Aldean Redman Update
BRAND NAME: Aricept, Aricept ODT
DRUG CLASS AND MECHANISM: Donepezil is an oral medication used to treat Alzheimer's disease. It belongs to a class of drugs called cholinesterase inhibitors that also includes tacrine (Cognex). Scientists believe that Alzheimer's disease may result from a deficiency in chemicals (neurotransmitters) used by nerves in the brain to communicate with one another. Donepezil inhibits acetylcholinesterase, an enzyme responsible for the destruction of one neurotransmitter, acetylcholine. This leads to increased concentrations of acetylcholine in the brain, and the increased concentrations are believed to be responsible for the improvement seen during treatment with donepezil. Donepezil improves the symptoms but does not slow down the progression of Alzheimer's disease. Donepezil was approved by the FDA in 1996.
GENERIC AVAILABLE: no
PREPARATIONS: Aricept is available in 5 and 10 mg tablets. Aricept ODT (orally disintegrating tablets) also are available in 5 and 10 mg tablets.
STORAGE: Tablets should be stored at room temperature, 15-30°C (59-86°F).
PRESCRIBED FOR: Donepezil is used for the treatment of mild to moderate dementia of the Alzheimer's type.
DOSING: Donepezil is generally taken once daily at night prior to retiring. Its absorption is not affected by food so that it may be taken with or without food.
DRUG INTERACTIONS: Drugs with anti-cholinergic properties that can cross into the brain, such as atropine, benztropine (Cogentin), and trihexyphenidyl (Artane) counteract the effects of donepezil and should be avoided during therapy with donepezil.
Donepezil is metabolized (eliminated) by enzymes in the liver. The rate of metabolism of donepezil may be increased by medications that increase the amounts of these enzymes, such as carbamazepine (Tegretol), dexamethasone (Decadron), phenobarbital, phenytoin (Dilantin), and rifampin (Rifadin). By increasing elimination, these drugs may reduce the effects of donepezil.
Ketoconazole (Nizoral) has been shown to block the enzymes in the liver that metabolize donepezil. Therefore, concurrent use of ketoconazole and donepezil may result in increased concentrations of donepezil in the body and possibly lead to donepezil side effects. Quinidine (Quinidex, Quinaglute) also has been shown to inhibit the enzymes that metabolize donepezil and may cause donepezil side effects.
SIDE EFFECTS: The most frequently reported side effects associated with donepezil include headache, generalized pain, fatigue, dizziness, nausea, vomiting, diarrhea, loss of appetite, weight loss, muscle cramping, joint pain, insomnia, and increased frequency of urination.
Tacrine (Cognex), another anticholinesterase medication used in the treatment of Alzheimer's disease, is associated with liver toxicity. Donepezil does not appear to be associated with liver toxicity.
BRAND NAME(S): Augmentin
USES: Amoxicillin/clavulanic acid is a penicillin-type antibiotic used to treat a wide variety of bacterial infections.
HOW TO USE: Take this medication by mouth with a meal or snack, usually every 12 hours, or as directed by your doctor. Antibiotics work best when the amount of medicine in your body is kept at a constant level. Therefore, take this drug at evenly spaced intervals. Continue to take this medication until the full prescribed amount is finished even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a relapse of the infection. Inform your doctor if your condition persists or worsens.
SIDE EFFECTS: Diarrhea, nausea, or vomiting may occur during the first few days as your body adjusts to the medication. Take with food to minimize stomach upset. If any of these effects persist or worsen, contact your doctor or pharmacist promptly. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: easy bruising or bleeding, persistent sore throat or fever, dark urine, persistent nausea or vomiting, severe stomach/abdominal pain, yellowing eyes or skin. This medication may rarely cause a severe intestinal condition (pseudomembranous colitis) due to a resistant bacteria. This condition may occur weeks after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have the following symptoms because these products may make them worse. Tell your doctor immediately if you develop: persistent diarrhea, severe abdominal or stomach pain/cramping, or blood/mucus in your stool. Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection (oral or vaginal fungal infection). Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge or other new symptoms. 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, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Before taking amoxicillin/clavulanic acid, tell your doctor or pharmacist if you are allergic to it; or to penicillin or cephalosporin antibiotics; 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/hemodialysis requirements, or a history of liver problems (e.g., cholestatic jaundice) associated with prior use of amoxicillin/clavulanic acid. Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, other infections (e.g., mononucleosis). This medication should be used only when clearly needed during pregnancy. Caution is advised if this medication is given before delivery for a certain condition (premature rupture of fetal membranes) due to a possible increased risk of harm to the newborn. Discuss the risks and benefits with your doctor. This medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: allopurinol, live vaccines, methotrexate, probenecid. This medication may decrease the effectiveness of combination-type birth control pills. This can result in pregnancy. You may need to use an additional form of reliable birth control while using this medication. Consult your doctor or pharmacist for details. This antibiotic may cause false positive results with certain diabetic urine testing products (cupric sulfate-type). This drug may also affect the results of certain lab tests. Make sure laboratory personnel and your doctors know you use this drug. 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: severe stomach/abdominal pain, severe vomiting, persistent diarrhea, a severe decrease in the amount of urine, or seizures.
NOTES: Do not share this medication with others. This medication has been prescribed for your current condition only. Do not use it later for another infection. A different medication may be necessary in those cases. With prolonged treatment, laboratory and/or medical tests (e.g., kidney and liver function, complete blood counts) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
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.
GENERIC NAME: valproic acid, divalproex
BRAND NAME: Depakote, Depakote ER, Depakene, Depacon
DRUG CLASS AND MECHANISM: Valproic acid and its derivative, divalproex, are oral drugs that are used for the treatment of convulsions, migraines and bipolar disorder. The active ingredient in both products is valproic acid or valproate. Scientists do not know the mechanism of action of valproate. The most popular theory is that valproate exerts its effects by increasing the concentration of gamma-aminobutyric acid (GABA) in the brain. Gamma-aminobutyric acid is a neurotransmitter, a chemical that nerves use to communicate with one another.
GENERIC AVAILABLE: yes (valproic acid), no (divalproex)
PREPARATIONS: Depakote delayed release tablets: 125, 250 and 500 mg. Depakote sprinkle capsules: 125 mg. Depakote ER tablets: 500 mg. Depakene capsules: 250 mg. Depakene syrup: 250 mg/5 ml. Depacon (valproate sodium) injection: 100 mg/5 ml. Valproic acid capsules: 250 mg. Valproic acid syrup: 250 mg/5mL
PRESCRIBED FOR: Valproic acid and divalproex are used for the treatment of seizures, bipolar disorder and prevention of migraines. Depakote extended- release (ER) is used 1) for the prevention of migraine 2) as sole and adjunctive therapy for complex partial seizures in isolation or in association with other types of seizures and simple and complex absence seizures in children with epilepsy ages 10 and above 3) for the treatment of acute manic or mixed episodes associated with bipolar disorder.
DOSING: For seizures, therapy is initiated at 10-15 mg/kg/day and increased by 5-10 mg/kg/day every week to achieve the desired response. Response is usually seen when the blood concentration of valproic acid is 50-100 mcg/mL.
For acute mania due to bipolar disorder, treatment is started at 750 mg per day of divalproex delayed-release tablets in divided doses. The dose should be increased rapidly to achieve the desired effect. The maximum dose is 60 mg/kg/day.
The recommended dose for prevention of migraines is 250 mg twice daily of divalproex delayed-release tablets. The maximum recommended dose is 1000 mg/day. When using divalproex ER tablets, the recommended dose is 500-1000 mg given once daily.
DRUG INTERACTIONS: Valproic acid and divalproex have numerous suspected or proven drug interactions. Although the following drug interactions refer to valproic acid, similar interactions would be expected to occur with divalproex.
Valproic acid can reduce the number of platelets or inhibit the ability of platelets to stick together and form a blood clot. Therefore, it may exaggerate the effects of other medications which inhibit the stickiness of platelets or inhibit other steps in the clotting of blood. This can lead to abnormal bleeding due to the inability of blood to clot. Such medications include warfarin (Coumadin), heparin or low-molecular weight heparin (Lovenox), clopidogrel (Plavix), ticlopidine (Ticlid), and nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), indomethacin (Indocin), nabumetone (Relafen), diclofenac (Voltaren, Cataflam, Arthrotec), ketorolac (Toradol) and aspirin.
Aspirin and felbamate (Felbatol) can reduce the elimination of valproic acid and result in elevated blood concentrations of valproic acid.
Rifampin (Rifadin; Rimactane), carbamazepine (Tegretol), phenytoin (Dilantin) can increase the elimination of valproic acid, thereby reducing blood concentrations. Since this can result in loss of seizure control and seizures, adjustments in the dose of valproic acid may be necessary if these medications are begun.
Cholestyramine (Questran) can reduce the absorption of valproic acid from the intestine. Therefore, valproic acid should be taken at least 2 hours before or 6 hours after doses of cholestyramine.
Valproic acid can significantly decrease the elimination of lamotrigine (Lamictal), ethosuximide (Zarontin), diazepam (Valium), zidovudine (AZT) and phenobarbital, thereby increasing their concentrations in blood. Valproic acid also increases the blood levels of warfarin and phenytoin by displacing them from blood proteins that they bind to. Since increased blood concentrations of these drugs may lead to an increase in side effects, the dose of warfarin and phenytoin may need to be altered when they are taken with valproic acid.
SIDE EFFECTS: The most common side effects with valproic acid therapy are drowsiness, dizziness, nausea, vomiting, indigestion, diarrhea, weight loss and tremors. Divalproex may have a lower incidence of stomach upset, and taking valproic acid or divalproex with food can reduce the stomach upset. Valproic acid also causes skin reactions such as alopecia (loss of hair), rash, itching and sensitivity to sunlight.
The most serious side effects due to valproic acid are liver injury, pancreatitis and abnormal bleeding. Liver injury is most common in the first 6 months of treatment. It also is more common in children, especially children less than 2 years old. Persons taking more than one type of anticonvulsant seem to be at higher risk. Symptoms of liver damage include jaundice, malaise, weakness, swelling in the face, loss of appetite and vomiting. Pancreatitis due to valproic acid can occur early in treatment or after several years of use. Symptoms of pancreatitis are unexplained weight loss, nausea, vomiting and severe abdominal pain. Valproic acid inhibits the formation of blood clots by interfering with the clot-promoting effects of platelets. This can cause abnormal bleeding.
GENERIC NAME: IPRATROPIUM/ALBUTEROL (SALBUTAMOL) SOLUTION - INHALATION (al-BYOU-ter-ohl/ip-ruh-TROW-pee-um)
BRAND NAME(S): DuoNeb
USES: This combination medication is used to treat severe breathing trouble (bronchospasm) in patients with lung disease (chronic obstructive pulmonary disease or COPD).
HOW TO USE: Inhale this medication into the mouth and lungs using a special breathing device (nebulizer) usually 4 times daily, or use as directed by your doctor. Consult your doctor, pharmacist, or respiratory therapist on the proper use of a nebulizer with this medication. The dosage is usually one 3ml vial added to the nebulizer, but may be based on your medical condition and response to therapy. Use this medication exactly as prescribed. Do not increase your dose, take it more frequently, or use it for a longer period of time than prescribed because serious side effects could occur.
SIDE EFFECTS: Nausea, diarrhea, constipation, blurred
vision, dry mouth, and drowsiness may occur. If any of these effects
persist or worsen, notify your doctor. Tell your doctor immediately if any
of these serious side effects occur: sore throat,
heartburn, back pain, leg cramps. Tell your doctor immediately if
any of these unlikely but serious side effects occur: wheezing, severe trouble
breathing (worsening of COPD symptoms), eye pain. Tell your doctor immediately
if any of these highly unlikely but very serious side effects occur: chest
pain, unusually fast or irregular heartbeat. 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,
dizziness, trouble breathing. If you notice other effects not listed above,
contact your doctor or pharmacist.
GENERIC NAME: glyburide
BRAND NAMES: Micronase, Diabeta, Glynase
DRUG CLASS AND MECHANISM: Glyburide is an oral glucose lowering-drug in a class of diabetes medicines called sulfonylureas. Glyburide lowers the sugar level by stimulating insulin secretion in the pancreas. Insulin is a hormone which lowers the blood sugar level.
Approximately 90% of patients with diabetes have type 2 or non-insulin dependent diabetes mellitus. Type 2 diabetes usually occurs in adulthood, and is associated with obesity and a strong family history of the disease. Sugar (glucose) intolerance is related to impaired insulin secretion by the pancreas and resistance to insulin at the cell level.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets; 1.25mg, 1.5mg, 2.5mg, 3mg, 5mg.
STORAGE: Glyburide should be stored at room temperature in a tight container.
PRESCRIBED FOR: Glyburide is used in type 2 diabetes to help lower and control blood sugars in those not controlled by diet alone. Studies have shown that strict sugar control in diabetics decreases the risks of eye, kidney, and nerve damage. Oral sulfonylureas are used in type 2 diabetics after a trial on a strict diabetic diet and usually before insulin is tried.
DOSING: Glyburide may be taken with or without food. Since glyburide is metabolized by the liver and excreted by the kidneys, dosages may need to be lowered in patients with liver or kidney dysfunction.
DRUG INTERACTIONS: All sulfonylureas can cause low blood sugar (hypoglycemia). Therefore, glyburide must be used cautiously in patients with kidney or liver problems, and those with poor food intake, using alcohol, or participating in heavy exercise, as well as in patients taking other glucose-lowering drugs. Drug interactions causing hypoglycemia can occur with nonsteroidal anti-inflammatories, sulfa drugs, coumadin, miconazole, fluoroquinolone antibiotics, and beta-blocking drugs. High glucose reactions (hyperglycemia) can occur with thiazide diuretics, corticosteroids, thyroid medicines, estrogens, niacin, dilantin, and calcium channel blocking drugs.
SIDE EFFECTS: Minor side effects include nausea, heartburn, and bloating. Skin rashes can occur and cause itching, hives, or a diffuse measles-like rash. Rare but serious side effects include hepatitis, jaundice, and a low sodium concentration.
GENERIC NAME: atorvastatin
BRAND NAME: Lipitor
DRUG CLASS AND MECHANISM: Atorvastatin is an oral drug that lowers the level of cholesterol in the blood. It belongs to a class of drugs referred to as statins which includes lovastatin (Mevacor), simvastatin, (Zocor), fluvastatin (Lescol), and pravastatin (Pravachol). All statins, including atorvastatin, prevent the production of cholesterol by the liver by blocking the enzyme that makes cholesterol, HMGCoA reductase. They lower total blood cholesterol as well as 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. Unlike the other drugs in this class, atorvastatin also can reduce the concentration of triglycerides in the blood. High blood concentrations of triglycerides also have been associated with coronary artery disease. Atorvastatin was approved by the FDA in December of 1996.
GENERIC AVAILABLE: no
PREPARATIONS: Tablets of 10, 20, and 40 mg.
STORAGE: Tablets should be stored below or at room temperature,15-30°C (59-86°F).
PRESCRIBED FOR: Atorvastatin is used for the treatment of high cholesterol and triglyceride levels. High blood cholesterol is first treated with exercise, weight loss, and a diet low in cholesterol and saturated fats. When these measures fail to achieve enough cholesterol-lowering, medications such as atorvastatin may 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 factors that increase the risk for coronary artery disease such as diabetes, hypertension, cigarette smoking, low HDL cholesterol level, and family history of early coronary heart disease. The effectiveness of atorvastatin in lowering cholesterol is dose related, meaning that higher doses reduce cholesterol more. Blood cholesterol determinations are performed at regular intervals during treatment so that adjustments in doses can be made.
DOSING: Atorvastatin is prescribed once daily. Starting doses are 10-40 mg. daily. It may be taken with or without food and at any time of day.
DRUG INTERACTIONS: As with other drugs in this class, the risk of muscle breakdown (see "Side Effects," below) is increased when atorvastatin is given together with other medications such as cyclosporine (Sandimmune), gemfibrozil (Lopid), erythromycin and nicotinic acid.
SIDE EFFECTS: Atorvastatin is generally well-tolerated, and side effects
are rare. Minor side effects include constipation, diarrhea, fatigue, gas,
heartburn, and headache. Atorvastatin should be used with caution in patients
with alcohol or other liver diseases. Persistently abnormal liver tests
during treatment are rare but may require discontinuation of the medication.
Rare cases of muscle inflammation (myositis) and breakdown have been reported
with other drugs in this class (HMGCoA reductase antagonists), and it is
assumed that this side effect also may occur with atorvastatin. Muscle breakdown
causes the release of muscle protein (myoglobin) into the blood and accumulation
of the protein in the kidney tubules, resulting in kidney failure.
BRAND NAME: Namenda
DRUG CLASS AND MECHANISM: Memantine is an oral medication for treating patients with Alzheimer's disease. Other medications used for Alzheimer's disease affect acetylcholine, one of the neurotransmitter chemicals that nerve cells in the brain use to communicate with one another. These drugs--galantamine (Reminyl), donezepil (Aricept), rivastigmine (Exelon), and tacrine (Cognex)-- inhibit the enzyme acetylcholinesterase that destroys acetylcholine and thereby increases the effects of acetylcholine. Memantine's effects are independent of acetylcholine and acetylcholinesterase.
Glutamate is the main excitatory neurotransmitter in the brain. It is believed that too much stimulation of nerve cells by glutamate may be responsible for the degeneration of nerves that occurs in some neurological diseases such as Alzheimer's disease. Like other neurotransmitters, glutamate is produced and released by nerve cells in the brain. The released glutamate then travels to nearby nerve cells where it attaches to a receptor on the surface of the cells called the N-methyl-D-aspartate (NMDA) receptor. Memantine blocks the receptor and thereby decreases the effects of glutamate. It is thought that by blocking the NMDA receptor and the effects of glutamate, memantine may protect nerve cells from excess stimulation by glutamate. Memantine was approved by the FDA in October, 2003.
GENERIC AVAILABLE: No.
PREPARATIONS: Tablets: 5 mg (tan) and 10 mg (gray).
STORAGE: Tablets should be stored at room temperature, 15-30°C (59-86°F).
PRESCRIBED FOR: Memantine is used for the treatment of moderate to severe dementia of the Alzheimer's type. Dementia can be categorized into three levels of severity. Mild: Patients are alert and sociable, but forgetfulness begins to interfere with daily living. Moderate: This is often the longest stage of the disease with deterioration of intellect, logic, behavior, and function. Severe: Loss of long-term memory and language skills. Patients may require 24-hour care and can no longer complete basic self-care tasks including washing, eating, and using the bathroom.
DOSING: The usual starting dose of memantine is 5 mg once daily. The dose usually is increased to 5 mg twice daily, then 5 mg and 10 mg as separate doses daily, and finally 10 mg twice daily. Memantine can be taken with or without food.
DRUG INTERACTIONS: Medicines that make the urine more alkaline (for example, carbonic anhydrase inhibitors such as acetazolamide (Diamox) and sodium bicarbonate would be expected to reduce the elimination of memantine by the kidneys and might increase the blood levels and the risk of side effects of memantine. Combining memantine with other NMDA receptor antagonists (for example, amantadine (Symmetrel), ketamine, and dextromethorphan) has not been evaluated and should be approached cautiously.
SIDE EFFECTS: The most common side effect of memantine are fatigue, pain, increases in blood pressure, dizziness, headache, constipation, vomiting, back pain, confusion, somnolence, hallucination, coughing, and difficulty in breathing. The side effects are most often mild to moderate.
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.
GENERIC AVAILABLE: no
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.
BRAND NAME: Norvasc
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.
GENERIC AVAILABLE: no
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.
Prilosec (Replaces Protonix, see below, 6-2-07.)
GENERIC NAME: omeprazole
BRAND NAME: Prilosec, Rapinex
DRUG CLASS AND MECHANISM: Omeprazole 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), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). Proton pump inhibitors are used for the treatment of conditions such as ulcers, gastroesophageal reflux disease (GERD) and the Zollinger-Ellison Syndrome which are all caused by stomach acid. Omeprazole, 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. Omeprazole OTC has been approved for sale without a prescription.
GENERIC AVAILABLE: Yes
PRESCRIPTION: Yes and no
PREPARATIONS: Omeprazole by prescription: 10, 20 & 40 mg. Omeprazole OTC: 20 mg tablet. Omeprazole powder for oral suspension (Rapinex), which is rapidly absorbed, is available in 20 mg packets for dilution with water. It is combined with sodium bicarbonate to neutralize stomach acid that would destroy the omeprazole.
STORAGE: Store at room temperature, 15-30°C (59-86°F). Keep away from moisture and light.
PRESCRIBED FOR: Omeprazole is used for treating acid-induced inflammation and ulcers of the stomach and duodenum, gastroesophageal reflux disease (GERD) and Zollinger-Ellison Syndrome. It also is used in combination with antibiotics for eradicating H. pylori infection of the stomach.
DOSING: For ulcers, GERD and eradication of H. pylori the recommended dose for adults is 20-40 mg daily. Ulcer healing usually occurs within 4-8 weeks. H. pylori infections are treated for 10-28 days. Omeprazole OTC has been approved for more severe heartburn for up to two weeks.
For the management of Zollinger-Ellison Syndrome the starting dose for adults is 60 mg daily, and the dose is adjusted based on either the response of symptoms or the actual measurement of acid production. Doses greater than 80 mg should be divided. Doses up to 120 mg three times a day have been used in the treatment of Zollinger-Ellison Syndrome.
For maximal efficacy, omeprazole tablets should be taken before meals, swallowed whole and should not be crushed, chewed or opened.
DRUG INTERACTIONS: Omeprazole potentially can increase the concentrations in blood of diazepam (Valium), warfarin (Coumadin), and phenytoin (Dilantin) by decreasing the elimination of these drugs by the liver.
The absorption of certain drugs may be affected by stomach acidity, and, as a result, omeprazole 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: Omeprazole like other PPIs is well-tolerated. The most common side effects are diarrhea, nausea, vomiting, headaches, rash and dizziness. Nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps and water retention occur infrequently.
BRAND NAME: Protonix (Discontinued 6-2, replaced with Prilosec, above.)
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.
GENERIC AVAILABLE: No
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: risperidone
BRAND NAME: Risperdal
DRUG CLASS AND MECHANISM: Risperidone is an antipsychotic medication that works by interfering with the communication among nerves in the brain. The nerves communicate with one another by producing and releasing chemicals called neurotransmitters. The neurotransmitters attach to receptors on other nearby nerves, and the attachment of the neurotransmitter causes changes in the cells that have the receptor on them. Risperidone blocks several of the receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2 adrenergic receptors and this blocks communication among nerves. Risperidone is a relatively new antipsychotic medication that probably has fewer side effects than many of the older medications.
GENERIC AVAILABLE: No
PREPARATIONS: Tablets of 1, 2, 3, and 4 mg.
STORAGE: Tablets should be kept at room temperature, 15-30°C (59-86°F).
PRESCRIBED FOR: Risperidone is used for the treatment of psychotic disorders, for example, schizophrenia. It also is used in combination with lithium or valproate for the treatment of acute manic or mixed episodes associated with bipolar I disorder.
DOSING: Risperidone usually is begun as two small doses each day. The doses often are increased every few days or each week until the optimal dose is found. Patients who are elderly or have kidney disease may need lower doses since the kidneys, which are partially responsible for removing risperidone from the blood, remove risperidone more slowly, and this can lead to toxic levels of risperidone in the blood. Similarly, patients with liver disease may need lower doses since the liver also is partially responsible for removing risperidone.
DRUG INTERACTIONS: Risperidone may interfere with elimination by the kidneys of clozapine (Clozaril), a different type of antipsychotic medication, causing increased levels of clozapine in the blood. This could increase the risk of side effects with clozapine.
SIDE EFFECTS: The most commonly noted side effects associated with risperidone are extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes), dizziness, hyperactivity, tiredness, and nausea. Risperidone may cause a condition called orthostatic hypotension during the early phase of treatment (the first week or two). Patients who develop orthostatic hypotension have a drop in their blood pressure when they rise from a lying position and may become dizzy.
Although there is no clear link between risperidone
and diabetes, patients should be tested during treatment for elevated blood-sugars.
Additionally, persons with risk factors for diabetes, including obesity
or a family history of diabetes, should have their fasting levels of blood
sugar tested before starting treatment and periodically throughout treatment
to detect the onset of diabetes. Any patient developing symptoms that suggest
diabetes during treatment should be tested for diabetes.
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.
GENERIC NAME: acetaminophen
BRAND NAME: Tylenol and many other
DRUG CLASS AND MECHANISM: Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers). The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before it is felt by a person. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body's temperature when the temperature is elevated. Acetaminophen was approved by the FDA in 1951.
GENERIC AVAILABLE: yes
PREPARATIONS: Liquid suspension, chewable tablets, coated caplets, gelcaps, geltabs, and suppositories. Common dosages are 325, 500 and 650 mg.
STORAGE: Store tablets and solutions at room temperature 15-30°C (59-86°F). Suppositories should be refrigerated below 27°C (80°F ).
PRESCRIBED FOR: Acetaminophen is used for the relief of fever as well as aches and pains associated with many conditions. Acetaminophen relieves pain in mild arthritis but has no effect on the underlying inflammation, redness and swelling of the joint. If the pain is not due to inflammation, acetaminophen is as effective as aspirin. It is as effective as the non-steroidal anti-inflammatory drug ibuprofen (Motrin) in relieving the pain of osteoarthritis of the knee.
DOSING: The oral dose for adults is 325 to 650 mg every 4-6 hours. The maximum daily dose is 4 grams. The oral dose for a child is based on the child's age, and the range is 40-650 mg every 4 hours.
When administered as a suppository, the adult dose is 650 mg every 4-6 hours. For children, the dose is 80-325 mg every 4-6 hours depending on age.
DRUG INTERACTIONS: Acetaminophen is metabolized (eliminated by conversion to other chemicals) by the liver. Therefore drugs that increase the action of liver enzymes that metabolize acetaminophen (e.g. carbamazepine, isoniazid, rifampin) may decrease the action of acetaminophen. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver.
SIDE EFFECTS: When used appropriately, side effects are rare. The most serious side effect is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver.
GENERIC NAME: hydrocodone/acetaminophen
BRAND NAMES: Vicodin, Vicodin ES, Anexsia, Lorcet, Lorcet Plus, Norco
DRUG CLASS AND MECHANISM: Hydrocodone is a narcotic pain-reliever and a cough suppressant, similar to codeine. The precise mechanism of pain relief by hydrocodone and other narcotics is not known. Acetaminophen is a non-narcotic analgesic (pain reliever) and antipyretic (fever reducer). Acetaminophen relieves pain by elevating the pain threshold. It reduces fever through its action on the heat regulating center of the brain. Frequently, hydrocodone and acetaminophen are combined to achieve pain relief, as in Vicodin and Lortab. For more information please see acetaminophen (Tylenol).
GENERIC AVAILABLE: yes
PREPARATIONS: Among the many brands the dose of acetaminophen ranges between 500 and 750 mg, and the dose of hydrocodone ranges between 2.5 and 10 mg.
STORAGE: Store at room temperature, sealed, light- resistant container.
PRESCRIBED FOR: Hydrocodone is prescribed for the relief of moderate to moderately severe pain.
DOSING: Should be taken with food.
DRUG INTERACTIONS: Hydrocodone can depress breathing, and is used with caution in elderly, debilitated patients and in patients with serious lung disease. Hydrocodone can impair thinking and the physical abilities required for driving or operating machinery. Alcohol and other sedatives, such as Xanax, can produce further brain impairment and even confusion when combined with hydrocodone. Hydrocodone is generally avoided in children. Hydrocodone may be habit forming. Mental and physical dependence can occur, but are unlikely when used for short-term pain relief.
SIDE EFFECTS: The most frequent adverse reactions include lightheadedness,
dizziness, sedation, nausea, and vomiting. Other side effects include drowsiness,
constipation, and spasm of the ureter, which can lead
to difficulty in urinating.
BRAND NAME: Zocor
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.
GENERIC AVAILABLE: yes
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: sertraline
BRAND NAME: Zoloft
DRUG CLASS AND MECHANISM: Sertraline belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRI). Other drugs in this class are Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram) and Luvox (fluvoxamine). Serotonin is a neurotransmitter (a chemical messenger) produced by nerve cells in the brain that is used by the nerves to communicate with one another. A nerve releases the serotonin it produces into the space surrounding it. The serotonin either travels across the space and attaches to receptors on the surface of nearby nerves or it attaches to receptors on the surface of the nerve that produced it, to be taken up by the nerve and released again (a process referred to as re-uptake). A balance is reached for serotonin between attachment to the nearby nerves and reuptake. Selective serotonin inhibitors block the reuptake of serotonin and therefore change the level of serotonin in the brain. It is believed that some illnesses such as depression are caused by disturbances in the balance between serotonin and other neurotransmitters. The leading theory is that drugs such as sertraline restore the chemical balance among neurotransmitters in the brain. Sertraline was approved by the Food and Drug Administration in December, 1991.
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 25, 50, and 100 mg; oral concentrate: 20 mg/ml
STORAGE: Store at room temperature between 15-30°C (59-86°F).
PRESCRIBED FOR: Sertraline is a drug that is used to treat depression, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder. Like other SSRIs, sertraline also is used for treating social anxiety disorder and postmenstrual dysphoric disorder.
DOSING: The recommended dose of sertraline is 25-200 mg once daily. Treatment usually is started at 25-50 once daily and then increased at weekly intervals until the desired response is seen. Sertraline may be taken with or without food.
DRUG INTERACTIONS: Serious reactions such as hyperthermia, fluctuations in blood pressure and rigidity of muscles may occur when SSRIs are used in combination with monoamine oxidase inhibitors (MAOI) such as phenelzine, tranylcypromine (Parnate) and isocarboxazid. Therefore, SSRIs should not be used in combination with MAOIs. In addition, SSRIs and MAOIs should not be used within 14 days of each other.
Cimetidine may increase the levels in blood of sertraline by reducing the elimination of sertraline by the liver. Increased levels of sertraline may lead to more side effects.
Sertraline increases the blood level of pimozide (Orap) by 40%. High levels of pimozide can affect electrical conduction in the heart and lead to sudden death. Therefore, patients should not receive treatment with both pimozide and sertraline.
Through unknown mechanisms, sertraline may increase the blood thinning action of warfarin. The effect of warfarin should be monitored when sertraline is started or stopped.
SIDE EFFECTS: The most common side effects of sertraline are sleepiness, nervousness, insomnia, dizziness, nausea, tremor, skin rash, upset stomach, loss of appetite, headache, diarrhea, abnormal ejaculation, dry mouth and weight loss. Important side effects are irregular heartbeats, allergic reactions and activation of mania in patients with bipolar disorder.
If sertraline is discontinued abruptly, some patients experience symptoms such as abdominal cramps, flu like symptoms, fatigue and memory impairment. Although this reaction is not well established, it is reasonable to gradually reduce the dose when therapy is discontinued.
It has been suggested that SSRIs may cause depression to worsen and
even lead to suicide in a small number of patients. These potential side
effects are difficult to evaluate in depressed patients because depression
can progress with or without treatment, and suicide is itself a consequence
of depression. Moreover, the evidence supporting these potential side effects
is weak. Therefore, no conclusions can yet be drawn about the relationship
between SSRIs and worsening depression and suicide. Until better information
is available, patients receiving SSRIs should be monitored
for worsening depression and suicidal tendencies.
GENERIC NAME: CETIRIZINE - ORAL TABLET (set-EYE-rizz-een)
BRAND NAME(S): Zyrtec
USES: This medication is an antihistamine which provides relief of seasonal and perennial allergy symptoms such as watery eyes, runny nose (rhinitis), itching eyes, and sneezing. It is also used for hives.
HOW TO USE: Take this medication by mouth once a day; or use as directed by your doctor. This drug may be taken with or without food. The chewable tablet form of this medication may be taken with or without water. Do not increase your dose or take this more often than directed. Do not take this medication for several days before allergy testing since test results can be affected.
SIDE EFFECTS: Drowsiness, fatigue and dry mouth may occur. In children, stomach pain and vomiting may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Tell your doctor immediately if any of these unlikely but serious side effects occur: yellowing eyes or skin, dark urine, persistent fatigue. 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, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Before taking cetirizine, tell your doctor or pharmacist if you are allergic to it; or to hydroxyzine; or if you have any other allergies. Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease. This drug may make you drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages. Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially the drowsiness effect.
DRUG INTERACTIONS: Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription products you may use, especially of drugs that cause drowsiness such as: anti-anxiety drugs (e.g., diazepam), other antihistamines that cause drowsiness (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep (e.g., sedatives), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., phenothiazines such as chlorpromazine, or tricyclics such as amitriptyline), tranquilizers. Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain drowsiness-causing ingredients. 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: severe drowsiness. In children, symptoms may include initial restlessness and irritability followed by drowsiness.
NOTES: Do not share this medication with others.
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.
STORAGE: Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.
MEDICAL ALERT: Your condition can cause complications in a medical
emergency. For enrollment information call MedicAlert at 1-800-854- 1166
(USA) or 1-800-668-1507 (Canada).