325 mg

Cardura - Deleted 4-5

Celebrex = Deleted 3-27

Duoneb - Lungs

Ecotrin - Aspirin

Humulin N - Insulin

Humulin R - Insulin

Imodium - Added on 4-5
for diarrhea 2mg as needed

Lasix * - Water
Deleted 4-5

Lovenox -Blood Clots -
Deleted 4-5




Provigil =Deleted 3-27 -wakefulness / nervousness, anxiety and insomnia


Zestril - It narrows blood vessels and thereby maintains (elevates) blood pressure. When the enzyme is blocked by lisinopril, angiotensin cannot be converted into its active form. As a result, blood pressure falls.








Aldean Redman Update


GENERIC NAME: doxazosin mesylate


DRUG CLASS AND MECHANISM: Cardura is an inhibitor of the alpha 1 adrenergic nervous system. It is in a class of drugs referred to as alpha blockers that includes alfusosin (Uroxatral), terazosin (Hytrin), tamsulosin (Flomax), and prazosin (Minipress). Elevated blood pressure (hypertension) is lowered as the action of these nerves, which promote constriction of blood vessels, is blocked.

Cardura was also found to relax the muscles around the prostate gland which is also under the influence of the alpha adrenergic portion nervous system. This can makes urination easier for men affected by enlarged prostate glands.



PREPARATIONS: 1mg, 2mg, 4mg, and 8mg oral tablets.

PRESCRIBED FOR: Cardura is used for the control of elevated blood pressure (hypertension) and for benign prostatic hyperplasia (noncancerous enlargement of the prostate gland).

DOSING: Cardura should be taken at doses specifically directed by your physician. This medication can be taken with or without food. Cardura should be taken the same time each day to maintain proper blood levels. Do not take Cardura within two hours of taking an antacid. If stopped you must taper the dose.

DRUG INTERACTIONS: Do not use in excess. First doses of Cardura or any Alpha 1 inhibitor should be taken with caution. The first doses may cause excessive lowering of the blood pressure and cause dizziness and fainting. Strict compliance with dosing is mandatory. Usually a slow increase in dosing is desirable.

SIDE EFFECTS: An uncommon but dangerous side effect is a drop in the white blood cells which normally help to fight infection. Liver damage is uncommon. Dizziness and fainting can occur if the blood pressure is lowered too fast. Swelling of the ankles and fatigue may occur. Most persons should have periodic blood studies while taking Cardura. This medication will rarely cause nausea, headaches, anxiety, insomnia, drowsiness, nasal congestion and sexual dysfunction.

GENERIC NAME: celecoxib

BRAND NAME: Celebrex

DRUG CLASS AND MECHANISM: Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that is used to treat arthritis, pain, menstrual cramps, and colonic polyps. Prostaglandins are chemicals that are important contributors to the inflammation of arthritis that causes the pain, fever, swelling and tenderness. Celecoxib blocks the enzyme that makes prostaglandins (cyclooxygenase 2), resulting in lower concentrations of prostaglandins. As a consequence, inflammation and its accompanying pain, fever, swelling and tenderness are reduced. Celecoxib differs from other NSAIDs in that it causes less inflammation and ulceration of the stomach and intestine (at least with short-term treatment) and does not interfere with the clotting of blood. NSAIDs have been found to prevent the formation and reduce the size of polyps in patients with the genetic disease, familial adenomatous polyposis (FAP). In FAP, patients develop large numbers of polyps in their colons, and the polyps invariably become malignant. The only cure of FAP requires removal of the entire colon. Celecoxib is approved as an adjunctive (secondary) treatment among patients with FAP. The cramping and pain during menstrual periods is due to prostaglandins, and blocking the production of prostaglandins with celecoxib reduces the cramps and pain.



PREPARATIONS: Capsules: 100 mg (white with a blue band), 200 mg (white with a gold band), 400 mg (white with a green band)

STORAGE: Capsules should be stored at 25°C (77°F). It is okay for brief periods in temperatures between 15-30°C (59-86°F).

PRESCRIBED FOR: Celecoxib is used for the relief of pain, fever, swelling, and tenderness caused by osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis . Celecoxib does not prevent the progression of either type of arthritis. It reduces only the symptoms and signs of arthritis. Celecoxib has been approved for patients with familial FAP who have not had their colons removed. Celebrex also is approved for the relief of acute pain and the pain of menstrual cramps (primary dysmenorrhea).

DOSING: The lowest effective dose should be used for each patient. For the management of osteoarthritis, the dose usually is 100 mg twice daily or 200 mg as a single dose. For rheumatoid arthritis, the dose usually is 100 or 200 mg twice daily. For acute pain or menstrual cramps, the dose is 400 mg as a single dose on the first day followed by an additional 200 mg if needed, then 200mg twice daily as needed. For FAP, the recommended dose is 400 mg twice daily.

DRUG INTERACTIONS: Concomitant use of celecoxib with aspirin or other NSAIDs (e.g., ibuprofen, naproxen, etc.) may increase the occurrence of stomach and intestinal ulcers.

Fluconazole (Diflucan) increases the concentration of celecoxib in the body by inhibiting the breakdown of celecoxib in the liver. Therefore, treatment with celecoxib should be initiated at the lowest recommended doses in patients who are taking fluconazole.

Celecoxib increases the concentration of lithium (Eskalith) in the blood by 17%. Therefore, lithium therapy should be closely monitored during and after therapy with celecoxib.

Persons taking the anticoagulant (blood thinner) warfarin (Coumadin) should have their blood tested when initiating or changing celecoxib treatment, particularly in the first few days, for any changes in the effects of the anticoagulant.

Persons who drink more than 3 alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking NSAIDs, and this also may be true with celecoxib.

PREGNANCY: Celecoxib has not been studied in pregnant women. In animal studies, doses that were twice the maximally recommended dose were harmful to the fetus. Celecoxib should only be used in pregnant women when the benefits outweigh the potential risk to the fetus.

SIDE EFFECTS: Although stomach and intestinal ulcers occur with the use of celecoxib, their incidence is less than with other NSAIDs in short-term studies.

Celecoxib does not interfere with the function of the blood platelets and, as a result, does not reduce clotting and lead to increased bleeding like other NSAIDs.

The most common adverse effects are headache, abdominal pain, dyspepsia, diarrhea, nausea, flatulence and insomnia. Other side effects include fainting, kidney failure, heart failure, aggravation of hypertension, chest pain, ringing in the ears, deafness, stomach and intestinal ulcers, bleeding, blurred vision, anxiety, photosensitivity, weight gain, water retention, flu-like symptoms, drowsiness and weakness.

Allergic reactions can occur with celecoxib. Individuals who have developed allergic reactions (rash, itching, difficulty breathing) from sulfonamides (e.g., Bactrim), aspirin or other NSAIDs may experience an allergic reaction to celecoxib and should not take celecoxib.

GENERIC NAME: loperamide

BRAND NAMES: Imodium; Kaopectate II; Imodium A-D; Maalox Anti-Diarrheal Caplets; Pepto Diarrhea Control.

DRUG CLASS AND MECHANISM: Loperamide is a medication that is used for the relief of acute diarrhea and the management of chronic diarrhea in patients with inflammatory bowel disease (Crohn's disease and ulcerative colitis). The effectiveness of loperamide is comparable to another anti-diarrheal, diphenoxylate (Lomotil). Loperamide reduces diarrhea by slowing the forward propulsion of intestinal contents by the intestinal muscles. Although loperamide is related chemically to narcotics such as morphine, it does not have any of the narcotics pain- relieving effects even at high doses. Loperamide was approved by the FDA in 1976.

PRESCRIPTION: yes (Imodium). no (all other brand names)


PREPARATIONS: capsules or tablets (2mg); liquid (1 mg per teaspoonsful).

STORAGE: Store at room temperature, 15-30°C (59- 86°F).

PRESCRIBED FOR: Loperamide is used for the relief of acute or chronic diarrhea.

DOSING: In adults and children 12 years of age and older, the usual dose is 4 mg (2 capsules) as a first dose, followed by 2 mg (1 capsule) after each unformed stool. The maximum dose is 16 mg/day. The dose for children is: age 9 to 11 years, 2 mg three times the first day; age 6 to 8 years, 2 mg twice the first day; age 2 to 5 years, 1 mg times three times the first day. After the first day, children less than 12 years of age usually receive a dose of 0.1 mg/kg after an unformed stool.

DRUG INTERACTIONS: Cholestyramine (Questran) binds to loperamide in the intestines and prevents its absorption, thereby reducing the effect of loperamide. Therefore, there should be at least a two hour interval between doses of loperamide and cholestyramine. Some drugs which are used to increase propulsion of intestinal contents theoretically could counteract loperamide. Such drugs include bethanechol (Urecholine), cisapride (Propulsid), metoclopramide (Reglan), and erythromycin.

SIDE EFFECTS: Loperamide is generally well- tolerated. The side effects that have been reported during loperamide treatment include abdominal pain, constipation, drowsiness, dizziness, dry mouth, fatigue, nausea, and vomiting.


BRAND NAME(S): Delone, Detue, Lasix

WARNING: This is a very potent medication. Using too much of this drug can lead to serious water and mineral loss. Therefore, it is important that you are closely monitored by your doctor. Tell your doctor immediately if you become very thirsty or confused, or develop muscle cramps/weakness while taking this medication. See also Side Effects section.

USES: Furosemide is a "water pill" (diuretic) that increases the amount of urine you make, which causes your body to get rid of excess water. This drug is used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. This medication also reduces swelling/fluid retention (edema) which can result from conditions such as congestive heart failure, liver disease, or kidney disease. This can help to improve symptoms such as trouble breathing.

OTHER USES: This medication may also be used to decrease excess calcium in the blood (hypercalcemia).

HOW TO USE: Take this medication by mouth with or without food, usually once or twice daily, or as directed by your doctor. The dosage is based on your medical condition and response to therapy. In children, doses greater than 6 mg per kilogram of body weight are not recommended. It is best to take this medication early in the day, before 4-6PM, to prevent having to wake up during the night to urinate. Consult your doctor or pharmacist if you have questions about your dosing schedule. Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time(s) of the day as directed. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick. Do not stop taking this medication without consulting your doctor. Sucralfate, cholestyramine, and colestipol can decrease the absorption of furosemide. If you are taking any of these drugs, separate them from furosemide by at least 2 hours. If your condition persists or worsens, contact your doctor or pharmacist.

SIDE EFFECTS: Dizziness, lightheadedness, headache, blurred vision, loss of appetite, stomach upset, diarrhea, or constipation may occur as your body adjusts to the medication. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. This medication may lead to excessive loss of body water and minerals (including potassium). Tell your doctor immediately if you have any of these unlikely but serious symptoms of dehydration or mineral loss: muscle cramps or weakness, confusion, severe dizziness, drowsiness, unusual dry mouth or thirst, nausea or vomiting, fast/irregular heartbeat, unusual decrease in the amount of urine, fainting, seizures. Tell your doctor immediately if any of these unlikely but serious side effects occur: numbness/tingling of the arms/legs, ringing in the ears, hearing loss. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: signs of infection (e.g., fever, persistent sore throat), easy bleeding or bruising, stomach/abdominal pain, persistent nausea/vomiting, yellowing of eyes/skin. A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Before taking furosemide, tell your doctor or pharmacist if you are allergic to it; or to sulfa medications; or if you have any other allergies. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: severe kidney disease (inability to make urine or anuria). Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, untreated mineral imbalance (e.g., sodium, potassium), gout, lupus. If you have diabetes, furosemide may worsen control of blood glucose levels. Monitor your blood glucose levels regularly and inform your doctor of the results. This drug may reduce the potassium levels in your blood. Ask your doctor about adding potassium to your diet. A potassium supplement may be prescribed by your doctor. This medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths or sunlamps. Use a sunscreen and wear protective clothing when outdoors. Before having surgery, tell your doctor or dentist that you are taking this medication. This drug may make you dizzy, drowsy, or cause blurred vision; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages. To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position. Caution is advised when using this drug in the elderly because they may be more sensitive to its effects, especially dizziness. Furosemide should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. This drug passes into breast milk. Consult your doctor before breast-feeding.

RUG INTERACTIONS: See also the How to Use section. This drug should not be used with the following medications because very serious interactions may occur: cisapride, ethacrynic acid. If you are currently using any of these medications, tell your doctor or pharmacist before starting furosemide. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: other drugs that can affect hearing/balance (e.g., aminoglycoside antibiotics such as gentamicin, tobramycin), amphotericin B, cholestyramine, cisplatin, colestipol, corticosteroids (e.g., prednisone), digoxin, lithium, nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen, indomethacin), large doses of aspirin and aspirin-like drugs (salicylates), sucralfate. Check the labels on all your medicines (e.g., cough-and-cold products, diet aids, NSAIDs for pain/fever reduction) because they may contain ingredients that could increase your blood pressure or swelling (edema). Ask your pharmacist about the safe use of those products. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include fainting, a severe decrease in amount of urine, or severe weakness.

NOTES: Do not share this medication with others. Lifestyle changes such as stress reduction programs, exercise, and dietary changes may increase the effectiveness of this medicine. Talk to your doctor or pharmacist about lifestyle changes that might benefit you. Laboratory and/or medical tests (e.g., kidney and liver function tests, uric acid, cholesterol levels, blood mineral levels such as potassium,) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details. Have your blood pressure checked regularly while taking this medication. Discuss with your doctor how to monitor your own blood pressure.
MISSED DOSE: If you 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.

GENERIC NAME: gabapentin

BRAND NAME: Neurontin


DRUG CLASS AND MECHANISM: Gabapentin is in the class of drugs called anticonvulsants because they are used to treat seizures (epilepsy) and herpes zoster (shingles). Gabapentin is related to the brain chemical gamma aminobutyric acid (GABA) but exactly how it works is unknown.






PREPARATIONS: Capsules are available in 100mg, 300mg, 400mg, and 800mg sizes by Park-Davis labs.


STORAGE: Store in a dry place at 15-30 degrees C (69-86 F)


PRESCRIBED FOR: Gabapentin is used for treating seizure disorders and herpes zoster (shingles).


DOSING: Gabapentin can be taken with or without food at doses specifically directed by your physician. Individual doses vary greatly between individuals. Usually the drug is taken two to three times daily. It is currently not approved under the age of 12 years old. If discontinued, gabapentin should be gradually withdrawn (usually over one week) as directed by the doctor.


DRUG INTERACTIONS: Gabapentin appears to be relatively safe and has not been shown to interact with other drugs except for it's potential of added sedation. Gabapentin should not be taken within 2 hours of Maalox. Gabapentin may interfere with the reading of N- Multistix in detecting urine protein.


SIDE EFFECTS: Neurontin has few side effects which include sleepiness, dizziness, unsteady gait, fatigue and eye twitching.

GENERIC NAME: amlodipine



DRUG CLASS AND MECHANISM: Amlodipine belongs to a class of medications called calcium channel blockers. These medications block the transport of calcium into the smooth muscle cells lining the coronary arteries and other arteries of the body. Since calcium is important in muscle contraction, blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. By relaxing coronary arteries, amlodipine is useful in preventing chest pain (angina) resulting from coronary artery spasm. Relaxing the muscles lining the arteries of the rest of the body lowers the blood pressure, which reduces the burden on the heart as it pumps blood to the body. Reducing heart burden lessens the heart muscle's demand for oxygen, and further helps to prevent angina in patients with coronary artery disease. For more detailed information related to coronary artery disease, please read the Chest Pain, Cholesterol, and Heart Attack articles.






PREPARATIONS: Tablets ( 2.5mg, 5mg, 10mg.)


STORAGE: Amlodipine should be stored at room temperature in a tight, light resistant container.


PRESCRIBED FOR: Chest pain (angina) occurs because of insufficient oxygen delivered to the heart muscles. Insufficient oxygen may be a result of coronary artery blockage or spasm, or because of physical exertion which increases heart oxygen demand in a patient with coronary artery narrowing. Amlodipine is used for the treatment and prevention of angina resulting from coronary spasm as well as from exertion. Amlodipine is also used in the treatment of high blood pressure.


DOSING: Amlodipine can be taken with or without food. Amlodipine is metabolized mainly by the liver and dosages may need to be lowered in patients with liver dysfunction.

DRUG INTERACTIONS: In patients with severe coronary artery disease, amlodipine can increase the frequency and severity of angina or actually cause a heart attack on rare occasions. This phenomenon usually occurs when first starting amlodipine, or at the time of dosage increase. Excessive lowering of blood pressure during initiation of amlodipine treatment can occur, especially in patients already taking another blood pressure lowering medication. In rare instances, congestive heart failure has been associated with amlodipine, usually in patients already on a beta blocker. For further information on beta blockers, please read the propranolol (Inderal) article.

SIDE EFFECTS: Side effects of amlodipine are generally mild and reversible. The two most common side effects are headache and edema (swelling) of the lower extremities. Less common side effects include dizziness, flushing, fatigue, nausea, and palpitations.

GENERIC NAME: pantoprazole

BRAND NAME: Protonix

DRUG CLASS AND MECHANISM: Pantoprazole is in a class of drugs called proton pump inhibitors (PPI) which block the production of acid by the stomach. Other drugs in the same class include lansoprazole (Prevacid), omeprazole (Prilosec) and rabeprazole (Aciphex). Proton pump inhibitors are used for the treatment of conditions such as ulcers, gastroesophageal reflux disease (GERD) and Zollinger-Ellison Syndrome that are caused by stomach acid. Pantoprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal.



PREPARATIONS: Tablets: 40 mg . An intravenous form of pantoprazole is expected soon.

STORAGE: Store at room temperature, 15-30°C (59-86°F). Keep away from moisture.

PRESCRIBED FOR: Although pantoprazole is approved for the treatment of gastroesophageal reflux disease (GERD), like other PPI's it also is used for treating ulcers of the stomach and duodenum, and the Zollinger-Ellison Syndrome.

DOSING: For GERD the recommended dose for adults is 40 mg daily for 4-8 weeks.

It generally is recommended that tablets be taken approximately 30 minutes prior to meals for maximal effectiveness. Tablets should be swallowed whole and should not be crushed, split or chewed.

DRUG INTERACTIONS: Pantoprazole is less likely than omeprazole to interact with other drugs.

The absorption of certain drugs may be affected by stomach acidity, and, as a result, pantoprazole and other PPIs that reduce stomach acid also reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole or increased digoxin toxicity, respectively.

SIDE EFFECTS: Pantoprazole like other PPIs is well-tolerated. The most common side effects are diarrhea, nausea, vomiting, constipation, rash and headaches. Dizziness, nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps and water retention rarely occur.

GENERIC NAME: simvastatin


DRUG CLASS AND MECHANISM: Simvastatin is a cholesterol- lowering medicine. It inhibits the production of cholesterol by the liver. It lowers overall blood cholesterol as well as blood LDL cholesterol levels. LDL cholesterol is believed to be the "bad" cholesterol that is primarily responsible for the development of coronary artery disease. Lowering LDL cholesterol levels retards progression and may even reverse coronary artery disease.



PREPARATIONS: tablets: 5 mg,10 mg, 20 mg, 40 mg

STORAGE: Tablets should be stored at room temperature in a tightly closed container.

PRESCRIBED FOR: High blood cholesterol is first treated with exercise, weight loss, and a diet low in cholesterol and saturated fats. When these measures fail, cholesterol-lowering medications such as simvastatin can be added. The National Cholesterol Education Program (NCEP) has published treatment guidelines for use of these medications. These treatment guidelines take into account the level of LDL cholesterol as well as the presence of other risk factors such as diabetes, hypertension, cigarette smoking, low HDL cholesterol level, and family history of early coronary heart disease. The effectiveness of the medication in lowering cholesterol is dose related. Blood cholesterol determinations are performed in regular intervals during treatment so that dosage adjustments can be made.

DOSING: May be taken on an empty or full stomach.

DRUG INTERACTIONS: Simvastatin is generally well- tolerated. The medication should be used with caution in patients with alcohol or other liver diseases. Persistently abnormal liver tests during treatment are rare, but may lead to a discontinuation of the medication. Rare cases of muscle inflammation (myositis) and breakdown have been reported with simvastatin. Muscle breakdown causes the release of muscle protein (myoglobin) into the blood and kidney tubules, resulting in acute kidney failure. The risk of muscle breakdown is increased when simvastatin is given together with other medications such as cyclosporine (Sandimmune), gemfibrozil (Lopid), erythromycin and nicotinic acid. Simvastatin may interact with cholestyramine (Questran), warfarin (Coumadin), and cimetidine (Tagamet) to alter the blood levels of these medicines. When Coumadin is given together with simvastatin, blood clotting times require monitoring to avoid excessive blood thinning and bleeding. Simvastatin should not be used in children. Simvastatin is not habit forming.

SIDE EFFECTS: Simvastatin is generally well-tolerated and side effects are rare. Minor side effects include constipation, diarrhea, fatigue, gas, heartburn, and headache. Major side effects include abdominal pain or cramps, blurred vision, dizziness, easy bruising or bleeding, itching, muscle pain or cramps, rash, and yellowing of the skin or eyes.

GENERIC NAME: levothyroxine sodium

BRAND NAME: Synthroid, Levoxyl, Levothroid, Unithroid

DRUG CLASS AND MECHANISM: Levothyroxine is a synthetic (man-made) version of the principle thyroid hormone, thyroxine (T4), that is made and released by the thyroid gland. Thyroid hormone increases the metabolic rate of cells of all tissues in the body. In the fetus and newborn, thyroid hormone is important for the growth and development of all tissues including bones and the brain. In adults, thyroid hormone helps to maintain brain function, food metabolism, and body temperature, among other effects.

GENERIC AVAILABLE: Yes. Generic and branded tablets of levothyroxine may differ in the amount of levothyroxine they contain, the absorption of the levothyroxine into the body, and the distribution of levothyroxine throughout the body. This means that ingestion of one mg of generic levothyroxine may not have the same effect on the body as one mg of another generic or branded levothyroxine. Practically speaking, this means that when changing between levothyroxine manufactured by different pharmaceutical companies, a change in dose may be necessary to maintain the desired effect or to prevent toxicity.


PREPARATIONS: Tablets: 0.025, 0.05, 0.075, 0.088, 0.1, 0.112, 0.125, 0.137, 0.15, 0.175, 0.2, and 0.3 mg. Powder for intravenous injection: 6 and 10 ml vials containing 0.2 mg or 0.5mg of levothyroxine per vial.

STORAGE: Levothyroxine tablets usually are kept at room temperature, 15-30°C (59-86°F) in a light-resistant, tight container. However, some manufacturers vary in their storage recommendations. Therefore, storage conditions for each product should be clarified with a pharmacist.

Powdered levothyroxine for intravenous injection should be used immediately once mixed with a liquid.

PRESCRIBED FOR: Levothyroxine is approved to treat hypothyroidism and to suppress thyroid hormone release in the management of cancerous thyroid nodules and growth of goiters. In addition, Synthroid, Levoxyl and Levothroid also are prescribed with anti-thyroid drugs, for example methimazole (Tapazole), to manage thyrotoxicosis (high thyroid hormone levels due to over-activity of the thyroid gland). Thyrotoxicosis may result in the growth of goiters and/or hypothyroidism.

DOSING: Levothyroxine is usually started at 0.05 mg/day. Starting doses and dose changes may differ with individual patients based upon the presence of cardiovascular disease, the development of tolerance (reduced effectiveness with continued use), side effects to the medication, and blood levels of thyroid hormone. It may take one to three weeks after initiating therapy with levothyroxine or changing the dose before effects are seen.

DRUG INTERACTIONS: Initiation or discontinuation of therapy with levothyroxine in diabetic patients may create a need for an increase or decrease in the required dose of insulin and/or antidiabetic drug, e.g., glyburide (Micronase).

Levothyroxine may increase the effect of blood thinners such as warfarin (Coumadin). Therefore, monitoring of blood clotting is necessary, and a decrease in the dose of warfarin may be necessary.

Intravenous administration of epinephrine to patients with coronary artery disease may lead to complications ranging from difficulty in breathing to a heart attack. These complications may occur more frequently among patients also taking levothyroxine. Therefore, careful observation is needed when intravenous epinephrine is given to patients receiving levothyroxine who also have coronary artery disease.

Converting a state of hypothyroidism (underactivity) to a normal state (euthyroid state) with levothyroxine may decrease the actions of certain beta-blocking drugs, e.g., metoprolol (Lopressor) or propranolol (Inderal). It may be necessary, therefore, to change the dose of beta-blocker. For the same reason, the dose of digoxin (Lanoxin), a drug used to manage heart failure or an irregular heart rhythm (e.g., atrial-fibrillation), also may need to be changed.

Converting hypothyroidism to the euthyroid state with levothyroxine may increase the blood level of theophylline (Slo-Bid), and it may be necessary to change the dose of theophylline.

Taking levothyroxine at the same time as cholestyramine (Questran) or colestipol (Colestid), two cholesterol-lowering drugs, may decrease the effect of levothyroxine and lead to hypothyroidism. This occurs because the levothyroxine binds to the cholesterol-lowering drugs and is not absorbed. Taking the levothyroxine one hour before or four hours after cholestyramine or colestipol is necessary to prevent the binding.

SIDE EFFECTS: Levothyroxine therapy is usually well-tolerated. If symptoms occur, often they are due to toxic levels of thyroid hormone and the symptoms are those of hyperthyroidism. Symptoms may include all or some of the following: chest pain, increased heart rate or pulse rate, excessive sweating, heat intolerance, nervousness, headache, insomnia, diarrhea, vomiting, weight loss, or fever. Women may experience irregular menstrual cycles.




March 26, 2007- @JCL