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Antibiotics - Clinda-ipp (Brand name: cleocin)

Product Description Common use Cleocin kills sensitive bacteria by stopping the production of essential bacterial proteins after binding a bacterial ribosome. Cleocin is close by its qualities to Lincomycin. Lincosamides are usually used to treat staphylococci and streptococci. Cleocin is administered to treat protozoal diseases such as malaria, infections of respiratory system, skin and soft tissures, bones and joints, abdominal organs, and others. It does not treat meningitis.

Dosage and directions Take orally four times a day with or without food with a full glass of water. Take Cleocin at evenly spaced intervals.

Precautions This medication should be used only for treatment of serious bacterial infections due to its ability to cause severe and even fatal intestinal condition known as pseudomembranous colitis. This condition may appear during treatment or even weeks after treatment has stopped. So if you have persistent diarrhea, abdominal or stomach pain/cramping, or blood/mucus in your stool do not use anti-diarrhea drugs and inform your doctor about your condition.

Contraindications Do not take this drug if you have antibiotic-associated colitis, Crohn disease, ulcerative colitis or meningitis, have allergy to Cleocin or Lincomycides. Inform your doctor if you are pregnant or breastfeeding, if you have diarrhea, a history of liver problems or stomach or bowel problems before taking this medication.

Possible side effect Mild diarrhea, nausea, vomiting or upset stomach may occur. If they persist or become bothersome contact your doctor. Seek medical attention right away if you have serious signs of allergy (hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face) or other side effects: bloody or tarry stools, decreased urination, severe stomach cramps or pain, unusual vaginal discharge, yellowing of the skin or eyes.

Inform your doctor about all drugs you are taking and especially about erythromycin, kaolin-pectin, live bacterial vaccines. Clindamycin may increase the effects of drugs used during surgery so your doctor should know if you are taking Cleocin and plan to be operated.

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

Overdose Cleocin overdose may cause serious consequences, so in case of persistent symptoms of abdominal pain, nausea, vomiting, and diarrhea contact your doctor.

Storage Store at room temperature between 59-77 degrees F (15-25 degrees C) away from light and moisture, kids and pets.

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



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Cyklo-F 500mg Film Coated Tablets - Summary Of Product Characteristics (Spc), Cyklo-F

Cyklo-f 500mg film coated tablets

Allergic skin reactions

Other adverse events have been reported with the use of tranexamic acid but the frequency of the reports cannot be estimated from the available data: thromboembolic events, retinal/artery occlusion and impaired colour vision or other visual disturbances.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www. mhra. gov. uk/yellowcard .

Symptoms may be nausea, vomiting, orthostatic symptoms and/or hypotension. Initiate vomiting, then stomach lavage, and charcoal therapy. Maintain a high fluid intake to promote renal excretion. There is a risk of thrombosis in predisposed individuals. Anticoagulant treatment should be considered.

5. Pharmacological properties

5.1 Pharmacodynamic properties

Tranexamic acid is an antifibrinolytic compound which is a potent competitive inhibitor of the activation of plasminogen to plasmin. At much higher concentrations it is a non-competitive inhibitor of plasmin. The inhibitory effect of tranexamic acid in plasminogen activation by urokinase has been reported to be 6-100 times and by streptokinase 6-40 times greater than that of aminocaproic acid. The antifibrinolytic activity of tranexamic acid is approximately ten times greater than that of aminocaproic acid.

A 2001 study involving more than 800 women demonstrated a significant improvement in their quality of life when taking tranexamic acid.

5.2 Pharmacokinetic properties

Following oral administration, 1.13% and 39% of the administered dose were recovered after 3 and 24 hours respectively. Tranexamic acid administered parenterally is distributed in a two compartment model. Tranexamic acid crosses the placenta, and may reach one hundredth of the serum peak concentration in the milk of lactating women. Tranexamic acid crosses the blood brain barrier.

Following intravenous administration, the biological half-life of tranexamic acid has been determined to be 1.9 hours and 2.7 hours.

5.3 Preclinical safety data

There are no preclinical data of relevance to the prescriber which are additional to that already included in other sections of the Summary of Product Characteristics.

6. Pharmaceutical particulars

Meda Pharmaceuticals



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All Information published below is from public sources and cannot be used as expert's opinion. We request you to consult your doctor for more information

1 Why Is it Used ?

PIROXICAM :

Adult: PO Rheumatic disorders Initial: 20 mg/day as a single dose. Maintenance: 10-30 mg in single or divided doses. Acute gout 40 mg/day for 5-7 days. Acute musculoskeletal conditions; Post-op pain Initial: 40 mg/day for 2 days. Maintenance: 20 mg/day for 1-2 wk. Topical Local pain As 0.5% gel: Apply 3-4 times/day.

2 What are the Side Effects ?

PIROXICAM :

GI disturbances, peptic ulcer, GI bleeding, headache, dizziness, blurred vision, tinnitus, skin rashes and pruritus. Haematological changes and photosensitivity. Potentially Fatal: Thrombocytopaenia and acute nephropathy. Toxic epidermal necrolysis and Stevens-Johnson syndrome.

3 What Precautions should be taken ?

PIROXICAM :



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Paediatric Dentistry- Pulpotomy Flashcards, Cresophene

Paediatric dentistry - Pulpotomy

Vital pulpotomy

* Involves the elimination of the coronal pulp & allows the remainder of the pulp to be retained * Tooth can be asymptomatic or exhibit signs of reversible pulpitis (pain of short duration or sensitivity to temperature changes) This indicates the pulp has undergone some inflammatory changes but is only confined to the coronal part & not the radicular pulp. * Treated with Ferric Sulphate 15.5%

Non vital pulpotomy

* Irreversible pulpitis (constant pain made worse by thermal changes) * Inflammatory changes include radicular pulp tissue * Ferric Sulphate would not work as it would be placed on inflamed tissue. Ledermix or Caustinerf



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Cefaly Migraine Prevention, Cefal

Cefaly

Unique FDA approved device for migraine prevention

Cefaly offers the best safety efficacy ratio compared to current anti-migraine oral medication. It is the first line treatment for patients having frequent migraine attacks. Cefaly enables the use of medicines to be significantly reduced and the sufferer's quality of life to be markedly improved. It is the solution for most of migraineurs. Cefaly has been approved by the FDA for use under prescription.

What is Cefaly?

Cefaly is an External Trigeminal Nerve Stimulator (e-TNS). An adhesive electrode is placed on the forehead and the Cefaly is connected magnetically to this electrode. Precise micro-pulses are then sent through the electrode to the upper branch of the trigeminal nerve preventing future migraine attacks. Since 2008, Cefaly has been the subject of a number of clinical studies demonstrating its effectiveness and safety.

Who is Cefaly for?

Cefaly is intended for patients who suffer from frequent migraines, particularly when drug consumption needs to be reduced.



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Sucralfatum, Sucralfatum

Sucralfate

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

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

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Carafate is indicated in:

Short-term treatment (up to 8 weeks) of active duodenal ulcer. While healing with sucralfate may occur during the first week or two, treatment should be continued for 4 to 8 weeks unless healing has been demonstrated by x-ray or endoscopic examination.

Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of acute ulcers.

Carafate is a gastric protective. It works by forming a protective layer on the ulcer to serve as a barrier against acid, bile salts, and enzymes in the stomach.

Use Carafate as directed by your doctor.

Take Carafate by mouth on an empty stomach at least 1 hour before or 2 hours after eating.

Do not take an antacid for at least 30 minutes before or after taking Carafate.

It may take 4 to 8 weeks for complete healing of your ulcer. Continue taking Carafate for the full course of treatment even if you feel better.

Do not take Carafate at the same time as other medicines. Take Carafate at least 2 hours after other medicines. If you are not sure about the best time to take Carafate, ask your doctor or pharmacist.

If you miss a dose of Carafate, take it as soon as possible. If it is almost time for your next dose, go back to your regular dosing schedule. Do not take 2 doses at once.

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

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

Active Ingredient: Sucralfate.

Do NOT use Carafate if:

you are allergic to any ingredient in Carafate.

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

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

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

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

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

if you have kidney problems or are on dialysis, or have blockage of the intestines or difficulty swallowing.

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

Citrate salts or medicines that contain aluminum, specifically in patients with kidney disease, because side effects from aluminum buildup may occur.

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

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

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

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

Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Carafate while you are pregnant. It is not known if Carafate is found in breast milk. If you are or will be breast-feeding while you take Carafate, check with your doctor. Discuss any possible risks to your baby.

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

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

Constipation; dizziness; feeling of a whirling motion.

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).

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.

Carafate is indicated in:

Short-term treatment (up to 8 weeks) of active duodenal ulcer. While healing with sucralfate may occur during the first week or two, treatment should be continued for 4 to 8 weeks unless healing has been demonstrated by x-ray or endoscopic examination.

Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of acute ulcers.

Carafate is a gastric protective. It works by forming a protective layer on the ulcer to serve as a barrier against acid, bile salts, and enzymes in the stomach.

Use Carafate as directed by your doctor.

Take Carafate by mouth on an empty stomach at least 1 hour before or 2 hours after eating.

Do not take an antacid for at least 30 minutes before or after taking Carafate.

It may take 4 to 8 weeks for complete healing of your ulcer. Continue taking Carafate for the full course of treatment even if you feel better.

Do not take Carafate at the same time as other medicines. Take Carafate at least 2 hours after other medicines. If you are not sure about the best time to take Carafate, ask your doctor or pharmacist.

If you miss a dose of Carafate, take it as soon as possible. If it is almost time for your next dose, go back to your regular dosing schedule. Do not take 2 doses at once.

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

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

Active Ingredient: Sucralfate.

Do NOT use Carafate if:

you are allergic to any ingredient in Carafate.

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

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

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

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

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

if you have kidney problems or are on dialysis, or have blockage of the intestines or difficulty swallowing.

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

Citrate salts or medicines that contain aluminum, specifically in patients with kidney disease, because side effects from aluminum buildup may occur.

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

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

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

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

Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Carafate while you are pregnant. It is not known if Carafate is found in breast milk. If you are or will be breast-feeding while you take Carafate, check with your doctor. Discuss any possible risks to your baby.

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

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

Constipation; dizziness; feeling of a whirling motion.

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).

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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Quinomax

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.

Was this page helpful?

Product Description Common use Floxin belongs to the group of anti-microbial medications called the fluoroquinolones which are synthetic broad-spectrum antibiotics. Due to their principally different mechanism of action they are active against great range of resistant microorganisms including polyresistant ones. They prevent unwinding and duplicating of bacterial DNA. Floxin is used to treat patients with infections of respiratory system (ears, throat, nose), skin, soft tissues, osteomyelitis, infectious diseases of abdomen, kidney, urinary tract, prostatitis, in gynecology, gonorrhea.

Dosage and directions Do not take Floxin with food. Dosage should be corrected for patients with severely abnormal liver or kidney function. Avoid taking of Floxin with antacids, minerals, and vitamins with iron which block the absorption of Floxin.

Avoid exposure of your body to sunlight during treatment with this drug.

Contraindications Hypersensitivity to quinolones, epilepsy, pregnancy, breastfeeding women, children and teenagers younger than 15 y. o.

Possible side effect The most frequent side effects include nausea, vomiting, diarrhea, insomnia, headache, dizziness, itching, and vaginitis in women. Rare allergic reactions may also occur (hives and anaphylaxis). Symptoms of nervous system stimulation, such as anxiety, euphoria, and hallucinations are rather rare.

Drug interaction Floxin is able to interact with caffeine, cyclosporine, theophylline (asthma), warfarin (anticoagulant), medications used to treat diabetes.

If you missed a dose take it as soon as you remember. If it is almost time of your next dose just skip it and return to your regular schedule. Never double the dose of this medication.

Overdose In case of serious and persistent drowsiness, nausea, hot or cold feeling, confusion, and slurred speech consult your doctor about medical attention.

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

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



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Metoclopramide - Oral (Reglan) Side Effects, Medical Uses, And Drug Interactions, Metoclor

metoclopramide - oral, Reglan

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

GENERIC NAME: METOCLOPRAMIDE - ORAL (MET-oh-KLOE-pra-mide)

BRAND NAME(S): Reglan

WARNING: This medication may cause a condition known as tardive dyskinesia. In some cases, this condition may be permanent. Tardive dyskinesia is more likely to occur when metoclopramide is used for longer than 3 months, in high doses, or when used in the elderly (especially elderly women). Contact your doctor immediately if you develop any unusual uncontrolled movements (especially of the face, mouth, tongue, arms or legs). There is no treatment for tardive dyskinesia, but in some cases symptoms may lessen or stop once metoclopramide is stopped.

Because of the risk for tardive dyskinesia, metoclopramide should not be used for longer than 3 months (12 weeks), except in rare cases where the benefits of this drug outweigh the risk of developing tardive dyskinesia. Discuss the risks and benefits with your doctor.

USES: This medication is used to treat certain conditions of the stomach and intestines. Metoclopramide is used as a short-term treatment (4 to 12 weeks) for persistent heartburn when the usual medicines do not work well enough. It is used mostly for heartburn that occurs after a meal or during the daytime. Treating persistent heartburn can decrease the damage done by stomach acid to the swallowing tube (esophagus ) and help healing. Metoclopramide is also used in diabetic patients who have poor emptying of their stomachs (gastroparesis ). Treating gastroparesis can decrease symptoms of nausea. vomiting. and stomach/abdominal fullness. Metoclopramide works by blocking a natural substance (dopamine ). It speeds up stomach emptying and movement of the upper intestines. OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. This drug may also be used to prevent nausea /vomiting from chemotherapy or radiation treatments for cancer .

Quick Guide Heartburn Causes, Symptoms, Remedies, and Treatments

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

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Ciprofloxacin Advanced Patient Information, Ancipro

ciprofloxacin (Oral route)

Oral route(Tablet, Extended Release;Suspension)

Fluoroquinolones, including ciprofloxacin, are associated with an increased risk of tendinitis and tendon rupture in all ages. Risk further increases with age over 60 years, concomitant steroid therapy, and kidney, heart, or lung transplants. Fluoroquinolones, including ciprofloxacin, may exacerbate muscle weakness in persons with myasthenia gravis. Avoid in patients with known history of myasthenia gravis .

Oral route(Tablet, Extended Release;Tablet)

Fluoroquinolones, including ciprofloxacin hydrochloride, are associated with an increased risk of tendinitis and tendon rupture in all ages. Risk further increases with age over 60 years, concomitant steroid therapy, and in kidney, heart, or lung transplant recipients. Fluoroquinolones, including ciprofloxacin hydrochloride, may exacerbate muscle weakness in persons with myasthenia gravis. Avoid in patients with known history of myasthenia gravis .

Commonly used brand name(s)

Available Dosage Forms:

Therapeutic Class: Antibiotic

Chemical Class: Fluoroquinolone

Uses For ciprofloxacin

Ciprofloxacin is used to treat bacterial infections in many different parts of the body. Ciprofloxacin oral liquid and tablets are also used to treat anthrax infection after inhalational exposure. Ciprofloxacin may mask or delay the symptoms of syphilis. It is not effective against syphilis infections.

Ciprofloxacin extended-release tablets are only used to treat urinary tract infections, including acute uncomplicated pyelonephritis.

Proquin® XR tablets are only used to treat uncomplicated or simple urinary tract infections (acute cystitis).

Ciprofloxacin belongs to the class of drugs known as quinolone antibiotics. It works by killing bacteria or preventing their growth. However, ciprofloxacin will not work for colds, flu, or other virus infections.

ciprofloxacin is available only with your doctor's prescription.

Before Using ciprofloxacin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For ciprofloxacin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to ciprofloxacin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of ciprofloxacin in children. However, because of ciprofloxacin's toxicity, it should be used with caution, after other medicines have been considered and found ineffective. Ciprofloxacin oral liquid or tablets may be used in children to prevent anthrax infection after possible exposure, and to treat serious kidney infections.

Appropriate studies have not been performed on the relationship of age to the effects of ciprofloxacin extended-release tablets in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of ciprofloxacin in the elderly. However, elderly patients are more likely to have age-related kidney or heart problems, or develop severe tendon problems (including tendon rupture), which may require caution in patients receiving ciprofloxacin.

Pregnancy

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking ciprofloxacin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using ciprofloxacin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Agomelatine

Amifampridine

Bepridil

Cisapride

Dronedarone

Lomitapide

Mesoridazine

Pimozide

Piperaquine

Saquinavir

Sparfloxacin

Terfenadine

Thioridazine

Tizanidine

Ziprasidone

Using ciprofloxacin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose

Acecainide

Acetohexamide

Alfuzosin

Alogliptin

Alosetron

Amiodarone

Amitriptyline

Amoxapine

Anagrelide

Apixaban

Apomorphine

Aripiprazole

Arsenic Trioxide

Artemether

Asenapine

Astemizole

Azimilide

Azithromycin

Bendamustine

Benfluorex

Bosutinib

Bretylium

Buserelin

Canagliflozin

Chlorpromazine

Chlorpropamide

Cilostazol

Citalopram

Clarithromycin

Clomipramine

Clozapine

Crizotinib

Cyclobenzaprine

Dabrafenib

Dapagliflozin

Dasatinib

Degarelix

Delamanid

Desipramine

Deslorelin

Disopyramide

Dofetilide

Dolasetron

Domperidone

Donepezil

Doxorubicin

Doxorubicin Hydrochloride Liposome

Droperidol

Eliglustat

Eltrombopag

Erlotinib

Erythromycin

Escitalopram

Everolimus

Exenatide

Fentanyl

Fingolimod

Flecainide

Fluconazole

Fluoxetine

Gatifloxacin

Gemifloxacin

Gliclazide

Glimepiride

Glipizide

Gliquidone

Glyburide

Gonadorelin

Goserelin

Granisetron

Halofantrine

Haloperidol

Histrelin

Hydrocodone

Hydroxychloroquine

Ibrutinib

Ibutilide

Ifosfamide

Iloperidone

Imipramine

Insulin

Insulin Aspart, Recombinant

Insulin Bovine

Insulin Degludec

Insulin Detemir

Insulin Glulisine

Insulin Lispro, Recombinant

Ivabradine

Ketoconazole

Lapatinib

Leuprolide

Levofloxacin

Linagliptin

Liraglutide

Lopinavir

Lumefantrine

Lurasidone

Mefloquine

Metformin

Methadone

Metronidazole

Mifepristone

Miglitol

Moricizine

Moxifloxacin

Nafarelin

Naloxegol

Nateglinide

Nilotinib

Norfloxacin

Nortriptyline

Octreotide

Ofloxacin

Olaparib

Ondansetron

Paliperidone

Panobinostat

Pasireotide

Pazopanib

Perflutren Lipid Microsphere

Pioglitazone

Pirfenidone

Pomalidomide

Posaconazole

Pramlintide

Procainamide

Prochlorperazine

Promethazine

Propafenone

Protriptyline

Quetiapine

Quinidine

Quinine

Ranolazine

Rasagiline

Repaglinide

Rosiglitazone

Salmeterol

Saxagliptin

Sematilide

Sevoflurane

Simeprevir

Simvastatin

Sitagliptin

Sodium Phosphate

Sodium Phosphate, Dibasic

Sodium Phosphate, Monobasic

Solifenacin

Sorafenib

Sotalol

Sunitinib

Tasimelteon

Tedisamil

Telavancin

Telithromycin

Teriflunomide

Tetrabenazine

Theophylline

Tolazamide

Tolbutamide

Toremifene

Trazodone

Trifluoperazine

Trimipramine

Triptorelin

Vandetanib

Vardenafil

Vemurafenib

Vilanterol

Vildagliptin

Vinflunine

Voriconazole

Warfarin

Using ciprofloxacin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Aluminum Carbonate, Basic

Aluminum Hydroxide

Aluminum Phosphate

Betamethasone

Budesonide

Calcium

Chloroquine

Corticotropin

Cortisone

Cosyntropin

Cyclosporine

Deflazacort

Dexamethasone

Diclofenac

Didanosine

Dihydroxyaluminum Aminoacetate

Dihydroxyaluminum Sodium Carbonate

Dutasteride

Fludrocortisone

Fluocortolone

Fosphenytoin

Hydrocortisone

Itraconazole

Lanthanum Carbonate

Levothyroxine

Magaldrate

Magnesium Carbonate

Magnesium Hydroxide

Magnesium Oxide

Magnesium Trisilicate

Methylprednisolone

Mycophenolate Mofetil

Olanzapine

Phenytoin

Prednisolone

Prednisone

Probenecid

Rifapentine

Ropinirole

Ropivacaine

Sevelamer

Sildenafil

Sucralfate

Triamcinolone

Zolpidem

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using ciprofloxacin with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use ciprofloxacin, or give you special instructions about the use of food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of ciprofloxacin. Make sure you tell your doctor if you have any other medical problems, especially:

Bradycardia (slow heartbeat) or

Diabetes or

Diarrhea or

Heart attack, history of or

Heart disease (eg, heart failure) or

Heart rhythm problems (eg, prolonged QT interval), or family history of or

Hypokalemia (low potassium in the blood), uncorrected or

Hypomagnesemia (low magnesium in the blood), uncorrected or

Liver disease or

Seizures (epilepsy), history of or

Stroke, history of—Use with caution. May make these conditions worse.

Brain disease (eg hardening of the arteries) or

Kidney disease, severe or

Organ transplant (eg, heart, kidney, or lung), history of or

Tendon disorder (eg, rheumatoid arthritis), history of—Use with caution. May cause side effects to become worse.

Myasthenia gravis (severe muscle weakness)—Should not be used in patients with this condition.

Proper Use of ciprofloxacin

Take ciprofloxacin only as directed by your doctor . Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

ciprofloxacin comes with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.

ciprofloxacin works best when there is a constant amount in the blood or urine. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times, day and night. For example, if you are to take one dose a day, try to take it at the same time each day.

If you need to take ciprofloxacin for anthrax infection . your doctor will want you to begin taking it as soon as possible after you are exposed to anthrax.

Swallow the extended-release tablet whole. Do not crush, split, or chew it.

Shake the oral liquid for at least 15 seconds just before each use. The oral liquid has small microcapsules floating in it. These microcapsules may look like bubbles or small beads. Do not chew the microcapsules when you take the oral liquid . Measure the oral liquid with the marked measuring spoon that comes with the bottle.

You may take ciprofloxacin with or without food. However, Proquin® XR tablets should be taken with a main meal, preferably the evening meal.

Drink plenty of fluids while you are taking ciprofloxacin. Drinking extra water will help prevent some unwanted effects of ciprofloxacin.

Do not take ciprofloxacin alone with milk, yogurt, or other dairy products. Do not drink any juice with calcium added when you take ciprofloxacin. It is okay to have dairy products or juice as part of a larger meal when you take ciprofloxacin.

If you are taking aluminum or magnesium-containing antacids, iron supplements, multivitamins, didanosine (Videx®), lanthanum carbonate (Fosrenol®), sevelamer (Renagel®), sucralfate (Carafate®), or any products containing calcium or zinc, do not take them at the same time that you take ciprofloxacin. It is best to take these medicines at least 2 hours before or 4 to 6 hours after taking ciprofloxacin . These medicines may keep ciprofloxacin from working properly.

Keep using ciprofloxacin for the full treatment time . even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.

Dosing

The dose of ciprofloxacin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of ciprofloxacin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (extended-release tablets):

For uncomplicated urinary tract infections (acute cystitis):

Adults—500 milligrams (mg) once a day for 3 days.

Children—Use and dose must be determined by your doctor.

For complicated urinary tract infections:

Adults—1000 milligrams (mg) once a day.

Children—Use and dose must be determined by your doctor.

For acute uncomplicated pyelonephritis:

Adults—1000 milligrams (mg) once a day.

Children—Use and dose must be determined by your doctor.

For oral dosage forms (suspension or tablets):

For infections:

Adults—250 to 750 milligrams (mg) two times a day, taken every 12 hours.

Children—Use and dose must be determined by your doctor.

For urinary tract or serious kidney infections:

Adults—250 to 500 milligrams (mg) two times a day, taken every 12 hours.

Children—Dose is based on body weight and must be determined by your doctor. The dose is usually 10 to 20 milligrams (mg) per kilogram (kg) of body weight every 12 hours. However, the dose is usually not more than 750 mg per day.

For gonorrhea:

Adults—250 milligrams (mg) taken as a single dose.

Children—Use and dose must be determined by your doctor.

For anthrax infection (post-exposure):

Adults—500 milligrams (mg) two times a day, taken every 12 hours.

Children—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligram (mg) per kilogram (kg) of body weight every 12 hours. However, the dose is usually not more than 500 mg per day.

Missed Dose

If you miss a dose of ciprofloxacin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Do not take more than one extended-release tablet each day.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

You may store the oral liquid at room temperature or in the refrigerator. Do not freeze the bottle. Do not keep the mixed oral liquid for more than 14 days. Throw away any unused liquid after 14 days.

Precautions While Using ciprofloxacin

It is very important that your doctor check your or your child's progress while you are using ciprofloxacin . This will allow your doctor to see if the medicine is working properly and to decide if you should continue to use it. Blood and urine tests may be needed to check for unwanted effects.

If your or your child's symptoms do not improve within a few days, or if they become worse, check with your doctor.

Do not use ciprofloxacin if you are also taking tizanidine (Zanaflex®). Tell your doctor if you or your child are also using theophylline (Theo-Dur®) or other products that contain caffeine (eg, coffee, soda, chocolate). Using these medicines together may increase risks for more serious side effects .

Ciprofloxacin may rarely cause inflammation (tendinitis) or tearing of a tendon (the cord that attaches muscles to bones). This can occur while you are taking the medicine or after you finish taking it. The risk of having tendon problems may be increased if you are over 60 years of age, are using steroid medicines (eg, dexamethasone, prednisolone, prednisone, Medrol®), have severe kidney problems, have a history of tendon problems (eg, rheumatoid arthritis), or if you have received an organ transplant (eg, heart, kidney, or lung). Check with your doctor right away if you have sudden pain or swelling in a tendon after exercise (eg, ankle, back of the knee or leg, shoulder, elbow, or wrist), bruise more easily after an injury, or are unable to bear weight or move the affected area. Refrain from exercise until your doctor says otherwise.

ciprofloxacin may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you or your child have a rash, itching, hives, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, mouth, or throat after you take ciprofloxacin.

Serious side effects can occur during treatment with ciprofloxacin. Sometimes serious side effects can occur without warning. However, possible warning signs are including black, tarry stools, blistering, peeling, or loosening of the skin, bloody or cloudy urine, chills, decreased urination, diarrhea, fever, joint or muscle pain, red skin lesions, often with a purple center, sores, ulcers, or white spots in the mouth or on the lips, severe stomach pain, skin rash, swelling of the face, fingers, feet, and/or lower legs, unusual bleeding or bruising, unusual weight gain, or yellow skin or eyes. Stop taking ciprofloxacin and check with your doctor immediately if you or your child notice any of these warning signs .

Check with your doctor right away if you have dark urine, clay-colored stools, abdominal or stomach pain, or yellow eyes or skin. These maybe symptoms of a serious liver problem.

Ciprofloxacin may cause diarrhea, and in some cases it can be severe. It may occur 2 months or more after you or your child stop taking ciprofloxacin. Do not take any medicine to treat diarrhea without first checking with your doctor. Diarrhea medicines may make the diarrhea worse or make it last longer. If you have any questions about this or if mild diarrhea continues or gets worse, check with your doctor.

Check with your doctor right away if you or your child start having numbness, tingling, or burning pain in your hands, arms, legs, or feet. These may be symptoms of a condition called peripheral neuropathy.

Some people who take ciprofloxacin may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause severe sunburn, skin rash, redness, itching, or discoloration. When you begin using ciprofloxacin:

Stay out of direct sunlight, especially between the hours of 10:00 AM and 3:00 PM, if possible.

Wear protective clothing, including a hat and sunglasses.

Apply a sun block product that has a sun protection factor (SPF) of at least 15. Some people may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your doctor.

Do not use a sun lamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

Ciprofloxacin may cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Make sure you know how you react to ciprofloxacin before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert . If these reactions are especially bothersome, check with your doctor.

If you are a diabetic patient taking diabetes medicine by mouth . Ciprofloxacin may cause hypoglycemia (low blood sugar) in some patients. Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out) . Different people may feel different symptoms of low blood sugar. If you experience symptoms of low blood sugar, stop taking ciprofloxacin and check with your doctor right away:

Symptoms of low blood sugar can include: Anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty with concentrating, drowsiness, excessive hunger, headache, nausea, nervousness, rapid heartbeat, shakiness, or unusual tiredness or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

ciprofloxacin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Diarrhea

Rare

Bloody or black, tarry stools

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

changes in skin color

changes in urination

chest pain or discomfort

chest tightness or heaviness

chills or fever

clumsiness or unsteadiness

confusion

continuing ringing or buzzing or other unexplained noise in the ears

coughing or spitting up blood

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

fast, irregular, pounding, or racing heartbeat or pulse

headache, severe and throbbing

hearing loss

hives or welts

joint stiffness

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

light-colored stools

muscle pain or stiffness

nausea and vomiting

nightmares

numbness of the hands

pain in the joints

pain or discomfort in the arms, jaw, back, or neck

painful, red lumps under the skin, mostly on the legs

pounding in the ears

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

redness of the face, neck, arms, and occasionally, upper chest

seizures

severe abdominal or stomach pain, cramping, or burning

shakiness in the legs, arms, hands, or feet

skin rash

swelling of the face, feet, or lower legs

swollen, painful, or tender lymph glands in the neck, armpit, or groin

thick, white vaginal discharge with no odor or with a mild odor

unsteadiness, trembling, or other problems with muscle control or coordination

unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

white patches in the mouth and/or on the tongue

yellow eyes or skin

Incidence not known

Acid or sour stomach

blistering, peeling, or loosening of the skin

bluish-colored lips, fingernails, or palms

bone pain

diarrhea, watery and severe, which may also be bloody

difficulty with breathing, chewing, or talking

double vision

excessive muscle tone

feeling of discomfort

feeling, seeing, or hearing things that are not there

increased sensitivity to pain

increased sensitivity to touch

irregular or slow heart rate

mood changes

nosebleeds

rapid heart rate

red skin lesions, often with a purple center

sores, ulcers, or white spots on the lips or in the mouth

unusual bleeding or bruising

unusual excitement, nervousness, or restlessness

vaginal yeast infection

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

The information contained in the Truven Health Micromedex products as delivered by Drugs. com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Truven Health products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Truven Health and Drugs. com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products.

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Naclof

Naclof ch?a diclofenac sodium, ch?t non-steroid co tac d?ng khang viem va gi?m dau.

Co ch? tac d?ng c?a diclofenac da du?c ch?ng minh qua th?c nghi?m la ?c ch? s? t?ng h?p prostaglandin. Prostaglandin dong m?t vai tro quan tr?ng trong sinh b?nh h?c c?a ph?n ?ng viem va dau.

Khi du?c dung tru?c ph?u thu?t l?y th?y tinh th? d?c, Naclof ngan ch?n s? co d?ng t? x?y ra trong luc ph?u thu?t. Naclof cung co tac d?ng khang viem khi du?c dung sau ph?u thu?t ho?c ch?n thuong m?t ho?c cac tinh tr?ng viem khong do nhi?m trung khac c?a m?t. Khi dung v?i m?c dich d? phong cho b?nh nhan m? l?y th?y tinh th? d?c va d?t kinh n?i nhan, Naclof lam gi?m t?n su?t va d? n?ng (n?u co x?y ra) c?a phu hoang di?m d?ng nang.

Khi nh? m?t, li?u dung hi?u qu? m?i ngay ch? vao kho?ng 0,25-0,5 mg (1 gi?t x 3-5 l?n/ngay) va li?u nay b?ng 1% li?u Voltaren dung cho b?nh nhan th?p kh?p.

Th?c nghi?m tren th? kh?e m?nh cho th?y diclofenac (danh d?u b?ng 14 C) d?t n?ng d? t?i da trong giac m?c va k?t m?c vao th?i di?m 30 phut sau khi nh?. Thu?c du?c th?i tr? nhanh va hoan toan ra kh?i co th? sau 6 gi?.

? ngu?i, kh? nang ng?m vao ti?n phong c?a diclofenac da du?c xac nh?n.

Khong phat hi?n th?y diclofenac trong huy?t thanh ngu?i sau khi nh? diclofenac sodium 0,1% vao m?t.

Ngan ch?n s? co d?ng t? trong ph?u thu?t l?y th?y tinh th? d?c.

Tinh tr?ng viem sau ph?u thu?t l?y th?y tinh th? d?c va cac can thi?p ph?u thu?t khac.

Dung tru?c va sau ph?u thu?t d? phong ng?a phu hoang di?m d?ng nang trong ph?u thu?t l?y th?y tinh th? d?c va d?t th?y tinh th? nhan t?o.

Cac tinh tr?ng viem khong do nhi?m trung c?a ph?n tru?c m?t (vi d?. viem k?t m?c m?n tinh khong do nhi?m trung).

Tinh tr?ng viem sau ch?n thuong xuyen th?ng va khong xuyen th?ng (k?t h?p v?i di?u tr? khang sinh t?i ch?).

B?nh nhan da co qua m?n c?m v?i diclofenac ho?c thiomersal.

Gi?ng nhu cac thu?c khang viem khong corticoid khac, Naclof cung co ch?ng ch? d?nh d?i v?i b?nh nhan suy?n, n?i m? day, ho?c viem mui c?p co can nguyen do acetylsalicylic acid ho?c cac thu?c ?c ch? s? t?ng h?p prostaglandin khac.

TH?N TR?NG LUC DUNG

B?nh nhan mang kinh ti?p xuc ch? nen nh? Naclof vao nh?ng luc khong mang kinh. Trong tru?ng h?p nhi?m trung ho?c co nguy co nhi?m trung cao, c?n k?t h?p cung luc v?i cac di?u tr? khac nhu khang sinh.

N?u dap ?ng di?u tr? khong th?a man, c?n danh gia l?i ch?n doan (nhi?m trung, qua m?n c?m v?i thu?c).

N?u b?nh nhan b? m? m?t sau khi nh? thu?c thi khong nen lai xe hay v?n hanh may.

LUC CO THAI va LUC NUOI CON BU

Th? nghi?m v? d?c tinh tren s? sinh s?n ? d?ng v?t cho th?y khong co nguy co d?i v?i thai nhung chua du?c ki?m ch?ng tren ph? n? mang thai.

Do chua co tai li?u xac nh?n tinh an toan c?a Naclof tren ph? n? co thai hay cho con bu, khong nen dung thu?c cho d?i tu?ng nay tr? tru?ng h?p b?t bu?c.

TUONG TAC THU?C

Cho d?n nay chua ro.

Co th? k?t h?p Naclof v?i cac thu?c nh? m?t co ch?a corticoid n?u c?n thi?t.

D? ngan ng?a thu?c ch?y ra ngoai, nen nh? cac thu?c cach nhau t?i thi?u 5 phut.

TAC D?NG NGO?I Y

Cac th? nghi?m tren lam sang da ghi nh?n nh?ng ph?n ?ng ph? sau.

Th?nh tho?ng xot nh? ho?c v?a thoang qua va/ho?c m? m?t ngay sau khi nh? thu?c.

Hi?m. ph?n ?ng qua m?n c?m du?i d?ng ng?a, d? va nh?y c?m anh sang.

LI?U LU?NG va CACH DUNG

- Tru?c ph?u thu?t. nh? m?t 5 l?n, m?i l?n 1 gi?t trong vong 3 gi? tru?c ph?u thu?t.

- Sau ph?u thu?t. ngay sau ph?u thu?t, nh? 1 gi?t, l?p l?i 3 l?n ; sau do, nh? 3-5 l?n m?i ngay cho d?n khi d?t hi?u qu? di?u tr?.

- Cac ch? d?nh khac. nh? 1 gi?t, 4-5 l?n m?i ngay, tuy thu?c d? n?ng nh? c?a b?nh.

Ch? can nh?c vi?c di?u tr? lau dai khi da danh gia k? ch? d?nh va kham m?t c?n th?n. Noi chung, khong nen dung thu?c lau hon vai tu?n. Chua co kinh nghi?m nhi?u trong vi?c dung thu?c lau dai.

Chua co nghien c?u c? th? v? vi?c dung Naclof ? tr? em nhung tai li?u ghi nh?n co th? dung Voltaren d?ng u?ng va d?ng t?a du?c cho tr? tren 12 thang tu?i.

Vi?c u?ng l?m Naclof khong gay tac d?ng ph? gi vi m?t l? thu?c nh? m?t 5 ml ch? ch?a 5 mg diclofenac sodium, lu?ng nay tuong duong kho?ng 3% li?u u?ng t?i da dung cho ngu?i l?n.

Dong n?p l?i sau m?i khi dung. Khong nen dung m?t chai thu?c lau hon m?t thang sau khi da m? n?p.



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Isoxsuprine Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Isoxsuprin

isoxsuprine

Uses

This medication is used along with other treatment for certain blood vessel diseases (e. g. arteriosclerosis obliterans, Raynaud's disease, Buerger's disease. cerebrovascular insufficiency). It works by widening blood vessels to help increase blood flow (improve circulation) to certain parts of the body (e. g. hands/feet, brain ). This effect may help to decrease symptoms such as cold hands and feet, numbness, tingling, and decreased memory or judgment.

How to use isoxsuprine

This medication is taken by mouth with or without food, usually 3 to 4 times daily or as directed by your doctor. Dosage is based on your medical condition and response to treatment.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

Tell your doctor if your condition persists or worsens.

Side Effects

Dizziness. flushing, stomach upset, nausea. shaking, or nervousness may occur as your body adjusts to the medication. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

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

Tell your doctor right away if any of these unlikely but serious side effects occur: fast/pounding heartbeat, weakness .

Seek immediate medical attention if this rare but very serious side effect occurs: chest pain .

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

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

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

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

Precautions

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

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: current abnormal bleeding, recent childbirth .

Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding disorders, glaucoma. heart disease (including recent heart attack ).

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

To reduce dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

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

It is not known whether this medication passes into breast milk. Consult your doctor before breast - feeding.

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 your doctor or pharmacist first.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use.

Check the labels on all your medicines (e. g. cough - and-cold products, diet aids ) because they may contain ingredients that could increase your heart rate or affect your blood pressure. Ask your pharmacist about using those products safely.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Notes

Do not share this medication with others.

Missed Dose

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

Storage

Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

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

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

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Advair Diskus, Flutide Diskus

Asthma - Flutide diskus (Brand name: advair diskus)

What is this medicine?

FLUTICASONE; SALMETEROL inhalation is for treating asthma that is not controlled with other asthma medicines or when more than one treatment is necessary. Fluticasone is a corticosteroid which decreases inflammation in the lungs. Salmeterol helps open the airways in the lungs. This medicine is intended for regular use. It will not cure your condition, but when used regularly it can open up your air passages and make breathing easier. It will not relieve an acute asthma attack. Fluticasone; salmeterol can be used along with other inhaled or oral asthma medications.

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

They need to know if you have any of these conditions: an asthmatic attack or bronchospasm chicken pox or measles (recent exposure or infection) diabetes heart disease including high blood pressure, irregular heart beat, blockage in heart vessels immune system problems infection, especially fungal infection or tuberculosis liver disease osteoporosis or other bone disease overactive thyroid pheochromocytoma seizures an unusual or allergic reaction to Fluticasone, Salmeterol, other corticosteroids, other medicines, foods, dyes, or preservatives pregnant or trying to get pregnant breast-feeding

How should this medicine be used?

DO NOT use this medicine for an asthma attack. If you have severe onset or worsening of cough, wheezing, chest tightness, and/or shortness of breath seek immediate medical attention. Always keep a short-acting asthma medication such as albuterol on hand for asthma attacks.

This medicine is for inhalation through the mouth. Shake the inhaler well for 5 seconds before each spray. Prime the inhaler before the first use with 4 test sprays pointing away from your face. If you drop the inhaler or of it has not been used for 4 weeks, prime it with 2 test sprays pointing away from your face. Avoid contact with eyes. After using the inhaler, rinse your mouth with water to minimize build-up of medicine; do not swallow the water. Clean your inhaler at least once a week. Never place the inhaler in water to determine how much medicine is in it. Do not use more than the recommended dose.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

NOTE: This medicine is only for you. Don't share it with others.

What if I miss a dose?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, take only that dose and continue with your regular schedule, spacing doses evenly. Do not use double or extra doses.

What may interact with this medicine?

arsenic trioxide astemizole bepridil beta-blockers, often used for high blood pressure or heart problems caffeine certain antibiotics (such as clarithromycin, erythromycin, gatifloxacin, gemifloxacin, grepafloxacin, levofloxacin, linezolid, moxifloxacin, sparfloxacin) chloroquine cisapride droperidol halofantrine levomethadyl medicines for colds and breathing difficulties medicines for heart disease or high blood pressure medicines known as MAO inhibitors, such as phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), and selegiline (Carbex®, Eldepryl®) medicines to control heart rhythm (examples: amiodarone, disopyramide, dofetilide, flecainide, procainamide, quinidine, sotalol) medicines for treating depression or mental illness (amoxapine, haloperidol, maprotiline, pimozide, phenothiazines, risperidone, sertindole, tricyclic antidepressants, ziprasidone) methadone pentamidine probucol some medicines for weight loss (including some herbal products, ephedra, ephedrine, dextroamphetamine) steroid hormones such as dexamethasone, cortisone, hydrocortisone terfenadine theophylline thyroid hormones water pills or diuretics

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking this medicine?

Visit your prescriber or health care professional for regular checks on your progress. Carry an identification card with your name, the type and dose of medicine you are taking, and your prescriber's name and address. It can take up to 2 weeks before you see the full effect of this medicine.

Check with your prescriber or health care professional if your symptoms do not improve. Seek emergency medical attention if your breathing problems get worse quickly while taking this medicine, or if your rescue inhaler (like albuterol) does not help your breathing. If you find that you are using your rescue inhaler more than normal or it is not as effective in treating your symptoms, you should contact your health care professional as soon as possible. You may need a change of therapy or may be having worsening of your lung condition. Do not stop using this medicine except on your prescriber's advice.

Using your inhalers regularly as prescribed will help control your symptoms; try not to run out of your medications. It is recommended that you keep an extra refill of your inhalers on hand in case you need them.

Tell your prescriber or health care professional if you are exposed to anyone with measles or chickenpox, or if you develop sores or blisters that do not heal properly.

People who are taking certain dosages of this medicine may need to avoid getting certain vaccines or may need to have changes in their vaccination schedules to ensure adequate protection from certain diseases. Make sure to tell your prescriber or health care professional that you are taking fluticasone; salmeterol before receiving any vaccine.

If you are going to have surgery tell your prescriber or health care professional that you are using this medicine.

What side effects may I notice from this medicine?

Side effects that you should report to your prescriber or health care professional as soon as possible: chest pain dizziness or lightheadedness fever or chills skin rash and itching (hives) sore mouth with white patches in the mouth or throat troubled breathing or wheezing unusual swelling unusual tiredness or weakness vision problems vomiting

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome): coughing, hoarseness, throat irritation diarrhea headache nausea nervousness sore throat stomach upset stuffy nose

Where can I keep my medicine?

Keep out of the reach of children in a container that small children cannot open.

Store at room temperature between 15—30 degrees C (59—86 degrees F) with mouthpiece facing down. Keep away from heat or open flames. Discard canister after 120 sprays.



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5 Ways To Do Lunges, Longes

How to Do Lunges

Lunges are an easy and efficient exercise to help build strength in your quadriceps, glutes, hamstrings, calves, and core. They are also relatively safe to do as they have simple movements that are easy to follow, and lunges require no special equipment to complete. Lunges are also great to help you improve your balance, increase your hip flexibility, develop better coordination, build muscle strength, improving spine health, enhancing your core stability, and toning a good variety of muscle groups to provide balance in strength and muscle growth. [1]

Steps Edit

Method One of Five: Performing the Forward Lunge Edit

Start in a standing position. Start by standing up straight with your feet hip-width apart and flat on the ground. Relax your shoulders and allow your shoulder blades to sink down towards your hips. Keep yourself in this position by flexing your abdominal muscles to keep your spine straight and stable. [2] [3]

Throughout a lunge exercise your arms and hands can be in any position that helps you maintain your balance. Some people may prefer to put their hands on their hips while others may prefer to keep their arms held out to the side.

Ideally you should keep your back straight throughout a lunge exercise. This means you should try to keep your head upright while looking straight ahead. However, if you need to look down to ensure you’re in the right position, that’s okay.

Some people find it helpful to stare at a particular space on a wall (or another object) directly in front of them to help keep their balance.

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Lift one foot off the floor and move it forward. Lift your right foot off the ground by bending your knee. Move your right foot forward like you’re taking a step. Place your right foot on the ground, heel first. Lean your body forward so you’re balanced on both feet, but keep your back and upper body straight. [4] [5]

/9/9c/Do Lunges Step 2 Version 2.360p. mp4

Lower your body until your right knee is at a 90-degree angle. While keeping your upper body and back straight, continue to move your body forward until your right upper leg (thigh) is parallel to the floor. Your right lower leg (shin) should be perpendicular to the floor. You may need to bend your hips slightly to stay in this position, but keep your back straight. [6] [7]

/c/c6/Do Lunges Step 3 Version 2.360p. mp4

Try not to move your right knee beyond your right foot. Your right knee should be positioned directly above your right ankle.

Once in the lunge position, your left (back) knee should also form a 90-degree angle, but your lower leg (shin) will be parallel to the ground while your upper leg (thigh) will be perpendicular to the ground.

Due to the position you’re in, you will only be able to keep your left toes on the ground. Your left heel will lift off the ground as you lean forward.

Push yourself upwards with your right foot. Use your right foot to push yourself upwards. Return your body to the position you started in, standing straight with your feet hip-width apart. [8] [9]

/5/55/Do Lunges Step 4 Version 2.360p. mp4

Repeat the forward lunge. Once you’ve completed a lunge with your right leg, you can either switch sides and perform a lunge with your left leg, or you can continue to work your right side. It doesn’t matter what order you do lunges in, but try to do an equal number of lunges using both your left and right side before you finish. [10] [11]

/2/2a/Do Lunges Step 5 Version 2.360p. mp4

Another alternative is to keep your right foot and left in the forward position, with your right foot flat on the ground, and unbend both your legs to move upwards.

In this position your legs will be in a v-shape with your right leg in front. In a standing position both your right and left feet will be flat on the ground.

After moving to this standing position, bend your legs and lower your body back into the lunge position. Repeat this several times and then switch to your left side.

Method Two of Five: Reversing the Lunge Edit

Start in a standing position. Start the reverse lunge by standing straight up with your feet flat on the ground, hip-width apart. Keep your shoulders relaxed and keep your back straight and stable by using your abdominal muscles. [12] [13]

Throughout a lunge exercise your arms and hands can be in any position that helps you maintain your balance. Some people may prefer to put their hands on their hips while others may prefer to keep their arms held out to the side.

Move your left foot and leg backward. Lift your left foot off the ground and move it backward. Lower your body until your left foot touches the ground, toes first. [14] [15]

Keep both of your legs at 90-degree angles. Once your left foot touches the ground, continue to shift your body backward until both your right and left legs form 90-degree angles at the knees. Your right lower leg (shin) should be perpendicular to the floor and your right upper leg (thigh) should be parallel to the floor. Your left lower leg (shin) should be parallel to the floor while your left upper leg (thigh) should be perpendicular to the floor. [16] [17]

You’re left foot will remain with only your toes touching the ground.

Return to your starting position. Push off the floor with your left foot until you’re able to return to the starting position. Return your feet beside each other, both flat on the ground, hip-width apart. [18] [19]

Repeat the reverse lunge. Repeat the reverse lunge by either continuing on your left side (left leg going backwards) or switch to your right side (right leg going backwards). It doesn’t matter what order you perform the lunges in, but try to do an equal number of lunges on both sides before you finish your exercise routine. [20] [21]

Method Three of Five: Completing a Side Lunge Edit

Start in a standing position. Start the side lunge by standing up straight with your feet hip-width apart. Your head should stay upwards with your chin tilted slightly upwards. Place the majority of your weight on your heels and flex your abdominal muscles to keep your back stable. Relax your shoulders so they sink down towards your hips. [22] [23]

Throughout a lunge exercise your arms and hands can be in any position that helps you maintain your balance. Some people may prefer to put their hands on their hips while others may prefer to keep their arms held out to the side.

Step to the right. Lift your right foot off the ground, by bending at the knee, and step to the right. Keep your left foot flat on the ground and your back straight. At this stage, your weight should all be on your left leg. Then, shift your weight to the right and place your right foot on the ground. [24] [25]

How far your feet will be apart may depend on your height, but aim to place your right foot at least 2 feet from your left foot.

Adjust your stance as you go to whatever distance allows you to feel the stretch in your leg muscles without any discomfort.

Bend your right knee. Once your right foot is on the ground, bend your right knee so your body continues to move lower. Keep your lower leg (shin) perpendicular to the floor and line up your right knee so it’s above your right ankle. Keep your left leg as straight as possible while your left foot remains flat on the ground. The majority of your weight should now be on your right leg. [26] [27]

Push off the floor with your right foot. Use your right foot to push yourself upwards and return yourself to the starting position standing straight up with both feet flat on the ground, hip-width apart. [28] [29]

Repeat the same steps on the left side. Complete a side lunge to the left following all the same steps, just in the opposite direction. [30] [31]

Alternatively, you can continue performing side lunges to the right and then move to your left side later.

Ensure you perform the same number of lunges on both sides of your body before you finish your exercise routine.

Method Four of Five: Adding Twists to a Forward Walking Lunge Edit

Start in a standing position. Start by standing straight up, with both feet flat on the ground, hip-width apart. Keep your back, upper body, and head straight. Use your abdominal muscles to keep your back stable. [32] [33]

To add some extra strength training to this type of lunge, hold a medicine ball in your hands directly in front of you. A medicine ball is heavier than a regular ball and comes in different weights. Select a weight that works for you.

If you do not yet want to add the extra weight, use a regular ball instead. It is still helpful to hold something in your hands as you do the twist portion of the exercise.

Lift your right foot off the ground. Start by lifting your right foot straight off the ground by bending at the knee. Pause in this position until you feel balanced. Keep your back and upper body straight by using your abdominal muscles. [34] [35]

Place your right foot on the ground heel first. Move your right leg forward and place your right foot on the ground starting with your right heel. Shift your upper body forward so your right knee bends. Your lower leg should be perpendicular to the floor while your upper leg should be parallel to the floor. Do not lean too far forward such that your knee moves beyond your right foot. You may need to lean forward slightly forward from your hips, but keep your back straight. [36] [37]

Twist your upper body to the right. While you’re in the forward lunge position, with your right leg forward and your right foot on the ground, twist your upper body to the right. Keep the medicine ball in both of your hands in front of you as you twist. Once you are facing to the right, twist back to your starting position. [38] [39]

Shift your left leg and foot forward. As this is a walking lunge, the next step is not to move back into the starting position, but rather to continue moving forward. Using the same movements you made with your right leg, lift your left foot off the ground and slowly move it forward like you’re taking a big step. [40] [41]

You will need to balance yourself on your right leg for a moment as you move your left leg forward.

Put your left foot on the ground. Shift your body forwards while placing your left foot on the ground, heel first. Continue to shift your weight until your left upper leg is parallel to the ground and your left lower leg is perpendicular to the ground. Do not lean too far forward such that your left knee moves forward of your left foot. You may need to lean slightly forward at the hips, but keep your upper body and back straight. [42] [43]

Perform a twist to the left. Using the same twist movements, with your medicine ball in your hands in front of you, complete a twist to the left. [44] [45]

Continue the movements as your lunge forward. Repeat the movements with your right and left leg as you continue to lunge forward twist, and lunge forward again. Continue moving forward until you’ve run out of space. You can then turn around and continue the walking lunges in the opposite direction. [46] [47]

Method Five of Five: Pushing Yourself with the 30-Day Lunge Challenge Edit

Pick a 30-day period to complete the challenge. A 30-day lunge challenge is a great way to practice all types of lunges and get a great workout on a regular basis. Having a specific goal in mind when exercising can at times, increase your motivation. Before you get started, however, you’ll need to select a 30-day period that works best for you. Using an actual calendar month will probably be the most convenient and easiest to follow. [48]

Perform at least 100 lunges per week. Ideally, you should perform some lunges on a daily basis, but you don’t need to perform all 100 every day right from day 1. Start by performing 20-30 lunges per day until you can build up your endurance. However, try to fit in at least 100 lunges every week. [49]

Work your way up to 100 lunges per day. Once you’ve built up some endurance and energy, try to perform all 100 lunges every day. The lunges can be broken down as follows: [50]

30 forward lunges, 15 for each leg

40 side lunges, 20 to each side

30 reverse lunges, 15 for each leg

Track your achievement. Keep track of the number of lunges you do every day, and which lunges you were able to perform. Even if you are not able to work your way up to 100 lunges a day, by tracking your progress you’ll be able to see how much you’ve improved over the 30 days. [51]

Regardless of your progress, reward yourself with something at the end of the 30 days. Keep that reward in mind throughout the 30 days as an incentive to keep going.

In order to help you visualize the movements of a forward stationary and walking lunge, you may want to watch the following video on the Mayo Clinic website — http://www. mayoclinic. org/healthy-lifestyle/fitness/multimedia/lunge/vid-20084662 .

For added resistance, you can hold weights or dumbbells in both your hands while you perform the forward lunges. The amount of weight should be based on what you are comfortable with, don’t use weights that are too heavy. If you don’t have “real” weights or dumbbells, you can use household items like cans, plastic bottles filled with water (or another liquid), etc. [52]

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Product Description Common use Citalopram belongs to a class of selective serotonin reuptake inhibitors (SSRIs). This medication is used to treat major depression associated with mood disorders. It is also applied in the treatment of body dysmorphic disorder and anxiety.

Dosage and direction

Take Celexa by mouth with a glass of water, with or without food. Avoid cutting, crushing or chewing this medicine. Do not take the medicine more often than it is prescribed. Do not give up taking it except on the advice of your doctor. It may need time for the medicine to help. Consult your doctor concerning a proper dose for you.

Precautions Before taking Citalopram tell your doctor or chemist if you are allergic to it; or if you have other allergies. Inform your doctor or chemist if you have bipolar confusion, eye, liver or kidney problems. Aged people can be more sensitive to side effects of the medicine. During the pregnancy this treatment should be used only when strongly necessary. As this medicament can be absorbed by skin, women who are pregnant or may become pregnant should not manipulate this medicine.

Contraindications Celexa should not be used by pregnant/nursing women or children as well as by the patients having demonstrated a reaction of hypersensitivity to Citalopram.

Possible side effect The most common side effects are quick and irregular pulse, tremor, anxiety, blurred vision, vomiting, fever, diarrhoeia, etc. A very serious allergic reaction rarely occurs. Many people using this medicine do not have serious side effects. Turn to your doctor or pharmacist for more details. In case you notice the effects not listed here, contact your doctor or pharmacist.

Drug interaction Tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use before using this medication. Citalopram can interact with: * MAO inhibitors: Furazolidone, Isocarboxazid, Linezolid, Moclobemide Tranylcypromine, etc. * Antiarrhythmic drugs: Propafenone, Quinidine, etc * Serotonin-norepinephrine reuptake inhibitors (SNRIs): Desvenlafaxine, Duloxetine, Milnacipram, Venlafaxine. * Antipsychotics (also called neuroleptics): Fluphenazine, etc. * H2-receptor antagonists: Cimetidine, Ranitidine, Famotidine, Nizatidine, etc. Turn to your doctor or pharmacist for more details.

Missed dose If you have missed your dose, take it as soon as you remember. If you see that it is near the time for the next dose, skip the missed dose and resume your usual dosing schedule. Do not take your dose twice.

Overdose If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

Storage Store your medicines at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store them in the bathroom. Keep all drugs away from children and pets.

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

Citalopram is used for treating depression. It may also be used for other conditions as determined by your doctor.

Use Citalopram as directed by your doctor.

Drug Class and Mechanism

Citalopram is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin, a natural substance in the brain, which helps to improve certain mood problems.

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

Do not use Citalopram if:

you are allergic to any ingredient in Citalopram; you are taking escitalopram; you are taking or have taken a monoamine oxidase inhibitor (MAOI) (e. g. phenelzine), selegiline, or St. John's wort within the last 14 days; you are taking a fenfluramine derivative (e. g. dexfenfluramine), an H1 antagonist (e. g. astemizole, terfenadine), nefazodone, pimozide, or sibutramine. Contact your doctor or health care provider right away if any of these apply to you.

Important: Citalopram may cause drowsiness or dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Citalopram with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Do not drink alcohol while you are using Citalopram. Check with your doctor before you use medicines that may cause drowsiness (e. g. sleep aids, muscle relaxers) while you are using Citalopram; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. One to 4 weeks may pass before your symptoms improve. Do not take more than the recommended dose, change your dose, or use Citalopram for longer than prescribed without checking with your doctor. Children, teenagers, and young adults who take Citalopram may be at increased risk for suicidal thoughts or actions. Watch all patients who take Citalopram closely. Contact the doctor at once if new, worsened, or sudden symptoms such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual change in mood or behavior occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur. Citalopram and a medicine called escitalopram have the same active ingredient. Do not take Citalopram if you are also taking escitalopram. Citalopram may rarely cause a prolonged, painful erection. This could happen even when you are not having sex. If this is not treated right away, it could lead to permanent sexual problems such as impotence. Contact your doctor right away if this happens.

Possible Side Effects

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

Decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; increased sweating; lightheadedness when you stand or sit up; loss of appetite; nausea; stuffy nose; tiredness.

Seek medical attention right away if any of these severe side effects occur: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); absent menstrual period; bizarre behavior; black or bloody stools; chest pain; confusion; decreased concentration; fast or irregular heartbeat; hallucinations; memory loss; new or worsening agitation, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still; persistent, painful erection; red, swollen, blistered, or peeling skin; seizures; severe or persistent anxiety or trouble sleeping; stomach pain; suicidal thoughts or attempts; tremor; unusual bruising or bleeding; unusual or severe mental or mood changes; vision changes; worsening of depression.

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

What is this medicine?

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

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

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

How should I use this medicine?

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

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

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

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

What if I miss a dose?

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

What may interact with this medicine?

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

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

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

What should I watch for while using this medicine?

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

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

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

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

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

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

What side effects may I notice from this medicine?

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

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

This list may not describe all possible side effects.

Where should I keep my medicine?

Keep out of reach of children.

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



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Albuterol Sulfate Inhalation Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Salbutam

albuterol sulfate inhalation

Uses

Albuterol (also known as salbutamol) is used to treat wheezing and shortness of breath caused by breathing problems such as asthma. It is a quick-relief medication. Albuterol belongs to a class of drugs known as bronchodilators. It works in the airways by opening breathing passages and relaxing muscles. Controlling symptoms of breathing problems can decrease time lost from work or school.

How to use albuterol sulfate inhalation

Read the Patient Information Leaflet provided by your pharmacist before you start using this medication and each time you get a refill. This medication is used with a special machine called a nebulizer that changes the solution to a fine mist that you inhale. Learn all instructions for the use of this medication and the nebulizer. If a child is using this medication, a parent or other responsible adult should supervise the child. If you have any questions, consult your doctor, pharmacist, or respiratory therapist.

This product should be clear and colorless to light yellow. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Use the dropper supplied by the manufacturer to carefully measure the prescribed amount of medication and place in the nebulizer with sterile saline as directed. If you are using the single dose package, empty the contents of the package in the nebulizer and add sterile saline as directed. Gently swirl the nebulizer to mix the solution.

Do not rinse the dropper. Replace the dropper and tightly close the bottle after each use. To avoid contamination, do not touch the dropper tip or let it touch any other surface. Discard any unused mixed solution. Do not save for future use.

Using a mouthpiece or face mask with the nebulizer, inhale the prescribed dose of medication into your lungs as directed by your doctor, usually 3 or 4 times daily as needed. Each treatment usually takes about 5 to 15 minutes. Use this medication only through a nebulizer. Do not swallow or inject the solution. Do not mix with other medicines in your nebulizer. To prevent infections, clean the nebulizer and mouthpiece/face mask according to the manufacturer's directions.

Dosage is based on your medical condition, age, weight. and response to treatment. Do not increase your dose or use this drug more often than prescribed without your doctor's approval. Using too much of this medication will increase your risk of serious (possibly fatal) side effects.

Learn which of your inhalers/medications you should use every day (controller drugs) and which you should use if your breathing suddenly worsens (quick-relief drugs). Ask your doctor ahead of time what you should do if you have new or worsening cough or shortness of breath, wheezing. increased sputum, worsening peak flow meter readings, waking up at night with trouble breathing, if you use your quick-relief inhaler/medication more often (more than 2 days a week), or if your quick-relief inhaler/medication does not seem to be working well. Learn when you can treat sudden breathing problems by yourself and when you must get medical help right away.

Tell your doctor if your symptoms do not improve or if they worsen.

Side Effects

Nervousness, shaking (tremor), headache. nausea or dizziness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

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

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if you have any serious side effects, including: fast/pounding heartbeat.

Get medical help right away if you have any rare but very serious side effects, including: chest pain. irregular heartbeat. rapid breathing, confusion.

Rarely, this medication has caused severe (rarely fatal), sudden worsening of breathing problems/asthma (paradoxical bronchospasm). If you experience sudden wheezing, get medical help right away.

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

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

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

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

Precautions

Before using albuterol, tell your doctor or pharmacist if you are allergic to it; or if you have had a serious reaction to similar drugs (such as levalbuterol. metaproterenol. terbutaline ); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as irregular heartbeat, angina. heart attack ), high blood pressure. diabetes. seizure .

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

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

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

It is unknown if this medication passes into breast milk. Consult your doctor before breast - feeding.

Interactions

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

Albuterol is very similar to levalbuterol. Do not use medications containing levalbuterol while using albuterol.

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast/pounding/irregular heartbeat, severe shaking (tremors), seizures.

Notes

Do not share this medication with others.

Laboratory and/or medical tests (such as a lung /breathing test, blood pressure) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Avoid allergens/irritants such as smoke, pollen. pet dander, dust, or molds that may worsen breathing problems.

Learn to use a peak flow meter, use it daily, and promptly report worsening breathing problems (such as readings in the yellow/red range, increased use of quick-relief inhalers).

Ask your doctor or pharmacist whether you should have an annual flu shot .

Missed Dose

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

Storage

Different brands of this medication have different storage needs. Store at room temperature or in the refrigerator as directed before opening. Do not freeze. This medication may need to be refrigerated after opening. Check the product package for instructions on how to store your brand, or ask your pharmacist.

Do not store in the bathroom. Keep all medicines away from children and pets.

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

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

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

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Antibiotics

Doxycycline (Soldoxin)

Doxycycline is used for treating infections caused by certain bacteria. It may be used in combination with other medicines to treat certain amoeba infections. It may also be used to prevent or slow the progression of anthrax after exposure. Doxycycline is a tetracycline antibiotic. It works by slowing the growth of bacteria. Slowing bacteria's growth allows the body's immune system to destroy the bacteria.

Take Doxycycline exactly as it was prescribed for you.

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.

Take Doxycycline with a full glass of water (8 ounces).

Do not take the medication with milk or other dairy products, unless your doctor has told you to. Dairy products can make it harder for your body to absorb the medicine.

Do not crush, break, or open a capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time.

Take Doxycycline for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated.

Doxycycline will not treat a viral infection such as the common cold or flu.

Do not give this medicine to another person, even if they have the same condition you have.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking Doxycycline. You may need to stop using the medicine for a short time.

Do not take any Doxycycline after the expiration date printed on the label. Using expired Doxycycline can cause damage to your kidneys.

Do not give Doxycycline to a child younger 8 years. It can cause permanent yellowing or graying of the teeth, and it can affect a child's growth.

If you miss a dose of Doxycycline, 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 Doxycycline.

Store Doxycycline at room temperature between 68 and 77 degrees F (20 and 25 degrees C) in a tightly closed container. Brief periods at temperatures of 59 to 86 degrees F (15 to 30 degrees C) are permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Doxycycline out of the reach of children and away from pets.

Do NOT use Doxycycline if:

you are allergic to any ingredient in Doxycycline, or to similar medicines such as demeclocycline (Declomycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap)

you are taking acitretin, isotretinoin, or a penicillin (eg, amoxicillin)

you have recently received or will be receiving a live oral typhoid vaccine.

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

Some medical conditions may interact with Doxycycline. 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 diarrhea, a stomach or intestinal infection, a history of lupus, or the blood disease porphyria

if you have liver or kidney disease, you may need a dose adjustment or special tests to safely take Doxycycline.

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

Barbiturates (eg, phenobarbital), carbamazepine, or hydantoins (eg, phenytoin) because they may decrease Doxycycline's effectiveness

Acitretin or isotretinoin because side effects, such as increased pressure inside the skull (resulting in severe headaches and vision problems) may occur

Anticoagulants (eg, warfarin), digoxin, methotrexate, or methoxyflurane because the risk of their side effects may be increased by Doxycycline

Live oral typhoid vaccine, hormonal birth control (eg, birth control pills), or penicillins (eg, amoxicillin) because their effectiveness may be decreased by Doxycycline.

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

Be sure to use Doxycycline for the full course of treatment. If you do not, the medicine may not clear up your infection completely. The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future.

Long-term or repeated use of Doxycycline may cause a second infection. Tell your doctor if signs of a second infection occur. Your medicine may need to be changed to treat this.

Mild diarrhea is common with antibiotic use. However, a more serious form of diarrhea (pseudomembranous colitis) may rarely occur. This may develop while you use the antibiotic or within several months after you stop using it. Contact your doctor right away if stomach pain or cramps, severe diarrhea, or blood stools occur. Do not treat diarrhea without first checking with your doctor.

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

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

Hormonal birth control (eg, birth control pills) may not work as well while you are using Doxycycline. To prevent pregnancy, use an extra form of birth control (eg, condoms).

Doxycycline may interfere with certain lab tests. Be sure your doctor and lab personnel know you are using Doxycycline.

Pregnancy and breast-feeding: Doxycycline has been shown to cause harm to the fetus. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Doxycycline while you are pregnant. Doxycycline is found in breast milk. Do not breastfeed while taking Doxycycline.

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:

Loss of appetite; nausea; sensitivity to sunlight; vomiting.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); bloody stools; chest pain; dark urine; decreased urination; fever, chills, or sore throat; moderate to severe sunburn; severe diarrhea; severe or persistent headache; stomach pain or cramps; throat irritation; trouble swallowing; unusual bruising or bleeding; unusual joint pain; unusual tiredness; vaginal irritation or discharge; vision changes; yellowing of the skin or eyes.

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

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

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

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

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

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

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

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

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

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

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



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In a bar in Toledo Across from the depot On a bar stool she took off her ring I thought I'd get closer So I walked on over I sat down and asked her name When the drinks finally hit her She said I'm no quitter But I finally quit livin' on dreams I'm hungry for laughter And here ever after I'm after whatever the other life brings

In the mirror I saw him And I closely watched him I thought how he looked out of place He came to the woman Who sat there beside me He had a strange look on his face The big hands were calloused He looked like a mountain For a minute I thought I was dead But he started shakin' His big heart was breakin' He turned to the woman and said

You picked a fine time to leave me Lucille With four hungry children And a crop in the field I've had some bad times Lived through some sad times But this time your hurtin' won't heal You picked a fine time to leave me Lucille

After he left us I ordered more whisky I thought how she'd made him look small From the lights of the bar room To a rented hotel room We walked without talkin' at all She was a beauty But when she came to me She must have thought I'd lost my mind I could'nt hold her 'Cos the words that he told her Kept coming back time after time

You picked a fine time to leave me Lucille With four hungry children And a crop in the field I've had some bad times Lived through some sad times But this time your hurtin' won't heal You picked a fine time to leave me Lucille

Lucille Lyrics

Love Me Like You Do

Can't Feel My Face

Take Me To Church

The Heart Wants What It Wants

translated from English to English

Kenny Rogers – Lucille Lyrics

Translation in progress. Please wait.

Songwriters: BOWLING, ROGER / BYNUM, HAL / HAMILTON, ANTHONY / COOMES, ERICK / COOMES, TYLER / BALFOUR, DAVID

Lucille lyrics © Sony/ATV Music Publishing LLC, THE BICYCLE MUSIC COMPANY, ANDITE INVASION

Lyrics term of use

More Kenny Rogers lyrics

In a bar in Toledo Across from the depot On a bar stool she took off her ring I thought I'd get closer So I walked on over I sat down and asked her name When the drinks finally hit her She said I'm no quitter But I finally quit livin' on dreams I'm hungry for laughter And here ever after I'm after whatever the other life brings

In the mirror I saw him And I closely watched him I thought how he looked out of place He came to the woman Who sat there beside me He had a strange look on his face The big hands were calloused He looked like a mountain For a minute I thought I was dead But he started shakin' His big heart was breakin' He turned to the woman and said

You picked a fine time to leave me Lucille With four hungry children And a crop in the field I've had some bad times Lived through some sad times But this time your hurtin' won't heal You picked a fine time to leave me Lucille

After he left us I ordered more whisky I thought how she'd made him look small From the lights of the bar room To a rented hotel room We walked without talkin' at all She was a beauty But when she came to me She must have thought I'd lost my mind I could'nt hold her 'Cos the words that he told her Kept coming back time after time

You picked a fine time to leave me Lucille With four hungry children And a crop in the field I've had some bad times Lived through some sad times But this time your hurtin' won't heal You picked a fine time to leave me Lucille

Lucille Lyrics

Love Me Like You Do

Can't Feel My Face

Take Me To Church

The Heart Wants What It Wants

translated from English to English

Kenny Rogers – Lucille Lyrics

Translation in progress. Please wait.

Songwriters: BOWLING, ROGER / BYNUM, HAL / HAMILTON, ANTHONY / COOMES, ERICK / COOMES, TYLER / BALFOUR, DAVID

Lucille lyrics © Sony/ATV Music Publishing LLC, THE BICYCLE MUSIC COMPANY, ANDITE INVASION

Lyrics term of use

More Kenny Rogers lyrics



Buy Online Lucille Lyrics - Kenny Rogers, Lucille

Adalat - Blood Pressure, Towarat Cr

Adalat is used to treat hypertension (high blood pressure) and angina (chest pain). Adalat is in a class of drugs called calcium channel blockers. Adalat relaxes (widens) your blood vessels (veins and arteries), which makes it easier for the heart to pump and reduces its workload.

Take Adalat exactly as prescribed by your doctor.

Do not take in larger or smaller amounts or for longer than recommended.

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

Take Adalat on an empty stomach. Do not crush, chew, or break a tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.

Do not stop taking Adalat even if you feel fine. Stopping suddenly may make your condition worse. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Your blood pressure will need to be checked often and you may need other blood tests at your doctor's office. Visit your doctor regularly.

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

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

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

Active Ingredient: Nifedipine.

you are allergic to any ingredient in Adalat.

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

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

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

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

if you have kidney or liver disease (especially cirrhosis), coronary artery disease, congestive heart failure, or digestive problems

if you have recently had or will be having surgery, or if you have recently stopped taking a beta-blocker (eg, propranolol).

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

acarbose (Precose);

cimetidine (Tagamet);

fentanyl (Actiq, Duragesic, Fentora) or other narcotic pain medications;

digoxin (Lanoxin);

nefazodone;

St. John's wort;

rifabutin (Mycobutin), rifampin (Rifadin, Rifater, Rifamate) or rifapentine (Priftin);

a blood thinner such as warfarin (Coumadin);

an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), or erythromycin (E. E.S. EryPed, Ery-Tab, Erythrocin);

antifungal medication such as fluconazole (Diflucan), itraconazole (Sporanox), or ketoconazole (Nizoral);

a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), timolol (Blocadren), and others;

a heart rhythm medication such as quinidine (Quin-G) or flecaininde (Tambocor);

HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), or ritonavir (Norvir, Kaletra, or saquinavir (Invirase);

medicines used to prevent organ transplant rejection, such as sirolimus (Rapamune) or tacrolimus (Prograf);

other heart or blood pressure medications such as benazepril (Lotensin), diltiazem (Cartia, Cardizem), doxazosin (Cardura), or verapamil (Calan, Covera, Isoptin, Verelan); or

seizure medication such as carbamazepine (Carbatrol, Tegretol), phenobarbital (Solfoton), or phenytoin (Dilantin).

This list is not complete and other drugs may interact with Adalat. Tell your doctor about all medications you use.

Important safety information:

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

Proper dental care is important while you are taking Adalat. Brush and floss your teeth and visit the dentist regularly.

Use Adalat with caution in the elderly.

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

Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Adalat while you are pregnant. It is not known if Adalat is found in breast milk. If you are or will be breast-feeding while you use Adalat, check with your doctor. Discuss any possible risks to your baby.

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

Call your doctor at once if you have a serious side effect while using Adalat such as:

worsening angina;

feeling like you might pass out;

feeling short of breath, swelling in your hands or feet;

fast or pounding heartbeats;

numbness or tingly feeling;

jaundice (yellowing of the skin or eyes); or

chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling.

Less serious side effects may include:

headache, dizziness;

drowsiness, tired feeling;

nausea, constipation, diarrhea, stomach pain;

sleep problems (insomnia);

mild rash or itching;

joint pain, leg cramps;

warmth, redness, or tingly feeling under your skin; or

urinating more than usual.

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.

Adalat is used to treat hypertension (high blood pressure) and angina (chest pain). Adalat is in a class of drugs called calcium channel blockers. Adalat relaxes (widens) your blood vessels (veins and arteries), which makes it easier for the heart to pump and reduces its workload.

Take Adalat exactly as prescribed by your doctor.

Do not take in larger or smaller amounts or for longer than recommended.

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

Take Adalat on an empty stomach. Do not crush, chew, or break a tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.

Do not stop taking Adalat even if you feel fine. Stopping suddenly may make your condition worse. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Your blood pressure will need to be checked often and you may need other blood tests at your doctor's office. Visit your doctor regularly.

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

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

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

Active Ingredient: Nifedipine.

you are allergic to any ingredient in Adalat.

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

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

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

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

if you have kidney or liver disease (especially cirrhosis), coronary artery disease, congestive heart failure, or digestive problems

if you have recently had or will be having surgery, or if you have recently stopped taking a beta-blocker (eg, propranolol).

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

acarbose (Precose);

cimetidine (Tagamet);

fentanyl (Actiq, Duragesic, Fentora) or other narcotic pain medications;

digoxin (Lanoxin);

nefazodone;

St. John's wort;

rifabutin (Mycobutin), rifampin (Rifadin, Rifater, Rifamate) or rifapentine (Priftin);

a blood thinner such as warfarin (Coumadin);

an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), or erythromycin (E. E.S. EryPed, Ery-Tab, Erythrocin);

antifungal medication such as fluconazole (Diflucan), itraconazole (Sporanox), or ketoconazole (Nizoral);

a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), timolol (Blocadren), and others;

a heart rhythm medication such as quinidine (Quin-G) or flecaininde (Tambocor);

HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), or ritonavir (Norvir, Kaletra, or saquinavir (Invirase);

medicines used to prevent organ transplant rejection, such as sirolimus (Rapamune) or tacrolimus (Prograf);

other heart or blood pressure medications such as benazepril (Lotensin), diltiazem (Cartia, Cardizem), doxazosin (Cardura), or verapamil (Calan, Covera, Isoptin, Verelan); or

seizure medication such as carbamazepine (Carbatrol, Tegretol), phenobarbital (Solfoton), or phenytoin (Dilantin).

This list is not complete and other drugs may interact with Adalat. Tell your doctor about all medications you use.

Important safety information:

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

Proper dental care is important while you are taking Adalat. Brush and floss your teeth and visit the dentist regularly.

Use Adalat with caution in the elderly.

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

Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Adalat while you are pregnant. It is not known if Adalat is found in breast milk. If you are or will be breast-feeding while you use Adalat, check with your doctor. Discuss any possible risks to your baby.

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

Call your doctor at once if you have a serious side effect while using Adalat such as:

worsening angina;

feeling like you might pass out;

feeling short of breath, swelling in your hands or feet;

fast or pounding heartbeats;

numbness or tingly feeling;

jaundice (yellowing of the skin or eyes); or

chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling.

Less serious side effects may include:

headache, dizziness;

drowsiness, tired feeling;

nausea, constipation, diarrhea, stomach pain;

sleep problems (insomnia);

mild rash or itching;

joint pain, leg cramps;

warmth, redness, or tingly feeling under your skin; or

urinating more than usual.

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.

Adalat is used to treat hypertension (high blood pressure) and angina (chest pain). Adalat is in a class of drugs called calcium channel blockers. Adalat relaxes (widens) your blood vessels (veins and arteries), which makes it easier for the heart to pump and reduces its workload.

Take Adalat exactly as prescribed by your doctor.

Do not take in larger or smaller amounts or for longer than recommended.

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

Take Adalat on an empty stomach. Do not crush, chew, or break a tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.

Do not stop taking Adalat even if you feel fine. Stopping suddenly may make your condition worse. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Your blood pressure will need to be checked often and you may need other blood tests at your doctor's office. Visit your doctor regularly.

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

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

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

Active Ingredient: Nifedipine.

you are allergic to any ingredient in Adalat.

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

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

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

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

if you have kidney or liver disease (especially cirrhosis), coronary artery disease, congestive heart failure, or digestive problems

if you have recently had or will be having surgery, or if you have recently stopped taking a beta-blocker (eg, propranolol).

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

acarbose (Precose);

cimetidine (Tagamet);

fentanyl (Actiq, Duragesic, Fentora) or other narcotic pain medications;

digoxin (Lanoxin);

nefazodone;

St. John's wort;

rifabutin (Mycobutin), rifampin (Rifadin, Rifater, Rifamate) or rifapentine (Priftin);

a blood thinner such as warfarin (Coumadin);

an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), or erythromycin (E. E.S. EryPed, Ery-Tab, Erythrocin);

antifungal medication such as fluconazole (Diflucan), itraconazole (Sporanox), or ketoconazole (Nizoral);

a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), timolol (Blocadren), and others;

a heart rhythm medication such as quinidine (Quin-G) or flecaininde (Tambocor);

HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), or ritonavir (Norvir, Kaletra, or saquinavir (Invirase);

medicines used to prevent organ transplant rejection, such as sirolimus (Rapamune) or tacrolimus (Prograf);

other heart or blood pressure medications such as benazepril (Lotensin), diltiazem (Cartia, Cardizem), doxazosin (Cardura), or verapamil (Calan, Covera, Isoptin, Verelan); or

seizure medication such as carbamazepine (Carbatrol, Tegretol), phenobarbital (Solfoton), or phenytoin (Dilantin).

This list is not complete and other drugs may interact with Adalat. Tell your doctor about all medications you use.

Important safety information:

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

Proper dental care is important while you are taking Adalat. Brush and floss your teeth and visit the dentist regularly.

Use Adalat with caution in the elderly.

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

Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Adalat while you are pregnant. It is not known if Adalat is found in breast milk. If you are or will be breast-feeding while you use Adalat, check with your doctor. Discuss any possible risks to your baby.

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

Call your doctor at once if you have a serious side effect while using Adalat such as:

worsening angina;

feeling like you might pass out;

feeling short of breath, swelling in your hands or feet;

fast or pounding heartbeats;

numbness or tingly feeling;

jaundice (yellowing of the skin or eyes); or

chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling.

Less serious side effects may include:

headache, dizziness;

drowsiness, tired feeling;

nausea, constipation, diarrhea, stomach pain;

sleep problems (insomnia);

mild rash or itching;

joint pain, leg cramps;

warmth, redness, or tingly feeling under your skin; or

urinating more than usual.

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.



Buy Online Adalat - Blood Pressure, Towarat Cr

Panum Group Sr, Panum

Sr. Acquisition SME

Описание компании

Panum Group, LLC, located in Bethesda, Maryland, is an Economically Disadvantaged Women Owned Small Business (EDWSOB). Our Federal client base and contract awards have increased significantly over the last three years due to our subject matter experts and skill set necessary to provide innovative and state-of-the-art solutions. Panum focus areas include Acquisition Support, Program/ Project Management and Network Infrastructure and Security Consulting.

Описание вакансии

Panum is seeking an experienced Sr. Acquisition SME who can support our government client, DHS - Customs & Border Protection. Duties will include but are not limited to:

• Consult and interface with OIT and PD staff and customers to identify and clarify requirements, establish milestones schedules, develop and review documents and provide feedback. The contractor will review, analyze and evaluate information and provide acquisition solutions recommendations. Draft acquisition plans, conduct market research and analysis, conduct cost benefit analysis, prepare statements of work, statements of objectives and performance based work statements, Section 508 Compliance forms, develop evaluation plans, provide technical evaluation guidance and conduct cost or price analysis for recommending negotiation position to government personnel. • Assist with the compilation of the solicitation, including the identification and production of exhibits and attachments, and other documentation required to support the preparation and issuance of solicitations to prospective offers. • Prepare acquisition templates and provide samples documents to program staff to assist with preparation of required solicitation documentation. Research and become thoroughly knowledgeable in the particular products and services for acquisition in order to identify and document the acquisition strategy. Comply with the Federal Acquisition Regulation (FAR) and DHS Acquisition Regulation supplements. Attend meetings and interface with budget, finance, and accounting staff, legal staff, PD staff, and external contracting offices as appropriate. • Use the CBP approved financial and procurement software system, currently SAP and PPS systems, for the creation of all procurement requisition (PR) actions. Assist OIT and PD by facilitating the SAP and PPS “approval” process by tracking the PR through the award phase. Attend Government provided SAP and PPS training before access will be granted. • Support market research by identify products, services; determine if capable commercial sources exit in the marketplace and to determine associate contractor availability, interest and capability. Review and analyze relevant market research information and technical profiles on industry trends and technology assessments to determine the best source for DHS services. Document the results of the market research and/or when insufficient data exists to determine private sector interest/capability and provide the documentation to the Government as directed. • Conduct review and oversight analysis of associate contractor compliance with the terms and conditions of their contract; and provide documentation of any discrepancies or adverse action recommendations to the Government as directed. • Support the review and analysis of associated contractor submitted contract deliverables to determine their compliance with contract/program requirements and applicable DHS standards. Prepare an analysis report documenting the findings to the Government. • Prepare and provide to the Government applicable program office procurement required documentation and/or data to support the issuance of Contract Change Orders and Contract Modifications. • Review other contract invoices to validate receipt of products and services and to ensure accuracy of the invoice for completeness and compliance with contractual requirements. Coordinate invoice approval with the Government Contracting Representative (COR) prior to payment by the CBP Payment Office. • Provide audit and analysis of completed contracts for all services and receipt of all deliverables to facilitate closeout the contract. Perform services such as research and analysis of the program office or COR files or the financial office files to validate completion, proper invoicing and payment of all Contracts, Delivery Orders or Task Orders as required by the COR. • The contractor will provide subject matter experts to PD and OIT personnel. SME will principally support PD personnel in working through procurement challenges, strategies, and work efforts with the goal of improving the overall quality of documentation and work products. SME will provide ”instant” and desk-side support to PD contracting officers and specialists and may support OIT and PD integrated project work teams as they work through complex procurement activities. Additionally, SME will collaborate with PD Workforce Development efforts to ensure learning objective are being communicated and executed through PD’s procurement work products.

Salary Range: $120-125K

Contract Period of Performance: Upon security clearance-09/16/2017

Required Clearance level: BI

Required schedule: Ad hoc Telework. No specified core hours.

Требования к квалификации

BA/BS in relevant field.

10+ years of government experience.

DAWIA Level II and/or FAC-C Level II certification (or completion of equivalent coursework) preferred.

Provides insight and advice concerning strategic direction and applicability of up to date, industry standard solutions, all based on in-depth understanding of the last developments. Responsible for providing high-level vision to program/project manager or senior leadership to influence objectives of complex efforts. Provide guidance on the functional procedures /processes/policies reflecting detailed knowledge of functional areas. May lead in-depth research in support of studies and analyses.

Дополнительная информация

Panum is an equal opportunity employer.

All your information will be kept confidential according to EEO guidelines.



Buy Online Panum Group Sr, Panum

Ecwid Help Portal, Ecwin

Frequently Asked Questions

If you want to help Ecwid, there are some ways to contribute.

Help Ecwid users on our forums .

Post your suggestions about new features to ideas. ecwid. com

Help us translate to Ecwid to as many languages as possible .

Give us any feedback about Ecwid. We really do appreciate your opinion about our work. -)

Spread the word about Ecwid. Tell your friends about it. Write a post to your blog. Send us a tweet.

We appreciate your help so much. Thank you!

Ecwid (pronounced eck-wid) is a shopping cart that seamlessly integrates with your existing website, blog, or social page. It can be added to your site, website builders (Joomla, WordPress, etc), social media networks (Facebook, Tumblr, etc), and is packed with easy-to-use features. With no setup charges or transaction fees, Ecwid is a low-cost, high-return solution for your e-commerce business.

If you sell items online, Ecwid helps you set up a professional online store, make checkout safe and easy, sell more items, and track your sales. You can quickly integrate Ecwid into your site with a few simple lines of code, and Ecwid makes it easy to add to your Facebook or Joomla store, change the design to match your site, and start selling right away. Sign up today.

Our 4 account types vary by number of products, types of functionality, and level of support. For more information, check out our pricing page. Free - Up to 10 products Venture - $15/month Business - $35/month Unlimited - $99/month You can also save money by enrolling in our annual plans.

What are your partnership programs all about?

We have two different partnership programs.

Our Channel Partnership program lets you easily integrate Ecwid into your existing products or services. Contact us for more information.

Our WebPartner program lets anyone who builds websites sign up to receive revenue share for paying customers referred to Ecwid.

How to add advanced search/filters to your store

If you have a large product base advanced product search will allow your customers navigate in the store faster and more efficiently.

Ecwid App Market features a few apps that allows to add advanced search to your store and enhance your customers’ shopping experience.

Product Search Enhancer

Product Search Enhancer app offers a list autosuggestions while the user types into the search field. The autosuggestions list shows the product image and description on hover. This feature helps to find the needed product faster without extra clicks.

The Advanced Search feature, allows to filter by price, categories, keyword, etc.

The app settings allow to customize the widget according to your needs:

configure Autosuggest

change the Mouse Hover Popup

add a custom search field to your site pages

This is a paid app with 7-day free trial.

Clickable Brand

Clickable Brand app allows to improve navigation in your store by making the 'Brand' attribute clickable, which allows to filter the products by brand.

Please refer to this article for details on how to assign 'Brand' attribute to your products: Product Types and Attributes

This is a paid app with 14-day free trial.

What design elements in my Ecwid store can I change?

Ecwid allows you to change CSS styles of customer storefront, including colors, fonts, margins, and images. This helps your integrated Ecwid store match the design of your site completely.

HTML is not available for editing, that is you can’t change the interface logic (how Ecwid behaves). We believe that most HTML changes people do are outside of Ecwid boundaries.

Ecwid does not need those "change header HTML / change footer HTML" functionality. The site owner can change the layout of the whole site. And CSS capabilities within Ecwid are more than enough for you to make Ecwid look as an integral part of your site.

In most cases, you won't have to edit anything, not even the CSS. Just pick one of the pre-defined schemes. Ecwid is designed to fit well in most sites.

If you’d like to change some elements in your store, our FAQs will guide you through this process and give you many ready-to-use solutions.

Ecwid can be integrated into any website, blog, or social network page. Or in several places at the same time: Ecwid is a wonderful solution to open multiple selling channels for your business.

Facebook. Joomla. WordPress. Wix - these are just some of the most popular platforms or site-builders that offer built-in plugins for Ecwid. You can find setup instruction for many other website platforms in our help center . If you have a custom web site, you can embed Ecwid there as well. It is possible to add Ecwid to any site that allows embedding HTML/JavaScript code. All you need is:

Create a free Ecwid account at my. ecwid. com.

Get the integration code through the setup wizard on Dashboard page in your Ecwid control panel or generate it here .

Copy the integration code into your web-page.

What requirements does Ecwid have for hosting?

Ecwid is a SaaS solution which stands for Software as a Service. In short, this means that your Ecwid shop and all its data is stored and processed on our own servers (we use Amazon Web Services for that). Ecwid does not use or consume resources of the server that runs your website.

The main advantage of this approach is that all software updates/upgrades/fixes are delivered automatically to your Ecwid store by our team. Security of your data is also our major daily concern and is handled by us as well. We take care of all the technical aspects so that you could focus on selling online.

You can use Ecwid with any site/hosting that allows embedding HTML/Javascript code (and even open an online store if you don't have a website/hosting with our Starter Site yet). So you should be choosing the hosting based on the requirements of your website's engine and other services that you are going to use and run on your webpages.

How will I receive payments from my customers?

Ecwid provides several ways to process payments. You can setup your Ecwid store to receive online payments like PayPal and/or credit cards (through various payment processors) as well as simply arrange the payment offsite. Check out this topic explaining this question in detail: Payment Options

Can I set the tax rate for a certain area or state?

Yes. You can assign a tax rate for a country, state, or ZIP code. When a customer checks out, we automatically apply the tax rate from their billing or mailing address. If you have multiple states or countries with the same tax rate, you can create a destination zone for that rate.

Can I have different combinations for the same product?

Yes. You can set different combinations for each product (size, color, etc), and assign a different image/price/SKU/quantity/low stock notification for each. Learn more about product combinations in this article .

Zapier: Save Ecwid Orders to Google Sheets

Sometimes it is necessary to have the orders from your store to be transferred to Google Sheets. This is a great instrument for managing your orders or creating reports. Now you can have your orders sent from Ecwid to Google Sheets automatically.

This can be done with the help of Zapier. Please see step-by-step instruction below.

Getting started

You need just two things: paid account in Ecwid and an account in Zapier.

Connecting Ecwid to Zapier

Select “New Order”

Connect a new account

Login to your Ecwid account if prompted and grant permissions

Now your Ecwid account is connected

Select orders statuses that will evoke creating a new zap

Test the first part of your zap

Connecting Google Sheets to Zapier

Login to your Google account, open a new tab and create a new spreadsheet (https://docs. google. com/spreadsheets/) for your orders from Ecwid, Zapier will add orders there as new lines.

Return to your Zapier tab. Select Google Sheets on the apps list

Select “Create Spreadsheet row”

Connect a new account

Grant permissions Select the spreadsheet you have created and a worksheet where your orders will be added

Select the desired Ecwid fields that you want to add to the spreadsheet NOTE: Please see the full list of available fields here: https://developers. ecwid. com/api-documentation#get-order-details If you do not see the field you need when creating a zap, create an order where this field is not empty, and it will appear on the list

Click “Create and Continue”

Name your zap and turn it on

Here is how the order automatically sent from Ecwid via our zap looks in Google Sheets



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Tenoblock Generic Name Atenolol Online, Tenoblock

Tenoblock General Information

Tenoblock - Pharmacology:

Like metoprolol, atenolol competes with sympathomimetic neurotransmitters such as catecholamines for binding at beta(1)-adrenergic receptors in the heart and vascular smooth muscle, inhibiting sympathetic stimulation. This results in a reduction in resting heart rate, cardiac output, systolic and diastolic blood pressure, and reflex orthostatic hypotension. Higher doses of atenolol also competitively block beta(2)-adrenergic responses in the bronchial and vascular smooth muscles.

Tenoblock for patients

This belongs to the group of medicines known as beta-blockers. Tenoblock can be used to treat high blood pressure, angina (chest pain) and irregular heartbeat. It has varied effects in different parts of the body. High Blood Pressure: Tenoblock works by blocking the transmission of messages to the beta receptors in the heart which slows down the activity of the heart, decreasing blood pressure. Angina: Tenoblock works by blocking the transmission of messages to the beta receptors in the heart which slows down the activity of the heart and reduces the hearts need for oxygen. This makes angina attacks less likely to occur. Irregular Heartbeat: Normally the heartbeat is regulated by special tissues which conduct electricity. Some cases of irregular heartbeat are caused by these tissues conducting electricity too quickly. Tenoblock works by reducing over-activity in the conducting tissue.

This description is suitable for active ingredient Atenolol

Tenoblock Interactions

Catecholamine-depleting drugs (eg, reserpine) may have an additive effect when given with beta-blocking agents. Patients treated with TENORMIN plus a catecholamine depletor should therefore be closely observed for evidence of hypotension and/or marked bradycardia which may produce vertigo, syncope, or postural hypotension.

Calcium channel blockers may also have an additive effect when given with TENORMIN .

Beta blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. If the two drugs are coadministered, the beta blocker should be withdrawn several days before the gradual withdrawal of clonidine. If replacing clonidine by beta-blocker therapy, the introduction of beta blockers should be delayed for several days after clonidine administration has stopped.

Concomitant use of prostaglandin synthase inhibiting drugs, eg, indomethacin, may decrease the hypotensive effects of beta blockers.

Information on concurrent usage of atenolol and aspirin is limited. Data from several studies, ie, TIMI-II, ISIS-2, currently do not suggest any clinical interaction between aspirin and beta blockers in the acute myocardial infarction setting.

While taking beta blockers, patients with a history of anaphylactic reaction to a variety of allergens may have a more severe reaction on repeated challenge, either accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat the allergic reaction.

Tenoblock Contraindications

TENORMIN is contraindicated in sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure.

TENORMIN is contraindicated in those patients with a history of hypersensitivity to the atenolol or any of the drug productis components.

This description is suitable for active ingredient Atenolol

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

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Flexible - Definition Of Flexible By The Free Dictionary, Flexibel

flexible

a. Capable of being bent or flexed; pliable: a flexible hose.

b. Readily bending or twisting the body without injury: You can play soccer much better if you're flexible.

2. Able to change to cope with variable circumstances: "a flexible and quietly competent administrator" (Jerome Karabel).

3. Capable of being changed or adjusted to meet particular or varied needs: a job with flexible hours; a flexible definition of normality.

[From Latin flexibilis . from flexus . past participle of flectere . to bend .]

flex′i·bil′i·ty . flex′i·ble·ness n.

Synonyms: flexible , elastic , resilient , supple These adjectives refer literally to what is capable of withstanding stress without damage and figuratively to what can undergo change or modification: a flexible wire; flexible plans; an elastic rubber band; an elastic interpretation of the law; thin, resilient copper; a resilient temperament; supple suede; a supple mind.

flexible

1. Also: flexile able to be bent easily without breaking; pliable

2. adaptable or variable: flexible working hours.

3. able to be persuaded easily; tractable

?flexi?bility . ?flexibleness n

flex•i•ble

(ˈflɛk sə bəl)

1. capable of being bent, usu. without breaking; easily bent.

2. susceptible of modification or adaptation; adaptable: a flexible schedule.

3. willing or disposed to yield; pliable; tractable: a flexible personality.

[1375–1425; late Middle English < Latin flexibilis . See flex 1. - ible ]

flex`i•bil′i•ty, flex′i•ble•ness, n.

flexible

flex

to bend, especially in order to test. to flex one's muscles. bult ??????? ?????? огувам (се) flexionar napnout, ohybat biegen bev?ge; rore ?????? flexionar. tensar painutama ?? ????? ??? ? ???? ???? taivuttaa flechir ???????? ?????? savijati, pregibati feszit menekuk beygja flettere. contrarre ??? (?? ???? ?? ????) ??? lankstyti, pa(mankstinti) []liekt; izvingrinat; izlocit menekuk buigen boye, spenne; vise muskler zginac ?????: ????? ?????? ?????? flectir a indoi сгибать ; напрягать ohybat (sa) upogniti stegnuti boja, spanna ?? bukmek ??,?? згинати(ся) ??? ??? ?? ?????? ?? ????? ??? ?????? lam cong; u?n cong ??,??

(a piece of) thin insulated wire for carrying electricity. That lamp has a long flex. koord ????? ?????????? ??????? шнур fio eletrico snura das Kabel ledning ??????? cable uhendusjuhe ??? ??? sahkojohto fil ???? ?????? ????? ?? ??? kabel, znora (vasalo)zsinor kabel einangru? raftaug cordoncino. filo flessibile ??? ??(??)?, ?? lankstus laidas (elektribas) vads wayar snoer elektrisk ledning. kabel przewod. sznur ? ????? ??? fio electrico lita гибкий шнур snura zica gajtan sladd ????? kordon ?? гнучкий шнур ?????? ???? ??? ??? ?? ???? ?? ???? ?? ???? ?? ?? ???? ?? day m?m ??

1. that can be bent easily. flexible metal. buigbaar ????? ?????????? гъвкав maleavel ohebny biegsam fleksibel; bojelig ????????? flexible painduv ?????? ???? taipuisa flexible ???? ????? savitljiv, elastican hajlithato lentur sveigjanlegur flessibile ????? ?? ?? lankstus lokans; elastigs mudah lentur buigzaam boyelig. smidig. fleksibel gietki ????????? ????????? ?????????? ???????? ??? ?? ?? ????? ??? ?? ???? ????? ???? maleavel flexibil гибкий ohybny upogljiv savitljiv bojbar, mjuk, elastisk ????????????? esnek ???? гнучкий ?????? d?o; d? u?n ????

2. able or willing to change according to circumstances etc . My holiday plans are very flexible. buigsaam ????? приспособим flexivel pruzny, prizpusobivy flexibel fleksibel ?????????. ????????? flexible paindlik ????? ???? joustava souple ???? ?????? ?? ?????? ????? fleksibilan, podlozan promjeni rugalmas lentur sveigjanlegur flessibile ????? ??? ?? lankstus elastigs fleksibel flexibel fleksibel elastyczny ???????? flexivel flexibil гибкий pruzny prilagodljiv fleksibilan flexibel ????????????????? esnek. degisebilir ??? гнучкий ?? ???? ?? ?? ???? linh d?ng; linh ho?t ???

buigsaamheid ???????? ?????? гъвкавост flexibilidade ohebnost; prizpusobivost die Biegsamkeit fleksibilitet ????????????. ???????? flexibilidad paindlikkus ?????? ????? joustavuus souplesse ?????? ??????? fleksibilnost, savitljivost, elasticnost hajlekonysag, rugalmassag kelenturan sveigjanleiki flessibilita ??? ???, ??? lankstumas lokanums; elastigums kelenturan flexibiliteit boyelighet. smidighet. fleksibilitet elastycznosc ????? ?????? ?????? flexibilidade flexibilitate гибкость ohybnost; pruznost prilagodljivost fleksibilnost bojlighet, flexibilitet ???????????? esneklik ??? гнучкість ??????? tinh m?m d?o; tinh linh ho?t ???

a system where employees may choose their own working hours. skiktyd ????? ????? ????? гъвкаво работно време horario flexivel pohybliva pracovni doba die Gleitzeit flekstid ???????? ?????? horario flexible paindlik toograafik ???? ??? ????? ???? liukuva tyoaika ?????? ???????? ????????? ??????? ??? ? ???? fleksibilno radno vrijeme rugalmas munkaido jam kerja yang dapat dipilih orario flessibile ??????? ?? ??? ?? ??? laisvas darbo grafikas brivs darba rezims waktu kerja fleksibel variabele werktijden fleksitid system plynnego czasu pracy ???? ???? ?????? ??? свободный режим рабочего дня pohybliva pracovna doba premicen delovni cas klizno radno vreme flextid ????????????????????????????????????????????????? esnek mesai saati ????? змінний графік роботи ????? ?? ???? ?? ????? ??? ???? h? th?ng gi? lam vi?c linh ho?t ?????

flexible

flexible

References in classic literature ?

The travelers anxiously regarded the upright, flexible figure of the young Mohican, graceful and unrestrained in the attitudes and movements of nature.

The life of the long and busy day--spent in occupations that might so easily have taken a squalid and ugly aspect--had been made pleasant, and even lovely, by the spontaneous grace with which these homely duties seemed to bloom out of her character; so that labor, while she dealt with it, had the easy and flexible charm of play.

They viciously snapped, not only at each other's disembowelments, but like flexible bows, bent round, and bit their own; till those entrails seemed swallowed over and over again by the same mouth, to be oppositely voided by the gaping wound.

True, from the unmarred dead body of the whale, you may scrape off with your hand an infinitely thin, transparent substance, somewhat resembling the thinnest shreds of isinglass, only it is almost as flexible and soft as satin; that is, previous to being dried, when it not only contracts and thickens, but becomes rather hard and brittle.

Instantly the flexible limbs of the child assumed the appearance of deformity and distortion, as, with his back humped up, and his master's stick in his hand, he hobbled about the room, his childish face drawn into a doleful pucker, and spitting from right to left, in imitation of an old man.

First you wrap a layer or two of blanket around your body, for a sort of cushion and to keep off the cold iron; then you put on your sleeves and shirt of chain mail -- these are made of small steel links woven together, and they form a fabric so flexible that if you toss your shirt onto the floor, it slumps into a pile like a peck of wet fish-net; it is very heavy and is nearly the uncomfortablest material in the world for a night shirt, yet plenty used it for that -- tax collectors, and reformers, and one-horse kings with a defective title, and those sorts of people; then you put on your shoes -- flat-boats roofed over with interleaving bands of steel -- and screw your clumsy spurs into the heels.

If Riverboro could have been suddenly emptied into a larger community, with different and more flexible opinions, he was, perhaps, the only personage in the entire population who would have attracted the smallest attention.

He was, in a word, a man of the most in - flexible firmness and stone-like coolness.

Mobile and flexible. it was never intended to be compressed in the eternal silence of solitude: it is a mouth which should speak much and smile often, and have human affection for its interlocutor.

She has the flexible face, the manageable voice, and the dramatic knack which fit a woman for character-parts and disguises on the stage.

This upper robe concealed what at first view seemed rather inconsistent with its form, a shirt, namely, of linked mail, with sleeves and gloves of the same, curiously plaited and interwoven, as flexible to the body as those which are now wrought in the stocking-loom, out of less obdurate materials.

Almost in the same breath, a strain of gallantry which was incorrigible in him, and to which his humor and his tenderness to women whom he liked gave variety and charm, would supervene upon his seriousness with a rapidity which her far less flexible temperament could not follow.



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Keflex Uses, Dosage - Side Effects, Kefalex

Keflex

an allergy to any drugs (especially penicillins);

kidney disease; or

a history of intestinal problems, such as colitis.

Keflex is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

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

How should I take Keflex?

Take Keflex exactly as it was prescribed for you. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Do not use Keflex to treat any condition that has not been checked by your doctor.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Keflex will not treat a viral infection such as the flu or a common cold.

Do not share Keflex with another person, even if they have the same symptoms you have.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using Keflex.

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

What happens if I miss a dose?

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

What happens if I overdose?

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

Overdose symptoms may include nausea, vomiting, stomach pain, diarrhea, and blood in your urine.

What should I avoid while taking Keflex?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Keflex side effects

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

Call your doctor at once if you have:

severe stomach pain, diarrhea that is watery or bloody;

jaundice (yellowing of the skin or eyes);

easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

little or no urination;

agitation, confusion, hallucinations; or

severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common Keflex side effects may include:

dizziness, feeling tired;

headache, joint pain; or

vaginal itching or discharge.

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

Keflex dosing information

Usual Adult Dose of Keflex for Bacterial Endocarditis Prophylaxis:

2 g orally as a single dose one hour before the procedure

Usual Adult Dose for Cystitis:

250 mg orally every 6 hours or 500 mg orally every 12 hours for 7 to 14 days

Usual Adult Dose for Otitis Media:

500 mg orally every 6 hours for 10 to 14 days

Usual Adult Dose for Pharyngitis:

250 mg orally every 6 hours or 500 mg orally every 12 hours

Usual Adult Dose for Skin or Soft Tissue Infection:

250 mg orally every 6 hours or 500 mg orally every 12 hours

Usual Adult Dose for Osteomyelitis:

500 mg orally every 6 hours Therapy should be continued for approximately 4 to 6 weeks, depending on the nature and severity of the infection. Chronic osteomyelitis may require an additional one to two months of antibiotic therapy and may benefit from surgical debridement.

Usual Adult Dose for Prostatitis:

500 mg orally every 6 hours for 14 days

Usual Adult Dose for Pyelonephritis:

500 mg orally every 6 hours for 14 days

Usual Adult Dose for Upper Respiratory Tract Infection:

250 to 500 mg orally every 6 hours for 7 to 10 days

Usual Adult Dose of Keflex for Bacterial Infection:

250 to 500 mg orally every 6 hours Therapy should be continued for approximately 7 to 21 days, depending on the nature and severity of the infection.

Usual Pediatric Dose of Keflex for Otitis Media:

12.5 to 25 mg/kg orally every 6 hours

Usual Pediatric Dose for Pharyngitis:

Over 1 year of age: Streptococcal pharyngitis: 12.5 to 25 mg/kg orally every 12 hours

Usual Pediatric Dose for Skin or Soft Tissue Infection:

12.5 to 25 mg/kg orally every 12 hours

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis:

As an alternative in penicillin-allergic patients (non-anaphylactoid type): 50 mg/kg (maximum 2 g) orally once, 1 hour before procedure

What other drugs will affect Keflex?

Other drugs may interact with Keflex, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

More about Keflex (cephalexin)

Consumer resources

Professional resources

Related treatment guides

Where can I get more information?

Your pharmacist can provide more information about Keflex.

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

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

Copyright 1996-2016 Cerner Multum, Inc. Version: 8.01. Revision Date: 2016-02-04, 8:31:42 AM.

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Doxycycline is used for treating infections caused by certain bacteria. It may be used in combination with other medicines to treat certain amoeba infections. It may also be used to prevent or slow the progression of anthrax after exposure. Doxycycline is a tetracycline antibiotic. It works by slowing the growth of bacteria. Slowing bacteria's growth allows the body's immune system to destroy the bacteria.

Take Doxycycline exactly as it was prescribed for you.

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.

Take Doxycycline with a full glass of water (8 ounces).

Do not take the medication with milk or other dairy products, unless your doctor has told you to. Dairy products can make it harder for your body to absorb the medicine.

Do not crush, break, or open a capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time.

Take Doxycycline for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated.

Doxycycline will not treat a viral infection such as the common cold or flu.

Do not give this medicine to another person, even if they have the same condition you have.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking Doxycycline. You may need to stop using the medicine for a short time.

Do not take any Doxycycline after the expiration date printed on the label. Using expired Doxycycline can cause damage to your kidneys.

Do not give Doxycycline to a child younger 8 years. It can cause permanent yellowing or graying of the teeth, and it can affect a child's growth.

If you miss a dose of Doxycycline, 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 Doxycycline.

Store Doxycycline at room temperature between 68 and 77 degrees F (20 and 25 degrees C) in a tightly closed container. Brief periods at temperatures of 59 to 86 degrees F (15 to 30 degrees C) are permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Doxycycline out of the reach of children and away from pets.

Do NOT use Doxycycline if:

you are allergic to any ingredient in Doxycycline, or to similar medicines such as demeclocycline (Declomycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap)

you are taking acitretin, isotretinoin, or a penicillin (eg, amoxicillin)

you have recently received or will be receiving a live oral typhoid vaccine.

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

Some medical conditions may interact with Doxycycline. 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 diarrhea, a stomach or intestinal infection, a history of lupus, or the blood disease porphyria

if you have liver or kidney disease, you may need a dose adjustment or special tests to safely take Doxycycline.

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

Barbiturates (eg, phenobarbital), carbamazepine, or hydantoins (eg, phenytoin) because they may decrease Doxycycline's effectiveness

Acitretin or isotretinoin because side effects, such as increased pressure inside the skull (resulting in severe headaches and vision problems) may occur

Anticoagulants (eg, warfarin), digoxin, methotrexate, or methoxyflurane because the risk of their side effects may be increased by Doxycycline

Live oral typhoid vaccine, hormonal birth control (eg, birth control pills), or penicillins (eg, amoxicillin) because their effectiveness may be decreased by Doxycycline.

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

Be sure to use Doxycycline for the full course of treatment. If you do not, the medicine may not clear up your infection completely. The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future.

Long-term or repeated use of Doxycycline may cause a second infection. Tell your doctor if signs of a second infection occur. Your medicine may need to be changed to treat this.

Mild diarrhea is common with antibiotic use. However, a more serious form of diarrhea (pseudomembranous colitis) may rarely occur. This may develop while you use the antibiotic or within several months after you stop using it. Contact your doctor right away if stomach pain or cramps, severe diarrhea, or blood stools occur. Do not treat diarrhea without first checking with your doctor.

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

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

Hormonal birth control (eg, birth control pills) may not work as well while you are using Doxycycline. To prevent pregnancy, use an extra form of birth control (eg, condoms).

Doxycycline may interfere with certain lab tests. Be sure your doctor and lab personnel know you are using Doxycycline.

Pregnancy and breast-feeding: Doxycycline has been shown to cause harm to the fetus. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Doxycycline while you are pregnant. Doxycycline is found in breast milk. Do not breastfeed while taking Doxycycline.

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:

Loss of appetite; nausea; sensitivity to sunlight; vomiting.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); bloody stools; chest pain; dark urine; decreased urination; fever, chills, or sore throat; moderate to severe sunburn; severe diarrhea; severe or persistent headache; stomach pain or cramps; throat irritation; trouble swallowing; unusual bruising or bleeding; unusual joint pain; unusual tiredness; vaginal irritation or discharge; vision changes; yellowing of the skin or eyes.

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

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Migrex Drug Information, Professional, Migrex

Migrex

Generic Name: Isometheptene, Dichloralphenazone, and Acetaminophen

INN: Acetaminophen—Paracetamol VA CLASSIFICATION Primary: CN103 Secondary: CN105

Commonly used brand name(s): Amidrine; Duradrin; I. D.A; Iso-Acetazone; Isocom; Midchlor; Midrin; Migquin; Migrapap; Migratine; Migrazone; Migrend; Migrex; Mitride.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

† Not commercially available in Canada.

Vascular headache suppressant (migraine)— Note: Some headache specialists question the validity of the term ``vascular headache'' because a correlation between dilatation of cerebral blood vessels and symptoms of migraine has not been demonstrated conclusively.

Headache, migraine (treatment) and Headache, tension-type (treatment)—Isometheptene, dichloralphenazone, and acetaminophen combination is indicated to relieve occasional migraine headaches (with or without aura) and coexisting migraine and tension-type headaches (“mixed” headache syndrome) . However, the U. S. FDA has classified this combination as being “possibly” effective in the treatment of migraine headaches. This classification requires the submission of adequate and well-controlled studies in order to provide substantial evidence of effectiveness.

Note: Some headache specialists question the value of this formulation in pure tension-type headaches. However, the distinction between vascular, tension-type, and “mixed” headaches is often difficult or uncertain, and the medication may relieve some headaches characterized as tension-type. Because frequent use of headache-aborting medications by headache-prone individuals may lead to tolerance and dependence, this medication is not recommended for regular use by patients who experience frequent, especially daily, headaches . To reduce analgesic use, underlying problems that may contribute to tension-type headaches, such as inflammation or structural abnormalities in the cervical or temporomandibular areas, should be identified and treated . In some patients, application of heat, muscle relaxants, and/or physical therapy may be helpful . Other medications having the potential to cause habituation (e. g. benzodiazepines used as muscle relaxants) should be used as infrequently as possible . Chronic tension-type headaches and severe migraines that occur more frequently than twice a month may require additional prophylactic treatment to reduce the frequency, severity, and/or duration of the headaches . The prophylactic agents most commonly used for tension-type headaches are tricyclic antidepressants, especially amitriptyline, and/or beta-adrenergic blocking agents, especially propranolol . For migraines, beta-adrenergic blocking agents, calcium channel blocking agents, tricyclic antidepressants, monoamine oxidase inhibitors, methysergide, pizotyline (not commercially available in the U. S.), and sometimes cyproheptadine (especially in children) are used as prophylaxis . The combination of amitriptyline plus propranolol has been found superior to either agent used alone as prophylaxis against “mixed” headaches . Identification and avoidance of precipitating factors is also important in the overall management of the patient with migraine headaches . Relaxation and/or biofeedback techniques may also be helpful in controlling some types of headache, and may reduce the need for medication .

Physicochemical characteristics: Molecular weight— Isometheptene mucate: 492.7 Dichloralphenazone: 519.04 Acetaminophen: 151.16 Mechanism of action/Effect:

Isometheptene—The mechanism of action has not been established. Isometheptene is an indirect-acting sympathomimetic agent with vasoconstricting activity. It has been proposed that constriction of cerebral blood vessels reduces the pulsation in cerebral arteries that may be responsible for the pain of migraine headaches . However, studies have not consistently shown a significant correlation between dilatation of cerebral blood vessels and pain or other symptoms of migraine headaches, or between a vasoconstrictive action and relief of migraine .

Dichloralphenazone—A complex of chloral hydrate and antipyrine (INN: phenazone) . It is present in this formulation as a mild sedative and relaxant .

Acetaminophen—The mechanism of analgesic action has not been fully determined. Acetaminophen may act predominantly by inhibiting prostaglandin synthesis in the central nervous system (CNS) and, to a lesser extent, through a peripheral action by blocking pain-impulse generation. The peripheral action may also be due to inhibition of prostaglandin synthesis or to inhibition of the synthesis or actions of other substances that sensitize pain receptors to mechanical or chemical stimulation . Absorption:

Acetaminophen—Rapid and almost complete; may be decreased if taken following a high-carbohydrate meal. Distribution:

In breast milk—Acetaminophen: Peak concentrations of 10 to 15 mcg per mL (66.2 to 99.3 micromoles/L) have been measured 1 to 2 hours following maternal ingestion of a single 650-mg dose. Biotransformation:

Dichloralphenazone—Hydrolyzed to the active compounds chloral hydrate and antipyrine . Chloral hydrate is metabolized in the liver and erythrocytes to the active metabolite trichloroethanol, which may be further metabolized to inactive metabolites . It is also metabolized in the liver and kidneys to inactive metabolites.

Acetaminophen—Approximately 90 to 95% of a dose is metabolized in the liver, primarily by conjugation with glucuronic acid, sulfuric acid, and cysteine . An intermediate metabolite, which may accumulate in overdosage after the primary metabolic pathways become saturated, is hepatotoxic and possibly nephrotoxic . Half-life:

1 to 4 hours; does not change with renal failure but may be prolonged in acute overdosage, in some forms of hepatic disease, and in the elderly; may be somewhat shortened in children.

In breast milk: 1.35 to 3.5 hours.

Time to peak concentration:

Acetaminophen—0.5 to 2 hours. Peak plasma concentration

Acetaminophen—5 to 20 mcg per mL (with doses up to 650 mg). Time to peak effect

Acetaminophen—1 to 3 hours. Duration of action:

Acetaminophen—3 to 4 hours. Elimination: Acetaminophen—Renal, as metabolites, primarily conjugates; 3% of a dose may be excreted unchanged.

In dialysis— Hemodialysis: 120 mL per minute (for unmetabolized drug); metabolites are also cleared rapidly. Hemoperfusion: 200 mL per minute. Peritoneal dialysis: <10 mL per minute.

Precautions to Consider

Note: The quantity of dichloralphenazone in this combination formulation does not provide full therapeutic doses of its active components chloral hydrate and antipyrine (phenazone). However, the possibility should be considered that precautions applying to chloral hydrate (see Chloral Hydrate [Systemic] ) and to antipyrine may apply to ingestion of an overdose or to overuse of this combination medication.

Cross-sensitivity and/or related problems

Patients sensitive to aspirin are usually not sensitive to acetaminophen; however, acetaminophen has caused mild bronchospastic reactions in some aspirin-sensitive asthmatics (less than 5% of those tested) . Pregnancy/Reproduction Fertility— Chronic toxicity studies in animals have shown that high doses of acetaminophen cause testicular atrophy and inhibition of spermatogenesis; the relevance of this finding to use in humans is not known.

Pregnancy— Acetaminophen crosses the placenta. However, problems in humans have not been documented. Breast-feeding

Problems in humans have not been documented. Although peak concentrations of 10 to 15 mcg per mL (66.2 to 99.3 micromoles/L) of acetaminophen have been measured in breast milk 1 to 2 hours following maternal ingestion of a single 650-mg dose, neither acetaminophen nor its metabolites were detected in the urine of the nursing infants. The half-life in breast milk is 1.35 to 3.5 hours. Pediatrics

No published information is available on the relationship of age to the effects of this combination medication in pediatric patients.

No published information is available on the relationship of age to the effects of this combination medication in geriatric patients. Geriatric patients are more likely to have peripheral vascular disease, and are therefore more likely to be adversely affected by peripheral vasoconstriction, than are younger adults. However, isometheptene may be safer for elderly patients than the ergot derivatives used to abort acute vascular headaches . Also, elderly patients are more likely to have age-related renal function impairment, which may require caution in patients receiving acetaminophen and isometheptene. Drug interactions and/or related problems The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive ( » = major clinical significance):

Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

Alcohol or CNS depressants (concurrent use with dichloralphenazone may cause additive sedation)

Alcohol, especially chronic abuse of or Hepatic enzyme inducers (See Appendix II ) or Hepatotoxic medications, other (See Appendix II ) (risk of hepatotoxicity with single toxic doses of acetaminophen may be increased in alcoholics or in patients regularly taking other hepatotoxic medications or hepatic enzyme–inducing agents)

(chronic use of barbiturates [except butalbital] or primidone has been reported to decrease the therapeutic effects of acetaminophen, probably because of increased metabolism resulting from induction of hepatic microsomal enzyme activity; the possibility should be considered that similar effects may occur with other hepatic enzyme inducers)

» Monoamine oxidase (MAO) inhibitors (concurrent use with an indirect-acting sympathomimetic such as isometheptene may cause sudden and severe hypertension and hyperpyrexia, which can reach crisis levels)

Laboratory value alterations The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive ( » = major clinical significance):

With diagnostic test results Glucose, blood, determinations (acetaminophen may cause values to be falsely decreased when measured by the glucose oxidase/peroxidase method but probably not when measured by the hexokinase [glucose-6-phosphate dehydrogenase (G6PD)] method)

5-Hydroxyindoleacetic acid (5-HIAA), serum, determinations (acetaminophen may cause false-positive results with qualitative screening tests using nitrosonaphthol reagent; the quantitative test is unaffected)

Pancreatic function test using bentiromide (administration of acetaminophen prior to the bentiromide test will invalidate test results because acetaminophen is also metabolized to an arylamine and will thus increase the apparent quantity of para-aminobenzoic acid [PABA] recovered; it is recommended that acetaminophen be discontinued at least 3 days prior to administration of bentiromide)

Uric acid, serum, determinations (acetaminophen may cause falsely increased values when the phosphotungstate uric acid test method is used)

With physiology/laboratory test values Bilirubin, serum and Lactate dehydrogenase (LDH), serum and Prothrombin time and Transaminase, serum (values may be increased indicating acetaminophen-induced hepatotoxicity, especially in alcoholics, patients taking other hepatic enzyme inducers, or patients with pre-existing hepatic disease, when single toxic doses [>8 to 10 grams] are taken)

Medical considerations/Contraindications The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive ( » = major clinical significance).

Risk-benefit should be considered when the following medical problems exist » Alcoholism, active or » Hepatic function impairment or » Viral hepatitis (increased risk of acetaminophen-induced hepatotoxicity)

Any condition in which the vasoconstrictive or other sympathomimetic effects of isometheptene may be hazardous, such as: Cardiovascular or cerebrovascular insufficiency, including recent myocardial infarction or stroke » Glaucoma . not optimally controlled » Hypertension . not optimally controlled » Organic heart disease Peripheral vascular disease » Renal function impairment, severe Sensitivity to acetaminophen, dichloralphenazone, or to isometheptene, history of

Note: The quantity of dichloralphenazone in this combination formulation does not provide full therapeutic doses of its active metabolites chloral hydrate and antipyrine (phenazone). However, the possibility should be considered that ingestion of an overdose or overuse of this combination medication may induce side effects characteristic of chloral hydrate (see Chloral Hydrate [Systemic] ) and/or antipyrine.

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive: Those indicating need for medical attention Incidence less frequent Anemia or methemoglobinemia (unusual tiredness or weakness )

Incidence rare Agranulocytosis (unexplained sore throat and fever) anemia (unusual tiredness or weakness) dermatitis, allergic (skin rash, hives, or itching) hepatitis (yellow eyes or skin) thrombocytopenia ( unusual bleeding or bruising; black, tarry stools; blood in urine or stools; pinpoint red spots on skin)—usually asymptomatic

Symptoms of tolerance and/or dependence —with overuse Headaches —more frequent, severe, and difficult to treat than previously

Those indicating need for medical attention only if they continue or are bothersome Incidence more frequent Drowsiness

Overdose For specific information on the agents used in the management of isometheptene, dichloralphenazone, and acetaminophen overdose, see: • Acetylcysteine (Systemic) monograph. For more information on the management of overdose or unintentional ingestion, contact a poison control center (see Poison Control Center Listing ). Clinical effects of overdose The following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive: Acute Gastrointestinal upset (diarrhea; loss of appetite ; nausea or vomiting; stomach cramps or pain) increased sweating Note: Early signs and symptoms of acetaminophen overdose, i. e. gastrointestinal upset and increased sweating often do not occur. However, when they do occur, they usually appear within 6 to 14 hours after ingestion of an overdose and persist for about 24 hours.

Chronic Hepatotoxicity (pain, tenderness, and/or swelling in upper abdominal area) Note: The first indications of overdosage may be signs and symptoms of possible liver damage and abnormalities in liver function tests, which may not occur until 2 to 4 days after ingestion of the overdose. Maximal changes in liver function tests usually occur 3 to 5 days after ingestion of the overdose. Overt hepatic disease or failure may occur 4 to 6 days after ingestion of the overdose. Hepatic encephalopathy (with mental changes, confusion, agitation, or stupor), convulsions, respiratory depression, coma, cerebral edema, coagulation defects, gastrointestinal bleeding, disseminated intravascular coagulation, hypoglycemia, metabolic acidosis, cardiac arrhythmias, and cardiovascular collapse may occur. Renal tubular necrosis leading to renal failure (signs may include bloody or cloudy urine and sudden decrease in amount of urine) has also been reported in acetaminophen overdose, usually, but not exclusively, in conjunction with acetaminophen-induced hepatotoxicity .

For acetaminophen: To decrease absorption—Emptying the stomach via induction of emesis or gastric lavage.

Removing activated charcoal (if used) by gastric lavage may be advisable. Although activated charcoal is recommended in cases of mixed drug overdose, it may interfere with absorption of orally administered acetylcysteine (antidote used to protect against acetaminophen-induced hepatotoxicity) and decrease its efficacy.

To enhance elimination—Instituting hemodialysis or hemoperfusion to remove acetaminophen from the circulation may be beneficial if acetylcysteine administration cannot be instituted within 24 hours following ingestion of a massive acetaminophen overdose. However, the efficacy of such treatment in preventing acetaminophen-induced hepatotoxicity is not known.

Specific treatment—Use of acetylcysteine. It is recommended that acetylcysteine administration be instituted as soon as possible after ingestion of an overdose has been reported, without waiting for the results of plasma acetaminophen determinations or other laboratory tests. Acetylcysteine is most effective if treatment is started within 10 to 12 hours after ingestion of the overdose; however, it may be of some benefit if treatment is started within 24 hours. See the package insert or Acetylcysteine (Systemic) monograph for specific dosing guidelines for use of this product.

Monitoring—Determining plasma acetaminophen concentration at least 4 hours following ingestion of the overdose. Determinations performed prior to this time are not reliable for assessing potential hepatotoxicity. Initial plasma concentrations above 150 mcg per mL (mcg/mL [993 micromoles/L]) at 4 hours, 100 mcg/mL (662 micromoles/L) at 6 hours, 70 mcg/mL (463.4 micromoles/L) at 8 hours, 50 mcg/mL (331 micromoles/L) at 10 hours, 20 mcg/mL (132.4 micromoles/L) at 15 hours, 8 mcg/mL (53 micromoles/L) at 20 hours, or 3.5 mcg/mL (23.2 micromoles/L) at 24 hours postingestion indicate possible hepatotoxicity and the need for completing the full course of acetylcysteine treatment. If the initial determination indicates a plasma concentration below those listed at the times indicated, cessation of acetylcysteine therapy can be considered. However, some clinicians advise that more than one determination should be performed to ascertain peak absorption and half-life of acetaminophen prior to considering discontinuation of acetylcysteine.

Monitoring renal and cardiac function and administering appropriate therapy as required.

Performing liver function tests (serum aspartate aminotransferase [AST; SGOT], serum alanine aminotransferase [ALT; SGPT], prothrombin time, and bilirubin) at 24-hour intervals for at least 96 hours postingestion if the plasma acetaminophen concentration indicates potential hepatotoxicity. If no abnormalities are detected within 96 hours, further determinations are not needed.

Supportive care—May include maintaining fluid and electrolyte balance, correcting hypoglycemia, and administering vitamin K 1 (if prothrombin time ratio exceeds 1.5) and fresh frozen plasma or clotting factor concentrate (if prothrombin time ratio exceeds 3.0).

For dichloralphenazone: To decrease absorption—May include gastric lavage (endotracheal tube with inflated cuff should be in place to prevent aspiration of vomitus).

To enhance elimination—Hemodialysis may be effective in promoting the clearance of the active metabolite trichloroethanol.

Specific treatment—May include providing artificial respiration with oxygen.

Monitoring—Continuous cardiac monitoring is important, especially in patients with predisposing cardiac disease.

Supportive care— May include maintaining normal body temperature, maintaining appropriate fluid and electrolyte therapy and urinary output, and supporting respiration and circulation. Patients in whom intentional overdose is known or suspected should be referred for psychiatric consultation.

For isometheptene: To decrease absorption—Emptying the stomach by induction of emesis or gastric lavage.

Monitoring—May include monitoring the patient, especially for signs and symptoms of excessive sympathetic stimulation or vasoconstriction, and treating observed symptoms as necessary.

Patient Consultation As an aid to patient consultation, refer to Advice for the Patient, Isometheptene, Dichloralphenazone, and Acetaminophen (Systemic).

In providing consultation, consider emphasizing the following selected information ( » = major clinical significance): Before using this medication » Conditions affecting use, especially: Allergic reaction to acetaminophen or to this combination medication, history of

Pregnancy—Acetaminophen crosses the placenta

Breast-feeding—Acetaminophen is excreted in breast milk Other medications, especially monoamine oxidase inhibitors Other medical problems, especially alcoholism (active), glaucoma, hypertension, heart disease, hepatic disease or viral hepatitis, and severe renal function impairment Proper use of this medication » Importance of not taking more medication than the amount prescribed; risk of tolerance and dependence with too frequent use; also, acetaminophen may cause liver damage with long-term use or greater than recommended doses

» Most effective when taken as soon as headache appears or at first sign of migraine attack (prodromal stage)

» Lying down in a quiet, dark room after taking initial dose

» Compliance with prophylactic therapy, if prescribed

» Proper storage Precautions while using this medication » Checking with physician if usual dose fails to relieve headaches, or if frequency and/or severity of headaches increases; possibility that tolerance to the medication has developed and/or withdrawal (rebound) or chronic, daily headaches are occurring

» Caution if other medications containing acetaminophen are used

» Caution when driving or doing jobs requiring alertness because of possible drowsiness or dizziness, especially if also taking a CNS depressant.

» Avoiding use of alcohol, which increases the risk of liver toxicity with high doses of acetaminophen, especially in alcoholics; also, alcohol may aggravate or induce headache

Side/adverse effects Signs of potential side effects, especially allergic dermatitis, blood dyscrasias, hepatotoxicity, and methemoglobinemia

General Dosing Information Therapy is most effective when initiated at the first symptoms of a headache (during the prodrome, for migraine with aura) .

After the first dose has been administered, it is recommended that the patient lie down and relax in a quiet, darkened room, because this contributes to relief of headaches .

In headache-prone individuals, frequent use of headache relievers may cause tolerance, leading to an increased dosage requirement . and to physical dependence, leading to both medication abuse and chronic (daily or near-daily) headaches. Patients who experience frequent headaches may also be dependent on a variety of other medications, including opioid analgesics, barbiturate-containing analgesic combinations, simple analgesics such as acetaminophen or aspirin, ergotamine, and antianxiety agents or sedatives .

Chronic headaches resulting from overmedication may be difficult to relieve, especially if the patient continues to take headache suppressants and/or analgesics . It is recommended that all such medications be discontinued . In-patient treatment may be necessary during detoxification . Naproxen, alone or together with amitriptyline . may reduce the severity of the headaches. Repetitive intravenous administration of dihydroergotamine (in conjunction with metoclopramide [to control dihydroergotamine-induced nausea and vomiting]) is recommended by some headache specialists to relieve chronic, intractable headaches associated with dependency on headache-aborting medications . Appropriate treatment for symptoms of withdrawal from other substances frequently used or abused by chronic headache patients may also be needed . In addition, appropriate prophylactic treatment should be initiated or adjusted to reduce the frequency and/or severity of future headaches .

Oral Dosage Forms ISOMETHEPTENE MUCATE, DICHLORALPHENAZONE, AND ACETAMINOPHEN CAPSULES USP Usual adult dose Tension-type headache Oral, 1 or 2 capsules every four hours as needed, up to 8 capsules a day.

Vascular headache suppressant (migraine) Oral, 2 capsules at the start of the attack (during the prodrome, for migraine with aura), followed by 1 capsule every hour as needed, up to 5 capsules in twelve hours.

Usual pediatric dose Dosage has not been established. Strength(s) usually available U. S.—

65 mg of isometheptene mucate, 100 mg of dichloralphenazone, and 325 mg of acetaminophen (Rx) [ Amidrine ] [ Duradrin (FD&C yellow No. 10)] [ I. D.A (FD&C yellow No. 10)] [ Iso-Acetazone ] [ Isocom ] [ Midchlor (FD&C yellow No. 10)] [ Midrin (FD&C yellow No. 6) ] [ Migrapap ] [ Migquin ] [ Migratine ] [ Migrazone ] [ Migrend ] [ Migrex ] [ Mitride ][Generic]

Canada— Not commercially available.

Packaging and storage: Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F). Store in a well-closed container.

References

All references used in the development and earlier revisions of this monograph have not yet been incorporated into the computer database and, therefore, are not listed below. Citations for information not yet referenced in the monograph will be provided upon request.

Prescribing information Midrin, Carnrick (U. S.), in Physician's desk reference 46th ed 1991: 836. rev. 11/88.

Kunkel RS. Diagnosis and treatment of muscle contraction (tension-type) headaches. Med Clin N Amer 1991; 75: 595-603.

AMA Drug Evaluations (Subscription). Chicago: American Medical Association; 1990 (summer update): Section 2, 2:1-2:11.

Couch JR. Headache. In: Rakel RE, ed. Conn's current therapy. Philadelphia: W. B. Saunders; 1991: 830-41.

Anthony M. The treatment of migraine and other headaches. Curr Opin Neurol Neurosurg 1991; 4: 245-52.

Diamond S. Migraine headache. Med Clin N Amer 1991; 75: 545-66.

Baumel B. Eisner LS. Diagnosis and treatment of headache in the elderly. Med Clin N Amer 1991; 75: 661-75.

Mathew NT. Prophylaxis of migraine and mixed headache. A randomized controlled study. Headache 1991; 21: 105-9.

Reynolds JEF, ed. Martindale. The extra pharmacopeia 29th ed. London: Pharmaceutical Press; 1985: 15, 273, 799-800.

Fleeger CA, ed. USAN and the USP dictionary of drug names. Rockville: The U. S. Pharmacopeial Convention, Inc. 1992: 18, 194.

Gennaro AR, ed. Remington's pharmaceutical sciences 17th ed. Easton: Mack; 1985: 881, 891-2.

Gilman AG, Rall TW, Nies AS, Taylor P, eds. Goodman and Gilman's the pharmacological basis of therapeutics 8th ed. New York: Pergamon Press; 1990: 357; 364-5; 640-1; 656-7.

Sandler DP, Smith JC, Weinberg CR et al. Analgesic use and chronic renal disease. N Engl J Med 1989 May 11; 320: 1238-43.

Szczeklik A. Analgesics, allergy, and asthma. Drugs 1986; 32 (suppl 4): 148-63.

Reviewer comment; Acetaminophen (Systemic) monograph, 1991 revision.

Hering R, Steiner TJ. Abrupt outpatient withdrawal of medication in analgesic-abusing migraineurs. Lancet 1991; 337: 1442-3.

Silberstein SD, Schulman EA, Hopkins M. Repetitive intravenous DHE in the treatment of refractory headache. Headache 1990; 30: 334-9.

Raskin NH. Pharmacology of migraine. Prog Drug Res 1990; 34: 209-30.

Panelist comments, draft 1/92 and ballot 5/92.

Product information: Midrin®, isometheptene mucate, dichloralphenazone, and acetaminophen. Carnrick Laboratories, Inc. Cedar Knolls, NJ, U. S.A. Rev. 5/98, Rec. 11/99.

Product Information: isometheptene mucate, dichloralphenazone and acetaminophen. Duramed Pharmaceuticals, Inc. Cincinnati, OH, U. S.A. Rev. 4/98, Rec. 11/99.



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Finasteride Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Fisteride

finasteride

GENERIC NAME(S): FINASTERIDE

Uses

Finasteride is used to shrink an enlarged prostate (benign prostatic hyperplasia or BPH ) in adult men. It may be used alone or taken in combination with other medications to reduce symptoms of BPH and may also reduce the need for surgery.

Finasteride may improve symptoms of BPH and provide benefits such as decreased urge to urinate, better urine flow with less straining, less of a feeling that the bladder is not completely emptied, and decreased nighttime urination. This medication works by decreasing the amount of a natural body hormone (DHT) that causes growth of the prostate .

Finasteride is not approved for prevention of prostate cancer. It may slightly increase the risk of developing a very serious form of prostate cancer. Talk to your doctor about the benefits and risks.

Women and children should not use this medication.

How to use finasteride

Read the Patient Information Leaflet provided by your pharmacist before you start taking finasteride and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist.

Take this medication by mouth. with or without food, usually once a day, or as directed by your doctor.

If the tablet is crushed or broken, it should not be handled by a woman who is pregnant or by a woman who may become pregnant (see also Precautions section).

Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day. Do not stop taking this medication without consulting your doctor.

It may take 6-12 months to notice a benefit.

Inform your doctor if your condition persists or worsens.

Side Effects

Decreased sexual ability/desire may occur. In some men, this medication can decrease the amount of semen released during sex. This is harmless, but has continued in some men even after stopping treatment. Finasteride may also increase hair growth. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

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

Tell your doctor right away if any of these unlikely but serious side effects occur: lump in the breast. nipple discharge. breast enlargement /tenderness/pain, pain in the testicles, inability to urinate.

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

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

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

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

Precautions

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

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, prostate cancer. infections, urinary problems.

Finasteride should not be used in children.

The drug can be absorbed through the skin. If the film coating of the tablet has been broken or the tablet crushed, it should not be handled by a woman who is pregnant or planning to become pregnant. Exposing a developing male infant to finasteride can result in abnormalities of the genitals.

Finasteride should not be used in women, especially during pregnancy or breast - feeding. It may harm an unborn or breast-feeding baby. Consult your doctor if you have any questions about this medication.

Interactions

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

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use.

This medication can affect the results of the blood test used to detect prostate cancer (prostatic-specific antigen or PSA levels ). Make sure laboratory personnel and your doctors know you use this drug.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Notes

Do not share this medication with others.

Laboratory and/or medical tests (e. g. prostate exams, PSA levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Keep all appointments with your doctor and the laboratory. You should have a complete physical examination. Follow your doctor's instructions for examining your breasts and testicles, and report any lumps right away.

Although early improvement is often seen, at least 6 to 12 months of therapy may be necessary in some patients to assess whether or not a benefit has occurred. Therefore, it is important to keep regular doctor appointments and get blood tests as scheduled to make sure this medication is working.

Many men are born with the condition this drug mimics (prostate glands that are smaller than usual) and lead normal lives with normal sex drives.

Missed Dose

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

Storage

Store US product at room temperature below 86 degrees F (30 degrees C) away from light and moisture in a tightly closed container.

Store Canadian product at room temperature between 59 to 86 degrees F (15 to 30 degrees C) away from light and moisture in a tightly closed container.

Do not store in the bathroom. Keep all medicines away from children and pets.

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

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

Images

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, expect as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

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Lisinopril Medlineplus Drug Information, Sinopryl

Lisinopril

Lisinopril is used alone or in combination with other medications to treat high blood pressure. It is used in combination with other medications to treat heart failure. Lisinopril is also used to improve survival after a heart attack. Lisinopril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.

High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

How should this medicine be used?

Lisinopril comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take lisinopril, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lisinopril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of lisinopril and gradually increase your dose.

Lisinopril controls high blood pressure and heart failure but does not cure them. Continue to take lisinopril even if you feel well. Do not stop taking lisinopril without talking to your doctor.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking lisinopril,

tell your doctor and pharmacist if you are allergic to lisinopril; other ACE inhibitors such as enalapril (Vasotec, in Vaseretic), benazepril (Lotensin, in Lotrel), captopril (Capoten), fosinopril (Monopril), moexipril (Univasc, in Uniretic), perindopril (Aceon), quinapril (Accupril, in Accuretic, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); any other medications; or any ingredients in lisinopril tablets. Ask your pharmacist for a list of the ingredients.

tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take lisinopril if you have diabetes and you are also taking aliskiren.

tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin, Tivorbex); diuretics ('water pills'); lithium (Lithobid); and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

tell your doctor if you have or have ever had heart or kidney disease; diabetes; lupus; scleroderma (a condition in which extra tissue grows on the skin and some organs); or angioedema (a condition that causes difficulty swallowing or breathing and painful swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs).

tell your doctor if you are breastfeeding.

if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lisinopril.

you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.

What special dietary instructions should I follow?

Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

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

cough

dizziness

headache

excessive tiredness

nausea

diarrhea

weakness

sneezing

runny nose

decrease in sexual ability

rash

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs

hoarseness

difficulty breathing or swallowing

fever, sore throat, chills, and other signs of infection

yellowing of the skin or eyes

lightheadedness

fainting

chest pain

Lisinopril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www. fda. gov/Safety/MedWatch ) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include the following:



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Hyzaar - Blood Pressure, Losachlor

What is this medicine?

LOSARTAN; HYDROCHLOROTHIAZIDE is a combination of a drug that relaxes blood vessels and a diuretic. It is used to treat high blood pressure. This medicine may also reduce the risk of stroke in certain patients.

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

They need to know if you have any of these conditions: decreased urine kidney disease liver disease if you are on a special diet, like a low-salt diet immune system problems, like lupus an unusual or allergic reaction to losartan, hydrochlorothiazide, sulfa drugs, other medicines, foods, dyes, or preservatives pregnant or trying to get pregnant breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. This medicine can be taken with or without food. Take your doses at regular intervals. Do not take your medicine more often than directed.

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

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

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

What if I miss a dose?

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

What may interact with this medicine? barbiturates, like phenobarbital blood pressure medicines celecoxib cimetidine corticosteroids diabetic medicines diuretics, especially triamterene, spironolactone or amiloride fluconazole lithium NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen potassium salts or potassium supplements prescription pain medicines rifampin skeletal muscle relaxants like tubocurarine some cholesterol-lowering medicines like cholestyramine or colestipol

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

What should I watch for while using this medicine?

Check your blood pressure regularly while you are taking this medicine. Ask your doctor or health care professional what your blood pressure should be and when you should contact him or her. When you check your blood pressure, write down the measurements to show your doctor or health care professional. If you are taking this medicine for a long time, you must visit your health care professional for regular checks on your progress. Make sure you schedule appointments on a regular basis.

You must not get dehydrated. Ask your doctor or health care professional how much fluid you need to drink a day. Check with him or her if you get an attack of severe diarrhea, nausea and vomiting, or if you sweat a lot. The loss of too much body fluid can make it dangerous for you to take this medicine.

Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child, particularly in the second or third trimester. Talk to your health care professional or pharmacist for more information.

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

This medicine may affect your blood sugar level. If you have diabetes, check with your doctor or health care professional before changing the dose of your diabetic medicine.

Avoid salt substitutes unless you are told otherwise by your doctor or health care professional.

Do not treat yourself for coughs, colds, or pain while you are taking this medicine without asking your doctor or health care professional for advice. Some ingredients may increase your blood pressure.

What side effects may I notice from this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible: allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue breathing problems dark urine fast or irregular heart beat, palpitations, or chest pain feeling faint or lightheaded muscle cramps persistent dry cough redness, blistering, peeling or loosening of the skin, including inside the mouth stomach pain trouble passing urine or change in the amount of urine unusual bleeding or bruising worsened gout pain yellowing of the eyes or skin

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

This list may not describe all possible side effects.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light. Keep container tightly closed. Throw away any unused medicine after the expiration date.

What is this medicine?

LOSARTAN; HYDROCHLOROTHIAZIDE is a combination of a drug that relaxes blood vessels and a diuretic. It is used to treat high blood pressure. This medicine may also reduce the risk of stroke in certain patients.

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

They need to know if you have any of these conditions: decreased urine kidney disease liver disease if you are on a special diet, like a low-salt diet immune system problems, like lupus an unusual or allergic reaction to losartan, hydrochlorothiazide, sulfa drugs, other medicines, foods, dyes, or preservatives pregnant or trying to get pregnant breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. This medicine can be taken with or without food. Take your doses at regular intervals. Do not take your medicine more often than directed.

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

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

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

What if I miss a dose?

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

What may interact with this medicine? barbiturates, like phenobarbital blood pressure medicines celecoxib cimetidine corticosteroids diabetic medicines diuretics, especially triamterene, spironolactone or amiloride fluconazole lithium NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen potassium salts or potassium supplements prescription pain medicines rifampin skeletal muscle relaxants like tubocurarine some cholesterol-lowering medicines like cholestyramine or colestipol

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

What should I watch for while using this medicine?

Check your blood pressure regularly while you are taking this medicine. Ask your doctor or health care professional what your blood pressure should be and when you should contact him or her. When you check your blood pressure, write down the measurements to show your doctor or health care professional. If you are taking this medicine for a long time, you must visit your health care professional for regular checks on your progress. Make sure you schedule appointments on a regular basis.

You must not get dehydrated. Ask your doctor or health care professional how much fluid you need to drink a day. Check with him or her if you get an attack of severe diarrhea, nausea and vomiting, or if you sweat a lot. The loss of too much body fluid can make it dangerous for you to take this medicine.

Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child, particularly in the second or third trimester. Talk to your health care professional or pharmacist for more information.

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

This medicine may affect your blood sugar level. If you have diabetes, check with your doctor or health care professional before changing the dose of your diabetic medicine.

Avoid salt substitutes unless you are told otherwise by your doctor or health care professional.

Do not treat yourself for coughs, colds, or pain while you are taking this medicine without asking your doctor or health care professional for advice. Some ingredients may increase your blood pressure.

What side effects may I notice from this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible: allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue breathing problems dark urine fast or irregular heart beat, palpitations, or chest pain feeling faint or lightheaded muscle cramps persistent dry cough redness, blistering, peeling or loosening of the skin, including inside the mouth stomach pain trouble passing urine or change in the amount of urine unusual bleeding or bruising worsened gout pain yellowing of the eyes or skin

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

This list may not describe all possible side effects.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light. Keep container tightly closed. Throw away any unused medicine after the expiration date.



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Fexofenadine - Fda Prescribing Information, Side Effects And Uses, Fexofenadinum

Fexofenadine

Table 3 lists adverse reactions in subjects 6 months to 5 years of age which were reported by greater than 2% of subjects treated with Fexofenadine hydrochloride in 3 open single - and multiple-dose pharmacokinetic studies and 3 placebo-controlled safety studies with Fexofenadine hydrochloride capsule content (484 subjects) and suspension (50 subjects) at doses of 15 mg (108 subjects) and 30 mg (426 subjects) given twice a day.

Table 3: Adverse Reactions Reported in Placebo-Controlled Studies in Pediatric Subjects With Allergic Rhinitis Aged 6 Months to 5 Years of Age at Rates Greater Than 2%

Fexofenadine 15 mg Twice Daily (n = 108) Frequency

Fexofenadine 30 mg Twice Daily (n = 426) Frequency

Fexofenadine Total Twice Daily (n = 534) Frequency

Placebo (n = 430) Frequency

Chronic Idiopathic Urticaria

Adverse reactions reported by subjects 12 years of age and older in placebo-controlled chronic idiopathic urticaria studies were similar to those reported in placebo-controlled seasonal allergic rhinitis studies.

In placebo-controlled chronic idiopathic urticaria clinical trials, 726 subjects 12 years of age and older received Fexofenadine hydrochloride tablets at doses of 20 to 240 mg twice daily. Table 4 lists adverse reactions in subjects aged 12 years and older which were reported by greater than 2% of subjects treated with Fexofenadine hydrochloride 60 mg tablets twice daily in controlled clinical studies in the United States and Canada.

In a placebo-controlled clinical study in the United States, 167 subjects aged 12 years and older received Fexofenadine hydrochloride 180 mg tablets. Table 4 also lists adverse reactions that were reported by greater than 2% of subjects treated with Fexofenadine hydrochloride tablets at doses of 180 mg once daily.

Table 4: Adverse Reactions Reported in Subjects 12 Years of Age and Older in Placebo-Controlled Chronic Idiopathic Urticaria Studies

Twice-daily dosing with Fexofenadine hydrochloride in studies in the United States and Canada at rates of greater than 2%

Fexofenadine 60 mg Twice Daily (n = 191) Frequency

The safety of Fexofenadine hydrochloride in the treatment of chronic idiopathic urticaria in pediatric patients 6 months to 11 years of age is based on the safety profile of Fexofenadine hydrochloride in adults and pediatric patients at doses equal to or higher than the recommended dose [ see Use in Specific Populations (8.4 ) ].

Postmarketing Experience

In addition to the adverse reactions reported during clinical studies and listed above, the following adverse events have been identified during post-approval use of Fexofenadine hydrochloride. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Events that have been reported rarely during postmarketing experience include: insomnia, nervousness, sleep disorders or paroniria, and hypersensitivity reactions (including anaphylaxis, urticaria, angioedema, chest tightness, dyspnea, flushing, pruritus, and rash).

Drug Interactions

Antacids

Fexofenadine hydrochloride should not be taken closely in time with aluminum and magnesium containing antacids. In healthy adult subjects, administration of 120 mg of Fexofenadine hydrochloride (2 x 60 mg capsule) within 15 minutes of an aluminum and magnesium containing antacid (Maalox ® ) decreased Fexofenadine AUC by 41% and C max by 43%.

Erythromycin and Ketoconazole

Fexofenadine has been shown to exhibit minimal (ca. 5%) metabolism. However, coadministration of Fexofenadine hydrochloride with either ketoconazole or erythromycin led to increased plasma concentrations of Fexofenadine in healthy adult subjects. Fexofenadine had no effect on the pharmacokinetics of either erythromycin or ketoconazole. In 2 separate studies in healthy adult subjects, Fexofenadine hydrochloride 120 mg twice daily (240 mg total daily dose) was coadministered with either erythromycin 500 mg every 8 hours or ketoconazole 400 mg once daily under steady-state conditions to healthy adult subjects (n = 24, each study). No differences in adverse events or QT c interval were observed when subjects were administered Fexofenadine hydrochloride alone or in combination with either erythromycin or ketoconazole. The findings of these studies are summarized in the following table:

Table 5: Effects on Steady-State Fexofenadine Pharmacokinetics After 7 Days of Coadministration With Fexofenadine Hydrochloride 120 mg Every 12 Hours in Healthy Adult Subjects (n = 24)

C maxSS (Peak plasma concentration)

AUC ss(0-12h) (Extent of systemic exposure)

The changes in plasma levels were within the range of plasma levels achieved in adequate and well-controlled clinical trials.

The mechanism of these interactions has been evaluated in in vitro, in situ. and in vivo animal models. These studies indicate that ketoconazole or erythromycin coadministration enhances Fexofenadine gastrointestinal absorption. This observed increase in the bioavailability of Fexofenadine may be due to transport-related effects, such as p-glycoprotein. In vivo animal studies also suggest that in addition to enhancing absorption, ketoconazole decreases Fexofenadine gastrointestinal secretion, while erythromycin may also decrease biliary excretion.

Fruit Juices

Fruit juices such as grapefruit, orange and apple may reduce the bioavailability and exposure of Fexofenadine. This is based on the results from 3 clinical studies using histamine induced skin wheals and flares coupled with population pharmacokinetic analysis. The size of wheal and flare were significantly larger when Fexofenadine hydrochloride was administered with either grapefruit or orange juices compared to water. Based on the literature reports, the same effects may be extrapolated to other fruit juices such as apple juice. The clinical significance of these observations is unknown. In addition, based on the population pharmacokinetics analysis of the combined data from grapefruit and orange juices studies with the data from a bioequivalence study, the bioavailability of Fexofenadine was reduced by 36%. Therefore, to maximize the effects of Fexofenadine, it is recommended that Fexofenadine hydrochloride tablets should be taken with water [ see Clinical Pharmacology (12.3 ) and Dosage and Administration (2.1 ) ].

USE IN SPECIFIC POPULATIONS

Pregnancy

Pregnancy Category C. There was no evidence of teratogenicity in rats or rabbits at oral doses of terfenadine up to 300 mg/kg (which led to Fexofenadine exposures that were approximately 4 and 30 times, respectively, the exposure at the maximum recommended human daily oral dose of 180 mg of Fexofenadine hydrochloride based on comparison of AUCs).

In mice, no adverse effects and no teratogenic effects during gestation were observed with Fexofenadine hydrochloride at oral doses up to 3730 mg/kg (which led to Fexofenadine exposures that were approximately 15 times the exposure at the maximum recommended human daily oral dose of 180 mg of Fexofenadine hydrochloride based on comparison of AUCs).

There are no adequate and well controlled studies in pregnant women. Fexofenadine hydrochloride should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Dose-related decreases in pup weight gain and survival were observed in rats exposed to an oral dose of 150 mg/kg of terfenadine (which led to Fexofenadine exposures that were approximately 3 times the exposure at the maximum recommended human daily oral dose of 180 mg of Fexofenadine hydrochloride based on comparison of AUCs).

Nursing Mothers

It is not known if Fexofenadine is excreted in human milk. There are no adequate and well-controlled studies in women during lactation. Because many drugs are excreted in human milk, caution should be exercised when Fexofenadine hydrochloride is administered to a nursing woman.

Pediatric Use

The recommended doses of Fexofenadine hydrochloride in pediatric patients 6 months to 11 years of age are based on cross-study comparison of the pharmacokinetics of Fexofenadine in adults and pediatric subjects and on the safety profile of Fexofenadine hydrochloride in both adult and pediatric subjects at doses equal to or higher than the recommended doses. The safety and effectiveness of Fexofenadine hydrochloride in pediatric patients under 6 months of age have not been established.

The safety of Fexofenadine hydrochloride is based on the administration of Fexofenadine hydrochloride tablets at a dose of 30 mg twice daily demonstrated in 438 pediatric subjects 6 years to 11 years of age in 2 placebo-controlled 2 week seasonal allergic rhinitis trials. The safety of Fexofenadine hydrochloride at doses of 15 mg and 30 mg given once and twice a day has been demonstrated in 969 pediatric subjects (6 months to 5 years of age) with allergic rhinitis in 3 pharmacokinetic studies and 3 safety studies. The safety of Fexofenadine hydrochloride for the treatment of chronic idiopathic urticaria in subjects 6 months to 11 years of age is based on cross-study comparison of the pharmacokinetics of Fexofenadine hydrochloride in adult and pediatric subjects and on the safety profile of Fexofenadine in both adult and pediatric subjects at doses equal to or higher than the recommended dose.

The effectiveness of Fexofenadine hydrochloride for the treatment of seasonal allergic rhinitis in subjects 6 to 11 years of age was demonstrated in 1 trial (n = 411) in which Fexofenadine hydrochloride tablets 30 mg twice daily significantly reduced total symptom scores compared to placebo, along with extrapolation of demonstrated efficacy in subjects aged 12 years and above, and the pharmacokinetic comparisons in adults and children. The effectiveness of Fexofenadine hydrochloride 30 mg twice daily for the treatment of seasonal allergic rhinitis in patients 2 to 5 years of age is based on the pharmacokinetic comparisons in adult and pediatric subjects and an extrapolation of the demonstrated efficacy of Fexofenadine hydrochloride in adult subjects with this condition and the likelihood that the disease course, pathophysiology, and the drug’s effect are substantially similar in pediatric patients to those in adult patients. The effectiveness of Fexofenadine hydrochloride for the treatment of chronic idiopathic urticaria in patients 6 months to 11 years of age is based on the pharmacokinetic comparisons in adults and children and an extrapolation of the demonstrated efficacy of Fexofenadine hydrochloride in adults with this condition and the likelihood that the disease course, pathophysiology and the drug’s effect are substantially similar in children to that of adult patients. Administration of a 15 mg dose of Fexofenadine hydrochloride to pediatric subjects 6 months to less than 2 years of age and a 30 mg dose to pediatric subjects 2 to 11 years of age produced exposures comparable to those seen with a dose of 60 mg administered to adults.

Geriatric Use

Clinical studies of Fexofenadine hydrochloride tablets and capsules did not include sufficient numbers of subjects aged 65 years and over to determine whether this population responds differently from younger subjects. Other reported clinical experience has not identified differences in responses between the geriatric and younger subjects. This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function [ see Clinical Pharmacology (12.3 ) ].

Renal Impairment

Based on increases in bioavailability and half-life, a dose of 60 mg once daily is recommended as the starting dose in adult patients with decreased renal function (mild, moderate or severe renal impairment). For pediatric patients with decreased renal function (mild, moderate or severe renal impairment), the recommended starting dose of Fexofenadine is 30 mg once daily for patients 2 to 11 years of age and 15 mg once daily for patients 6 months to less than 2 years of age [ see Clinical Pharmacology (12.3 ) ].

Hepatic Impairment

The pharmacokinetics of Fexofenadine hydrochloride in subjects with hepatic impairment did not differ substantially from that observed in healthy subjects.

Overdosage

Dizziness, drowsiness, and dry mouth have been reported with Fexofenadine hydrochloride overdose. Single doses of Fexofenadine hydrochloride up to 800 mg (6 healthy subjects at this dose level), and doses up to 690 mg twice daily for 1 month (3 healthy subjects at this dose level) or 240 mg once daily for 1 year (234 healthy subjects at this dose level) were administered without the development of clinically significant adverse events as compared to placebo.

In the event of overdose, consider standard measures to remove any unabsorbed drug. Symptomatic and supportive treatment is recommended. Following administration of terfenadine, hemodialysis did not effectively remove Fexofenadine, the major active metabolite of terfenadine, from blood (up to 1.7% removed).

No deaths occurred at oral doses of Fexofenadine hydrochloride up to 5000 mg/kg in mice (110 times the maximum recommended daily oral dose in adults and children based on mg/m 2 ) and up to 5000 mg/kg in rats (230 times the maximum recommended daily oral dose in adults and 210 times the maximum recommended daily oral dose in children based on mg/m 2 ). Additionally, no clinical signs of toxicity or gross pathological findings were observed. In dogs, no evidence of toxicity was observed at oral doses up to 2000 mg/kg (300 times the maximum recommended daily oral dose in adults and 280 times the maximum recommended daily oral dose in children based on mg/m 2 ).

Fexofenadine Description

Fexofenadine hydrochloride, the active ingredient of Fexofenadine hydrochloride tablets, is a histamine H 1 - receptor antagonist with the chemical name (±)-4-[1-hydroxy-4-[4-(hydroxydiphenylmethyl)-1-piperidinyl]-butyl]-α, α-dimethyl benzeneacetic acid hydrochloride. It has the following chemical structure:

C 32 H 39 NO 4 •HCl M. W. 538.13

Fexofenadine hydrochloride is a white to off-white crystalline powder. It is freely soluble in methanol and ethanol, slightly soluble in chloroform and water, and insoluble in hexane. Fexofenadine hydrochloride is a racemate and exists as a zwitterion in aqueous media at physiological pH.

Fexofenadine hydrochloride is formulated as a tablet for oral administration. Each tablet contains 30, 60, or 180 mg Fexofenadine hydrochloride (depending on the dosage strength) and the following excipients: colloidal silicon dioxide, croscarmellose sodium, hypromellose, iron oxide black, iron oxide red, iron oxide yellow, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, povidone, and titanium dioxide.

Fexofenadine hydrochloride tablets meet USP Dissolution Test 3 .

Fexofenadine - Clinical Pharmacology

Mechanism of Action

Fexofenadine hydrochloride, the major active metabolite of terfenadine, is an antihistamine with selective H 1 - receptor antagonist activity. Both enantiomers of Fexofenadine hydrochloride displayed approximately equipotent antihistaminic effects. Fexofenadine hydrochloride inhibited antigen-induced bronchospasm in sensitized guinea pigs and histamine release from peritoneal mast cells in rats. The clinical significance of these findings is unknown. In laboratory animals, no anticholinergic or alpha 1 - adrenergic blocking effects were observed. Moreover, no sedative or other central nervous system effects were observed. Radiolabeled tissue distribution studies in rats indicated that Fexofenadine does not cross the blood-brain barrier.

Pharmacodynamics

Wheal and Flare: Human histamine skin wheal and flare studies in adults following single and twice daily doses of 20 and 40 mg Fexofenadine hydrochloride demonstrated that the drug exhibits an antihistamine effect by 1 hour, achieves maximum effect at 2 to 3 hours, and an effect is still seen at 12 hours. There was no evidence of tolerance to these effects after 28 days of dosing. The clinical significance of these observations is unknown.

Histamine skin wheal and flare studies in 7 to 12 year old subjects showed that following a single dose of 30 or 60 mg, antihistamine effect was observed at 1 hour and reached a maximum by 3 hours. Greater than 49% inhibition of wheal area, and 74% inhibition of flare area were maintained for 8 hours following the 30 and 60 mg dose.

No statistically significant increase in mean QT c interval compared to placebo was observed in 714 adult subjects with seasonal allergic rhinitis given Fexofenadine hydrochloride capsules in doses of 60 to 240 mg twice daily for 2 weeks. Pediatric subjects from 2 placebo-controlled trials (n = 855) treated with up to 60 mg Fexofenadine hydrochloride twice daily demonstrated no significant treatment - or dose-related increases in QT c. In addition, no statistically significant increase in mean QT c interval compared to placebo was observed in 40 healthy adult subjects given Fexofenadine hydrochloride as an oral solution at doses up to 400 mg twice daily for 6 days, or in 230 healthy adult subjects given Fexofenadine hydrochloride 240 mg once daily for 1 year. In subjects with chronic idiopathic urticaria, there were no clinically relevant differences for any ECG intervals, including QT c. between those treated with Fexofenadine hydrochloride 180 mg once daily (n = 163) and those treated with placebo (n = 91) for 4 weeks.

Pharmacokinetics

The pharmacokinetics of Fexofenadine hydrochloride in subjects with seasonal allergic rhinitis and subjects with chronic urticaria were similar to those in healthy subjects.

Fexofenadine hydrochloride was absorbed following oral administration of a single dose of two 60 mg capsules to healthy male subjects with a mean time to maximum plasma concentration occurring at 2.6 hours post-dose. After administration of a single 60 mg capsule to healthy adult subjects, the mean maximum plasma concentration (C max ) was 131 ng/mL. Following single dose oral administrations of either the 60 and 180 mg tablet to healthy adult male subjects, mean C max were 142 and 494 ng/mL, respectively. The tablet formulations are bioequivalent to the capsule when administered at equal doses. Fexofenadine hydrochloride pharmacokinetics are linear for oral doses up to a total daily dose of 240 mg (120 mg twice daily). The administration of the 60 mg capsule contents mixed with applesauce did not have a significant effect on the pharmacokinetics of Fexofenadine in adults. Coadministration of 180 mg Fexofenadine hydrochloride tablet with a high fat meal decreased the mean area under the curve (AUC) and (C max ) of Fexofenadine by 21 and 20% respectively.

Fexofenadine hydrochloride is 60% to 70% bound to plasma proteins, primarily albumin and α 1 - acid glycoprotein.

Approximately 5% of the total dose of Fexofenadine hydrochloride was eliminated by hepatic metabolism.

The mean elimination half-life of Fexofenadine was 14.4 hours following administration of 60 mg twice daily in healthy adult subjects.

Human mass balance studies documented a recovery of approximately 80% and 11% of the [ 14 C] Fexofenadine hydrochloride dose in the feces and urine, respectively. Because the absolute bioavailability of Fexofenadine hydrochloride has not been established, it is unknown if the fecal component represents primarily unabsorbed drug or is the result of biliary excretion.

Pharmacokinetics in renally and hepatically impaired subjects and geriatric subjects, obtained after a single dose of 80 mg Fexofenadine hydrochloride, were compared to those from healthy subjects in a separate study of similar design.

In subjects with mild to moderate (creatinine clearance 41 to 80 mL/min) and severe (creatinine clearance 11 to 40 mL/min) renal impairment, peak plasma concentrations of Fexofenadine were 87% and 111% greater, respectively, and mean elimination half-lives were 59% and 72% longer, respectively, than observed in healthy subjects. Peak plasma concentrations in subjects on dialysis (creatinine clearance ≤ 10 mL/min) were 82% greater and half-life was 31% longer than observed in healthy subjects. Based on increases in bioavailability and half-life, a dose of 60 mg once daily is recommended as the starting dose in adult patients with decreased renal function. For pediatric patients with decreased renal function, the recommended starting dose of Fexofenadine is 30 mg once daily for patients 2 to 11 years of age and 15 mg once daily for patients 6 months to less than 2 years of age.

The pharmacokinetics of Fexofenadine hydrochloride in subjects with hepatic impairment did not differ substantially from that observed in healthy subjects.

In older subjects (≥ 65 years old), peak plasma levels of Fexofenadine were 99% greater than those observed in younger subjects (< 65 years old). Mean Fexofenadine elimination half-lives were similar to those observed in younger subjects.

A population pharmacokinetic analysis was performed with data from 77 pediatric subjects (6 months to 12 years of age) with allergic rhinitis and 136 adult subjects. The individual apparent oral clearance estimates of Fexofenadine were on average 44% and 36% lower in pediatric subjects 6 to 12 years (n = 14) and 2 to 5 years of age (n = 21), respectively, compared to adult subjects.

Administration of a 15 mg dose of Fexofenadine hydrochloride to pediatric subjects 6 months to less than 2 years of age and a 30 mg dose to pediatric subjects 2 to 11 years of age produced exposures comparable to those seen with a dose of 60 mg administered to adults.

Effect of Gender:

Across several trials, no clinically significant gender-related differences were observed in the pharmacokinetics of Fexofenadine hydrochloride.

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

The carcinogenic potential of Fexofenadine was assessed using terfenadine studies with adequate Fexofenadine exposure (based on plasma area-under-the-concentration vs. time [AUC] values). No evidence of carcinogenicity was observed in an 18 month study in mice and in a 24 month study in rats at oral doses up to 150 mg/kg of terfenadine (which led to Fexofenadine exposures that were approximately 3 and 5 times the exposure at the maximum recommended daily oral dose of Fexofenadine hydrochloride in adults [180 mg] and children [60 mg] respectively).

In in vitro (Bacterial Reverse Mutation, CHO/HGPRT Forward Mutation, and Rat Lymphocyte Chromosomal Aberration assays) and in vivo (Mouse Bone Marrow Micronucleus assay) tests, Fexofenadine hydrochloride revealed no evidence of mutagenicity.

In rat fertility studies, dose-related reductions in implants and increases in postimplantation losses were observed at an oral dose of 150 mg/kg of terfenadine (which led to Fexofenadine exposures that were approximately 3 times the exposure at the maximum recommended human daily oral dose of 180 mg of Fexofenadine hydrochloride based on comparison of AUCs). In mice, Fexofenadine hydrochloride produced no effect on male or female fertility at average oral doses up to 4438 mg/kg (which led to Fexofenadine exposures that were approximately 13 times the exposure at the maximum recommended human daily oral dose of 180 mg of Fexofenadine hydrochloride based on comparison of AUCs).

Animal Toxicology and/or Pharmacology

In dogs (30 mg/kg/orally twice daily for 5 days) and rabbits (10 mg/kg, intravenously over 1 hour), Fexofenadine hydrochloride did not prolong QT c. In dogs, the plasma Fexofenadine concentration was approximately 9 times the therapeutic plasma concentrations in adults receiving the maximum recommended human daily oral dose of 180 mg. In rabbits, the plasma Fexofenadine concentration was approximately 20 times the therapeutic plasma concentration in adults receiving the maximum recommended human daily oral dose of 180 mg. No effect was observed on calcium channel current, delayed K + channel current, or action potential duration in guinea pig myocytes, or on the delayed rectifier K + channel cloned from human heart at concentrations up to 1 x 10 -5 M of Fexofenadine.

Clinical Studies

Seasonal Allergic Rhinitis

Adults: In three 2 week, multicenter, randomized, double-blind, placebo-controlled trials in subjects 12 to 68 years of age with seasonal allergic rhinitis (n = 1634), Fexofenadine hydrochloride 60 mg twice daily significantly reduced total symptom scores (the sum of the individual scores for sneezing, rhinorrhea, itchy nose/palate/throat, itchy/watery/red eyes) compared to placebo. Statistically significant reductions in symptom scores were observed following the first 60 mg dose, with the effect maintained throughout the 12 hour interval. In these studies, there was no additional reduction in total symptom scores with higher doses of Fexofenadine hydrochloride up to 240 mg twice daily.

In one 2 week, multicenter, randomized, double-blind clinical trial in subjects 12 to 65 years of age with seasonal allergic rhinitis (n = 863), Fexofenadine hydrochloride 180 mg once daily significantly reduced total symptom scores (the sum of the individual scores for sneezing, rhinorrhea, itchy nose/palate/throat, itchy/watery/red eyes) compared to placebo. Although the number of subjects in some of the subgroups was small, there were no significant differences in the effect of Fexofenadine hydrochloride across subgroups of subjects defined by gender, age, and race. Onset of action for reduction in total symptom scores, excluding nasal congestion, was observed at 60 minutes compared to placebo following a single 60 mg Fexofenadine hydrochloride dose administered to subjects with seasonal allergic rhinitis who were exposed to ragweed pollen in an environmental exposure unit. In 1 clinical trial conducted with Fexofenadine hydrochloride 60 mg capsules, and in 1 clinical trial conducted with Fexofenadine hydrochloride and pseudoephedrine hydrochloride extended-release tablets (12 hour formulation), onset of action was seen within 1 to 3 hours.

Pediatrics: Two 2 week, multicenter, randomized, placebo-controlled, double-blind trials in 877 pediatric subjects 6 to 11 years of age with seasonal allergic rhinitis were conducted at doses of 15, 30, and 60 mg (tablets) twice daily. In 1 of these 2 studies, conducted in 411 pediatric subjects, all 3 doses of Fexofenadine hydrochloride significantly reduced total symptom scores (the sum of the individual scores for sneezing, rhinorrhea, itchy nose/palate/throat, itchy/watery/red eyes) compared to placebo, however, a dose-response relationship was not seen. The 60 mg twice daily dose did not provide any additional benefit over the 30 mg twice daily dose in pediatric subjects 6 to 11 years of age.

Administration of a 30 mg dose to pediatric subjects 2 to 11 years of age produced exposures comparable to those seen with a dose of 60 mg administered to adults [ see Clinical Pharmacology (12.3 ) ].

Chronic Idiopathic Urticaria

Two 4 week, multicenter, randomized, double-blind, placebo-controlled clinical trials compared four different doses of Fexofenadine hydrochloride tablet (20, 60, 120, and 240 mg twice daily) to placebo in subjects aged 12 to 70 years with chronic idiopathic urticaria (n = 726). Efficacy was demonstrated by a significant reduction in mean pruritus scores (MPS), mean number of wheals (MNW), and mean total symptom scores (MTSS, the sum of the MPS and MNW score). Although all 4 doses were significantly superior to placebo, symptom reduction was greater and efficacy was maintained over the entire 4 week treatment period with Fexofenadine hydrochloride doses of ≥ 60 mg twice daily. However, no additional benefit of the 120 or 240 mg Fexofenadine hydrochloride twice daily dose was seen over the 60 mg twice daily dose in reducing symptom scores. There were no significant differences in the effect of Fexofenadine hydrochloride across subgroups of subjects defined by gender, age, weight, and race.

In one 4 week, multicenter, randomized, double-blind, placebo-controlled clinical trial in subjects 12 years of age and older with chronic idiopathic urticaria (n = 259), Fexofenadine hydrochloride 180 mg once daily significantly reduced the mean number of wheals (MNW), the mean pruritus score (MPS), and the mean total symptom score (MTSS, the sum of the MPS and MNW scores). Similar reductions were observed for mean number of wheals and mean pruritus score at the end of the 24 hour dosing interval. Symptom reduction was greater with Fexofenadine hydrochloride 180 mg than with placebo. Improvement was demonstrated within 1 day of treatment with Fexofenadine hydrochloride 180 mg and was maintained over the entire 4 week treatment period. There were no significant differences in the effect of Fexofenadine hydrochloride across subgroups of subjects defined by gender, age, and race.

How Supplied/Storage and Handling

Fexofenadine hydrochloride tablets USP are available as follows:

30 mg – peach, capsule-shaped, film-coated tablets debossed with “93” on one side and “7251” on the other side, in bottles of 100.

60 mg – peach, round, film-coated tablets debossed with “93” on one side and “7252” on the other side, in bottles of 100 and 500.

180 mg – peach, round, film-coated tablets debossed with “93” on one side and “7253” on the other side, in bottles of 100 and 500.

Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature]. Protect from excessive moisture.

Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as required).

Patient Counseling Information

Provide the following information to patients and parents/caregivers of pediatric patients taking Fexofenadine hydrochloride tablets:

Fexofenadine hydrochloride tablets are prescribed for the relief of symptoms of seasonal allergic rhinitis or for the relief of symptoms of chronic idiopathic urticaria (hives). Instruct patients to take Fexofenadine hydrochloride tablets only as prescribed. Do not exceed the recommended dose. If any untoward effects occur while taking Fexofenadine hydrochloride tablets, discontinue use and consult a doctor.

Patients who are hypersensitive to any of the ingredients should not use these products.

Patients who are pregnant or nursing should use these products only if the potential benefit justifies the potential risk to the fetus or nursing infant.

Advise patients and parents/caregivers of pediatric patients to store the medication in a tightly closed container in a cool, dry place, away from small children.

Advise patients and parents/caregivers not to take Fexofenadine hydrochloride tablets with fruit juices.

Advise patients to take the Fexofenadine hydrochloride tablets with water.

Maalox ® is a registered trademark of AVENTIS PHARMACEUTICALS PRODUCTS INC.

Manufactured In Israel By:

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paracetamol

An over-the-counter analgesic used for headaches, muscle or joint pain, and fever, which lacks anti-inflammatory activity.

Therapeutic range 10–25 mg/L

Critical value ≥ 300 mg/L

Toxicology Overdose can cause fatal liver failure. Up to 10% of hospitalisations for overdose and 40% of acute hepatic failure are linked to paracetamol overdose, which is more often accidental—e. g. children, alcoholics—than suicidal. Doses of > 150 mg/kg/24 hours cause acute liver failure.

Clinical stage of paracetamol toxicity 1. 1–24 hours—Non-specific. 2. 24–48 hours—Right upper quadrant pain, tenderness with elevated liver enzymes. 3. 72–96 hours—Marked increase in liver enzymes; fulminant hepatic failure, coagulopathy, acidosis. 4. 4–14 days—Liver recuperates or patient dies.

Pathogenesis of paracetamol overdose 90% is metabolised in the liver to non-toxic glucuronide and sulphate conjugates; 5% is oxidised by cytochrome p450 to NAPQI, which covalently binds to hepatocyte macromolecules, leading to hepatocyte death; 5% is excreted unchanged in urine.

paracetamol

A drug widely used to relieve pain and reduce fever. The drug does not irritate the stomach, as ASPIRIN does, but overdose causes liver and kidney damage and may cause death from liver failure. 15 g or more is potentially serious. The victim remains well for a day or two and liver failure develops between the third and fifth day. The drug is on the WHO official list. Brand names are Alvedon, Calpol Disprol Paediatric, Infadrops, Medinol and Salzone. Preparations that include paracetamol include Cosalgesic, Distalgesic, Domperamol, Fortagesic, Kapake, Midrid, Migraleve, Paradote, Paramax, Remedeine and Solpadol. acetaminophen; N - acetyl - p - aminophenol; paracetamol a non-opioid analgesic with little or no anti-inflammatory action; first-line painkiller of choice; used with care in patients with hepatic or renal impairment, or alcohol dependency, or those taking metoclopramide; overdose causes severe liver damage and death; recommended adult dose: daily maximum of 4 g (i. e. 8 × 500 mg tablets) ( see Table 1 )

Table 1: Principles of pain management

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Physician Aid-In-Dying Ethical Topic In Medicine, Euthanasia Iii

Physician Aid-in-Dying

What is physician aid-in-dying?

Physician aid-in-dying (PAD) refers to a practice in which a physician provides a competent, terminally ill patient with a prescription for a lethal dose of medication, upon the patient's request, which the patient intends to use to end his or her own life. (For related discussion, see also End of Life Issues .)

What role does language play in discussions of aid-in-dying?

A variety of terms have historically been used to describe when a terminally ill patient uses a lethal dose of medication for the purpose of ending his or her life (or having control over the timing of death). Prior to the passage of the Oregon Death with Dignity Act in 1996, the term most often used was “physician-assisted suicide” (PAS). Those who use this term feel that it is an accurate reflection of the relationship between doctor and patient and refer to the etymological roots of suicide as “auto-killing” or “self-killing.” The use of this term ties the role of the physician to one that aids the patient in killing him or herself. However, implicit in the understanding of the word suicide is the notion of a premature death that is being hastened out of despair, therefore when mental illness impairs judgment, intervention to stop a suicide is ethically warranted because the person seeking suicide has lost his ability to carefully weigh the benefits and burdens of continued life. Generally speaking, persons who are suicidal are treated as though their decision-making capacity is compromised and health care providers often intervene and provide life-sustaining treatments (including involuntary psychiatric treatment) over the objections of the patient. Therefore, some people, including several national professional organizations*, object to the term suicide for the choice of a terminally ill patient to hasten death, because of the associations between suicide and mental illness. They argue that, unlike the patients with impaired judgment who request suicide, terminally ill patients who request medication under the Act have the capacity to make a rational, autonomous decision to end their lives.

The term “physician aid-in-dying” is used to describe the practice authorized under the Washington, Oregon and Vermont Death with Dignity Acts and is meant to reflect the requirement that eligible persons must be decisionally competent and have a limited life expectancy of about 6 months or less. In this context, the term is meant to reflect that physicians provide assistance to patients who are otherwise going to die, and who seek help to control the timing and circumstances of their death in the face of end-of-life suffering they deem intolerable. While this term evades the mental health connotations associated with the word suicide, people who object to the use of “physician aid in dying” suggest that it could include other practices that are clearly outside the legal bounds of the three states’ Death with Dignity Acts, e. g. a patient who receives assistance in ingesting the medication, which would constitute euthanasia (see below). Here we use the term physician aid-in-dying to reflect the practice that is legal under the Washington Death with Dignity Act.

It is important to note that both terms, “physician assisted suicide” and “physician aid-in-dying” are value-laden and may reflect the speaker or writer’s political or ideological support for or objection to the practice. Recent research has detailed the need for open and honest discussion on end of life issues. This discussion should supersede any debate over the use of particular terms or language. Acknowledging the power of both historic and contemporary terminology, will help flesh out both sides of this sensitive and powerful debate.

*The Oregon Department of Public Health, American Public Health Association, American Psychological Association, American Academy of Hospice and Palliative Care, American Medical Women’s Association, and the American Medical Student Association have adopted the term patient directed dying or physician aid-in-dying and have rejected the term physician-assisted suicide. Neither term is used in Oregon, Washington or Vermont Death with Dignity laws.

Is physician aid-in-dying (PAD) the same as euthanasia?

No. While both physician aid-in-dying and euthanasia involve the use of lethal medications to deliberately end a patient's life, the key difference is in who acts to administer the medications that will end the patient’s life. In physician aid-in-dying, the patient must self-administer the medications; the "aid-in-dying" refers to a physician providing the medications, but the patient decides whether and when to ingest the lethal medication. Euthanasia occurs when a third party administers medication or acts directly to end the patient’s life. Euthanasia is illegal in every state, including Washington.

Some other practices that should be distinguished from physician aid-in-dying include:

Withholding/withdrawing life-sustaining treatments: When a competent adult patient makes an informed decision to refuse life-sustaining treatment, their wishes are generally respected. The right of a competent adult patient to refuse life-sustaining treatments is supported by law.

Pain medication that may hasten death: Often a terminally ill, suffering patient may require dosages of pain medication that have side effects that may hasten death, such as impairing respiration. Using the ethical principle of double effect as the foundational argument, it is generally held by most professional societies, and supported in court decisions, that this action is justifiable. Since the primary goal and intention of administering these medications is to relieve suffering, the secondary outcome of potentially hastening death is recognized as an expected and acceptable side-effect in a terminally ill patient.

Palliative sedation: This term refers to the practice of sedating a terminally ill patient to the point of unconsciousness, due to intractable pain and suffering that has been refractory to traditional medical management. Such patients are imminently dying, usually hours or days from death. Often other life-sustaining interventions continue to be withheld (CPR, respirator, antibiotics, artificial nutrition and hydration, etc.) while the patient is sedated. Palliative sedation may occur for a short period (respite from intractable pain) or the patient may be sedated until s/he dies. In the rare instances when pain and suffering is refractory to treatment even with expert clinical management by pain and palliative care professionals, palliative sedation may legally be employed.

Is physician aid-in-dying (PAD) ethically permissible?

The ethics of physician aid-in-dying continue to be debated. Some argue that PAD is ethically permissible (see arguments in favor ). Often this position is argued on the grounds that PAD may be a rational choice for a dying person who is choosing to escape unbearable suffering at the end of life. Furthermore, the physician's duty to alleviate suffering may, at times, justify providing aid-in-dying. These arguments rely on respect for individual autonomy, recognizing the right of competent people to choose the timing and manner of death in the face of a terminal illness.

Others have argued that PAD is not ethically permissible because PAD runs directly counter to the traditional duty of the physician to preserve life and to do no harm (see arguments against ). Furthermore, many argue if PAD were legal, abuses would take place, as the social forces that condone the practice are a slippery slope that could lead to euthanasia. For instance, the disabled, poor or elderly might be covertly pressured to choose PAD over more complex and expensive palliative care options.

For more information on the debate around PAD please see Euthanasia Pros and Cons . What are the arguments in favor of physician aid-in-dying (PAD)?

Those who argue that PAD is ethically justifiable offer the following arguments:

Respect for autonomy: Decisions about time and circumstances of death are personal. Competent people should have right to choose the timing and manner of death.

Justice: Justice requires that we "treat like cases alike." Competent, terminally ill patients have the legal right to refuse treatment that will prolong their deaths. For patients who are suffering but who are not dependent on life support, such as respirators or dialysis, refusing treatment will not suffice to hasten death. Thus, to treat these patients equitably, we should allow assisted death as it is their only option to hasten death.

Compassion: Suffering means more than pain; there are other physical, existential, social and psychological burdens such as the loss of independence, loss of sense of self, and functional capacities that some patients feel jeopardize their dignity. It is not always possible to relieve suffering. Thus PAD may be a compassionate response to unremitting suffering.

Individual liberty vs. state interest . Though society has strong interest in preserving life, that interest lessens when a person is terminally ill and has strong desire to end life. A complete prohibition against PAD excessively limits personal liberty. Therefore PAD should be allowed in certain cases.

Honesty & transparency: Some acknowledge that assisted death already occurs, albeit in secret. The fact that PAD is illegal in most states prevents open discussion between patients and physicians and in public discourse. Legalization of PAD would promote open discussion and may promote better end-of-life care as patients and physicians could more directly address concerns and options.

What are the arguments against physician aid-in-dying (PAD)?

Those who argue that PAD is ethically impermissible often offer arguments such as these:

Sanctity of life: Religious and secular traditions upholding the sanctity of human life have historically prohibited suicide or assistance in dying. PAD is morally wrong because it is viewed as diminishing the sanctity of life.

Passive vs. Active distinction: There is an important difference between passively "letting die" and actively "killing." Treatment refusal or withholding treatment equates to letting die (passive) and is justifiable, whereas PAD equates to killing (active) and is not justifiable.

Potential for abuse: Vulnerable populations, lacking access to quality care and support, may be pushed into assisted death. Furthermore, assisted death may become a cost-containment strategy. Burdened family members and health care providers may encourage loved ones to opt for assisted death and the protections in legislation can never catch all instances of such coercion or exploitation. To protect against these abuses, PAD should remain illegal.

Professional integrity: Historical ethical traditions in medicine are strongly opposed to taking life. For instance, the Hippocratic oath states, "I will not administer poison to anyone where asked," and I will "be of benefit, or at least do no harm." Furthermore, some major professional groups such as the American Medical Association and the American Geriatrics Society oppose assisted death. The overall concern is that linking PAD to the practice of medicine could harm both the integrity and the public's image of the profession.

Fallibility of the profession: The concern here is that physicians will make mistakes. For instance there may be uncertainty in diagnosis and prognosis. There may be errors in diagnosis and treatment of depression, or inadequate treatment of pain. Thus the State has an obligation to protect lives from these inevitable mistakes and to improve the quality of pain and symptom management at the end of life.

Is physician aid-in-dying (PAD) illegal?

Physician aid-in-dying is legal in Oregon, Washington, and Vermont, where voter-approved initiatives or legislative action have legalized aid-in-dying under very specific circumstances. A Montana lower court has also determined that physician aid-in-dying is permitted under Montana's State Constitution; this decision was upheld by the Montana State Supreme Court in December 2009.

In other states, without specific legislative authority or a court decision, physician aid-in-dying would most likely be considered illegal, and in many states is explicitly illegal. The citizens of Oregon passed Measure 16, the Oregon Death with Dignity Act, on November 16, 1994 by a margin of 51.3% to 48.7%. Opponents immediately challenged the law and it was not enacted. In response, the Oregon Legislature referred Measure 51 (a law to repeal Measure 16) for a public vote. That measure was defeated by 60% of the votes in 1997. Thus, physician-assisted dying has been legal in the state of Oregon since 1997. In November 2008, the citizens of Washington state passed I-1000, The Washington State Death with Dignity Act (DwDA) by a margin of 57.8% to 42.2%, and it went into effect on March 5th, 2009. On May 20, 2013, PAD was legalized in Vermont when the governor signed a bill that was passed by the state legislature. Similar legislation was been introduced in 2013 and 2014 in Connecticut, Hawaii, Kansas, Massachusetts, New Hampshire, New Jersey and Pennsylvania; none of these states has yet to approve these bills.

The laws in all three states have strict patient eligibility criteria, limiting access to competent, legal residents of the state over age 18, with a terminal illness (defined as an estimated life expectancy of 6 months or less) that is confirmed by two independent physicians. There is a requirement for two oral requests with a 15-day waiting period in between, as well as a written request that must be witnessed. Prescriptions may be written no less than 48 hours after the receipt of the written request. Patients must be able to self-administer the medications (i. e. have the mental and physical capacity to take the medications on their own). Providers may decline to prescribe medication under the Act.

Several major court decisions have been made regarding this issue. In the case of Washington v. Glucksberg . the plaintiffs argued that prohibitions against suicide impinged on an individual’s right to liberty, as stated in the due process clause of the 14th Amendment. The Ninth US Circuit Court of Appeals upheld this argument, but this decision was later overturned by the United States Supreme Court. In another case, Vacco v. Quill . the Second Circuit Court found a New York law prohibiting assisted suicide was in conflict with the equal protections clause of the 14th amendment, which says that no state shall "deny to any person within its jurisdiction the equal protection of the laws." The Court held that competent patients were being treated differently than incompetent patients. The US Supreme Court declined to find a federal constitutional right to “assisted suicide”, and made a legal distinction between refusal of treatment and PAS. The Court also left the decision of whether to legalize PAS up to each individual state.

There have been high-profile cases related to specific incidents of aid-in-dying. One involved Dr. Timothy Quill (of Vacco v. Quill) who was investigated but not indicted for his participation in the suicide of a patient after he published his account of the incident. Another involved Dr. Jack Kevorkian who claimed to have assisted over 100 patients in death, and was acquitted on murder charges on multiple occasions. In November 1998, he and his patient, 52 year-old Thomas Youk, who suffered from Amyotrophic Lateral Sclerosis (ALS-otherwise known as Lou Gehrig's Disease) appeared on the TV show 60 Minutes where Dr. Kevorkian administered a lethal injection. As a result of the show, Kevorkian was tried for first degree murder in Oakland County, Michigan. Prosecutors argued that, in administering a lethal injection to Youk, his actions constituted euthanasia rather than PAD. Kevorkian was convicted of second degree murder in 1998, sentenced to a 15-25 year term of which he served 8 years, and was released in 2007.

What does the medical profession think of physician aid-in-dying (PAD)?

Surveys of individual physicians show that half believe that PAD is ethically justifiable in certain cases (Cohen et al. 1994). However, professional organizations such as the American Medical Association have generally argued against PAD on the grounds that it undermines the integrity of the profession.

Surveys of physicians in practice show that about 1 in 5 will receive a request for PAD sometime in their career (Back et al. 1996; Meier et al. 1998). Qualitative research has shown that requests for PAD bring up sensitive issues and emotions. Physicians stated that the discussion around these issues was lengthy and included patient and physician concerns about depression, pain and symptom management, issues of control, and exploration of the fear of abandonment (Back et al. 2002; Dobscha et al. 2004; Ganzini et al. 2000, 2001).

What should I do if a patient asks me for physician aid-in-dying (PAD)?

One of the most important aspects of responding to a request for PAD is to be respectful and caring. Virtually every request represents a profound event for the patient, who may have agonized over his situation. The patient's request should be explored, to better understand its origin and to determine if there are other interventions that may help ameliorate the concerns that motivated the request. In most cases, there are alternatives in palliative and hospice care that likely will address most of the patient’s concerns. Palliative care physicians recommend the following process for evaluating and responding to requests (Emanuel, 1998; Quill & Arnold, 2008a, 2008b).

Wait to directly respond to the request until you have explored the reasons for the patient’s request. Discuss various ways of addressing the patient’s pain, suffering, hopes, and fears. If time permits, tell the patient that you would like to talk more about this at a subsequent appointment. That gives both you and the patient time to prepare for a fuller exploration of PAD as well as other palliative treatments, hospice, etc.

Evaluate for depression or other psychiatric conditions and treat appropriately.

Assess the patient’s decision-making competence.

Engage in discussion surrounding the patient’s diagnosis, prognosis, and goals for care. Make sure to assess patient understanding.

Evaluate patient’s physical, mental, social, and spiritual suffering. Be sure to take into account the patient’s support system as well as personal and professional pressures and stressors.

Discuss all alternative options, such as palliative care and hospice.

Consult with professional colleagues regarding the patient’s situation. Where appropriate, ask for help from a palliative care specialist to assure that all options have been explored.

Help the patient complete advance directives, DNR orders and POLST forms, as appropriate and ensure that preferences are followed.

What if the request for physician aid-in-dying persists?

If a patient's request for aid-in-dying persists, each individual clinician must decide his or her own position and choose a course of action that is ethically justifiable and legally permissible. It is useful to carefully reflect on and think through where you stand on the issue and be prepared to openly discuss your position with the patient, acknowledging and respecting difference of opinion when it occurs. Patients who ask for PAD-in states where it is legal or illegal-understand that physicians will have different opinions about what they can and should do. The most important thing is to be clear and transparent about your position. Even in states where it is illegal, some physicians will decide to help their patients, particularly when patients are enduring unbearable suffering. While we cannot condone this practice, we must recognize its occurrence and the reasoning behind it. No physician, however, should feel forced to provide assistance if he or she is morally opposed to PAD.

What are the attending physician’s duties and responsibilities under the Washington Death with Dignity Act?

Confirm the following eligibility criteria:

Washington State resident

Age 18 and older

Competent (able to make and communicate an informed decision to health care providers)

Terminally ill (incurable, irreversible disease expected to cause death within six months, as determined by the attending physician and a consulting physician)

Able to voluntarily express his or her wish to die

Assure that it is an informed decision, which means the patient has an appreciation of the relevant facts, after being fully informed about the following:

Medical diagnosis

Prognosis

Potential risks associated with taking the prescribed medication

Probable result of taking the prescribed medication

Feasible alternatives including, but not limited to, comfort care, hospice care, and pain control

Evaluate the patient's request:

Assess reasons,

Explore and recommend alternatives (palliative care, hospice, pain/symptom management, psychosocial and/or spiritual counseling, palliative sedation).

Counsel patient about the following:

Opportunities to rescind request at any time.

Recommend notifying next of kin.

Importance of having another person present and not taking medications in a public place.

Refer to a consulting physician, who reviews the medical record and interviews the patient to confirm the diagnosis, and confirm that the patient is competent and is making a voluntary request.

Refer to a counselor if concerned about a psychiatric or psychological disorder or depression causing impaired judgment.

Work with pharmacists to prescribe/get medications.

Document all steps in the medical record.

Sign the death certificate.

List the underlying terminal disease as the cause of death.

Send a copy of the dispensing record to DOH within 30 days.

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