. – Pruebas de la función hepática elevadas. – Síndrome malo neuroléptico. – Crisis oculógira. – Neuritis óptica. – Pancreatitis aguda. – Pancitopenia. – Porfiria. – Priapismo. – Prolactinemia – Hipertensión pulmonar – Falla renal aguda. – Epilepticus del estado. – Síndrome de la hormona antidiurética inadecuada (SIADH). – Trombocitopenia. – Necrólisis epidérmico. – Trismus. – Síndrome vasculítico. – Fibrilación ventricular. – Taquicardia ventricular. Las que indican la necesidad de la atención médica solamente si continúan o son fastidiosos: • Incidencia más frecuente – Dolor abdominal; astenia; estreñimiento; apetito disminuido; diarrea; vértigos. – Somnolencia; sequedad de la boca; dispepsia; indigestión; trastorno o dolor del estómago. – Flatulencia; dolor de cabeza; infección urinaria dolorosa (fiebre; tos). – Insomnio; libido disminuido; náusea; nerviosismo; disfunción sexual, especialmente impotencia o anorgasmiar capacidad sexual disminuida); sudoración; sinusitis; somnolencia; trauma; tremor; retención urinaria; desorden urinario; vómitos. Nota. La sequedad de la boca es probablemente debido a un efecto directo sobre el sistema de la serotonina más que al bloqueo colinérgico. • Incidencia menos frecuentes – Comodidad anormal. – Sueños anormales; visión anormal; reacción alérgica estacional. – Amnesia; ansiedad; apetito creciente; artralgia; dolor de espalda; visión velada; bronquitis; fiebre, concentración deteriorada; confusión, tos creciente; despersonalización; sensación narcotizada, eccema; carencia de emoción; hipercinesia; hipertensión; desorden menstrual; jaqueca; mioclonus; desorden del orofaringe; parestesia; faringitis; rinitis; fotosensibilidad de la piel; perversión del gusto; desorden del diente; infección del tracto urinario; vaginitis; vasodilatación; pérdida de peso o aumento; bostezo. Nota: El tratamiento a largo plazo de paroxetina puede causar aumento del apetito y de peso. Los que indican la necesidad de la atención médica si ocurren después de que se continúe la medicación: • Agitación; confusión; ansiedad; diarrea; vértigos; sensaciones de la descarga eléctrica. • Cambios emocionales. • Dolor de cabeza; hipomania; sudor creciente; insomnio; irritabilida; letargia; jaqueca; disturbios visuales; mialgia; náusea; parestesia; rinorrea; disturbios del sueño, incluyendo sueños anormales tremor; debilidad inusual. DOSIFICACIÓN Dosis usual del adulto • Tratamiento antiansiedad, antidepresivo, antiobsesional, tratamiento del desorden de la tensión postraumática: Oral, inicialmente 20 mg una vez al día, generalmente por la mañana. • Antiansiedad social: Oral, inicialmente 20 mg una vez al día, generalmente por la mañana. • Agente de antipánico: Oral, inicialmente 10 mg una vez al día, generalmente por la mañana. La dosificación se puede aumentar, según la necesidad y tolerancia, 10 mg al día en intervalos por lo menos de siete días. • Tratamiento disfórico premenstrual: Oral, inicialmente 12,5 mg una vez al día. Algunos pacientes que no respondan a una dosis de 12,5 mg pueden beneficiarse con el aumento con la dosis a 25 mg por día. Los cambios de la dosis deben hacerse a intervalos por lo menos a una semana. Las pacientes con TDPM deben ser evaluadas periodicamente para determinar la necesidad de continuar con el tratamiento. Nota: Para la mayoría de los pacientes, 20 mg al día es la dosificación óptima para el tratamiento de la depresión, desorden social de la ansiedad y desorden de la tensión postraumática. • Para el tratamiento del desorden obsesivo-obligatorio y del desorden del pánico, 40 mg día es la dosificación recomendada. Dosis usual límite en el adulto • Tratamiento antidepresivo desorden de la ansiedad o de la tensión postraumático: 50 mg por día. • Agente antiansiedad o agente antiobsesional o agente de antipánico: 60 mg por día. • Antiansiedad social: 20 mg por día. Nota: Para todas las indicaciones, pacientes con debilitación de la funcion renal o hepática severa, la dosificación no debe exceder los 40 mg por día. Dosis usual pediátrica: La seguridad y eficacia no se han establecido. Dosis usual geriátrica: Tratamiento antidepresivo, antiobsesional, antiansiedad, antipánico y desorden de la tensión postraumática, inicialmente 10 mg una vez al día, generalmente por la mañana. La dosificación puede ser aumentada de acuerdo a la necesidad y tolerancia del paciente. Límite usual geriátrica: Tratamiento antiansiedad, antidepresivo. antiobsesional, antipánico y desorden de la tensión postraumático 40 mg una vez al día.

TRATAMIENTO EN CASO DE SOBREDOSIS: No hay antídoto específico para la paroxetina. El tratamiento es esencialmente sintomático y de apoyo. Para disminuir la absorción en el aparato gastrointestinal, se realiza lavado gástrico, seguido por la administración de 20 a 30 gramos del carbón activado cada 4 a 6 horas durante las primeras 24 a 48 horas de la ingestión. Supervisión tomando un electrocardiograma (ECG) y la supervisión de la función cardiaca si hay cualquier muestra de la anormalidad. Supervisión de muestras vitales. Cuidado de apoyo: Estableciendo y supervisando la vía aérea. Los pacientes en quienes se confirma o se sospecha la sobredosis intencional deben ser referidos para la consulta psiquiátrica.

FORMAS DE PRESENTACIÓN: Cajas por 7, 10, 14, 20, 21, 28, 30, 40, 50, 60, 100, 200, 300 y 500 tabletas recubiertas.

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Forms Library, Apteor

Forms Library

For your convenience, the Apter Gastroenterology Center provides all patient forms in a downloadable format so you can fill them out in the comfort of your own home and save time when you arrive at the office. For information on where and when you should fill out each form, please read the descriptions below.

Understanding Patient Forms

Florida Hospital Medical Group (FHMG) Forms must be signed by FHMG patients once annually. These documents are standard across all FHMG practices and allow patients to move from one FHMG practice to another without signing repetitive paperwork.

Apter Gastroenterology Center Forms are specific to this practice. These forms must be signed by new patients to our practice. The documents are specific to our office and give our physicians specific clinical information about patients.

The below must be signed by new patients to Florida Hospital Medical Group.

Apter Gastroenterology Center Forms: (Download Practice Packet)

The below must be signed by new patients to Apter Gastroenterology Center .

The below must be signed only if you need to transfer patient medical records to or from our practice.



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Familial Adenomatous Polyposis - Genetics Home Reference, Fap

familial adenomatous polyposis

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

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

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

Related Information

Frequency

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

Related Information

Genetic Changes

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

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

Learn more about the genes associated with familial adenomatous polyposis

Familial adenomatous polyposis can have different inheritance patterns.

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

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

Related Information

Diagnosis & Management

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

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

Related Information

Other Names for This Condition

adenomatous familial polyposis

adenomatous familial polyposis syndrome

adenomatous polyposis coli

familial multiple polyposis syndrome

FAP

MYH-associated polyposis

Related Information

Additional Information & Resources

MedlinePlus (5 links)

Genetic and Rare Diseases Information Center (3 links)

Additional NIH Resources (5 links)

Educational Resources (12 links)

Patient Support and Advocacy Resources (3 links)

GeneReviews (2 links)

Genetic Testing Registry (4 links)

ClinicalTrials. gov (1 link)

Scientific articles on PubMed (1 link)

OMIM (3 links)

Sources for This Page

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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Frusenex

Description

Frusenex (Frusemide) is a diuretic which sheds excess water from the patient`s system, which helps to reduce swelling. It may be taken alone or combined with other medication.

It is popular for alleviating the symptoms of hypertension, and is also used to treat cirrhosis, nephritic syndrome, heart failure, and chronic kidney failure.

Dosage and Administration

Use Frusenex (Frusemide) only as prescribed by your physician. Never self-medicate or adjust your dosage without consulting your physician first. A typical starting dose is from 20mg to 80mg per dose, taken 1 to 2 times per day. Dosing should usually be done early in the day, as it may interrupt sleep when taken later due to frequent toilet breaks. Attend all medical appointments you have so your progress and response may be monitored.

Report all side effects to your physician. Side effects report by patients taking Frusenex (Frusemide) may encounter some side effects such as:

Headaches

Dizziness

Drowsiness

Indigestion

Stomach upset

Constipation

Diarrhea

Blurred vision

If you suffer from the following side effects consult your physician as soon as possible.

Dehydration

Dry mouth

Shakes, seizures, or convulsions

Abnormal weakness, tiredness, or faintness

Frusenex (Frusemide) can cause dehydration. Drink plenty of fluids while taking this medication.

This drug may not be suitable for all patients. Elderly patients may be at higher risk and therefore need closer monitoring and perhaps a reduced dosage.



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Makcin A® Sr 500 Mg Tablete Upute O Lijeku, Makcin

Opis

SASTAV Jedna tableta s produljenim oslobaA‘anjem sadrA?ava 500 mg klaritromicina. PomoA‡ne tvari: laktoza; sorbatna kiselina; boja titanijev dioksid (E171); boja quinoline yellow (E104). FARMACEUTSKI OBLIK I VELIA?INA PAKIRANJA Tableta s produljenim oslobaA‘anjem. Kutija sa 7 tableta u blisteru. FARMAKOTERAPIJSKA SKUPINA Klaritromicin je antimikrobni lijek za sustavnu primjenu iz skupine makrolida. NAA?IN I MJESTO IZDAVANJA Na recept. u ljekarni. ROK VALJANOSTI Otisnut je na pakiranju. Lijek se ne smije primijeniti nakon isteka roka valjanosti! NAA?IN A?UVANJA LIJEKA Lijek treba A?uvati pri temperaturi do 25°C, zaštiA‡eno od svjetlosti. Lijek treba A?uvati izvan dohvata i pogleda djece!

Primjena

TERAPIJSKE INDIKACIJE Makcin SR 500 mg tablete primjenjuju se u lijeA?enju infekcija uzrokovanih osjetljivim uzroA?nicima. Indikacije ukljuA?uju: • infekcije gornjih dišnih puteva (npr. sinusitis i faringitis)

• infekcije donjih dišnih puteva (akutni bronhitis, akutno pogoršanje kroniA?nog bronhitisa, upala pluA‡a)

• infekcije koA?e i potkoA?nog tkiva - blage i umjereno teške (npr. folikulitis, celulitis i erizipel).

Doziranje

DOZIRANJE I NAA?IN PRIMJENE Odrasli i djeca starija od 12 godina UobiA?ajena doza je jedna Makcin SR 500 mg tableta na dan. Tableta se uzima uz jelo. U teA?im oblicima infekcija doza se moA?e poveA‡ati na dvije Makcin SR 500 mg tablete na dan. UobiA?ajena duljina primjene je 7 do 14 dana. Djeca mlaA‘a od 12 godina Makcin SR 500 mg tablete nisu namijenjene za primjenu u djece mlaA‘e od 12 godina. Bolesnici s poremeA‡enom funkcijom bubrega Makcin SR 500 mg tablete ne primjenjuju se u bolesnika s poremeA‡enom funkcijom bubrega u kojih je klirens kreatinina manji od 30 ml/min. U spomenutih bolesnika mogu se primijeniti Makcin 500 mg tablete. PREDOZIRANJE Pri uzimanju prevelike doze klaritromicina mogu se oA?ekivati probavne smetnje. U jednog bolesnika s bipolarnim poremeA‡ajem, primjena 8 g klaritromicina imala je za posljedicu promjenu mentalnog statusa, paranoidno ponašanje, hipokalijemiju i hipoksemiju. U sluA?ajevima predoziranja potrebno je isprati A?eludac te poduzeti mjere za odrA?avanje normalne funkcije organizma. Kao i drugi makrolidni antibiotici, klaritromicin se ne moA?e ukloniti iz plazme postupkom hemodijalize ili peritonealne dijalize.

Mjere opreza

MJERE OPREZA Produljena ili ponavljana primjena klaritromicina moA?e imati za posljedicu superinfekciju otpornim bakterijama ili gljivicama. U sluA?aju superinfekcije, lijeA?enje klaritromicinom treba prekinuti i zapoA?eti s odgovarajuA‡om terapijom. KONTRAINDIKACIJE Makcin SR 500 mg tablete ne smiju se primijeniti u osoba koje su preosjetljive na klaritromicin ili neki drugi antibiotik iz skupine makrolida. Klaritromicin se ne smije primjenjivati istodobno s derivatima ergotamina. BuduA‡i da se Makcin SR tablete ne mogu primijeniti u dozi manjoj od 500 mg, njihova je primjena kontraindicirana u bolesnika koji imaju klirens kreatinina manji od 30 ml/min. Klaritromicin se ne smije primjenjivati istodobno sa sljedeA‡im lijekovima: cisapridom, pimozidom i terfenadinom. Pri istodobnoj primjeni cisaprida, pimozida te terfenadina i klaritromicina zabiljeA?eno je poveA‡anje koncentracija spomenutih lijekova u plazmi što moA?e rezultirati produljenjem QT intervala i posljediA?nim aritmijama, ukljuA?ujuA‡i ventrikularnu tahikardiju, fibrilaciju ventrikula i torsade de pointes. SliA?ni uA?inci opaA?eni su i pri istodobnoj primjeni astemizola i drugih makrolida. POSEBNA UPOZORENJA TrudnoA‡a Sigurnost primjene klaritromicina tijekom trudnoA‡e i dojenja nije utvrA‘ena. Stoga se klaritromicin ne smije primjenjivati tijekom trudnoA‡e, osim u sluA?aju kada moguA‡a korist za majku prevladava moguA‡e rizike po fetus. Dojenje Klaritromicin se izluA?uje u majA?ino mlijeko. Stoga se ne smije primjenjivati tijekom dojenja, osim kada moguA‡a korist za majku prevladava moguA‡e rizike po dojenA?e. Bolesnici s poremeA‡enom funkcijom bubrega ili jetre Klaritromicin se uglavnom izluA?uje putem jetre i bubrega. Pri primjeni klaritromicina u bolesnika s poremeA‡enom funkcijom jetre i bubrega potreban je poseban oprez. NUSPOJAVE Klaritromicin se u pravilu dobro podnosi. Nuspojave ukljuA?uju muA?ninu, dispepsiju, proljev, povraA‡anje, bolove u trbuhu i parestezije. ZabiljeA?eni su sluA?ajevi stomatitisa, glositisa, oralne kandidijaze te diskoloracije jezika. Ostale nuspojave ukljuA?uju glavobolju, bolove u zglobovima i mišiA‡ima te alergijske reakcije poA?evši od urtikarije, blagih erupcija na koA?i i angioedema do anafilaksije i rijetko Stevens - Johnsonovog sindroma i toksiA?ne epidermalne nekrolize. ZabiljeA?eni su sluA?ajevi promjena osjeta mirisa, obiA?no u kombinaciji s promjenom okusa. U bolesnika koji su uzimali klaritromicin opisane su i diskoloracije zuba, obiA?no reverzibilne nakon profesionalnog A?išA‡enja zubi od strane stomatologa. ZabiljeA?ena je i pojava prolaznih nuspojava na središnjem A?ivA?anom sustavu ukljuA?ujuA‡i omaglicu, vrtoglavicu, anksioznost, nesanicu, noA‡ne more, tinitus, konfuznost, dezorijentiranost, halucinacije, psihozu i depersonalizaciju. Opisani su i sluA?ajevi gubitka sluha, obiA?no reverzibilnog nakon prekida lijeA?enja. Rijetko se moA?e javiti i pseudomembranozni kolitis, u vrlo blagom obliku pa sve do oblika opasnog po A?ivot. Opisani su rijetki sluA?ajevi hipoglikemije, a poneki od njih javili su se u bolesnika koji su istodobno uzimali peroralne hipoglikemike ili inzulin. Opisani su vrlo rijetki sluA?ajevi uveitisa (obiA?no reverzibilni), uglavnom u bolesnika koji su istovremeno uzimali rifabutin. ZabiljeA?eni su izolirani sluA?ajevi leukopenije i trombocitopenije. Kao i u sluA?aju drugih makrolidnih antibiotika, pri primjeni klaritromicina zabiljeA?eni su sluA?ajevi poremeA‡aja funkcije jetre (obiA?no reverzibilni), ukljuA?ujuA‡i poremeA‡aje testova jetrene funkcije, hepatitis i kolestazu sa ili bez A?utice. Ponekad poremeA‡aj funkcije jetre moA?e biti teA?ak, a vrlo rijetko se moA?e javiti fatalno zatajivanje jetre. Opisani su rijetki sluA?ajevi poveA‡anja vrijednosti kreatinina u serumu, intersticijskog nefritisa, zatajivanja bubrega, pankreatitisa i konvulzija. Kao i u sluA?aju drugih makrolidnih antibiotika, pri primjeni klaritromicina rijetko moA?e doA‡i do produljenja QT intervala, ventrikularne tahikardije i pojave torsade de pointes. O svakoj nuspojavi obavijestite svog lijeA?nika ili ljekarnika! INTERAKCIJE Prije primjene Makcin SR 500 mg tableta obavijestite lijeA?nika o svim lijekovima koje uzimate! Klaritromicin ne stupa u interakcije s oralnim kontraceptivima. Pri istodobnoj primjeni klaritromicina i lijekova koji se metaboliziraju putem sustava citokroma P450 (varfarin, alkaloidi ergotamina, triazolam, midazolam, lovastatin, dizopiramid, rifabutin, fenitoin, ciklosporin, takrolimus) poveA‡ava se njihova koncentracija u plazmi. ZabiljeA?eni su sluA?ajevi rabdomiolize pri istodobnoj primjeni klaritromicina i inhibitora HMG-CoA reduktaze, kao što su lovastatin i simvastatin. Primjena klaritromicina u bolesnika koji uzimaju teofilin povezana je s poveA‡anjem koncentracije teofilina u plazmi i moguA‡im toksiA?nim uA?inkom. Istodobna primjena klaritromicina i varfarina moA?e rezultirati pojaA?anim uA?inkom varfarina. U tih su bolesnika obavezne A?este kontrole protrombinskog vremena. Pri istodobnoj primjeni digoksina i klaritromicina uA?inak digoksina moA?e biti pojaA?an. U tom je sluA?aju potrebna kontrola razine digoksina u serumu. Klaritromicin moA?e pojaA?ati uA?inke karbamazepina zbog toga što smanjuje njegovo izluA?ivanje. Studije u kojima bi se ispitivale interakcije klaritromicina u obliku SR tableta i zidovudina nisu provedene. U sluA?aju da je neophodna istodobna primjena klaritromicina i zidovudina, treba koristiti oblike klaritromicina s trenutnim oslobaA‘anjem. Pri istodobnoj primjeni s klaritromicinom, ritonavir poveA‡ava vrijednosti površine ispod koncentracijske krivulje (AUC), Cmax i Cmin klaritromicina. Zbog toga što klaritromicin ima veliku terapijsku širinu, u bolesnika koji imaju normalnu funkciju bubrega nije potrebno prilagoA‘avanje doze. MeA‘utim, u bolesnika s poremeA‡enom funkcijom bubrega treba primjenjivati oblike klaritromicina s trenutnim otpuštanjem. Klaritromicin u dozi veA‡oj od 1 g na dan ne treba primjenjivati istodobno s ritonavirom.

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Cathejell, Cathejell

Warnings and Precautions:

General: EXCESSIVE DOSAGE, OR SHORT INTERVALS BETWEEN DOSES, CAN RESULT IN HIGH PLASMA LEVELS OF LIDOCAINE OR ITS METABOLITES AND SERIOUS ADVERSE EFFECTS. Absorption from the mucous membranes is variable but is especially high from the bronchial tree. Such applications may therefore result in rapidly rising or excessive plasma concentrations, with an increased risk for toxic symptoms, such as convulsions. PATIENTS SHOULD BE INSTRUCTED TO STRICTLY ADHERE TO THE RECOMMENDED DOSAGE. This is especially important in children where doses vary with weight. The management of serious adverse reactions may require the use of resuscitative equipment, oxygen and other resuscitative drugs (see OVERDOSAGE).

The lowest dosage that results in effective anesthesia should be used to avoid high plasma levels and serious adverse effects. Tolerance to elevated blood levels varies with the status of the patient.

Lidocaine should be used with caution in patients with sepsis and/or traumatized mucosa at the area of application, since under such conditions there is the potential for rapid systemic absorption.

CATHEJELL Jelly 2% should be used with caution in children under the age of 2 as there is insufficient data to support the safety and efficacy of this product in this patient population at this time.

In patients under general anesthesia who are paralyzed, higher plasma concentrations may occur than in spontaneously breathing patients. Unparalyzed patients are more likely to swallow a large proportion of the dose, which then undergoes considerable first-pass hepatic metabolism following absorption from the gut.

Avoid contact with eyes.

Many drugs used during the conduct of anesthesia are considered potential triggering agents for familial malignant hyperthermia. It has been shown that the use of amide local anesthetics in malignant hyperthermia patients is safe. However, there is no guarantee that neural blockade will prevent the development of malignant hyperthermia during surgery. It is also difficult to predict the need for supplemental general anesthesia. Therefore, a standard protocol for the management of malignant hyperthermia should be available.

When used for endotracheal tube lubrication, care should be taken to avoid introduction of the jelly into the lumen of the tube. If allowed into the inner lumen, the jelly may dry on the inner surface leaving a residue which tends to clump with flexion, narrowing the lumen. There have been rare reports in which this residue has caused the lumen to occlude. Similarly, do not use the jelly to lubricate the endotracheal stylettes.

When topical anesthetics are used in the mouth, the patient should be aware that the production of topical anesthesia may impair swallowing and thus enhance the danger of aspiration. Numbness of the tongue or buccal mucosa may enhance the danger of unintentional biting trauma. Food or chewing gum should not be taken while the mouth or throat area is anesthetized. See also Part III: Consumer Information.

CATHEJELL Jelly 2% is ineffective when applied to intact skin.

Lidocaine has been shown to be porphyrinogenic in animal models. CATHEJELL Jelly 2% should only be prescribed to patients with acute porphyria on strong or urgent indications, when they can be closely monitored. Appropriate precautions should be taken for all porphyric patients.

Cardiovascular Lidocaine should be used with caution in patients with bradycardia or impaired cardiovascular function since they may be less able to compensate for functional changes associated with the prolongation of A-V conduction produced by amid-type local anesthetics.

Lidocaine should be used with caution in patients in severe shock.

Hepatic Because amide-type local anesthetics such as lidocaine are metabolized by the liver, these drugs, especially repeated doses, should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at greater risk of developing toxic plasma concentrations.

Neurologic Epilepsy: The risk of central nervous system side effects when using lidocaine in patients with epilepsy is very low, provided that the dose recommendations are followed. (See DOSAGE AND ADMISTRATION).

Locomotion and Coordination: Topical lidocaine formulations generally result in low plasma concentrations because of a low degree of systemic absorption. However, depending on the dose, local anesthetics may have a very mild effect on mental function and coordination even in the absence of overt CNS toxicity and may temporarily impair locomotion and alertness.

Renal Lidocaine is metabolized primarily by the liver to monoethylglycinexylidine (MEGX, which has some CNS activity), and then further to metabolites glycinexylidine (GX) and 2,6­dimethylaniline (see ACTION AND CLINICAL PHARMACOLOGY). Only a small fraction (2%) of lidocaine is excreted unchanged in the urine. The pharmacokinetics of lidocaine and its main metabolite were not altered significantly in haemodialysis patients (n=4) who received an intravenous dose of lidocaine. Therefore, renal impairment is not expected to significantly affect the pharmacokinetics of lidocaine when CATHEJELL Jelly 2% is used for short treatment durations, according to dosage instructions (see DOSAGE AND ADMINISTRATION). Caution is recommended when lidocaine is used in patients with severely impaired renal function because lidocaine metabolites may accumulate during long term treatment (see DOSAGE AND ADMINISTRATION).

Sensitivity Lidocaine should be used with caution in persons with known drug sensitivities.

CATHEJELL Jelly 2% is contraindicated in patients with known hypersensitivities to local anesthetics of the amide type, and to other components in the formulation.

Special Populations Debilitated patients, acutely ill patients, and patients with sepsis should be given reduced doses commensurate with their age, weight and physical condition because they may be more sensitive to systemic effects due to increased blood levels of lidocaine following repeated doses.

Pregnant Women: There are no adequate and well-controlled studies in pregnant women on the effect of lidocaine on the developing fetus.

It is reasonable to assume that a large number of pregnant women and women of child-bearing age have been given lidocaine. No specific disturbances to the reproductive process have so far been reported, e. g. no increased incidence of malformations. However, care should be given during early pregnancy when maximum organogenesis takes place.

Labour and Delivery: Lidocaine is not contraindicated in labour and delivery. Should CATHEJELL Jelly 2% be used concomitantly with other products containing lidocaine during labour and delivery, the total dose contributed by all formulations must be kept in mind.

Nursing Women: Lidocaine and its metabolites are excreted in the breast milk. At therapeutic doses, the quantities of lidocaine and its metabolites in breast milk are small and generally are not expected to be a risk for the infant.

Pediatrics: Children should be given reduced doses commensurate with their age, weight and physical condition because they may be more sensitive to systemic effects due to increased blood levels of lidocaine following repeated doses (see DOSAGE AND ADMINISTRATION).

CATHEJELL Jelly 2% should be used with caution in children under the age of 2 as there is insufficient data to support the safety and efficacy of this product in this patient population at this time.

Geriatrics: Elderly patients may be more sensitive to systemic effects due to increased blood levels of lidocaine following repeated doses and may require dose reductions.

Carcinogenesis and Mutagenesis Genotoxicity tests with lidocaine showed no evidence of mutagenic potential. A metabolite of lidocaine, 2,6-dimethylaniline, showed weak evidence of activity in some genotoxicity tests. A chronic oral toxicity study of the metabolite 2,6-dimethylaniline (0, 14, 45, 135 mg/kg) administered in feed to rats showed that there was a significantly greater incidence of nasal cavity tumors in male and female animals that had daily oral exposure to the highest dose of 2,6-dimethylaniline for 2 years. The lowest tumor-inducing dose tested in animals (135 mg/kg) corresponds to approximately 50 times the amount of 2,6-dimethylaniline to which a 50 kg subject would be exposed following the application of 20 g of lidocaine jelly 2% for 24 hours on the mucosa, assuming the highest theoretical extent of absorption of 100% and 80% conversion to 2,6-dimethylaniline. Based on a yearly exposure (once daily dosing with 2,6­dimethylaniline in animals and 5 treatment sessions with 20 g lidocaine jelly 2% in humans), the safety margins would be approximately 3400 times when comparing the exposure in animals to man.

ADVERSE REACTIONS Adverse experiences following the administration of lidocaine are similar in nature to those observed with other amide local anesthetic agents. These adverse experiences are, in general, dose-related and may result from high plasma levels caused by overdosage or rapid absorption, or may result from a hypersensitivity, idiosyncrasy or diminished tolerance on the part of the patient.

An increased incidence of postoperative sore throat has been reported following endotracheal tube lubrication with lidocaine jelly.

Serious adverse experiences are generally systemic in nature. The following types are those most commonly reported:

Central Nervous System: CNS manifestations are excitatory and/or depressant and may be characterized by the following signs and symptoms of escalating severity: circumoral paresthesia, light-headedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, hyperacusis, tinnitus, blurred vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. The excitatory manifestations (e. g. twitching, tremors, convulsions) may be very brief or may not occur at all, in which case the first manifestation of toxicity may be drowsiness merging into unconsciousness and respiratory arrest.

Drowsiness following the administration of lidocaine is usually an early sign of a high lidocaine plasma level and may occur as a consequence of rapid absorption.

Cardiovascular System: Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, arrhythmia and cardiovascular collapse, which may lead to cardiac arrest.

Allergic: Allergic reactions are characterized by cutaneous lesions, urticaria, edema or, in the most severe instances, anaphylactic shock. Allergic reactions of the amide type are rare (<0.1%) and may occur as a result of sensitivity either to the local anesthetic agent or to other components in the formulation (see DOSAGE FORM, COMPOSITION AND PACKAGING).

Overview Lidocaine is mainly metabolized in the liver by CYP1A2 and CYP3A4 to its two major metabolites, monoethylglycinexylidine (MEGX) and glycinexylidine (GX), both of which are pharmacologically active. Lidocaine has a high hepatic extraction ratio. Only a small fraction (2%) of lidocaine is excreted unchanged in the urine. The hepatic clearance of lidocaine is expected to depend largely on blood flow.

Strong inhibitors of CYP1A2, such as fluvoxamine, given concomitantly with lidocaine, can cause a metabolic interaction leading to an increased lidocaine plasma concentration.

Therefore, prolonged administration of lidocaine should be avoided in patients treated with strong inhibitors of CYP1A2, such as fluvoxamine. When co-administered with intravenous lidocaine, two strong inhibitors of CYP3A4, erythromycin and itraconazole, have each been shown to have a modest effect on the pharmacokinetics of intravenous lidocaine. Other drugs such as propranolol and cimetidine have been reported to reduce intravenous lidocaine clearance, probably through effects on hepatic blood flow and/or metabolism.

When lidocaine is used topically, plasma concentrations are of importance for safety reasons (see WARNINGS AND PRECAUTIONS, General; ADVERSE REACTIONS). However, with the low systemic exposure and short duration of topical application, the abovementioned metabolic drug-drug interactions are not expected to be of clinical significance when CATHEJELL Jelly 2% is used according to dosage recommendations.

Clinically relevant pharmacodynamic drug interactions may occur with lidocaine and other local anesthetics or structurally related drugs, and Class I and Class III antiarrhythmic drugs due to additive effects.

Drug-Drug Interactions Local anesthetics and agents structurally related to amide-type local anesthetics

Lidocaine should be used with caution in patients receiving other local anesthetics or agents structurally related to amide-type local anesthetics (e. g. antiarrhythmics such as mexiletine), since the toxic effects are additive.

Antiarryhythmic Drugs Class I Antiarrhythmic drugs Class I antiarrhythmic drugs (such as mexiletine) should be used with caution since toxic effects are additive and potentially synergistic.

Class III Antiarrhythmic drugs

Caution is advised when using Class III antiarrhythmic drugs concomitantly with lidocaine due to potential pharmacodynamic or pharmacokinetic interactions with lidocaine, or both. A drug interaction study has shown that the plasma concentration of lidocaine may be increased following administration of a therapeutic dose of intravenous lidocaine to patients treated with amiodarone (n=6). Case reports have described toxicity in patients treated concomitantly with lidocaine and amiodarone. Patients treated with Class III antiarrhythmic drugs (e. g. amiodarone) should be kept under close surveillance and ECG monitoring should be considered, since cardiac effects of these drugs and lidocaine may be additive.

Strong Inhibitors of CYP1A2 and CYP3A4 Cytochrome CYP1A2 and CYP3A4 are involved in the formation of the pharmacologically active lidocaine metabolite MEGX.

Fluvoxamine: Strong inhibitors of CYP1A2, such as fluvoxamine, given during prolonged administration of lidocaine to areas with a high extent of systemic absorption (e. g. mucous membranes) can cause a metabolic interaction leading to an increased lidocaine plasma concentration. The plasma clearance of a single intravenous dose of lidocaine was reduced by 41 to 60% during co-administration of fluvoxamine, a selective and potent CYP1A2 inhibitor, to healthy volunteers.

Erythromycin and Itraconazole: Erythromycin and itraconazole, which are strong inhibitors of CYP3A4, have been shown to reduce clearance of lidocaine by 9 to 18%, following a single intravenous dose of lidocaine to healthy volunteers.

During combined co-administration with fluvoxamine and erythromycin the plasma clearance of lidocaine was reduced by 53%.

?-blockers and cimetidine Following a single intravenous dose of lidocaine, administered to healthy volunteers, the clearance of lidocaine has been reported to be reduced up to 47% when co-administered with propanolol and up to 30% when co-administered with cimetidine. Reduced clearance of lidocaine when co-administered with these drugs is probably due to reduced liver blood flow and/or inhibition of microsomal liver enzymes. The potential for clinically significant interactions with these drugs should be considered during long-term treatment with high doses of lidocaine.

Drug-Food Interactions Interactions of lidocaine with food have not been established.

Drug-Herb Interactions Interactions of lidocaine with herbal products have not been established.

Drug-Laboratory Tests Interactions Interactions of lidocaine with laboratory tests have not been established.

Interactions of lidocaine with lifestyle have not been established.

DOSAGE AND ADMINISTRATION :

Dosing Considerations General When CATHEJELL Jelly 2% (lidocaine hydrochloride) is used concomitantly with other products containing lidocaine, the total dose contributed by all formulations must be kept in mind.

CATHEJELL Jelly 2% in the plastic syringe is preservative-free, and intended for single use only.

The absorption of lidocaine jelly from the nasopharynx is usually lower than with other lidocaine products. Blood concentrations of lidocaine after instillation of the jelly in the intact urethra and bladder in doses up to 800 mg are fairly low and below toxic levels.

Lidocaine should also be used with caution in patients with epilepsy, impaired cardiac conduction, bradycardia, impaired hepatic or renal function and in severe shock (see WARNINGS AND PRECAUTIONS).

Debilitated patients, elderly patients, acutely ill patients, patients with sepsis, and children should be given reduced doses commensurate with their age, weight and physical condition (see WARNINGS AND PRECAUTIONS).

CATHEJELL Jelly 2% should be used with caution in children under the age of 2 as there is insufficient data to support the safety and efficacy of this product in this patient population at this time (see WARNINGS AND PRECAUTIONS).

Recommended Dose and Dosage Adjustment When fully compressed each 1 x 12.5 g syringe will express approximately 10.0 g (corr. to 9.4 mL) of CATHEJELL Jelly 2% (200 mg of lidocaine hydrochloride).

Urethral Anesthesia Surface Anesthesia of the Male Adult Urethra

For adequate analgesia in males, 20 g (400 mg lidocaine hydrochloride) jelly (2 syringes) is usually required. The jelly is instilled slowly until the patient has a feeling of tension, approximately 10 g (200 mg lidocaine hydrochloride) jelly (1 syringe). A penile clamp is then applied for several minutes at the corona, after which another 10 g (200 mg lidocaine hydrochloride) of the jelly (1 syringe) is instilled.

When anesthesia is especially important, e. g. during sounding or cystoscopy, a larger quantity of jelly (e. g. 30-40 g, i. e. 600-800 mg lidocaine hydrochloride) (3-4 syringes) may be instilled in 3-4 portions and allowed to act for 10-12 minutes before insertion of the instrument. The jelly instilled into the bladder is also effective for procedures in this region.

To anesthetize only the anterior male urethra, e. g. for catheterization, small volumes (e. g. 5-10 g, i. e. 100-200 mg lidocaine hydrochloride) (? to 1 syringe) are usually adequate for lubrication.

For Surface Anesthesia of the Female Adult Urethra

Instill 5-10 g (100-200 mg lidocaine hydrochloride) jelly (? to 1 syringe) in small portions to fill the whole urethra. If desired, some jelly may be deposited on the orifice and covered with a cotton swab. In order to obtain adequate anesthesia, several minutes should be allowed prior to performing urological procedures.

Endoscopy The instillation of 10-20 g (200-400 mg lidocaine hydrochloride) jelly (1-2 syringes) is recommended for adequate analgesia and a small amount may be applied to the lubricating instrument. When combined with other lidocaine products (e. g. for bronchoscopy), the total dose of lidocaine hydrochloride should not exceed 400 mg (20 g jelly) (2 syringes).

Proctoscopy and rectoscopy Up to 20 g (400 mg lidocaine hydrochloride) jelly (2 syringes) can be used for anal and rectal procedures. The total dose of lidocaine hydrochloride should not exceed 400 mg (20 g jelly) (2 syringes).

Lubrication for Endotracheal Intubation Apply approximately 2 g of jelly to the external surface of the endotracheal tube just prior to insertion. Care should be taken to avoid introducing the product into the lumen of the tube (see WARNINGS AND PRECAUTIONS). Do not use the jelly to lubricate endotracheal stylettes. It is also recommended that the use of endotracheal tubes with dried jelly on the external surface be avoided for lack of lubricating effect.

Adults The dose of CATHEJELL Jelly 2% depends on the application site. A safe dose for oral use is 400 mg lidocaine hydrochloride (20 g jelly) (2 syringes). A safe dose for use in the urethra and bladder is 800 mg lidocaine hydrochloride (40 g jelly) (4 syringes). A maximum single dosage for CATHEJELL Jelly 2% is not established. No more than four doses should be given during a 24-hour period.

Children (Under 12 Years) It is difficult to recommend a maximum dose of any drug for children since this varies as a function of age and weight. The maximum amount per dose of CATHEJELL Jelly 2% should not exceed 6 mg/kg of body weight or 3 g CATHEJELL Jelly 2% per 10 kg body weight. No more than four doses should be given during a 24-hour period.

For children over 12 years of age doses should be commensurate with weight and physical condition.

For management of suspected drug overdose, contact your regional Poison Control Centre.

Acute systemic toxicity from local anesthetics is generally related to high plasma levels encountered during therapeutic use of local anesthetics and originates mainly in the central nervous and the cardiovascular systems (see ADVERSE REACTIONS and WARNINGS AND PRECAUTIONS). It should be kept in mind that clinically relevant pharmacodynamic drug interactions (i. e. toxic effects) may occur with lidocaine and other local anesthetics or structurally related drugs, and Class I and Class III antiarrhythimic drugs due to additive effects (see DRUG INTERACTIONS).

Symptoms Central nervous system toxicity is a graded response, with symptoms and signs of escalating severity. The first symptoms are circumoral paresthesia, numbness of the tongue, lightheadedness, hyperacusis and tinnitus. Visual disturbance and muscular tremors are more serious and precede the onset of generalized convulsions. Unconsciousness and grand mal convulsions may follow, which may last from a few seconds to several minutes. Hypoxia and hypercarbia occur rapidly following convulsions due to the increased muscular activity, together with the interference with normal respiration. In severe cases apnea may occur. Acidosis, hyperkalaemia, hypocalcaemia and hypoxia increase and extend the toxic effects of local anesthetics.

Recovery is due to redistribution and metabolism of the local anesthetic drug. Recovery may be rapid unless large amounts of the drug have been administered.

Cardiovascular effects may be seen in cases with high systemic concentrations. Severe hypotension, bradycardia, arrhythmia and cardiovascular collapse may be the result in such cases.

Cardiovascular toxic effects are generally preceded by signs of toxicity in the central nervous system, unless the patient is receiving a general anesthetic or is heavily sedated with drugs such as a benzodiazepine or barbiturate.

Treatment The first consideration is prevention, best accomplished by careful and constant monitoring of cardiovascular and respiratory vital signs and the patient's state of consciousness after each local anesthetic administration. At the first sign of change, oxygen should be administered.

The first step in the management of systemic toxic reactions consists of immediate attention to the maintenance of a patent airway and assisted or controlled ventilation with oxygen and a delivery system capable of permitting immediate positive airway pressure by mask. This may prevent convulsions if they have not already occurred.

If convulsions occur, the objective of the treatment is to maintain ventilation and oxygenation and support circulation. Oxygen must be given and ventilation assisted if necessary (mask and bag or tracheal intubation). Should convulsions not stop spontaneously after 15-20 seconds, an anticonvulsant should be given iv to facilitate adequate ventilation and oxygenation. Thiopental sodium 1-3 mg/kg iv is the first choice. Alternatively diazepam 0.1 mg/kg bw iv may be used, although its action will be slow. Prolonged convulsions may jeopardise the patient's ventilation and oxygenation. If so, injection of a muscle relaxant (e. g. succinylcholine 1 mg/kg bw) will facilitate ventilation, and oxygenation can be controlled. Early endotracheal intubation is required when succinylcholine is used to control motor seizure activity.

If cardiovascular depression is evident (hypotension, bradycardia), ephedrine 5-10 mg i. v. should be given and may be repeated, if necessary, after 2-3 minutes.

Should circulatory arrest occur, immediate cardiopulmonary resuscitation should be instituted. Continual oxygenation and ventilation and circulatory support as well as treatment of acidosis are of vital importance, since hypoxia and acidosis will increase the systemic toxicity of local anesthetics. Epinephrine (0.1-0.2 mg as intravenous or intracardial injections) should be given as soon as possible and repeated, if necessary.

Children should be given doses of epinephrine commensurate with their age and weight.

ACTION AND CLINICAL PHARMACOLOGY :

Mechanism of Action Lidocaine stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action. Local anesthetics of the amide type are thought to act within the sodium channels of the nerve membrane.

Onset of Action Anesthesia is achieved within 5 minutes, depending on the area of application. Duration of anesthesia is approximately 20-30 minutes. CATHEJELL Jelly 2% (lidocaine hydrochloride) is ineffective when applied to intact skin.

Hemodynamics Lidocaine, like other local anesthetics, may also have effects on excitable membranes in the brain and myocardium. If excessive amounts of drug reach systemic circulation rapidly, symptoms and signs of toxicity will appear, emanating from the central nervous and cardiovascular systems.

Central nervous system toxicity (see OVERDOSAGE) usually precedes the cardiovascular effects since it occurs at lower plasma concentrations. Direct effects of local anesthetics on the heart include slow conduction, negative inotropism and eventually cardiac arrest.

Pharmacokinetics Absorption: The rate and extent of absorption depends upon concentration and total dose administered, the specific site of application and duration of exposure. In general, the rate of absorption of local anesthetic agents following topical application to wound surfaces and mucous membranes is high, and occurs most rapidly after intratracheal and bronchial administration. The absorption of lidocaine jelly from the nasopharynx is usually lower than with other lidocaine products. Blood concentrations of lidocaine after instillation of the jelly in the intact urethra and bladder in doses up to 800 mg are fairly low and below toxic levels. Lidocaine is also well absorbed from the gastrointestinal tract, although little intact drug may appear in the circulation because of biotransformation in the liver.

Distribution: Lidocaine has a total plasma clearance of 0.95 L/min and a volume of distribution at steady state of 91 L.

Lidocaine readily crosses the placenta, and equilibrium in regard to free, unbound drug will be reached. Because the degree of plasma protein binding in the fetus is less than in the mother, the total plasma concentration will be greater in the mother, but the free concentrations will be the same.

The plasma binding of lidocaine is dependent on drug concentration, and the fraction bound decreases with increasing concentration. At concentrations of 1 to 4 µg of free base per mL, 60 to 80 percent of lidocaine is protein bound. Binding is also dependent on the plasma concentration of the alpha-1-acid glycoprotein. Lidocaine crosses the blood-brain and placental barriers, presumably by passive diffusion.

Metabolism: Lidocaine is metabolized rapidly by the liver, and its metabolites and the unchanged drug are excreted by the kidneys. Biotransformation includes oxidative N­dealkylation, ring hydroxylation, cleavage of the amide linkage, and conjugation. Only 2% of lidocaine is excreted unchanged. Most of it is metabolized first to monoethylglycinexylidide (MEGX) and then to glycinexylidide (GX) and 2,6-dimethylaniline. Up to 70% appears in the urine as 4-hydroxy - 2,6-dimethylaniline. The pharmacological/toxicological actions of MEGX and GX are similar to, but less potent than those of lidocaine. GX has a longer half-life (about 10 h) than lidocaine and may accumulate during long-term administration.

Excretion: Lidocaine has an elimination half-life of 1.6 h and an estimated hepatic extraction ratio of 0.65. The clearance of lidocaine is almost entirely due to liver metabolism, and depends both on liver blood flow and the activity of metabolizing enzymes. Approximately 90% of the lidocaine administrated intravenously is excreted in the form of various metabolites, and less than 10% is excreted unchanged in the urine. The primary metabolite in urine is a conjugate of 4-hydroxy - 2,6-dimethylaniline, accounting for about 70-80% of the dose excreted in the urine.

The elimination half-life of lidocaine following an intravenous bolus injection is typically 1.5 to 2.0 hours. The elimination half-life in neonates (3.2 h) is approximately twice that of adults. The half-life may be prolonged two-fold or more in patients with liver dysfunction. Renal dysfunction does not affect lidocaine kinetics but may increase the accumulation of metabolites.

Special Populations and Conditions

Acidosis increases the systemic toxicity of lidocaine while the use of CNS depressants may increase the levels of lidocaine required to produce overt CNS effects. Objective adverse manifestations become increasingly apparent with increasing venous plasma levels above 6.0 µg free base per mL.

Storage and Stability:



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The Biclars, Biclar

So there I was with Wong in Costco. She wanted a 12kg sack of flour to bake bread with at home. We left our trolley behind 30mins into shopping because there was only two clothing items in the gargantuan shopping trolley and figured that we didn’t really need those items anyway.

“Are you sure you’re going to bake with all this flour? This is a heck of a lot of flour”, I enquired with one raised eye brow. She nodded. So I picked up the sack off the shelf and heaved it over my shoulder and went straight to the checkout. Paid. Heaved it over my other shoulder and walked all the way to the other end of the car park where our Betty was.

Later that night at Larry’s, I felt a twinge in my upper back and got Wong to give me a 2 minute massage (she gets tired after 2 minutes)

Monday, I get up with the worst back pain. Later that night was even worse. Tuesday, I thought it would have gone away by then but had gotten really bad. I couldn’t cough or sneeze without excruciating pain. Wednesday, it was so bad I gave in and checked myself into a physio and after some tests, was told that I had a compressed disc in my spine and that it was also enflamed. The good thing is that it’s quite temporary and would only take time, like many things, to heal.

2 Voltaren dosages later, it’s now 2am and I’m writing this blog post because I’m too scared to lie down. That’s when it’s the worst funnily enough. Actually, I was able to get 2 hours sleep until I woke up with a sharp pain in my chest as if I’ve been stabbed with a kebab skewer!

Moral of the story, don’t be a hero and carry more than you can. Use a trolley or talk your partner out of buying things.

Thanks for coming guys! Really appreciate it… and thanks to Wong for organising

Hey guys, if you’re reading this, I’ve invited you to my photo walk this Friday night (29/7). I’m going to be doing long exposure shots of the cars whizzing past on the Eastlink Tollway on a bridge. And then Mike (PROtog) and I will be mucking around with off-camera flash (strobing).

We’ll meet at 8:30pm on the corner of Cathies Lane and George Street in Scoresby. Find parking and then you should be able to see the bridge from that intersection. I’ll most probably be already there shooting.

Store my number and buzz/text me if you need to: 0431 437 697.

I haven’t updated for a while but I thought I will now because I just had a weird dream…

I dreamt that I was at some kind of party gathering for a corporation with all the big shot executives but I had to run off somewhere to do something. So I was begging the coordinator (a hot chick) if I can leave but she wouldn’t let me. Anyway after a bit more coaxing, she rolled her eyes, put on her fighter pilot uniform and fired up the engines of her jet. Instinctively I jumped on the nose of the plane and she flew us out of there towards Europe. (Mind you in the dream, it felt so real and that I was genuinely scared I’d slip and fall into the sea since we were flying to Europe!)

So then we land in Germany and I was so happy because I’ve never been to Europe! She was about to head back to the party she’s supposed to coordinate but I asked her to stay with me because I’ve started taking a liking for her (sorry Wong, it’s just a dream!). She agreed.

In your dreams, you just seem to know exactly what’s going on in your mind and in the other person’s mind in your dream as well right? So from that point, I knew we were “dating”…

And then I hear a motorbike and a big “SNAP!”. I woke up, it was the mailman popping the letters into my letterbox. Don’t you hate it when you wake up in the middle of a good bit of your dream?!

So what do you think this dream means? Comment below

Wong and I did a bit of shopping last night. She wanted to decorate her own hat for the “dress up” for the Spring racing carnival at her workplace. I on the other hand was shopping for a nice umbrella that my bridal clients can use during wet conditions in an outdoor photoshoot. I just wish yesterday’s weather would’ve held up until the weekend was over but thanks to good ‘ol Melbourne weather, that is not the case.

Anyhow, here’s a pic of Wong with her hat. Isn’t she beautiful?!

Happy Friday everyone!

I’ve been watching a few YouTube videos on people posting video footage shot with their dSLR capable of HD video, so here’s my first attempt

I created this image whilst on holidays in Palawan. a beautiful Island in the Philippines.

Instead of making the usual mecca to Boracay Island whilst holidaying in the Phils, I thought I would visit Palawan as my cousins always raved about how beautiful it is and how it’s less populated and more serene than the overly-touristy Boracay Island. I’m glad I did

The afternoon was spent lazing not in a hammock, but in the soothing, comforting waters of the beach in Sabang. My wife, brother and his girl-friend had the whole beach to ourselves… that’s the life! Just as we were heading to the resort restaurant which was just absolutely amazing (can’t enough of the tender beef skewers with butter rice!), after looking at the sky I just couldn’t help not going back to my room to pick up my camera and snap this image. It will always remind me of how beautiful our planet is and how lucky we are that we exist at this time to enjoy such visual splendours

This post is from my Alba Photography website. If you’d like to order a print, my contact details are here. Thank you for your support

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Amoxicon Kaufen - Amoxicon (Amoxicillin, Clavulanate) Ohne Rezept, Amoxicon

Augmentin ist fur die Behandlung von Infektionen, die durch bestimmte Bakterien verursacht wurden. Augmentin ist ein Antibiotikum Penicillin. Es funktioniert durch das Toten von empfindlichen Bakterien.

Verwenden Sie Augmentin, wie von Ihrem Arzt verordnet wurde.

Nehmen Sie Augmentin durch den Mund mit oder ohne Nahrung. Wenn Magenbeschwerden auftreten, mit Nahrung zu reduzieren Magen Reizungen zu nehmen.

Zur Klarung Ihrer Infektion vollstandig nehmen Augmentin fur das gesamte Verlauf der Behandlung. Halten Sie dabei, selbst wenn Sie sich besser in ein paar Tagen zu spuren.

Wenn Sie eine Dosis von Augmentin vergessen haben, nehmen Sie es so bald wie moglich. Wenn es fast Zeit fur Ihre nachste Dosis ist, uberspringen Sie die vergessene Dosis und gehen Sie zuruck zu Ihrem regelma?igen Dosierungsschema. Nehmen Sie nicht 2 Dosen auf einmal.

Fragen Sie Ihren Arzt Fragen konnen Sie sich daruber, wie Sie Augmentin verwendet haben kann.

Shop Augmentin bei oder unter 77 Grad F (25 Grad C). Lager weg von der Hitze, Feuchtigkeit und Licht. Nicht im Bad. Halten Sie Augmentin au?erhalb der Reichweite von Kindern und weg von Haustieren.

Wirkstoff: Amoxicillin / Clavulansaure Kalium.

Verwenden Sie KEINE Augmentin, wenn:

Sie sind allergisch gegen jegliche Zutaten in Augmentin oder ein anderes Antibiotikum Penicillin (zB Ampicillin)

Sie haben eine Geschichte von Leberproblemen oder Gelbfarbung der Augen oder der Haut durch Augmentin verursacht

Sie haben infektiosen Mononukleose (mono)

Sie nehmen ein Tetracyclin-Antibiotika (zB Doxycyclin)

Sie haben vor kurzem erhalten oder werden empfangen Live oralen Typhus-Impfstoff.

Fragen Sie Ihren Arzt oder Ihre Arztin sofort, wenn einer dieser Punkte auf Sie zutreffen.

Einige medizinische Bedingungen konnen mit Augmentin interagieren. Informieren Sie Ihren Arzt oder Apotheker, wenn Sie irgendwelche medizinischen Bedingungen haben, vor allem, wenn einer der folgenden Punkte auf Sie zutrifft:

wenn Sie schwanger sind, planen, schwanger zu werden, oder stillen

wenn Sie verschreibungspflichtige oder nicht verschreibungspflichtige Arzneimittel, pflanzliche Zubereitung oder Nahrungserganzungsmittel

wenn Sie Allergien gegen Medikamente, Nahrungsmittel oder andere Substanzen,

wenn Sie eine Geschichte von Allergien, Asthma, Heuschnupfen oder Nesselsucht

wenn Sie eine schwere allergische Reaktion (z. B. schweren Hautausschlag, Nesselsucht, Atembeschwerden, Schwindel) zu einem Cephalosporin (zB Cephalexin) oder ein anderes Beta-Lactam-Antibiotika (zB Imipenem)

wenn Sie Probleme mit den Nieren oder Gonorrhoe

wenn Sie eine Geschichte von Leberproblemen oder Gelbfarbung der Augen oder der Haut.

Einige Arzneimittel konnen mit Augmentin interagieren. Informieren Sie Ihren Arzt, wenn Sie andere Arzneimittel einnehmen, vor allem einer der folgenden Eigenschaften sind:

Antikoagulantien (zB Warfarin), weil das Risiko von Blutungen erhoht werden kann

Probenecid weil es die Menge von Augmentin in Ihrem Blut erhohen kann

Chloramphenicol, Macrolid-Antibiotika (zB Erythromycin), Sulfonamide (z. B. Sulfamethoxazol) oder Tetracyclin-Antibiotika (zB Doxycyclin), weil sie die Effektivitat verringern Augmentin

Methotrexat, weil das Risiko der Nebenwirkungen konnen durch Augmentin erhoht werden

Live-oralen Typhus-Impfstoff oder hormonellen Empfangnisverhutung (zB Pille), weil ihre Wirksamkeit von Augmentin verringert werden kann.

Dies kann nicht eine vollstandige Liste aller Interaktionen, die auftreten konnen. Fragen Sie Ihren Arzt, wenn Augmentin mit anderen Medikamenten, die Sie einnehmen. Prufen Sie mit Ihrem Arzt, bevor Sie starten, stoppen, oder andern Sie die Dosis einer Medizin.

Wichtige Sicherheitshinweise:

Augmentin kann Schwindel verursachen. Dieser Effekt kann noch schlimmer, wenn Sie es mit Alkohol oder bestimmte Medikamente. Verwenden Sie Augmentin mit Vorsicht. Nicht Auto fahren oder andere moglicherweise unsichere Aufgaben, bis Sie, wie Sie darauf reagieren.

Augmentin funktioniert nur gegen Bakterien, es nicht zu behandeln virale Infektionen (zB eine Erkaltung).

Achten Sie darauf, Augmentin fur das gesamte Verlauf der Behandlung zu verwenden. Wenn Sie das nicht tun, kann die Medizin nicht klar, bis Ihre Infektion vollstandig. Die Bakterien konnten auch weniger anfallig fur diese oder andere Arzneimittel. Dies konnte die Infektion schwerer zu behandeln in der Zukunft.

Langfristige oder wiederholte Verwendung von Augmentin kann eine zweite Infektion. Informieren Sie Ihren Arzt, wenn Sie Anzeichen einer zweiten Infektion auftreten. Ihr Arzneimittel mussen geandert werden, um diese zu behandeln.

Mild Durchfall ist mit einer Antibiotika-Einsatz ublich. Allerdings kann eine schwere Form von Durchfall (pseudomembranose Kolitis) selten auftreten. Dies kann zu entwickeln, wahrend Sie das Antibiotikum oder innerhalb von mehreren Monaten, nachdem Sie mit ihn zu stoppen verwenden. Fragen Sie Ihren Arzt sofort, wenn Bauchschmerzen oder Krampfe, schwerer Durchfall oder Blut im Stuhl auftreten. Behandeln Sie Durchfall nicht, ohne vorher Rucksprache mit Ihrem Arzt.

Hormonelle Empfangnisverhutung (zB Pille) moglicherweise nicht so gut arbeiten, wahrend Sie mit Augmentin sind. Um eine Schwangerschaft zu verhindern, verwenden Sie eine zusatzliche Form der Empfangnisverhutung (zB Kondome).

Braun, gelb oder grau Zahnverfarbungen selten bei einigen Patienten unter Augmentin aufgetreten. Es traten am haufigsten bei Kindern. Die Verfarbung wurde reduziert oder durch Bursten oder Zahnreinigung in den meisten Fallen entfernt. Kontaktieren Sie Ihren Arzt, wenn Sie diesen Effekt zu erleben.

Diabetes-Patienten - Augmentin kann die Ergebnisse einiger Tests fur Urin Glucose falsch zu sein. Fragen Sie Ihren Arzt, bevor Sie Ihre Ernahrung oder die Dosis Ihres Diabetes Medizin zu andern.

Labortests, einschlie?lich der Leberfunktion, Nierenfunktion und Blutbild, kann durchgefuhrt werden, wenn Sie Augmentin fur eine lange Zeit nicht benutzt werden. Diese Tests konnen verwendet werden, um Ihren Zustand zu uberprufen oder auf Nebenwirkungen zu uberwachen. Achten Sie darauf, alle Arzt-und Labor-Terminen.

Verwenden Sie Augmentin mit Vorsicht bei alteren Menschen, sie kann mehr empfindlich auf die Auswirkungen, vor allem Patienten mit Nierenproblemen.

Verwenden Sie Augmentin mit au?erster Vorsicht bei Kindern junger als 10 Jahre alt, die Durchfall oder eine Infektion des Magens oder Darms haben.

Augmentin sollte nicht bei Kindern, die weniger als ? 88 (40 kg) wiegen werden, Sicherheit und Wirksamkeit bei diesen Kindern haben sich nicht bestatigt.

Schwangerschaft und Stillzeit: Wenn Sie schwanger werden, wenden Sie sich an Ihren Arzt. Sie mussen die Vorteile und Risiken der Verwendung von Augmentin zu diskutieren, wahrend Sie schwanger sind. Augmentin ist in der Muttermilch gefunden. Wenn Sie sind oder werden stillen, wahrend Sie Augmentin verwenden sind, mit Ihrem Arzt uberprufen. Diskutieren Sie mogliche Risiken fur Ihr Baby.



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Moment Synonyms, Moment Antonyms, Moment

moment

Word Origin & History

moment mid-14c. "very brief portion of time, instant," in moment of time, from O. Fr. moment, from L. momentum "movement, moving power," also "instant, importance," contraction of *movimentum, from movere "to move" (see move). Some (but not OED) explain the sense evolution of the L. word by notion of a particle so small it would just "move" the pointer of a scale, which led to the transferred sense of "minute time division." Sense of "importance, 'weight' " is attested in English from 1520s. Phrase never a dull moment first recorded 1889 in Jerome K. Jerome's "Three Men in a Boat." Phrase moment. of truth first recorded 1932 in Hemingway's "Death in the Afternoon," from Sp. el momento de la verdad, the final sword-thrust in a bull-fight.

Example Sentences for moment

I ask you to share with me today the majesty of this moment .

There was a moment 's silence during which the three stared at the Elephant.

There was a moment 's silence between the two in the kitchen, but the spell was broken.

Oscar stared and chewed his cigar and Jim smoked in silence for a moment .

For a moment there was silence, for the joke had taken a tragic turn.

Jim sat silent for a moment . then he turned suddenly on Sara.

Vivian, in spite of his philosophy, felt the excitement of the moment .

I shall be with you every moment . Jim, no matter where either of us is, bracing you with all the will I've got.

"The moment we begin business in the morning," went on Mr. Pendergast.

After a moment he turned up the trail toward the tent house.



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On Jan. 27, 2011, Clinton Foundation Chief Operating Officer Laura Graham sent an email to then-Secretary of State Hillary Clinton's chief of staff Cheryl Mills, voicing concern about a rumor. Ms. Graham had heard that Foggy Bottom was thinking about revoking the U. S. visa of Haitian Prime Minister Jean Max Bellerive. "Wjc will be v unhappy if that's the case," Ms. Graham warned Ms. Mills, using the initials of the former president.

A suspicious device found in a trash can near a New Jersey train station exploded early Monday as a bomb squad was attempting to disarm it with a robot, officials said. NJ Transit and Amtrak said the police investigation in the area of the Elizabeth station had affected passenger rail service on the busy Northeast Corridor.

China has once again publicly decided the U. S. is behind everything that's wrong with the world, according to a slew of anti-American articles in a state-sponsored newspaper.

The media showed up to the presidential ballroom of the new Trump International Hotel on Friday morning expecting Donald Trump to take questions about whether he still questions if President Obama was born in the United States.

Colin Kaepernick's National Anthem protest has started a ripple effect across the sports spectrum, reaching other NFL players, soccer stars and even high school student athletes. On Wednesday, his protest trickled into the Missouri Legislature.

Donald Trump's economic program has gone through several revisions and now deserves a citation at Trump University for "most improved." The candidate's New York Economic Club speech on Thursday, which included new tax reform details, was an encouraging if sometimes contradictory performance.



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Mesalazine Uses, Side Effects, Interactions, Pictures, Warnings & Dosing, Mesalazinum

Medicines & treatments centre

MESALAZINE WARNINGS

Mesalazine should be used with caution in: the elderly. patients with kidney or liver problems, active stomach ulcer disease or bleeding disorders, and women who are pregnant or who are breastfeeding.

It should not be used in: children under 2 years of age, patients with severe kidney or liver problems, or in those who have previously had hypersensitivity to any salicylate drugs (e. g. salicylic acid or aspirin ) or had a history of problems (sensitivity to) with sulphasalazine.

Also see list of precautions and interactions.

STORAGE

Store tablets below 25°C and protect from direct sunlight. Keep the bottle tightly closed.

MESALAZINE USES

What is it used for?

Mesalazine is used to treat a number of problems.

It is a member of a class of drugs called aminosalicylates, and it is sometimes called 5-aminosalicylic acid.

It is used in the treatment of inflammatory bowel (gut) diseases.

In general this drug is used to control the symptoms of a type of inflammatory bowel disease called ulcerative colitis, which is a disease of the lower intestine (colon ) characterised by open sores (ulcers) with symptoms such as frequent diarrhoea mixed with blood .

Benefits of being on this drug include the prevention of the symptoms of ulcerative colitis and remission (absence of active ulcerative colitis), though active ulcerative colitis is likely to reoccur and so another benefit with ongoing maintenance treatment is to prevent active disease from happening again. It is also used to maintain remission of a Crohn's ileo-colitis, a condition in which the small bowel (known as the ileum) and large bowel (the colon) linings become swollen and sore.

Listed below are the typical uses of balsalazide .

Treatment of mild-to-moderate ulcerative colitis

Maintaining remission of ulcerative colitis (preventing active ulcerative colitis from reocurring) when given as maintenance treatment

Maintaining remission of Crohn's ileo-colitis.

On occasion your doctor may prescribe this medicine to treat a condition not on the above list.

HOW TO USE/TAKE

How often do I take it?

Take tablets orally, every day. Swallow whole with water, and do not break, crush or chew the tablets before swallowing. Sachets of oral granules should be placed on the tongue and washed down with water or orange juice. It is also available as a suppository or enema, which should be taken rectally.

Use this medication regularly in order to get the most benefit from it.

Remember to use it at the same time each day - unless specifically told otherwise by your doctor.

It may take several months before the full benefit of this drug takes effect.

Certain medical conditions may require different dosage instructions as directed by your doctor.

What dose?

Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.

Do I need to avoid anything?

No.

When can I stop?

It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop.

MESALAZINE SIDE EFFECTS

Only the most common side effects have been listed. If any of these persist or you consider them severe then inform your doctor.

Tell your doctor immediately if you develop any of the following symptoms: unexplained bleeding, bruising. purpura (red spots/rash caused by a local bleeding within the skin ), sore throat. fever, or generally feeling unwell as these symptoms may indicate a blood disorder.

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

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

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.

MESALAZINE PRECAUTIONS

Before taking mesalazine, tell your doctor or pharmacist if you are allergic to it; or to other aminosalicylate drugs, or if you have any other allergies.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: severe liver problems or severe kidney problems, or if hypersensitive to any salicylate drugs (e. g. salicylic acid or aspirin).

Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following: any previous liver or kidney problems, or a history of problems (sensitivity) to sulphasalazine or salicylate drugs (e. g. salicylic acid or aspirin).

Before having surgery, tell your doctor or dentist that you are taking this medication.

Does alcohol intake affect this drug?

Not known.

Pregnancy and breastfeeding - please ensure you read the detailed information below

PREGNANCY

The safety of mesalazine has not been established during pregnancy. Ask your doctor or pharmacist if you have any doubts or questions about this.

It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.

If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.

BREAST FEEDING

Mesalazine is not safe to take if you are breastfeeding.

It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.

If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.

MESALAZINE INTERACTIONS

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.

This drug should not be used with the following medications because very serious, possibly fatal interactions may occur:

None known.

Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:

Cytotoxic agents (e. g. azathioprine or mercaptopurine)

Non-steroidal anti-inflammatory drugs (NSAIDs ) (e. g. paracetamol )

Others: methotrexate (used to treat rheumatoid arthritis, Crohn's disease. psoriasis and cancers) and lactulose (used to treat constipation ).

This information does not contain all possible interactions. Therefore, before using mesalazine, tell your doctor or pharmacist of all the products you use.

MESALAZINE OVERDOSE

Side effects of an overdose have not been reported.

If you think you, or someone you care for, might have accidentally taken more than the recommended dose of ezetimibe or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.

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.



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Hyaluronic Acid enhances proteoglycans in the joint matrix, thereby providing support for healthy joint function and maintaining joint shock absorption and cushioning.

As a dietary supplement, take 2 capsules daily, or as directed by a health care practitioner. Take with 8-10 ounces of water, with or without food.

Consult your Health Provider about the dosage appropriate for you.

If you miss a dose of Hyaluronic Acid, 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 Hyaluronic Acid at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Keep Hyaluronic Acid out of the reach of children and away from pets.

Do not take hyaluronic acid unless administered by a healthcare professional if:

You are pregnant or breast-feeding.

Hyaluronic Acid is not known to have any side effects if taken as per the prescribed dosage.

Urheberrecht © 2004-2016 Alle Rechte vorbehalten



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Versartis, Inc, Versatis

Senior Management Team

Jay P. Shepard President and Chief Executive Officer

Jay has more than 33 years of experience across pharmaceutical, biotechnology and drug delivery companies, most recently as an Executive Partner at Sofinnova Ventures, a healthcare focused venture capital firm, where he leveraged his industry expertise in support of the firm's portfolio companies and served as Executive Chairman of the Versartis Board of Directors since early 2014. Previously, he was President and CEO of NextWave Pharmaceuticals, a pediatric focused company acquired by Pfizer; President and CEO of Ilypsa, a nephrology company acquired by Amgen; and interim President and CEO of Relypsa (Ilypsa's spin-out company). Jay has extensive commercial experience, helping led over 17 product launches and establishing and coordinating multiple sales and marketing operations. He previously served as Vice President of Commercial Operations at Telik, where he oversaw all commercialization and market planning activities for the company's oncology programs. Jay was one of the early commercial executives at Alza Pharmaceuticals where he was Vice President in the Commercial Operations group, having held leadership roles of increasing responsibility in its establishment, operations and commercial presence. Alza was acquired by Johnson & Johnson in late 2001. He began his career in the pharmaceutical industry at Johnson & Johnson and Syntex Labs. Jay is a board member of Bullet Biotechnologies, Durect Corporation, Marinus Pharmaceuticals and the Santa Clara University Entrepreneurial School. Jay holds a BS in Business Administration from the University of Arizona.

Joshua T. Brumm Chief Financial Officer

Josh has more than a decade of operations, corporate finance and investment banking experience in the life science industry. He was most recently Executive Vice President of Finance and Principal Financial Officer for Pharmacyclics Inc. a NASDAQ-listed biopharmaceutical company. Previously as Chief Financial Officer at ZELTIQ Aesthetics, Inc. a NASDAQ-listed medical technology company, Josh held a number of operational and financial positions including strategic planning, global finance, IT and administration. As Vice President of Corporate Development and Investor Relations, Josh led the company’s successful $105 million initial public offering. Also at ZELTIQ as Senior Managing Director of International Sales and Corporate Development, he led the launch of its first commercial product in all markets outside of the United States and Canada. Prior to joining ZELTIQ, Josh was Director of Finance at Proteolix, Inc. helping in the sale of the company to Onyx Pharmaceuticals; he was a member of the West Coast Healthcare Team at Citigroup Global Markets, Inc.; and he was Founder and Chief Executive Officer of Nu-Ag Distribution, LLC, an agricultural consulting company. Josh began his career as a Healthcare Investment Banking Analyst for the West Coast Healthcare Team at Morgan Stanley. He holds a BA in Business Administration from the University of Notre Dame.

Colin Hislop, MD Chief Medical Officer

Colin has over 27 years of drug development experience in a variety of therapeutic areas, including endocrine disease. Dr. Hislop joined Versartis in 2016 from Anthera Pharmaceuticals, where he was a founding member of Anthera's management team and served as the company's Chief Medical Officer. Before joining Anthera, Dr. Hislop was Vice President, Clinical Development for Peninsula Pharmaceuticals, Inc. and prior to that Vice President, Clinical Development for CV Therapeutics, Inc. He began his industry career with Eli Lilly & Company as a Medical Director for the endocrine portfolio in the UK before moving to Procter & Gamble Co. to lead the initial risedronate (Actonel™) development program. Over the course of his career, Dr. Hislop has helped secure over $300 million in private and public equity financing, and has supported the in-licensing of compounds for development as well out-licensing and partnership opportunities. He has been involved in numerous regulatory interactions for drugs spanning from pre-IND to advisory committee meetings for approval. Among those drugs with approvals are ActonelTM, which went on to realize $1.0 billion in global sales, and RanexaTM, which was one of the key drivers behind Gilead's purchase of CV Therapeutics for $1.4 billion in 2009. Colin obtained his medical degree from Middlesex Hospital Medical School, University of London. He also holds a BS in Medical Biochemistry from the University of Surrey.

Paul Westberg Senior Vice President, Corporate Development

Paul joined Versartis from Bayhill Therapeutics, where he was the Vice President of Business Development responsible for the company’s licensing activities and was a key contributor to its private equity fundraisings, IPO preparations, and operational activities. Most notably, Paul led and closed a transformational $350M+ licensing deal with Genentech/Roche for Bayhill’s novel Phase 1/2 program in type 1 diabetes. Prior to Bayhill, Paul was the Vice President of Business Development at Novacea, where he was responsible for closing multiple transactions including the in-licensing of two clinical-stage oncology products. In addition, he was a key contributor to Novacea’s successful fundraising efforts, which resulted in approximately $100M from private equity financings and IPO. Previously, Paul held managerial positions at Deltagen, Collabra Pharma and Aviron, where he was responsible for establishing transactional, business development and financial planning operations, respectively. Earlier, Paul held positions of increasing responsibility at Genentech, including Manager, Project Finance and Manager, Financial Planning and Analysis. He began his career advising clients on product and company valuation, technology assessment and commercialization issues. Paul holds an MBA from the Haas School of Business at the University of California, Berkeley and a BA in Applied Mathematics from the University of California, San Diego.

Shane M. Ward Senior Vice President, Legal and Compliance

Shane is an attorney and corporate executive with more than fifteen years of pharmaceutical and biotechnology industry experience, having served as an in-house lawyer in large and small public companies as well as working in a specialty FDA practice group at a major Washington, DC law firm. Shane joined Versartis from Dynavax Technologies, Corp. where he was Vice President, Compliance and Associate General Counsel, also serving as the Compliance Officer and Assistant Secretary. He was responsible for all legal matters, including intellectual property, licensing, litigation, securities, corporate governance, regulatory, and healthcare law. Previously, he was Associate General Counsel, Assistant Compliance Officer, and Assistant Secretary at Human Genome Sciences, Inc. until its acquisition by GlaxoSmithKline for $3.6 billion. In that role, he established a commercial legal function and all elements of a comprehensive global compliance program prior to launch of HGS' first commercial product, Benlysta®. At Gilead Sciences, Inc. Shane directed a 9-person specialty regulatory law and healthcare compliance team within the Legal Department and prior to that he served as Senior Counsel, Legal Regulatory & Compliance at Abbott Laboratories. He began his career in the pharmaceutical industry as a medical writer and regulatory scientist at Quintiles, Inc. Shane received his JD cum laude from Georgetown University Law Center and his BA from the University of Virginia.

Bert Bakker, MD, PhD Senior Vice President, Medical Affairs

Bert is a medical affairs executive and clinical development physician with 14 years of pharmaceutical and biotech experience. He joined Versartis from Novartis Oncology, where he was Global Brand Medical Director, Global Medical Affairs. There he led and developed the global medical affairs strategy for the use of two somatostatin analogs in neuro-endocrine tumors. Previously at Ipsen, Bert was Vice President Medical Affairs and led all activities of the US Endocrine Medical Affairs group. He was a key contributor at Genentech for six years as Medical Director in the Clinical Development group, where he covered all four stages of drug development, from early clinical development to post marketing for products including growth hormone. Prior to Genentech, Bert was Medical Director, Worldwide Medical, Endocrine Care at Pfizer, Inc. and also held positions at Pharmacia and Schwarz Pharma Benelux. He is a European Union board certified pediatric endocrinologist and began his medical career as an Assistant Professor at the Academic Medical Center, University of Amsterdam, the Netherlands. He received his MD from the Medical School at the University of Leiden, the Netherlands and his PhD in Medical Sciences from the University of Amsterdam, the Netherlands. While completing a fellowship at Stanford University Bert was the recipient of a Fulbright Scholarship for IGF research. He is widely published and while at Genentech was one of the lead authors of the National Cooperative Growth Study Registry. His most cited publication is on the first year growth results with daily growth hormone in pediatric growth hormone deficiency.

Michael Burdick, RAC Senior Vice President, Regulatory Affairs

Mike has more than 30 years of experience in regulatory affairs and drug development in pharmaceutical and biopharmaceutical industries. During his career, Mike has worked in multiple therapeutic areas including metabolic and endocrine disorders, and has led dozens of successful regulatory submissions in the US, Europe and other countries. Mike joined Versartis in 2015 from SteadyMed Therapeutics, where he led the regulatory development activities for SMT-101, an investigational drug-device combination product for the treatment of pulmonary arterial hypertension. Previously, Mike was Vice President, Product Development at NextWave Pharmaceuticals, where he led NDA submission and approval activities for Quillivant XR. Prior to that, he served in senior management positions in Regulatory Affairs, Quality Assurance & Project Management at Relypsa, Ilypsa, and CV Therapeutics. Mike began his career at The Upjohn Company where he held positions of increasing responsibility during the company's evolution through mergers with Pharmacia, Searle, and lastly Pfizer, where he was Director, Global Regulatory Affairs for Respiratory, Metabolic and Women's Health Products. Mike has a BS in Biochemistry from Michigan State University and has received RAC certification from the Regulatory Affairs Professional Society.

George Bright, MD Vice President, Clinical Development

George is a pediatric endocrinologist with over 35 years experience in clinical care and clinical research. He completed training in Endocrinology at the University of Virginia; and his early research efforts included the treatment of growth problems with pituitary-derived human growth hormone. After 20 years in clinical care, in 1999 he joined the biopharmaceutical industry and has focused primarily on the design, conduct and interpretation of Phase 1, 2 and 3 trials of recombinant human growth hormone (rhGH), recombinant human insulin-like growth factor-1 (rhIGF-I). combination rhGH and rhIGF-I and now at Versartis, a novel long-acting rhGH fusion protein (VRS-317). While Growth Hormone Clinical Research Director for Novo Nordisk Pharmaceuticals (Princeton), he led efforts to evaluate alternative dosing regimens and treatment groups for rhGH. While at Tercica, he led the clinical efforts with rhIGF-I, culminating in FDA and EMA approvals in children with severe primary IGF-I deficiency. George is board certified in Pediatrics and Pediatric Endocrinology.

Eric Humphriss Vice President, Global Clinical Operations

Eric has over 28 years of industry experience in drug development. His focus has been on the conduct of clinical trials with senior management roles in clinical operations at both start-up and large biotech companies. He has held leadership positions in clinical operations at ChemGenex, Genentech, Matrix and SEQUUS. Eric began his career in Clinical Operations at Syntex after six years in supervisory roles of basic animal research. He was responsible for the oversight of all clinical operations activities and management of a $70M operating budget for seven molecules during his five years at Genentech including Nutropin AQ®, Nutropin Depot®, Raptiva®, Xolair®, Pulmozyme®, TNKase® and Activase®. He held leadership roles on NDA submissions and advisory panel defense teams and has been involved with multiple drug approvals including Xolair®, IntraDose and Synribo®. Eric has extensive experience managing Phase 1 through 4 clinical studies in endocrinology and oncology and has overseen multiple global studies in North America, Europe and Australasia. He holds a BA in Biology and Psychology from the University of California, San Diego and an MBA from the University of Phoenix.

Keith Lui Vice President, Marketing

Keith has held pharmaceutical marketing and sales positions for more than a decade and has executive management experience in both US and international operations. Keith joined Versartis from Pharmacylics, Inc. where as Vice President, Marketing, he led the marketing strategy and execution for the launch of the company’s first new chemical entity (NCE), Imbruvica® (ibrutinib), under the FDA’s “breakthrough” and accelerated approval program. In this position, he helped to build the commercial organization and oversee subsequent US and global launches of Imbruvica in multiple oncology indications. Previously, Keith spent more than six years in marketing at Genentech, Inc. working on product teams for Avastin® and Rituxan® and lastly, for the NCE launch of Zelboraf® and its companion diagnostic. Earlier in his career, he worked in oncology pharmaceutical sales at Johnson & Johnson’s Ortho Biotech and prior to that in healthcare investment banking and genomics research. He holds a BA in Integrative Biology from the University of California, Berkeley and an MBA from Vanderbilt University’s Owen Graduate School of Management.

Patrick Murphy Vice President, Manufacturing

Pat has over three decades of industry experience in CMC and operations roles including Manufacturing, Contract Manufacturing, Technical Operations, Pilot Plant Operations, Process Development, Analytical and Formulation Development, Pharmaceutical Development, Quality Assurance, Quality Control, Facilities, Engineering, Supply Chain and Logistics, Purchasing, Environmental Health and Safety, Security and Office Management. His experience includes 19 years at Genentech and he also held executive positions at Abgenix, Acologix and Solstice Neurosciences. During his career, Pat managed the manufacture of over 10 marketed and over 20 clinical products, including guiding more than 10 new products from pilot to full-scale commercial production while ensuring both product and facility compliance with FDA, EMA, Canadian, Korean and Japanese standards. Most of these products generated $200M to over $1B in annual revenues. Additionally, he has been responsible for more than 18 facilities construction projects totaling more than $250M. He has worked closely with corporate partners located in Europe, Japan and South Korea and been directly responsible for worldwide supplies of clinical and marketed products. Pat holds a BS in Biochemistry from The State University of New York at Binghamton.

Gregory S. Yedinak Vice President, Device & Pharmaceutical Development

Greg has nearly 30 years of experience in pharmaceutical development and manufacturing, from small-scale quantities to commercial-scale production. His expertise encompasses working closely with contract services organizations including leading teams of manufacturing, quality, regulatory affairs, medical affairs, marketing, clinical development, and clinical operations in the development and commercialization of both drugs and devices. Prior to joining the team at Versartis, he was Vice President, Operations at Zosano Pharma, which included management of manufacturing, QA/QC, facilities, engineering, supply chain, process development, and system design operations. Previously, Greg was Vice President, Process Sciences and Manufacturing at Nuvelo, Inc. where he was responsible for all process sciences and manufacturing activities for the company’s early and late-stage products using contract services organizations. He also held several manufacturing positions of increasing responsibility at Abgenix, Inc. (Amgen), lastly as Vice President, Manufacturing, Facilities and Engineering. Greg began his career at Genentech, Inc. working for 15 years in various product recovery areas, last of all as Associate Director, Manufacturing Operations. He holds a BS in Biological Sciences from the University of California, Irvine.

Rajendra Mohabir, PhD Vice President, Product Development

Raj has over 20 years of industry experience in research and development. His career began as a Research Scientist at Syntex, followed by 15 years working for Roche, Amgen and Genentech. Raj has provided leadership to research, development and commercialization teams primarily in the cardiovascular and oncology therapeutic areas. He has been involved in the following marketed drugs: Pulmozyme®, TNKase®, Activase®, Tracleer®, Aranesp®, Neupogen and Neulasta ®. In addition, he has managed several product development alliances with small biotechs as well as large biopharma. Most recently, Raj provided consultation and product development expertise for small biotechs, including LoneStar Heart, Inc. where he was involved in early-stage assets in regenerative medicine. Raj holds a BS in Microbiology and Immunology from McGill University, a PhD in Pharmacology from Dalhousie University and he completed postdoctoral training in the Cardiology Division at Stanford University School of Medicine.



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Thu?c Az, Kalecin

Kalecin

Thu?c la gi?

Clarithromycin la m?t khang sinh nhom macrolid. No ch?ng l?i vi khu?n trong co th? c?a b?n.

Clarithromycin du?c s? d?ng d? di?u tr? nhi?u lo?i b?nh nhi?m khu?n ?nh hu?ng d?n da va h? ho h?p. No cung du?c s? d?ng cung v?i cac lo?i thu?c khac d? di?u tr? loet d? day do Helicobacter pylori.

Clarithromycin cung co th? du?c s? d?ng cho cac m?c dich khong du?c li?t ke trong hu?ng d?n thu?c.

Thong tin quan tr?ng toi c?n bi?t v? Kalecin la gi ?

B?n khong nen s? d?ng thu?c nay n?u b?n b? d? ?ng v?i clarithromycin, ho?c cac lo?i thu?c tuong t? nhu azithromycin (Zithromax), erythromycin (EES, EryPed, Ery-Tab, Erythrocin, Pediazole), ho?c telithromycin (Ketek).

B?n khong nen s? d?ng thu?c nay n?u b?n co m?t r?i lo?n nh?p tim de d?a tinh m?ng, m?t l?ch s? c?a h?i ch?ng QT dai, n?u b?n da t?ng co v?n d? v? gan vang da ho?c gay ra b?ng cach l?y clarithromycin, ho?c n?u b?n co gan ho?c b?nh th?n va cung dang dung Colchicine (Colcrys).

Khong s? d?ng clarithromycin n?u b?n cung dang s? d?ng b?t k? thu?c nao du?c li?t ke du?i day. H? co th? tuong tac v?i clarithromycin va gay tac d?ng ph? nghiem tr?ng ho?c de d?a tinh m?ng:

lovastatin (Mevacor, Altoprev, Advicor) ho?c simvastatin (Zocor, Simcor, Vytorin), ho?c

thu?c ergot nhu ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), ho?c dihydroergotamine (DHE 45, Migranal x?t mui).

Dung thu?c nay trong chi?u dai quy d?nh d?y d? th?i gian. Cac tri?u ch?ng c?a b?n co th? c?i thi?n tru?c khi nhi?m trung la hoan toan xoa. Li?u b? qua cung co th? lam tang nguy co nhi?m trung hon n?a co kh? nang khang thu?c khang sinh. Clarithromycin s? khong di?u tr? nhi?m trung do virus nhu c?m l?nh thong thu?ng ho?c cum.

Tru?c khi d? d?ng Kalecin

B?n khong nen s? d?ng thu?c nay n?u b?n b? d? ?ng v?i clarithromycin ho?c cac lo?i thu?c tuong t? nhu azithromycin (Zithromax), erythromycin (EES, EryPed, Ery-Tab, Erythrocin, Pediazole), ho?c telithromycin (Ketek).

B?n khong nen s? d?ng thu?c nay n?u b?n co m?t r?i lo?n nh?p tim de d?a tinh m?ng, m?t l?ch s? c?a h?i ch?ng QT dai, n?u b?n da t?ng co v?n d? v? gan vang da ho?c gay ra b?ng cach l?y clarithromycin, ho?c n?u b?n co gan ho?c b?nh th?n va cung dang dung Colchicine (Colcrys).

Khong s? d?ng clarithromycin n?u b?n cung dang s? d?ng b?t k? thu?c nao du?c li?t ke du?i day. Chung co th? tuong tac v?i clarithromycin va gay tac d?ng ph? nghiem tr?ng ho?c de d?a tinh m?ng:

lovastatin (Mevacor, Altoprev, Advicor) ho?c simvastatin (Zocor, Simcor, Vytorin), ho?c

thu?c ergot nhu ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), ho?c dihydroergotamine (DHE 45, Migranal x?t mui).

D? ch?c ch?n r?ng b?n co th? an toan di clarithromycin, noi v?i bac si c?a b?n n?u b?n co b?t k? cac di?u ki?n khac:

s? m?t can b?ng di?n gi?i (nhu cac m?c th?p c?a kali ho?c magie trong mau c?a b?n);

m?t l?ch s? gia dinh c?a h?i ch?ng QT keo dai, ho?c

n?u b?n co b?t k? c?a cac lo?i thu?c nay nh?p tim - amiodarone (Cordarone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), flecainide (Tambocor), dronedaron (Multaq), ibutilide (Corvert), mexiletin (Mexitil), procainamide ( Procan, Pronestyl), propafenone, (Rythmol), quinidin (Quin-G), ho?c sotalol (Betapace).

FDA thai k? lo?i C. Ngu?i ta khong bi?t li?u clarithromycin s? gay t?n h?i cho thai nhi. Tru?c khi b?n co clarithromycin, noi v?i bac si c?a b?n n?u b?n dang mang thai ho?c d? d?nh co thai trong khi s? d?ng thu?c nay.

Ngu?i ta khong bi?t li?u clarithromycin di vao s?a m? ho?c n?u no co th? gay h?i cho em be bu m?. Khong s? d?ng thu?c nay ma khong noi v?i bac si c?a b?n n?u b?n dang cho con bu.

Khong cho clarithromycin cho m?t d?a tr? du?i 6 thang tu?i.

Ngu?i l?n tu?i co th? co nhi?u kh? nang co tac d?ng ph? tren nh?p tim, bao g?m m?t nh?p tim nhanh de d?a tinh m?ng.

Lam th? nao d? dung Kalecin

Hay dung clarithromycin chinh xac theo quy d?nh c?a bac si. Khong dung s? lu?ng l?n hon ho?c nh? hon ho?c lau hon du?c d? ngh?. Th?c hi?n theo cac hu?ng d?n tren nhan thu?c c?a b?n.

B?n co th? u?ng thu?c clarithromycin va h?n d?ch u?ng (ch?t l?ng) co ho?c khong co th?c an.

Clarithromycin vien gi?i phong keo dai (Biaxin XL) nen du?c th?c hi?n v?i th?c ph?m.

Khong nghi?n nat, nhai, ho?c pha v? m?t clarithromycin vien thu?c gi?i phong keo dai. Nu?t tr?n vien. Pha v? cac vien thu?c co th? gay ra qua nhi?u thu?c s? du?c phat hanh cung m?t luc.

L?c h?n d?ch u?ng (ch?t l?ng) cung ch? c?n tru?c khi b?n do du?c li?u. Do lu?ng ch?t l?ng v?i li?u do mu?ng ho?c ly thu?c d?c bi?t, khong ph?i v?i m?t mu?ng b?ng thong thu?ng. N?u b?n khong co m?t thi?t b? do li?u, hay h?i du?c si m?t.

Dung thu?c nay trong chi?u dai quy d?nh d?y d? th?i gian. Cac tri?u ch?ng c?a b?n co th? c?i thi?n tru?c khi nhi?m trung la hoan toan xoa. Li?u b? qua cung co th? lam tang nguy co nhi?m trung hon n?a co kh? nang khang thu?c khang sinh. Clarithromycin s? khong di?u tr? nhi?m trung do virus nhu c?m l?nh thong thu?ng ho?c cum.

Luu tr? ? nhi?t d? phong tranh ?m va nhi?t. Khong gi? ch?t l?ng u?ng trong t? l?nh.

D?u gi x?y ra n?u toi quen m?t li?u

Dung li?u do ngay khi nh? ra. B? qua li?u da quen n?u no g?n nhu la th?i gian cho li?u k? ho?ch ti?p theo c?a b?n. Khong dung thu?c them d? t?o nen li?u da quen.

Di?u gi x?y ra n?u toi qua li?u

Tim ki?m s? cham soc y t? kh?n c?p ho?c g?i du?ng day nong 115.

Qua li?u cac tri?u ch?ng co th? bao g?m dau b?ng, bu?n non, non m?a ho?c tieu ch?y.

Toi nen tranh nh?ng gi khi dung Kalecin

Thu?c khang sinh co th? gay ra tieu ch?y, co th? la m?t d?u hi?u c?a m?t nhi?m trung m?i. N?u b?n b? tieu ch?y la ch?y nu?c ho?c co mau, ngung dung clarithromycin va g?i cho bac si c?a b?n. Khong s? d?ng thu?c ch?ng tieu ch?y tr? khi bac si noi v?i b?n.

Tac d?ng ph? c?a Kalecin

Nh?n tr? giup y t? kh?n c?p n?u b?n co b?t c? d?u hi?u c?a m?t ph?n ?ng d? ?ng v?i clarithromycin: phat ban, kho th?, sung m?t, moi, lu?i, ho?c h?ng.

G?i cho bac si ngay n?u b?n co m?t tac d?ng ph? nghiem tr?ng nhu:

dau d?u v?i dau ng?c va chong m?t nghiem tr?ng, tim d?p nhanh hay d?p thinh th?ch, kho th?, ng?t x?u;

tieu ch?y la ch?y nu?c ho?c co mau;

s?t, sung h?ch, dau nh?c co th?, cac tri?u ch?ng cum, ho m?i ho?c x?u di;

phat ban da, b?m tim ho?c ch?y mau, ng?a ran, te, dau, y?u co tr?m tr?ng d? dang;

nh?m l?n, non m?a, sung t?y, tang can nhanh, di ti?u it hon binh thu?ng ho?c khong gi c?;

v?n d? v? thinh giac c?a b?n, ho?c

ph?n ?ng da nghiem tr?ng - s?t, dau h?ng, sung m?t ho?c lu?i c?a b?n, d?t chay trong doi m?t c?a b?n, dau da, ti?p theo la m?t phat ban da mau d? ho?c mau tim do lay lan (d?c bi?t la trong cac khuon m?t ho?c co th? phia tren) va gay ph?ng r?p va bong troc.

Clarithromycin cung co th? gay ra cac tri?u ch?ng gan n?ng. Ngung dung clarithromycin va g?i bac si ngay n?u b?n co b?t c? tri?u ch?ng gan:

bu?n non, dau b?ng tren, chan an;

nu?c ti?u d?m mau, d?t set mau phan, ho?c

vang da (vang da ho?c m?t).

Tac d?ng ph? clarithromycin it nghiem tr?ng co th? bao g?m:

dau b?ng, non m?a, tieu ch?y;

mui v? b?t thu?ng ho?c kho ch?u trong mi?ng c?a b?n;

ng?a nh? ho?c phat ban, ho?c

ng?a am d?o ho?c x?.

Day khong ph?i la m?t danh sach d?y d? cac tac d?ng ph? va nh?ng di?u khac co th? x?y ra. G?i cho bac si d? du?c tu v?n y t? v? tac d?ng ph?.

Thong tin d?nh lu?ng c?a Kalecin

Thong thu?ng danh cho ngu?i l?n li?u Clarithromycin cho viem amidan / viem h?ng:

Do Streptococcus pyogenes: Tac d?ng nhanh: 250 mg m?i 12 gi? trong 10 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho viem xoang:

viem xoang ham tren c?p tinh do Haemophilus influenzae, Moraxella catarrhalis, ho?c S pneumoniae: Tac d?ng nhanh: 500 mg m?i 12 gi? trong 14 ngay m? r?ng may tinh b?ng phat hanh: 1000 mg m?i 24 gi? trong 14 ngay

Thong thu?ng danh cho ngu?i l?n li?u Clarithromycin cho viem ph? qu?n:

D?t c?p c?a viem ph? qu?n man tinh: Tac d?ng nhanh: Do H. influenzae: 500 mg m?i 12 gi? trong 7 d?n 14 ngay Do H parainfluenzae: 500 mg m?i 12 gi? trong 7 ngay Do M catarrhalis ho?c S pneumoniae: 250 mg u?ng m?i 12 gi? trong 7 d?n 14 ngay phat hanh may tinh b?ng m? r?ng: Do H. influenzae, H parainfluenzae, M catarrhalis, ho?c S pneumoniae: 1000 mg u?ng m?i gi? 24 trong 7 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho viem ph?i:

C?ng d?ng viem ph?i m?c ph?i: Tac d?ng nhanh: Do H. influenzae: 250 mg m?i 12 gi? trong 7 ngay Do S pneumoniae ho?c Chlamydophila pneumoniae: 250 mg m?i 12 gi? trong 7 d?n 14 ngay phat hanh may tinh b?ng m? r?ng: Do H. influenzae, H parainfluenzae, M catarrhalis, S pneumoniae, ho?c C pneumoniae: 1000 mg m?i 24 gi? trong 7 ngay

Thong thu?ng danh cho ngu?i l?n li?u Clarithromycin cho viem ph?i Mycoplasma:

M?c viem ph?i c?ng d?ng do Mycoplasma pneumoniae: Tac d?ng nhanh: 250 mg m?i 12 gi? trong 7 d?n 14 ngay phat hanh may tinh b?ng m? r?ng: 1000 mg m?i 24 gi? trong 7 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho da va c?u truc nhi?m trung:

Nhi?m trung khong bi?n ch?ng do Staphylococcus aureus ho?c pyogenes S: Tac d?ng nhanh: 250 mg m?i 12 gi? trong 7 d?n 14 ngay

Li?u thong thu?ng danh cho ngu?i l?n d?i v?i nhi?m Helicobacter pylori:

Di?t vi khu?n H pylori d? lam gi?m nguy co tai phat loet ta trang: Tac d?ng nhanh: Ba di?u tr?: Clarithromycin c?ng v?i lansoprazole va amoxicillin: Clarithromycin 500 mg m?i 12 gi? trong 10 d?n 14 ngay Clarithromycin c?ng v?i omeprazole va amoxicillin: Clarithromycin 500 mg m?i 12 gi? 10 ngay di?u tr? kep: Clarithromycin c?ng v?i omeprazole: Clarithromycin 500 mg u?ng m?i 8 gi? trong 14 ngay c?ng v?i Clarithromycin ranitidine bismuth citrate: Clarithromycin 500 mg u?ng m?i 8 d?n 12 gi? trong 14 ngay

Thong thu?ng danh cho ngu?i l?n li?u Clarithromycin cho Mycobacterium avium-intracellulare - D? phong nhi?m:

Tac d?ng nhanh: Phong ch?ng ph? bi?n Mycobacterium avium ph?c t?p (MAC) b?nh ? nh?ng b?nh nhan nhi?m HIV giai do?n: 500 mg u?ng hai l?n m?t ngay Trung tam Ki?m soat va Phong ng?a d?ch b?nh (CDC), Vi?n Y t? Qu?c gia (NIH), va b?nh truy?n nhi?m H?i M? (IDSA) khuy?n ngh? cho b?nh nhan nhi?m HIV: phong chinh c?a b?nh MAC ph? bi?n: 500 mg u?ng hai l?n m?t ngay di?u tr? man tinh b?o tri (d? phong th? phat) cho b?nh MAC ph? bi?n: 500 mg u?ng hai l?n m?t ngay c?ng v?i ethambutol, co ho?c khong co rifabutin d? phong th? c?p thu?ng du?c ti?p t?c trong cu?c s?ng, tuy nhien, khong ti?p t?c co th? du?c xem xet ? nh?ng b?nh nhan ph?c h?i mi?n d?ch b?n v?ng d? dap ?ng v?i di?u tr? khang virus.

Li?u thong thu?ng danh cho ngu?i l?n cho Mycobacterium avium-intracellulare - Di?u tr?:

Tac d?ng nhanh: Di?u tr? cac b?nh nhi?m trung ph? bi?n mycobacteria do MAC: 500 mg u?ng hai l?n m?t ngayClarithromycin nen du?c s? d?ng k?t h?p v?i cac d?i ly antimycobacterial khac da th? hi?n trong ho?t d?ng in vitro d?i v?i MAC ho?c l?i ich lam sang trong di?u tr? MAC. di?u tr? Clarithromycin nen ti?p t?c cho cu?c s?ng n?u c?i ti?n mycobacteria lam sang du?c quan sat. CDC, NIH, va khuy?n ngh? IDSA:Di?u tr? cac b?nh nhi?m trung MAC ph? bi?n ? nh?ng b?nh nhan nhi?m HIV: 500 mg u?ng hai l?n m?t ngay c?ng v?i ethambutol, co ho?c khong co rifabutin Di?u tr? ph?i h?p v?i it nh?t 2 lo?i thu?c du?c khuy?n khich. Di?u tr? ?c ch? m?n tinh (d? phong th? phat) nen sau khi di?u tr? ban d?u.

Li?u thong thu?ng danh cho ngu?i l?n cho vi khu?n viem n?i tam m?c Phong ng?a:

(Khong ch?p thu?n c?a FDA) American Heart Association (AHA) khuy?n cao cho b?nh nhan d? ?ng v?i penicillin: Tac d?ng nhanh: 500 mg u?ng li?u duy nh?t 30 d?n 60 phut tru?c khi ph?u thu?t

Thong thu?ng danh cho ngu?i l?n li?u Clarithromycin cho viem ph?i:

(Khong ch?p thu?n c?a FDA) b?nh Legionnaires ': Tac d?ng nhanh: 500 mg m?i 12 gi? Th?i gian: 10 ngay d?i v?i b?nh nhi?m trung nh? ? nh?ng b?nh nhan co h? mi?n d?ch d?n trung binh, 3 tu?n co th? la c?n thi?t d? ngan ng?a tai phat, d?c bi?t la ? nh?ng b?nh nhan nhi?m khu?n n?ng hon ho?c v?i co b?n Comorbidity ho?c suy gi?m mi?n d?ch

Li?u thong thu?ng danh cho ngu?i l?n cho ho ga - D? phong:

(Khong ch?p thu?n c?a FDA) khuy?n cao c?a CDC cho di?u tr? va d? phong sau phoi: Tac d?ng nhanh: 500 mg m?i 12 gi? trong 7 ngay

Li?u thong thu?ng danh cho ngu?i l?n cho ho ga:

(Khong ch?p thu?n c?a FDA) khuy?n cao c?a CDC cho di?u tr? va d? phong sau phoi: Tac d?ng nhanh: 500 mg m?i 12 gi? trong 7 ngay

Li?u thong thu?ng ? tr? em Clarithromycin cho viem amidan / viem h?ng:

Do S pyogenes: Tac d?ng nhanh: 7,5 mg / kg u?ng m?i 12 gi? trong 10 ngay

Li?u thong thu?ng cho tr? em viem xoang:

viem xoang ham tren c?p tinh do H. influenzae, M catarrhalis, ho?c S pneumoniae: Tac d?ng nhanh: 7,5 mg / kg u?ng m?i 12 gi? trong 10 ngay

Li?u thong thu?ng cho tr? em viem ph?i:

M?c viem ph?i c?ng d?ng do ph? c?u M, S pneumoniae, ho?c C pneumoniae: Tac d?ng nhanh: 7,5 mg / kg u?ng m?i 12 gi? trong 10 ngay

Li?u thong thu?ng cho tr? em viem tai gi?a:

Nhi?m trung c?p tinh do H. influenzae, M catarrhalis, ho?c S pneumoniae: Tac d?ng nhanh: 7,5 mg / kg u?ng m?i 12 gi? trong 10 ngay

Li?u tr? em binh thu?ng cho da va c?u truc nhi?m trung:

Nhi?m trung khong bi?n ch?ng do S aureus ho?c S pyogenes: Tac d?ng nhanh: 7,5 mg / kg u?ng m?i 12 gi? trong 10 ngay ap xe thu?ng yeu c?u thoat nu?c ph?u thu?t.

Li?u tr? em thong thu?ng cho vi khu?n Mycobacterium avium-intracellulare - D? phong:

Tac d?ng nhanh: Phong ch?ng b?nh ph? bi?n MAC ? nh?ng b?nh nhan nhi?m HIV giai do?n: 20 thang tu?i tr? len: 7,5 mg / kg (t?i da: 500 mg / li?u) u?ng hai l?n m?t ngay CDC, NIH, IDSA, va American Academy of Pediatrics (AAP) khuy?n ngh? cho tr? so sinh va tr? em b? phoi nhi?m HIV va nhi?m HIV: phong chinh c?a nhi?m trung MAC: 7,5 mg / kg (t?i da: 500 mg / li?u) u?ng hai l?n m?t ngayphong ch?ng cac b?nh nhi?m trung th? c?p MAC: 7,5 mg / kg (t?i da: 500 mg / li?u) u?ng hai l?n m?t ngay c?ng v?i ethambutol, co ho?c khong co rifabutin CDC, NIH, va khuy?n ngh? IDSA cho thanh thi?u nien nhi?m HIV: phong chinh c?a b?nh MAC ph? bi?n: 500 mg u?ng hai l?n m?t ngay di?u tr? duy tri man tinh (d? phong th? phat) cho ph? bi?n MAC b?nh: 500 mg u?ng hai l?n m?t ngay c?ng v?i ethambutol, co ho?c khong co rifabutin d? phong th? c?p thu?ng du?c ti?p t?c trong cu?c s?ng, tuy nhien, khong ti?p t?c co th? du?c xem xet ? nh?ng b?nh nhan ph?c h?i mi?n d?ch b?n v?ng d? dap ?ng v?i di?u tr? khang virus.

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Tac d?ng nhanh: Di?u tr? cac b?nh nhi?m trung ph? bi?n mycobacteria do MAC: 20 thang tu?i tr? len: 7,5 mg / kg (t?i da: 500 mg / li?u) u?ng hai l?n m?t ngay Clarithromycin nen du?c s? d?ng k?t h?p v?i cac d?i ly antimycobacterial khac da th? hi?n trong ho?t d?ng in vitro ch?ng l?i. MAC ho?c l?i ich lam sang trong di?u tr? MAC. di?u tr? Clarithromycin nen ti?p t?c cho cu?c s?ng n?u c?i ti?n mycobacteria lam sang du?c quan sat CDC, NIH, IDSA, va khuy?n ngh? AAP cho b? phoi nhi?m HIV va nhi?m HIV tr? so sinh va tr? em: Di?u tr? cac b?nh nhi?m trung MAC: 7,5-15 mg / kg (t?i da: 500 mg / li?u) u?ng hai l?n m?t ngay c?ng v?i ethambutol, co ho?c khong co rifabutin CDC, NIH, va khuy?n ngh? IDSA cho thanh thi?u nien nhi?m HIV: Di?u tr? cac b?nh nhi?m trung ph? bi?n MAC: 500 mg u?ng hai l?n m?t ngay c?ng v?i ethambutol, co ho?c khong co rifabutin Di?u tr? ph?i h?p v?i it nh?t 2 lo?i thu?c du?c khuy?n khich. Di?u tr? ?c ch? m?n tinh (d? phong th? phat) nen sau khi di?u tr? ban d?u.

Li?u thong thu?ng cho tr? em ho ga - d? phong:

(Khong ch?p thu?n c?a FDA) khuy?n cao c?a CDC cho di?u tr? va d? phong sau phoi: Tac d?ng nhanh: 1-5 thang: 7,5 mg / kg u?ng m?i 12 gi? trong 7 ngay 6 thang tu?i tr? len: 7,5 mg / kg (t?i da: 500 mg / li?u) u?ng m?i 12 gi? trong 7 ngay

Li?u thong thu?ng cho tr? em ho ga:

(Khong ch?p thu?n c?a FDA) khuy?n cao c?a CDC cho di?u tr? va d? phong sau phoi: Tac d?ng nhanh: 1-5 thang: 7,5 mg / kg u?ng m?i 12 gi? trong 7 ngay 6 thang tu?i tr? len: 7,5 mg / kg (t?i da: 500 mg / li?u) u?ng m?i 12 gi? trong 7 ngay

Li?u tr? em thong thu?ng cho vi khu?n viem n?i tam m?c - phong ng?a:

(Khong ch?p thu?n c?a FDA) khuy?n cao c?a AHA cho tr? em b? d? ?ng v?i penicillin: Tac d?ng nhanh: 15 mg / kg (t?i da: 500 mg) du?ng u?ng nhu m?t li?u duy nh?t 30 d?n 60 phut tru?c khi th? t?c y t?

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DRUG CLASS AND MECHANISM: Bupropion is an antidepressant medication that affects chemicals within the brain that nerves use to send messages to each other. These chemical messengers are called neurotransmitters. Many experts believe that depression is caused by an imbalance among the amounts of neurotransmitters that are released. Nerves, in a process referred to as reuptake, may recycle released neurotransmitters. Bupropion works by inhibiting the reuptake of dopamine. serotonin. and norepinephrine; an action that results in more dopamine, serotonin, and norepinephrine to transmit messages to other nerves. Bupropion is unique and unlike other antidepressants in that its major effect is on dopamine, an effect that is not shared by the selective serotonin reuptake inhibitors or SSRIs (for example, paroxetine [Paxil ], fluoxetine [Prozac ], sertraline [Zoloft ]) or the tricyclic antidepressants or TCAs (for example, amitriptyline [Elavil. Endep ], imipramine [Tofranil ], desipramine [Norpramin ]). The FDA approved bupropion in December 1985.

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Napacetin - Pharmacology:

The exact mechanisms of action of Napacetin is unknown. Its antiinflammatory effects are believed to be due to inhibition of both cylooxygenase-1 (COX-1) and cylooxygenase-2 (COX-2) which leads to the inhibition of prostaglandin synthesis, and results in the inhibition of prostaglandin synthesis. Antipyretic effects may be due to action on the hypothalamus, resulting in an increased peripheral blood flow, vasodilation, and subsequent heat dissipation.

Napacetin for patients

Napacetin is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation, reduce fever, and treat osteoarthritis, rheumatoid arthritis, and menstrual cramps. Inform your physician if you are pregnant or nursing. Napacetin should not be taken during the last three months of pregnancy. Inform your physician if you use alcohol chronically. Napacetin should not be taken with aspirin products. This medication should be taken with food, milk or antacids if stomach upset occurs. Napacetin may cause dizziness and drowsiness; use caution while driving or operating hazardous machinery. Napacetin may cause increased sensitivity to sunlight. Use sunscreens and wear protective clothing until degree of sensitivity is determined. Notify your physician if you develop stomach pain, bloody vomit, bloody or black tarry stools, cloudy urine, trouble breathing, rash or hives.

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Coumarin-Type Anticoagulants: Several short-term controlled studies failed to wshow that ibuprofen significantly affected prothrombin times or a variety of other clotting factors when administered to individuals on coumarin-type anticoagulants. However, because bleeding has been reported when ibuprofen and other nonsteroidal anti-inflammatory agents have been administered to patients on coumarin-type anticoagulants, the physician should be cautious when administering ibuprofen to patients on anticoagulants.

Aspirin: Animal studies wshow that aspirin given with nonsteroidal anti-inflammatory agents, including ibuprofen, yields a net decrease in anti-inflammatory activity with lowered blood levels of the non-aspirin drug. Single dose bioavailability studies in normal volunteers have failed to wshow an effect of aspirin on ibuprofen blood levels. Correlative clinical studies have not been performed.

Methotrexate: Napacetin, as well as other nonsteroidal anti-inflammatory drugs, probably reduces the tubular secretion of methotrexate based on in vitro studies in rabbit kidney slices. This may indicate that ibuprofen could enhance the toxicity of methotrexate. Caution should be used if ibuprofen is administered concomitantly with methotrexate.

H-2 Antagonists: In studies with human volunteers, co-administration of cimetidine or ranitidine with ibuprofen had no substantive effect on ibuprofen serum concentrations.

Furosemide: Clinical studies, as well as random observations, have shown that ibuprofen can reduce the natriuretic effect of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis. During concomitant therapy with ibuprofen, the patient should be observed closely for signs of renal failure, as well as to assure diuretic efficacy.

Lithium: Napacetin produced an elevation of plasma lithium levels and a reduction in renal lithium clearance in a study of eleven normal volunteers. The mean minimum lithium concentration increased 15% and the renal clearance of lithium was decreased by 19% during this period of concomitant drug administration.

This effect has been attributed to inhibition of renal prostaglandin synthesis by ibuprofen. Thus, when ibuprofen and lithium are administered concurrently, subjects should be observed carefully for signs of lithium toxicity. (Read circulars for lithium preparation before use of such concurrent therapy).

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FORMA FARMACEUTICA E APRESENTACOES: - CYCRAM Cycram apresenta - se sob as formas de comprimidos revestidos e liofilo injetavel. Os comprimidos revestidos de Cycram sao redondos, de coloracao branca, para administracao oral, contendo 50mg de Ciclofosfamida cada. Acondicionados em frascos plasticos opacos com 50 comprimidos. O liofilo injetavel de Cycram, de coloracao branca, contendo 200mg ou 1g de Ciclofosfamida, destina - se a administracao parenteral, apos sua reconstituicao com o diluente apropriado. Caixas contendo 10 frascos-ampolas, para a apresentacao de 200mg, e 1 ou 10 frasco(s)-ampola(s) para a apresentacao de 1g.

USO ADULTO E PEDIATRICO

Comprimido revestido de 50mg: Cada comprimido revestido contem: Ciclofosfamida. 50 mg Hidroxipropilcelulose. 100 mg Lactose. 43,2 mg Povidona. 04,8 mg Estearato de Magnesio. 2 mg Hidroxipropilmetilcelulose. 13 mg Dioxido de Titanio. 1,3 mg Propilenoglicol. q. s.

Liofilo injetavel de 200mg: Cada frasco - ampola contem: Ciclofosfamida. 200 mg Cloreto de Sodio. 90 mg

Liofilo injetavel de 1g: Cada frasco - ampola de 1g contem: Ciclofosfamida. 1000 mg Cloreto de Sodio. 450 mg

INFORMACOES AO PACIENTE: - CYCRAM O medicamento (tanto os comprimidos revestidos como o liofilo injetavel) deve ser conservado em sua embalagem original, sob temperatura entre 15 ?C e 25 ?C, ao abrigo da luz, calor e umidade excessiva. Reconstituir Cycram Injetavel somente em Agua Esteril para Injecoes. Apos a reconstituicao, sob temperatura ambiente, caso ocorra precipitacao ou turbidez da solucao, o produto devera ser descartado. O prazo de validade de Cycram (tanto para os comprimidos revestidos como para o liofilo injetavel) e de 36 meses, a contar das suas datas de fabricacao, nas condicoes acima citadas, estando esses dados impressos em suas embalagens externas. Qualquer conteudo remanescente no frasco - ampola de Cycram Injetavel deve ser descartado.

" NAO USE O MEDICAMENTO SE O PRAZO DE VALIDADE ESTIVER VENCIDO"

Informe seu medico a ocorrencia de gravidez1 na vigencia do tratamento ou apos seu termino. Informe seu medico se esta amamentando. Siga a orientacao do seu medico, respeitando sempre os horarios, as doses e a duracao do tratamento. Nao interromper o tratamento sem o conhecimento do seu medico. Informe seu medico o aparecimento de reacoes desagradaveis.

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INFORMACOES TECNICAS - CYCRAM

Modo de Acao: Ciclofosfamida e uma mostarda alquilante. Apos sua conversao em metabolitos ativos no figado2.Cilcofosfamisa atua como um agente alquilante, interferindo na replicacao do DNA e na transdricao do RNA, resultando em interrupcao da funcao do acido nucleico. Ciclofosfamisa tem propriedades fosforilantes que aumentam sua citotoxicidade. Ciclofosfamida tambem apresenta potente atividade imunossupressora.

Farmacocinetica: Ciclofosfamida e bem absorvida apos administracao oral, com biodisponibilidade maior que 75‰. A concentracao plasmatica maxima ocorre em torno de 1 hora. A droga inalterada tem meia - vida de 3 a 12 horas. A maior parte da dose e eliminada na forma de metabolitos, porem, de 5‰ a 25‰ da dose e excretada na urina3, sob forma inalterada. Ainda nao se sabe qual e a atividade especifica de cada metabolito. Varios metabolitos citotoxicos e nao - citotoxicos tem sido identificados na urina3 e no plasma4. Concentracoes plasmaticas dos metabolitos atingem o pico maximo apos 2 a 3 horas da dose intravenosa. Ciclofosfamida liga - se pouco a proteinas5 plasmaticas, porem alguns metabolitos ligam-se em ate 60‰. Apesar de ocorrer um aumento nos niveis de metabolitos em pacientes com comprometimento renal6, nao foi observado aumento dos efeitos toxicos nesses pacientes. Ciclofosfamida e seus metabolitos distribuem - se rapidamente atraves do corpo todo, inclusive no cerebro e SNC. Ciclofosfamida atravessa a barreira placentaria e e excretada no leite materno. Ciclofosfamida e metabolizada no figado2 pelo sistema enzimatico de funcao mista da oxidase dos microssomos hepaticos para 4- hidroxiciclofosfamida, que esta em equilibrio com a aldofosfamida. A 4-hidroxiciclofosfamida pode ser metabolizada enzimaticamente para 4-cetociclofosfamida. Aldofosfamida pode ser metabolizada enzimaticamente para carboxifosfamida, mostarda fosforamida e acroleina. Alguns estudos demostraram que mostarda fosforamida e acroleina podem aumentar as propriedades citotoxicas da Ciclosfofamida. Ciclofosfamida e seus metabolitos sao excretados, principalmente, na urina3, sendo que 36‰ a 99‰ da dose e eliminada em 48 horas.

INDICACOES: - CYCRAM Cycram e um agente antineoplasico usado no tratamento de linfomas malignos, doenca de Hodgkin7, linfoma8 linfocitico (nodular ou difuso), linfomas de celulas mistas, linfoma8 histiocitico, linfoma8 de Burkitt, mieloma9 multiplo, leucemia10 linfocitica cronica, leucemia10 granulocitica cronica, leucemias mielogenica e monocitica agudas, leucemia10 linfoblastica aguda em criancas, linfoma8 de celula11- T cutanea, neuroblastoma, adenocarcinoma12 de ovario13, retinoblastoma e carcinoma14 de mama. Devido a sua acao imunomoduladora, pode ser usado em artrite reumatoide15, granulose de Wegener, lupo eritematoso sistemico, poliomiosite, esclerose multipla16 e na profilaxia de rejeicao a transplantes. Contudo, o uso de Cycram, em situacoes que nao envolvem neoplasias, deve ser feito com extremo cuidado, porque este medicamento possui potencial carcinogenico.

CONTRA-INDICACOES: - CYCRAM Cycram e contra - indicado nas seguintes situacoes: *Varicela17 existente ou recente; *Herpes zoster18; *Pacientes que apresentaram hipersensibilidade a Ciclofosfamida ou a qualquer outro componente da formula deste medicamento; *Pacientes com depressao de medula ossea grave; *Pacientes que receberam terapia anterior com pentostatina.

Cycram deve ser utilizado com cautela nas seguintes situacoes: *Pacientes com leucopenia19; *Pacientes com trombocitopenia20; *Pacientes com tumor21 de celulas de infiltracao de medula ossea; *Pacientes que receberam terapia previa com raio X; *Pacientes tratados previamente com outros agentes citotoxicos; *Pacientes com funcao renal6 ou hepatica prejudicada.

PRECAUCOES GERAIS: - CYCRAM Cycram pode reprimir o inicio do mecanismo de ativacao do sistema imunologico. Assim, a dose de controle ou a descontinuidade do tratamento em pacientes com infeccao22 viral, fungica ou bacteriana devem ser consideradas. A administracao de Cycram a pacientes recentemente tratados com esteroides, a pacientes com administracao concomitante de drogas esteroidais pode ser fatal e deve ser feita apos criteriosa avaliacao e com muita cautela. Sao necessarios ajustes nas doses de Cycram e doses de reposicao de esteroides em pacientes adrenalectomizados. Cycram pode interferir na cicatrizacao normal de feridas. Cardiotoxicidade tem sido observada em alguns pacientes recebendo altas doses de Cycram (120 a 270mg/Kg), administradas por um periodo de alguns dias, geralmente, como parte de um tratamento intensivo com varios antineoplasicos ou junto a procedimentos para transplantes. Em alguns casos, apos a administracao de altas doses de Cycram tem ocorrido grave insuficiencia cardiaca congestiva23 (ICC), as vezes fatal. Este efeito pode ocorrer ate mesmo alguns dias apos a primeira dose. Exame histopatologico demonstrou, primariamente, miocardite24 hemorragica. Nenhuma outra anormalidade cardiaca, evidenciada por eletrocardiograma25 ou ecocardiograma26, foi observada em pacientes que sobreviveram a episodios de cardiotoxicidade, aparentemente associada com altas doses de Cycram. Doencas malignas secundarias podem desenvolver - se em alguns pacientes tratados com Cycram, usado em terapia unica ou associado a outras drogas antineoplasicas. As mais frequentes estao relacionadas a doencas malignas da bexiga27, doencas malignas mieloproliferativas ou linfoproliferativas. Doencas malignas secundarias sao detectadas frequentemente em pacientes portadores de doencas primarias mieloproliferativas ou linfoproliferativas, malignas ou nao - malignas, nos quais as respostas imunes estao envolvidas patologicamente. Doencas malignas secundarias de bexiga27 ocorrem, geralmente, em pacientes que tiveram cistite28 hemorragica. Cistite28 hemorragica pode surgir em pacientes tratados com Cycram, e considera - se que e um efeito relacionado a um metabolito. Para reduzir o risco de cistite28 hemorragica, deve-se proceder a hidratacao oral adequada antes do tratamento com Cycram e apos 72 horas, a fim de assegurar amplo rendimento urinario. O paciente deve ser estimulado a usar Cycram pela manha, pois, desta maneira, a maioria dos metabolitos sera excretada ate a noite, prevenindo o contato noturno prolongado com os metabolitos e, consequentemente, irritacao da bexiga27. Ao primeiro sinal29 de cistite28 hemorragica, suspender o uso de Cycram. Celulas epiteliais atipicas de bexiga27 sao observadas na urina3. O desenvolvimento de nefropatia30 por acido urico, em pacientes com leucemia10 ou linfoma8, pode ser prevenido por hidratacao oral adequada, e em alguns casos, com a administracao de alopurinol. A alcalinizacao da urina3 pode ser necessaria se a concentracao serica de acido urico estiver elevada. Leucopenia19 e usada como referencia para os efeitos esperados do tratamento. Anemia31 pode ocorrer em alguns pacientes sendo de carater reversivel. No caso de leucopenia19 acentuada (principalmente, granulocitopenia) ou trompocitopenia, a terapia deve ser suspensa ate que os niveis de leucocitos32 e plaquetas33 sejam satisfatorios e, entao, reiniciar a terapia com doses menores. Os pacientes com leucopenia19 devem ser cuidadosamente monitorados quanto aos sinais34 de infeccao22. Pode haver necessidade do uso de antibioticos. Em pacientes neutropenicos e com febre35, utilizar, inicialmente, antibioticos de largo espectro ate o diagnostico36 microbiano ser definido. A depressao medular ossea pode aumentar a incidencia37 de infeccao22 microbiana, cura demorada e hemorragia38 gengival. No tratamento com Cycram tambem tem sido observado supressao das gonadas, resultando em amenorreia39 ou aspermatismo. Contudo, apesar de estes efeitos serem reversiveis devem ser considerados.

Uso na gravidez1 e lactacao40: A droga demonstrou possivel teratogenicidade em animais e absorcao pelo feto. Cycram somente deve ser usado durante a gravidez1 quando os possiveis beneficios para a mae superarem claramente os potenciais riscos para o feto. Homens e mulheres ferteis devem ser informados do potencial mutagenico da droga e orientados a usarem metodos anticoncepcionais adequados, durante a terapia com Cycram. Cycram e excretado no leite materno. A amamentacao41 deve ser suspensa durante a terapia.

Uso em criancas: Cycram pode ser usado em criancas, adequando - se as doses a essa faixa etaria.

INTERACOES MEDICAMENTOSAS: - CYCRAM Mesna e um composto sulfidril sintetico que interage com os metabolitos urotoxicos de Cycram e outros derivados oxazafosforinicos, diminuindo a gravidade ou prevenindo toxicidade de bexiga27 (como cistite28 hemorragica) induzida por essas drogas. Devido a cardiotoxicidade potencial, deve - se ter cautela na administracao concomitante de Cycram e outras drogas cardiotoxicas como a doxorrubicina. Barbituricos e outras drogas que induzem enzimas microssomais hepaticas podem resultar em aumento dos efeitos farmacologicos e da toxicidade de Cycram devido ao aumento da conversao da droga em metabolitos ativos. Apesar de a importancia clinica completa dessa interacao nao ter sido estabelecida, e importante monitorar pacientes que recebem essas drogas simultaneamente quanto a toxicidade de Cycram. O uso simultaneo de azatioprina, ciclosporina, mercaptopurina e corticoides pode aumentar o risco de infeccao22 e desenvolvimento de neoplasias. Cycram pode potencializar os efeitos induzidos pela doxorrubicina. Devido ao aumento da concentracao de acido urico no sangue42, pode ser necessario adequar a dose de alopurinol, colchicina, probenecida ou sulfimpirazona. Cycram pode reduzir as concentracoes sericas de pseudocolinesterase e pode prolongar o bloqueio da atividade neuromuscular da succinilcolina, especialmente, em pacientes que estao recebendo altas doses de Cycram por via intravenosa. Apesar de a importancia clinica dessa interacao nao ter sido devidamente esclarecida, recomenda - se cautela no tratamento. Cycram pode interferir com vacinas de virus43 vivos porque, estando suprimidos os mecanismos de defesa normal, pode haver potencializacao da replicacao do virus43 da vacina44 e diminuicao na formacao de anticorpos45.

REACOES ADVERSAS: - CYCRAM Disfuncoes cardiacas, insuficiencia cardiaca congestiva23 (ICC), doencas malignas de bexiga27, doencas malignas linfoproliferativas, doencas malignas mieloproliferativas, leucopenia19, anemia31, anorexia46, nausea47, vomito48, ulceracao da mucosa49 oral, ictericia50, colite51 hemorragica, cistite28 hemorragica e nao - hemorragica, hematuria52, toxicidade renal6 manifestada por hemorragia38 e conglobacao na pelvis renal6, amenorreia39, aspermatismo, fibrose ovariana, alopecia, pigmentacao da pele e mudancas nas unhas53, e fibrose intersticial pulmonar.

POSOLOGIA: - CYCRAM *Adultos: No tratamento com Cycram, como antineoplasico, a dose inicial para pacientes com quadro hematologico normal pode ser de 40 a 50mg/Kg, por via intravenosa, dividida em um periodo de 2 a 5 dias, ou doses de 10 a 15mg/Kg, a cada 7 a 10 dias, ou ainda doses de 3 a 5mg/Kg, 2 vezes por semana. A dose de manutencao pode seguir os mesmos padroes. Para o tratamento de pacientes que foram tratados previamente com terapia de raio X ou agentes antineoplasicos, os quais deprimem a medula ossea, ou em pacientes cuja medula possui infiltracoes tumorais, a dose recomendada e a metade ou um terco da dose inicial. A dose para uso oral deve ser de 1 a 5mg/Kg por dia, tanto para dose inicial como para a dose de manutencao. Como imunomodulador, a dose pode variar de 1 a 2mg/Kg ao dia.

*Criancas: A dose no tratamento com Cycram, como antineoplasico, tanto para uso oral como para uso intravenoso, pode ser de 2 a 8mg/Kg por dia ou 60 a 250mg/m2 por dia, fracionada em 6 ou mais dias. A dose total de 7 dias pode ser administrada uma vez por semana. Para manutencao, a dose pode ser de 2 a 5mg/Kg, por via oral, 2 vezes por semana, e a dose intravenosa, de 10 a 15mg/Kg, por via intravenosa, a cada 7 a 10 dias, ou 30mg/Kg, em intervalos de 3 a 4 semanas, ou ate a medula ossea recuperar - se. Como imunomodulador, na Sindrome Nefrotica54, a dose recomendada e de 2,5 a 3mg/dia, por um periodo de 60 a 90 dias. Tanto para adultos como para criancas deve - se monitorar a quantidade de celulas brancas sanguineas e respeitar o limite de tolerancia do paciente ao tratamento, fazendo-se adequacao de dose quando necessario, e evitando leucopenia19 e outras infeccoes mais complicadas.

*Po Liofilo Injetavel: Como se trata de um agente antineoplasico, devem ser considerados os procedimentos especificos quanto a manipulacao e descarte dessas drogas. Supervisao medica, por especialistas nesta area, e necessaria. Devem ser observados todos os cuidados de assepsia durante toda a manipulacao do medicamento ate o termino da injecao55. Solucoes para administracao parenteral devem ser inspecionadas visualmente em relacao a particulas em suspensao ou descoloracao da solucao ou depositos, caso a solucao e a embalagem permitam. Solucoes reconstituidas de Cycram Injetavel podem ser administradas por vias intravenosa, intramuscular, intraperitoneal e intrapleural. Qualquer porcao nao utilizada da solucao reconstituida deve ser descartada.

Reconstituicao: Cycram Injetavel deve ser reconstituido em Agua Esteril para Injecoes. Usar a quantidade de diluente apresentada abaixo para reconstituir o produto:

Dose Quantidade de Diluente 200 mg 10 mL 1g 50 mL

A solucao obtida pode ser, posteriormente, diluida em Dextrose56 Injetavel 5‰, Dextrose56 e Cloreto de Sodio Injetavel (5‰ e 0,9‰), Dextrose56 5‰ e Ringer Injetavel, Cloreto de Sodio Injetavel 0,45‰, Lactato de Sodio 1/6M Injetavel. A solucao reconstituida de Cycram nao contem conservantes antimicrobianos devendo ser portanto, usada imediatamente, apos reconstituicao, ou dentro de um periodo maximo de 6 horas. Preparacoes liquidas extemporaneas de Cycram para uso oral podem ser preparadas pela diluicao de Cycram Injetavel em veiculo apropriado (ex: Elixir Aromatico). A concentracao dessa solucao deve ser 1 a 5mg de Ciclofosfamida por mL. Essa preparacao deve ser conservada sob refrigeracao por ate 14 dias.

*Comprimidos Revestidos: Os comprimidos de Cycram devem ser deglutidos inteiros, preferencialmente, com estomago57 vazio e com bastante agua. Se ocorrer desconforto gastrico, as doses podem ser fracionadas e ingeridas com alimentos. Nao mastigar. Lavar as maos apos tocar os comprimidos.

SUPERDOSAGEM: - CYCRAM Nao se conhece nenhum antidoto58 especifico para Cycram. O tratamento para superdosagem deve conter medidas de suporte, incluindo tratamento apropriado para qualquer infeccao22 presente. Mielossupressao ou toxicidade cardiaca podem ocorrer.

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For oral administration bioavailability is 15-30%. Widely distributed in tissues and body fluids. Plasma protein binding is 9-33%. Metabolised in liver. T1/2 for oral administration - 3.3 h, intravenous - 2.5 hours; Acyclostad excreted in the urine, also in small quantities - with feces.

Why is Acyclostad prescribed?

For systemic use (oral and IV): infections caused by Herpes Simplex virus types 1 and 2 and Varicella Zoster; prevention of infections caused by viruses Herpes Simplex and Varicella Zoster (including in patients with low immunity); in combined therapy with the pronounced immunodeficiency (including in the clinical picture of HIV infection) and in patients undergoing marrow transplantation, prevention of cytomegalovirus infection after marrow transplantation.

For topical use in ophthalmology: keratitis and other eye damage caused by Herpes Simplex virus.

For external use: infections of the skin caused by Herpes Simplex virus and Varicella Zoster like Herpes Simplex of the skin and mucous membranes, genital herpes (primary and recurrent) localized zoster (support therapy).

Dosage and administration

Acyclostad for oral usage for adults and children older than 2 years - 200-400 mg of 3-5 times / day, if necessary - to 20 mg / kg (up to 800 mg per dose) 4 times / day. For children under 2 years are used in doses equal to half the adult dose. Duration of treatment - 5-10 days. In renal insufficiency is recommended correction dosing regimen.

IV in adults and children over 12 years - 5-10 mg / kg, the interval between infusions - 8 hours. Children under the age of 3 months to 12 years - 250-500 mg / m2 body surface, the interval between infusions - 8 hours, for infants dose is 10 mg / kg, the interval between infusions - 8 hours.

In renal insufficiency must be corrected dosing regimen.

Locally and externally applied 5 times / 24 h. Dose and duration of treatment depends on the testimony and the use of dosage form.

Maximum dose for adults for IV usage is 30 mg / kg / 24 h

Acyclostad side effects, adverse reactions

For oral usage: nausea, vomiting, diarrhea, abdominal pain, skin rash, headache, dizziness, fatigue, reduced concentration, hallucinations, drowsiness or insomnia, fever, rarely - hair loss, a transient increase in blood concentrations of bilirubin, urea, creatinine, liver enzymes, lymphocytopenia, eritropeniya, leukopenia.

For IV usage: acute renal failure, crystalluria, encephalopathy (confusion, hallucinations, agitation, tremors, convulsions, psychosis, drowsiness, coma), phlebitis, or inflammation at the injection site, nausea, vomiting.

For topically usage: a burning sensation in the application area, superficial punctate keratitis, blepharitis, conjunctivitis.

For external usage: in the application area may be a burning sensation, skin rash, itching, peeling, erythema, dry skin in contact with mucous membranes - inflammation.

Hypersensitivity to Acyclostad and valaciclovir; for IV usage - lactation (breast feeding).

Using during pregnancy and breastfeeding

Pregnancy. Perhaps, if the expected effect of the therapy outweighs the potential risk to the fetus (adequate and strictly controlled studies of safety in pregnant women is not conducted); Acyclostad passes through the placenta. Data on the outcome of pregnancy in women taking Acyclostad systemic action in the I trimester of pregnancy showed no increase in birth defects compared with the total population. Since the observation was included a small number of women, reliable and definitive conclusions about the safety of Acyclostad in pregnancy can be done.

Breastfeeding. Acyclostad penetrates into breast milk. After taking Acyclostad by mouth, it was determined in breast milk in concentrations, the ratio of which, with concentrations in blood plasma was 0,6-1,4. At these concentrations in breast milk, children who are breastfed can receive Acyclostad at a dose of 0.3 mg / kg / day. Given this, should appoint Acyclostad lactating women with caution, only if necessary.

Do not use Acyclostad with severely impaired renal function.

Note that the application of Acyclostad may develop acute renal failure due to precipitate formation of crystals of acyclovir, which is especially likely during rapid IV introduction, the simultaneous use of nephrotoxic drugs in patients with impaired renal function and lack of water stress.

When applying aciclovir should monitor renal function (determination of the level in the blood urea nitrogen and creatinine in blood plasma).

Treatment of elderly patients should be conducted with a sufficient increase in water load and under the supervision of a physician, because among these patients increased half-life of acyclovir.

In the treatment of genital herpes should avoid sex or use condoms, because use of Acyclostad does not prevent transmission to partners.

This medication Acyclostad in the form of dosage forms for topical use should not be applied to mucous membranes of the mouth, eyes, vagina.

With simultaneous use of probenecid decreases the tubular secretion of acyclovir, and thereby increases the concentration in blood plasma and the half-life of acyclovir.

With simultaneous use of Acyclostad with other nephrotoxic drugs increases the risk of nephrotoxicity (especially in patients with impaired renal function).

Enhancing effect of Acyclostad is noted while appointing immunostimulators.

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While using Generic Als-selegilina, you must not eat foods that are high in tyramine such as air dried meats, aged or fermented meats, sausage or salami (including cacciatore and mortadella), pickled herring, and any spoiled or improperly stored beef, poultry, fish, or liver; beer from a tap, beer that has not been pasteurized; aged cheeses, including blue, boursault, brick, brie, camembert, cheddar, emmenthaler, gruyere, parmesan, romano, roquefort, stilton, and swiss; sauerkraut, soy beans, soy sauce, tofu, miso soup, bean curd, fava beans; yeast extracts (such as Marmite).

Preferable food during Generic Als-selegilina usage are fresh meat, poultry, or fish (including lunch meat, hot dogs, breakfast sausage, and cooked sliced ham); any vegetables except broad bean pods (fava beans); processed cheese, mozzarella, ricotta, cottage cheese; pizza made with cheeses low in tyramine; soy milk, yogurt.

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Posted on Nov 16, 2013 in Cara

Masalah kulit yang paling sering ditemui di bagian muka adalah jerawat. Ya, jerawat bisa menyerang siapa saja, meskipun umumnya jerawat lebih banyak muncul pada pria maupun wanita di usia remaja. Jika jerawat tidak bisa diatasi, maka dikhawatirkan masalah jerawat ini akan terus menerus berlanjut hingga dewasa. Biasanya, jerawat pada remaja muncul karena hormon yang masih dalam kondisi yang tidak stabil.

Tentunya banyak cara untuk bisa menghilangkan jerawat. Cara yang paling tradisional ialah memakai produk-produk alami atau herbal. Misalnya, menggunakan telur, sisa cucian beras, lidah buaya, sampai kentang dan tomat. Cara alami memang baik, namun biasanya efeknya juga tidak begitu instan.

Untuk itu, pada kali ini akan dibahas mengenai cara menghilangkan jerawat dengan Vitacid.

Vitacid adalah sejenis salep/krim yang mengandung Tretinoin sehingga bisa digunakan untuk mengatasi masalah kulit yang kompleks, salah satunya jerawat. Selain jerawat, Vitacid ini juga bisa mengatasi muka berminyak, kusam, sampai komedo.

Vitacid ini ada 3 jenis:

– Vitacid yang mengandung 0.025% Retinioc Acid

– Vitacid yang mengandung 0.5% Retinioc Acid

– Vitacid yang mengandung 0.1% Retinioc Acid

Makin tinggi kadar Retinoic-nya, maka efeknya akan semakin kuat.

Cara menghilangkan jerawat dengan Vitacid:

– Bagi wanita, sebaiknya dimulai dengan menggunakan kadar 0.025%, untuk pria 0.025% juga atau 0.05%. Sebaiknya ketika baru pertama kali mencoba, tidak dulu menggunakan yang berkadar 0.1%.

– Oleskan tipis Vitacid ke bagian yang berjerawat setiap malam. Atau bila perlu, oleskan tipis ke seluruh wajah, dengan menghindari daerah vital seperti daerah kulit sekitar mata dan sekitar mulut. Biarkan Vitacid bekerja selama anda tidur. Ingat, Vitacid ini hanya bisa dipakai ketika malam, karena sifatnya yang sangat sensitif dengan matahari.

– Pada beberapa orang, pada pertama kali pemakaian, mungkin terjadi efek purging. Efek purging ini semacam efek detoksifikasi, yaitu Vitacid tersebut bekerja untuk mengeluarkan minyak berlebih pada kulit, serta mengeluarkan semua calon jerawat, komedo, dan melepaskan sel kulit mati. Sehingga pada beberapa orang tersebut, pemakaian Vitacid akan menimbulkan jerawat yang lebih banyak pada 2 sampai 3 minggu pemakaian. Makin tinggi kadar Retinoic pada Vitacid yang anda gunakan, maka semakin rentan pula anda mengalami purging. Oleh karena itu pakai dulu yang dosis rendah, ketika sudah kebal/terbiasa lalu gunakan dosis yang lebih tinggi. Namun, jika efek purging tetap terjadi maka anda tidak perlu terlalu khawatir. Efek purging ini akan selesai pada waktunya.

– Mulai dari 4 minggu lebih pemakaian, anda baru bisa melihat hasilnya. Keadaan kulit anda akan membaik dan jerawat sudah mulai hilang.

– Jika sudah mulai bebas jerawat, kurangi pemakaian Vitacid secara teratur. Misalnya, dari pemakaian setiap hari menjadi setiap dua hari, kemudian setiap minggu. Memang dalam beberapa referensi disebutkan bahwa Vitacid ini tidak menimbulkan ketergantungan, namun akan menyebabkan kekebalan terhadap Vitacid, sehingga efek dari Vitacid menjadi tidak begitu berefek lagi.

Hal-hal yang perlu diperhatikan dalam menggunakan Vitacid:

– Jangan memakai Vitacid ketika sedang hamil.

– Hindari membersihkan muka dengan bahan yang mengandung sulfur.

– Ketika dalam proses perawatan dengan Vitacid, selalu gunakan Sunblock ketika siang hari. Hindari wajah anda dari sinar matahari langsung.

Setiap orang memiliki pengalaman sendiri ketika mamakai Vitacid. Misalnya, ada yang menderita efek purging, ada juga yang tidak. Sebaiknya anda mencari juga referensi lain di internet.



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Cardiovascular Thrombotic Events

Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use. [see WARNINGS AND PRECAUTIONS ].

FELDENE is contraindicated in the setting of coronary artery bypass graft (CABG) surgery [see CONTRAINDICATION and WARNINGS AND PRECAUTIONS ].

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NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events [see WARNINGS AND PRECAUTIONS ].

DRUG DESCRIPTION

FELDENE (piroxicam) capsule is a nonsteroidal anti-inflammatory drug, available as maroon and blue #322 10 mg capsules and maroon #323 20 mg capsules for oral administration. The chemical name is 4-hydroxyl-2-methyl - N -2-pyridinyl-2 H -1,2,-benzothiazine-3- carboxamide 1,1-dioxide. The molecular weight is 331.35. Its molecular formula is C 15 H 13 N 3 O 4 S, and it has the following chemical structure.

Piroxicam occurs as a white crystalline solid, sparingly soluble in water, dilute acid, and most organic solvents. It is slightly soluble in alcohol and in aqueous solutions. It exhibits a weakly acidic 4-hydroxy proton (pK a 5.1) and a weakly basic pyridyl nitrogen (pK a 1.8).

The inactive ingredients in FELDENE include: Blue 1, Red 3, lactose, magnesium stearate, sodium lauryl sulfate, starch.

What are the possible side effects of piroxicam (Feldene)?

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 piroxicam 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.

What are the precautions when taking piroxicam (Feldene)?

Before taking piroxicam, tell your doctor or pharmacist if you are allergic to it; or to aspirin or other NSAIDs (such as ibuprofen, naproxen, celecoxib); 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 taking this medication, tell your doctor or pharmacist your medical history, especially of: asthma (including a history of worsening breathing after taking aspirin or other NSAIDs), blood disorders (such as anemia, bleeding/clotting problems), growths in the nose (nasal polyps), heart disease (such as previous heart attack), high blood pressure, liver disease, stroke, throat/stomach/intestinal problems (such as bleeding, heartburn.

Last reviewed on RxList: 6/13/2016 This monograph has been modified to include the generic and brand name in many instances.



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Tcl Reference Manual Tcl, Tcl-R

Tcl - Tool Command Language

The following rules define the syntax and semantics of the Tcl language:

[1] Commands. A Tcl script is a string containing one or more commands. Semi-colons and newlines are command separators unless quoted as described below. Close brackets are command terminators during command substitution (see below) unless quoted. [2] Evaluation. A command is evaluated in two steps. First, the Tcl interpreter breaks the command into words and performs substitutions as described below. These substitutions are performed in the same way for all commands. The first word is used to locate a command procedure to carry out the command, then all of the words of the command are passed to the command procedure. The command procedure is free to interpret each of its words in any way it likes, such as an integer, variable name, list, or Tcl script. Different commands interpret their words differently. [3] Words. Words of a command are separated by white space (except for newlines, which are command separators). [4] Double quotes. If the first character of a word is double-quote (""") then the word is terminated by the next double-quote character. If semi-colons, close brackets, or white space characters (including newlines) appear between the quotes then they are treated as ordinary characters and included in the word. Command substitution, variable substitution, and backslash substitution are performed on the characters between the quotes as described below. The double-quotes are not retained as part of the word. [5] Argument expansion. If a word starts with the string " " followed by a non-whitespace character, then the leading " " is removed and the rest of the word is parsed and substituted as any other word. After substitution, the word is parsed as a list (without command or variable substitutions; backslash substitutions are performed as is normal for a list and individual internal words may be surrounded by either braces or double-quote characters), and its words are added to the command being substituted. For instance, "cmd a d >" is equivalent to "cmd a b d f ". [6] Braces. If the first character of a word is an open brace (" "). Braces nest within the word: for each additional open brace there must be an additional close brace (however, if an open brace or close brace within the word is quoted with a backslash then it is not counted in locating the matching close brace). No substitutions are performed on the characters between the braces except for backslash-newline substitutions described below, nor do semi-colons, newlines, close brackets, or white space receive any special interpretation. The word will consist of exactly the characters between the outer braces, not including the braces themselves. [7] Command substitution. If a word contains an open bracket ("[") then Tcl performs command substitution . To do this it invokes the Tcl interpreter recursively to process the characters following the open bracket as a Tcl script. The script may contain any number of commands and must be terminated by a close bracket ("]"). The result of the script (i. e. the result of its last command) is substituted into the word in place of the brackets and all of the characters between them. There may be any number of command substitutions in a single word. Command substitution is not performed on words enclosed in braces. [8] Variable substitution. If a word contains a dollar-sign ("$") followed by one of the forms described below, then Tcl performs variable substitution . the dollar-sign and the following characters are replaced in the word by the value of a variable. Variable substitution may take any of the following forms: $ name Name is the name of a scalar variable; the name is a sequence of one or more characters that are a letter, digit, underscore, or namespace separators (two or more colons). Letters and digits are only the standard ASCII ones ( 0 - 9 . A - Z and a - z ). $ name ( index ) Name gives the name of an array variable and index gives the name of an element within that array. Name must contain only letters, digits, underscores, and namespace separators, and may be an empty string. Letters and digits are only the standard ASCII ones ( 0 - 9 . A - Z and a - z ). Command substitutions, variable substitutions, and backslash substitutions are performed on the characters of index . $ name > Name is the name of a scalar variable or array element. It may contain any characters whatsoever except for close braces. It indicates an array element if name is in the form " arrayName ( index ) " where arrayName does not contain any open parenthesis characters, " ( ", or close brace characters, " > ", and index can be any sequence of characters except for close brace characters. No further substitutions are performed during the parsing of name .

There may be any number of variable substitutions in a single word. Variable substitution is not performed on words enclosed in braces.

Note that variables may contain character sequences other than those listed above, but in that case other mechanisms must be used to access them (e. g. via the set command's single-argument form).

[9] Backslash substitution. If a backslash ("") appears within a word then backslash substitution occurs. In all cases but those described below the backslash is dropped and the following character is treated as an ordinary character and included in the word. This allows characters such as double quotes, close brackets, and dollar signs to be included in words without triggering special processing. The following table lists the backslash sequences that are handled specially, along with the value that replaces each sequence. a Audible alert (bell) (0x7). b Backspace (0x8). f Form feed (0xc). n Newline (0xa). r Carriage-return (0xd). t Tab (0x9). v Vertical tab (0xb). <newline> whiteSpace A single space character replaces the backslash, newline, and all spaces and tabs after the newline. This backslash sequence is unique in that it is replaced in a separate pre-pass before the command is actually parsed. This means that it will be replaced even when it occurs between braces, and the resulting space will be treated as a word separator if it is not in braces or quotes. \ Backslash (""). ooo The digits ooo (one, two, or three of them) give a eight-bit octal value for the Unicode character that will be inserted, in the range 000 - 377 . The parser will stop just before this range overflows, or when the maximum of three digits is reached. The upper bits of the Unicode character will be 0. x hh The hexadecimal digits hh (one or two of them) give an eight-bit hexadecimal value for the Unicode character that will be inserted. The upper bits of the Unicode character will be 0. u hhhh The hexadecimal digits hhhh (one, two, three, or four of them) give a sixteen-bit hexadecimal value for the Unicode character that will be inserted. The upper bits of the Unicode character will be 0. U hhhhhhhh The hexadecimal digits hhhhhhhh (one up to eight of them) give a twenty-one-bit hexadecimal value for the Unicode character that will be inserted, in the range U+0000..U+10FFFF. The parser will stop just before this range overflows, or when the maximum of eight digits is reached. The upper bits of the Unicode character will be 0.

The range U+010000..U+10FFFD is reserved for the future.

Backslash substitution is not performed on words enclosed in braces, except for backslash-newline as described above.

[10] Comments. If a hash character ("#") appears at a point where Tcl is expecting the first character of the first word of a command, then the hash character and the characters that follow it, up through the next newline, are treated as a comment and ignored. The comment character only has significance when it appears at the beginning of a command. [11] Order of substitution. Each character is processed exactly once by the Tcl interpreter as part of creating the words of a command. For example, if variable substitution occurs then no further substitutions are performed on the value of the variable; the value is inserted into the word verbatim. If command substitution occurs then the nested command is processed entirely by the recursive call to the Tcl interpreter; no substitutions are performed before making the recursive call and no additional substitutions are performed on the result of the nested script.

Substitutions take place from left to right, and each substitution is evaluated completely before attempting to evaluate the next. Thus, a sequence like

will always set the variable y to the value, 012 .

[12] Substitution and word boundaries. Substitutions do not affect the word boundaries of a command, except for argument expansion as specified in rule [5]. For example, during variable substitution the entire value of the variable becomes part of a single word, even if the variable's value contains spaces.



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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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Ranitidine (Nitised)

Ranitidine is used for treating certain conditions that cause your body to make too much stomach acid (eg, Zollinger-Ellison syndrome). It is also used to treat ulcers of the small intestine that have not responded to other treatment. It may be used as a short-term alternative to oral ranitidine, in patients who are not able to take medicine by mouth. Ranitidine is an H 2 - receptor blocker. It works by blocking the action of histamine in the stomach. This reduces the amount of acid the stomach makes. Reducing stomach acid helps to reduce heartburn, heal irritation of the esophagus, and heal ulcers of the stomach or intestines.

Use Ranitidine as directed by your doctor.

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

You may take antacids while you are using Ranitidine if you are directed to do so by your doctor.

Continue to use Ranitidine even if you feel well. Do not miss any dose.

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

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

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

Do NOT use Ranitidine if:

you are allergic to any ingredient in Ranitidine

you have a history of the blood disease porphyria

you are taking dasatinib.

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

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

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

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

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

if you have a history of kidney or liver problems

if you have abnormal blood electrolyte levels or a history of irregular heartbeat.

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

Certain benzodiazepines (eg, midazolam, triazolam), glipizide, procainamide, or warfarin because the risk of their side effects may be increased by Ranitidine

Dasatinib, delavirdine, gefitinib, certain HIV protease inhibitors (eg, atazanavir), itraconazole, or ketoconazole because their effectiveness may be decreased by Ranitidine.

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

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

Ranitidine may interfere with certain lab tests, including urine protein tests. Be sure your doctor and lab personnel know you are taking Ranitidine.

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

Ranitidine should be used with extreme caution in children younger than 1 month 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 Ranitidine while you are pregnant. Ranitidine is found in breast milk. Do not breastfeed while taking Ranitidine.

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

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

Constipation; diarrhea; headache; nausea; stomach upset.

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; confusion; dark urine; depression; fast, slow, or irregular heartbeat; fever, chills, or sore throat; hallucinations; severe or persistent headache or stomach pain; unusual bruising or bleeding; yellowing of the eyes or skin.

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

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