Indocin

Pronunciation: IN-doe-METH-a-sin
Generic Name: Indomethacin
Brand Name: Indocin

Indocin is a nonsteroidal anti-inflammatory drug (NSAID). It may cause an increased risk of serious and sometimes fatal heart and blood vessel problems (eg, heart attack, stroke). The risk may be greater if you already have heart problems or if you take Indocin for a long time. Do not use Indocin right before or after bypass heart surgery.

Indocin may cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding. Elderly patients may be at greater risk. This may occur without warning signs.

Indocin is used for:

Treating moderate to severe rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. It is used to treat gout or certain types of bursitis and tendonitis. It may also be used for other conditions as determined by your doctor.

Indocin is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms.

Do NOT use Indocin if:

• you are allergic to any ingredient in Indocin


• you have had a severe allergic reaction (eg, severe rash, hives, trouble breathing, growths in the nose, dizziness) to aspirin or an NSAID (eg, ibuprofen, celecoxib)


• you have recently had or will be having bypass heart surgery


• you are taking diflunisal, another NSAID (eg, ibuprofen), or triamterene


• you are in the last 3 months of pregnancy

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

Before using Indocin:

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

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


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


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


• if you have a history of kidney or liver disease, diabetes, or stomach or bowel problems (eg, bleeding, perforation, ulcers, inflammation)


• if you have a history of swelling or fluid buildup, depression, mental or mood problems, seizures, Parkinson disease, asthma, growths in the nose (nasal polyps), or mouth inflammation


• if you have high blood pressure, a blood disorder, bleeding or clotting problems, heart problems (eg, heart failure), or blood vessel disease, or if you are at risk for any of these diseases


• if you have poor health, dehydration or low fluid volume, low blood sodium levels, or high blood potassium levels, you drink alcohol, or you have a history of alcohol abuse

Some MEDICINES MAY INTERACT with Indocin. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Anticoagulants (eg, warfarin), corticosteroids (eg, prednisone), diflunisal, heparin, other NSAIDs (eg, ibuprofen), salicylates (eg, aspirin), or selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine) because the risk of stomach bleeding may be increased


• Potassium-sparing diuretics (eg, spironolactone, triamterene) because the risk of kidney problems or increased blood potassium levels may be increased


• Cyclophosphamide because low blood sodium levels may occur


• Probenecid because it may increase the risk of Indocin's side effects


• Cyclosporine, digoxin, lithium, methotrexate, quinolones (eg, ciprofloxacin), or sulfonylureas (eg, glipizide) because the risk of their side effects may be increased by Indocin


• Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), angiotensin receptor blockers (eg, losartan), beta-blockers (eg, propranolol), or diuretics (eg, furosemide, hydrochlorothiazide) because their effectiveness may be decreased by Indocin

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

How to use Indocin:

Use Indocin as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Indocin comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Indocin refilled.


• Take Indocin by mouth with food. This may not lower the risk of stomach or bowel problems (eg, bleeding, ulcers). Talk with your doctor if you have persistent stomach upset.


• Take Indocin with a full glass of water (8 oz/240 mL) as directed by your doctor.


• If you miss a dose of Indocin and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed 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 Indocin.

Important safety information:

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


• Serious stomach ulcers or bleeding can occur with the use of Indocin. Taking it in high doses or for a long time, smoking, or drinking alcohol increases the risk of these side effects. Taking Indocin with food will NOT reduce the risk of these effects. Contact your doctor or emergency room at once if you develop severe stomach or back pain; black, tarry stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling.


• Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.


• Indocin is an NSAID. Before you start taking any new medicine, read the ingredients. If it also has an NSAID (eg, ibuprofen) in it, check with your doctor. If you are not sure, check with your doctor or pharmacist.


• Do not take aspirin while you are using Indocin unless your doctor tells you to.


• Indocin may interfere with certain lab tests. Be sure your doctor and lab personnel know that you take Indocin.


• Lab tests, including kidney function, complete blood cell counts, and blood pressure, may be done to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.


• Use Indocin with caution in the ELDERLY; they may be more sensitive to its effects, including stomach bleeding, kidney problems, confusion, or mental changes.


• Indocin should be used with extreme caution in CHILDREN younger than 15 year old; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: Indocin may harm the fetus. Do not use it during the last 3 months of pregnancy. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Indocin while you are pregnant. Indocin is found in breast milk. Do not breast-feed while you are taking Indocin.

Possible side effects of Indocin:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; gas; headache; heartburn; nausea; stomach upset.

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

Severe allergic reactions (rash; hives; itching; trouble breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood in the urine; bloody or black, tarry stools; change in the amount of urine produced; chest pain; confusion; dark urine; depression; fainting; fast or irregular heartbeat; fever, chills, or persistent sore throat; mental or mood changes; numbness of an arm or leg; one-sided weakness; rectal bleeding; red, swollen, blistered, or peeling skin; ringing in the ears; seizures; severe headache or dizziness; severe or persistent stomach pain or nausea; severe vomiting; shortness of breath; sudden or unexplained weight gain; swelling of hands, legs, or feet; unusual bruising or bleeding; unusual joint or muscle pain; unusual tiredness or weakness; unusual vaginal bleeding; vision or speech changes; vomit that looks like coffee grounds; 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. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Indocin side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include confusion; decreased urination; loss of consciousness; seizures; severe dizziness or drowsiness; severe headache; severe nausea or stomach pain; slow or troubled breathing; unusual bleeding or bruising; vomit that looks like coffee grounds.

Proper storage of Indocin:

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

General information:

• If you have any questions about Indocin, please talk with your doctor, pharmacist, or other health care provider.


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


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is summary only. It does not contain all information about Indocin. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Indocin resources

• Indocin Side Effects (in more detail)
• Indocin Use in Pregnancy & Breastfeeding
• Drug Images
• Indocin Drug Interactions
• Indocin Support Group
• 14 Reviews for Indocin - Add your own review/rating

• Indocin Advanced Consumer (Micromedex) - Includes Dosage Information


• Indocin Concise Consumer Information (Cerner Multum)


• Indocin Monograph (AHFS DI)


• Indomethacin Prescribing Information (FDA)


• Indomethacin Professional Patient Advice (Wolters Kluwer)


• Indocin SR Prescribing Information (FDA)

Compare Indocin with other medications

• Ankylosing Spondylitis
• Back Pain
• Bartter Syndrome
• Bursitis
• Cluster Headaches
• Frozen Shoulder
• Gitelman Syndrome
• Gout, Acute
• Langerhans' Cell Histiocytosis
• Osteoarthritis
• Pain
• Patent Ductus Arteriosus
• Rheumatoid Arthritis
• Sciatica
• Tendonitis

Memantine Hydrochloride

Class: Central Nervous System Agents, Miscellaneous
VA Class: CN900
Chemical Name: 3,5-Dimethyl-1-adamantanamine21
Molecular Formula: C₁₂HN
CAS Number: 19982-08-2
Brands: Namenda

Introduction

N-Methyl-d-aspartate (NMDA) receptor antagonist.^{1 2 3 4 5 6 7 8 9 10 11 12 13}

Uses for Memantine Hydrochloride

Alzheimer’s Disease

Palliative treatment of moderate to severe dementia of the Alzheimer’s type (Alzheimer’s disease).^{1 2}

Memantine Hydrochloride Dosage and Administration

Administration

Oral Administration

Administer orally without regard to meals.¹

Administer dosages >5 mg daily in 2 divided doses.¹

Administer oral solution using the oral dosing syringe and dosing device provided; follow the patient instructions provided by the manufacturer.¹ Do not mix oral solution with any other liquids.¹

Dosage

Available as memantine hydrochloride; dosage expressed in terms of memantine hydrochloride.¹

Tablets and oral solution are equivalent on a mg-per-mg basis.¹⁵

Adults

Alzheimer’s Disease

Oral

Initially, 5 mg once daily for 1 week.¹

Subsequently, increase dosage to 10 mg daily (5 mg twice daily) for ≥1 week, then 15 mg daily (administered as separate doses of 5 mg and 10 mg) for ≥1 week, and then to 20 mg daily (10 mg twice daily).¹

Recommended target dosage: 20 mg daily given in 2 divided doses (10 mg twice daily).¹

Special Populations

Hepatic Impairment

No specific dosage recommendations at this time.¹ (See Special Populations under Pharmacokinetics.)

Renal Impairment

No dosage adjustment needed in patients with mild to moderate renal impairment.¹ In patients with severe renal impairment (i.e., Cl_cr 5–29 mL/minute), a target dosage of 5 mg twice daily is recommended.¹ (See Special Populations under Pharmacokinetics.)

Geriatric Patients

No specific dosage adjustments at this time.¹ (See Special Populations under Pharmacokinetics.)

Cautions for Memantine Hydrochloride

Contraindications

• 
  

  Known hypersensitivity to memantine hydrochloride or any ingredient in the formulation.¹

  
  

Warnings/Precautions

General Precautions

Seizures

Not systematically evaluated in patients with seizure disorders.¹

Urinary Excretion

Conditions increasing urinary pH (e.g., dietary changes, concomitant use of drugs that alkalinize urine, renal tubular acidosis, severe urinary tract infections) may decrease memantine elimination and increase plasma concentrations and adverse effects; use with caution under these conditions.^{1 11} (See Alkalinizing Agents under Interactions and Elimination under Pharmacokinetics.)

Specific Populations

Pregnancy

Category B.¹

Lactation

Not known whether memantine is distributed into human milk.¹ Caution if used in nursing women.¹

Pediatric Use

Safety and efficacy not established.¹

Geriatric Use

Efficacy studied principally in patients 50–93 (mean 76) years of age with moderate to severe Alzheimer’s disease.^{1 2 5 7 15} (See Special Populations under Pharmacokinetics.)

Hepatic Impairment

Not studied in patients with hepatic impairment.¹ (See Special Populations under Pharmacokinetics.)

Renal Impairment

Increased exposure in patients with renal impairment.¹ (See Renal Impairment under Dosage and Administration and see Special Populations under Pharmacokinetics.)

Common Adverse Effects

Dizziness, confusion, headache, constipation.^{1 8}

Interactions for Memantine Hydrochloride

Minimally metabolized by CYP isoenzymes.¹ Memantine produces minimal inhibition of isoenzymes 1A2, 2A6, 2C9, 2D6, 2E1, or 3A4 in vitro.¹ No induction of isoenzymes 1A2, 2C9, 2E1, or A4/5 observed in vitro at concentrations exceeding those associated with therapeutic efficacy.¹

Drugs Affecting Hepatic Microsomal Enzymes

Pharmacokinetic interactions unlikely.^{1 15}

Drugs Metabolized by Hepatic Microsomal Enzymes

Pharmacokinetic interactions unlikely.¹

Alkalinizing Agents

Potential decreased memantine clearance with resulting increases in adverse effects when the drug is used concomitantly with agents that increase urine pH.¹ Use with caution.¹

Protein-bound Drugs

Pharmacokinetic interaction with highly plasma protein-bound drugs is unlikely because memantine is only 45% bound to plasma proteins.¹

Drugs Secreted by Renal Tubular Cationic Transport

Potential pharmacokinetic interaction (altered plasma concentrations of both drugs) when used with drugs secreted by the same renal cationic system.¹⁰

Specific Drugs

Drug	Interaction	Comments
Amantadine	Potential additive NMDA antagonistic effects1 8	Not systematically evaluated; use caution1
Carbonic anhydrase inhibitors	Potential decreased memantine clearance because of alkaline urine; possible increased incidence of adverse effects 1	Use with caution1
Cholinesterase inhibitors (e.g., donepezil, galantamine, tacrine)	Concomitant use with donepezil has been well tolerated1 13 Reversible inhibition of acetylcholinesterase not affected by memantine in vitro and in animals1 10
Cimetidine	Potential altered plasma concentrations of both drugs1
Dextromethorphan	Potential additive NMDA antagonistic effects1	Not systematically evaluated; use caution1
Digoxin	Pharmacokinetic interaction unlikely1
Hydrochlorothiazide (HCTZ)	Potential altered plasma concentrations of both drugs1 Maximum plasma HCTZ concentrations and AUCs decreased by 20% with concomitant use of memantine with fixed-combination of HCTZ and triamterene; memantine bioavailability unaffected 1 10
Ketamine	Potential additive NMDA antagonistic effects1	Not systematically evaluated; use caution1
Metformin	No effect on pharmacokinetics of memantine, metformin, or glyburide with concomitant use of memantine and fixed combination of glyburide and metformin hydrochloride; hypoglycemic effects of glyburide-metformin combination not affected1
Nicotine	Potential altered plasma concentrations of both drugs1
Quinidine	Potential altered plasma concentrations of both drugs1
Ranitidine	Potential altered plasma concentrations of both drugs1
Sodium bicarbonate	Potential decreased memantine clearance because of alkaline urine; possible increased incidence of adverse effects 1	Use with caution1
Triamterene	Potential altered plasma concentrations of both drugs1 Bioavailability of memantine or triamterene unaffected by concomitant use with triamterene (in fixed-combination with hydrochlorothiazide) 1 10
Warfarin	Pharmacokinetic interaction unlikely1

Memantine Hydrochloride Pharmacokinetics

Absorption

Well absorbed following oral administration, with peak plasma concentrations attained in about 3–7 hours.^{1 4}

Tablets and oral solution are equivalent on a mg-per-mg basis.¹⁵

Food

Food does not appear to affect absorption.¹

Distribution

Extent

Not known whether memantine is distributed into human milk.¹

Plasma Protein Binding

45%.¹

Elimination

Metabolism

Undergoes limited metabolism, principally to 3 inactive metabolites; minimally metabolized by CYP isoenzymes.¹

Elimination Route

Excreted principally in urine as unchanged drug (57–82%).¹

Eliminated via active tubular secretion, moderated by pH-dependent tubular reabsorption. Clearance reduced by about 80% under alkaline urine conditions (urine pH of 8).

Half-life

Terminal half-life is approximately 60–80 hours.¹

Special Populations

In patients with hepatic impairment, only a modest effect on clearance is expected.¹

Renal impairment increases exposure.¹ AUC increased by 4, 60, or 115% in individuals with mild (Cl_cr >50 but <80 mL/minute), moderate (Cl_cr 30–49 mL/minute), or severe (Cl_cr 5–29 mL/minute) renal impairment, respectively.¹ Terminal elimination half-life increased by 18, 41, or 95% in those with mild, moderate, or severe renal impairment, respectively.¹ (See Renal Impairment under Dosage and Administration and under Cautions.)

In geriatric patients, pharmacokinetics similar to those in younger adults.¹

Stability

Storage

Oral

Tablets and Oral Solution

25°C (may be exposed to 15-30°C).¹

ActionsActions

• 
  

  Low- to moderate-affinity, noncompetitive NMDA receptor antagonist; binds preferentially to NMDA receptor-operated cation channels.^{1 3 4 5 6 7 8 9 10 11 12}

  
  


• 
  

  Differs structurally and pharmacologically from other currently available agents used for the palliative treatment of Alzheimer’s disease.^{1 2}

  
  


• 
  

  May act by blocking actions of glutamate (principal CNS excitatory neurotransmitter), which are mediated in part by NMDA receptors.^{1 2 3 5 6 7 9}

  
  


• 
  

  Persistent NMDA receptor activation by glutamate may cause neurodegeneration in various types of dementia and may contribute to Alzheimer’s disease symptomatology.^{1 3 5 6}

  
  


• 
  

  Low- to moderate-affinity NMDA receptor antagonists may prevent glutamate-induced neurotoxicity without interfering with NMDA receptor-mediated physiologic processes.^{3 6 7 12}

  
  


• 
  

  Currently no evidence that memantine prevents or slows neurodegeneration in patients with Alzheimer’s disease.¹

  
  


• 
  

  Does not affect reversible inhibition of acetylcholinesterase produced by donepezil, galantamine, or tacrine in vitro.¹

  
  

Advice to Patients

• 
  

  Importance of instructing caregiver regarding proper administration (divide dosages >5 mg daily into 2 separate doses) and dosage escalation (≥1 week between dosage increases).¹

  
  


• 
  

  Importance of instructing patients and/or caregivers in proper use of oral syringe and dosing device provided with oral solution.¹ Ensure that patients and/or caregivers are aware of the patient instruction sheet enclosed with the solution.¹ Oral solution should not be mixed with any other liquids.¹ Advise that questions about administration should be directed to their pharmacist or clinician.¹

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.¹

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

  
  


• 
  

  Importance of informing patients of other important precautionary information. (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Memantine Hydrochloride

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Solution	10 mg/5 mL	Namenda (with parabens and propylene glycol)	Forest
	Tablets, film-coated	5 mg	Namenda	Forest
		10 mg	Namenda	Forest
		5 mg (28 tablets) and 10 mg (21 tablets)	Namenda Titration Pak	Forest

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Namenda 10MG Tablets (FOREST): 60/$209.99 or 180/$585.97

Namenda 5MG Tablets (FOREST): 60/$205.99 or 120/$399.98

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions June 2006. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. Forest Pharmaceuticals, Inc. Namenda (memantine hydrochloride) tablets and oral solution prescribing information. St. Louis, MO; 2005 Jul.

2. Tariot PN, Farlow MR, Grossberg GT et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil. JAMA. 2004; 291:317-24. [IDIS 510229] [PubMed 14734594]

3. Doraiswamy PM. Non-cholinergic strategies for treating and preventing Alzheimer’s disease. CNS Drugs. 2002; 16:811-24. [PubMed 12421115]

4. Jarvis B, Figgitt DP. Memantine. Drugs Aging. 2003; 20:465-76. [PubMed 12710865]

5. Reisberg B, Doody R, Stöffler A et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med. 2003; 348: 1333-41.

6. Scarpini E, Scheltens P, Feldman H. Treatment of Alzheimer’s disease: current status and new perspectives. Lancet Neurol. 2003; 2:539-47. [PubMed 12941576]

7. Anon. Alzheimer’s disease: emerging noncholinergic treatments. Geriatrics. 2003; 58 (Suppl):3-14, inside cover. [IDIS 492749] [PubMed 12599937]

8. Anon. Memantine for Alzheimer’s disease. Med Lett Drugs Ther. 2003; 45:73-4. [PubMed 12968123]

9. Feret B, Dicks R. Memantine. Formulary. 2004; 39:91-103.

10. Cada DJ, Levien T, Baker DE. Memantine. Hosp Pharm. 2004; 39:254-63.

11. Anon. Memantine for dementia?. Drug Ther Bull. 2003; 41:73-6. [PubMed 14593973]

12. Areosa SA, Sherriff F. Memantine for dementia. Cochrane Database Syst Rev. 2003; 3:CD003154. [PubMed 12917950]

13. Periclou AP, Ventura D, Sherman T et al. Lack of pharmacokinetic or pharmacodynamic interaction between memantine and donepezil. Ann Pharmacother. 2004; 38:1389-94. [IDIS 528906] [PubMed 15266045]

14. Reisberg B, Ferris S, Möbius HJ et al. Long-term treatment with the NDMA antagonist memantine: results of a 24-week, open-label extension study in moderately severe-to-severe Alzheimer’s disease [abstract]. Neurobiol Aging. 2002; 23:S555, abst 2039.

15. Forest Laboratories, New York, NY. Personal communication.

More Memantine Hydrochloride resources

• Memantine Hydrochloride Side Effects (in more detail)
• Memantine Hydrochloride Use in Pregnancy & Breastfeeding
• Memantine Hydrochloride Drug Interactions
• Memantine Hydrochloride Support Group
• 10 Reviews for Memantine Hydrochloride - Add your own review/rating

Compare Memantine Hydrochloride with other medications

• Alzheimer's Disease

Zyprexa

Pronunciation: oh-LAN-za-peen
Generic Name: Olanzapine
Brand Name: Zyprexa

Zyprexa is an antipsychotic. It may increase the risk of death when used to treat mental problems caused by dementia in elderly patients. Most of the deaths were linked to heart problems or infection. Zyprexa is not approved to treat mental problems caused by dementia.

Zyprexa is used for:

Treating schizophrenia or bipolar disorder. It is also used along with another medicine (fluoxetine) to treat certain types of depression. It may also be used for other conditions as determined by your doctor.

Zyprexa is an atypical antipsychotic. Exactly how it works is not known. It is thought to affect certain substances in the brain.

Do NOT use Zyprexa if:

• you are allergic to any ingredient in Zyprexa

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

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Before using Zyprexa:

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

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


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


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


• if you have a history of seizures, heart problems (eg, heart failure; fast, slow, or irregular heartbeat), an abnormal electrocardiogram (ECG), a heart attack, a stroke or "mini-stroke," blood vessel problems, high blood cholesterol levels, high or low blood pressure, or low white blood cell levels


• if you have a history of liver problems, stomach or bowel problems (eg, decreased muscle movement), enlarged prostate, narrow-angle glaucoma, neuroleptic malignant syndrome (NMS), aspiration pneumonia, or suicidal thoughts or attempts


• if you have Alzheimer disease, bowel blockage, dementia, or trouble swallowing


• if you have diabetes or are very overweight, or if a family member has had diabetes


• if you have had high blood prolactin levels or a history of certain types of cancer (eg, breast, pancreas, pituitary), or if you are at risk of breast cancer


• if you are dehydrated or have low blood volume, drink alcohol, smoke, or you will be exposed to high temperatures

Some MEDICINES MAY INTERACT with Zyprexa. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Tramadol because the risk of seizures may be increased


• Alpha-blockers (eg, doxazosin), diazepam, or medicines for high blood pressure because the risk of low blood pressure and fainting may be increased


• Anticholinergics (eg, scopolamine), benzodiazepines (eg, lorazepam), or fluvoxamine because they may increase the risk of Zyprexa's side effects


• Carbamazepine, HIV protease inhibitors (eg, ritonavir), omeprazole, or rifampin because they may decrease Zyprexa's effectiveness


• Dopamine receptor agonists (eg, pramipexole) or levodopa because their effectiveness may be decreased by Zyprexa

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

How to use Zyprexa:

Use Zyprexa as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Zyprexa comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Zyprexa refilled.


• Take Zyprexa by mouth with or without food.


• Drinking extra fluids while you are taking Zyprexa is recommended. Check with your doctor for instructions.


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


• If you miss a dose of Zyprexa, 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 Zyprexa.

Important safety information:

• Zyprexa may cause dizziness, drowsiness, or decreased vision. These effects may be worse if you take it with alcohol or certain medicines. Use Zyprexa 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 taking Zyprexa.


• Talk with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are taking Zyprexa; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.


• Zyprexa may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.


• Do not suddenly stop taking Zyprexa without checking with your doctor.


• Do not become overheated or dehydrated in hot weather or while you are being active; heatstroke may occur.


• If vomiting or diarrhea occurs, you will need to take care not to become dehydrated. Contact your doctor right away if you think you may be dehydrated.


• Zyprexa may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away.


• Zyprexa may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.


• NMS is a possibly fatal syndrome that can be caused by Zyprexa. Symptoms may include fever; stiff muscles; confusion; abnormal thinking; fast or irregular heartbeat; and sweating. Contact your doctor at once if you have any of these symptoms.


• Some patients who take Zyprexa may develop muscle movements that they cannot control. This is more likely to happen in elderly patients, especially women. The chance that this will happen or that it will become permanent is greater in those who take Zyprexa in higher doses or for a long time. Muscle problems may also occur after short-term treatment with low doses. Tell your doctor at once if you have muscle problems with your arms; legs; or your tongue, face, mouth, or jaw (eg, tongue sticking out, puffing of cheeks, mouth puckering, chewing movements) while taking Zyprexa.


• Some patients have experienced weight gain while using Zyprexa. You may need to have regular weight checks while you use Zyprexa.


• Lab tests, including fasting blood glucose, cholesterol, complete blood cell counts, and liver function, may be performed while you take Zyprexa. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.


• Use Zyprexa with caution in the ELDERLY; they may be more sensitive to its effects, especially uncontrolled muscle movements.


• Caution is advised when using Zyprexa in CHILDREN; they may be more sensitive to its effects, especially drowsiness, increased cholesterol and lipid levels, increased levels of prolactin (a hormone), and weight gain. Children may need regular weight checks while they take Zyprexa.


• Zyprexa should be used with extreme caution in CHILDREN younger than 13 years old; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Zyprexa while you are pregnant. Taking Zyprexa during the third trimester may result in uncontrolled muscle movements or withdrawal symptoms in the newborn. Discuss any questions or concerns with your doctor. Zyprexa is found in breast milk. Do not breast-feed while taking Zyprexa.

Possible side effects of Zyprexa:

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:

Back or joint pain; constipation; cough; dizziness; drowsiness; dry mouth; increased appetite; indigestion; lightheadedness; numbness or tingling of the skin; restlessness; sore throat; weakness; weight gain.

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); abnormal thoughts; chest pain; confusion; decreased urination; fainting; fast, slow, or irregular heartbeat; fever, chills, or persistent sore throat; increased saliva production or drooling; increased sweating; memory loss; menstrual changes; muscle pain, weakness, or stiffness; new or worsening mental or mood changes (eg, depression, hallucinations); one-sided weakness; seizures; severe or prolonged dizziness or headache; shortness of breath; suicidal thoughts or actions; swelling of the hands, legs, or feet; symptoms of high blood sugar (eg, increased thirst, hunger, or urination; unusual weakness); symptoms of high prolactin levels (eg, enlarged breast size, decreased sexual ability, missed menstrual period, nipple discharge); tremor; trouble concentrating, speaking, or swallowing; trouble sitting still; trouble walking or standing; uncontrolled muscle movements (eg, arm or leg movements, jerking or twisting, twitching of the face or tongue); unusual bruising; 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. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Zyprexa side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include abnormal thinking; aggression; agitation; chest pain; coma; confusion; difficult or slurred speech; fainting; fast or irregular heartbeat; fever; mental or mood changes; seizure; severe drowsiness, dizziness, or weakness; severe or persistent headache; slow or shallow breathing; stiff muscles; sweating; uncontrolled muscle movements.

Proper storage of Zyprexa:

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

General information:

• If you have any questions about Zyprexa, please talk with your doctor, pharmacist, or other health care provider.


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


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Zyprexa. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Zyprexa resources

• Zyprexa Side Effects (in more detail)
• Zyprexa Dosage
• Zyprexa Use in Pregnancy & Breastfeeding
• Drug Images
• Zyprexa Drug Interactions
• Zyprexa Support Group
• 75 Reviews for Zyprexa - Add your own review/rating

• Zyprexa Consumer Overview


• Zyprexa Prescribing Information (FDA)


• Zyprexa Advanced Consumer (Micromedex) - Includes Dosage Information


• Olanzapine Professional Patient Advice (Wolters Kluwer)


• Olanzapine Monograph (AHFS DI)


• Zyprexa Relprevv Prescribing Information (FDA)


• Zyprexa Relprevv Advanced Consumer (Micromedex) - Includes Dosage Information


• Zyprexa Relprevv Consumer Overview

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Full Marks Mousse

1. Name Of The Medicinal Product

Full Marks Mousse.

2. Qualitative And Quantitative Composition

Phenothrin 0.5% w/w

3. Pharmaceutical Form

Topical mousse.

4. Clinical Particulars

4.1 Therapeutic Indications

For the treatment of head louse infestations.

4.2 Posology And Method Of Administration

Caution: Apply the product in a well ventilated room away from naked flames and lighted objects.

Adults, the elderly and children aged 6 months and above:

For topical external use only.

The source of infestation should be sought and treated.

Family members and close contacts should be inspected and, if found to be infected, treated simultaneously.

Shake the can well and invert to expel the mousse.

For Head Lice:

1. Apply sufficient mousse to dry hair at several points on the scalp; massage into the scalp ensuring no part of the scalp is left uncovered. Pay special attention to the temples and crown of the head. Take care to avoid the eyes.

2. Leave on the head for 30 minutes; do not attempt to dry the hair by artificial means (e.g. electric hair dryers).

3. Wash hair with normal shampoo.

4. While the hair is still wet, comb with an ordinary comb. A fine-toothed louse comb can then be used to remove the dead or dying lice and eggs.

Infants:

Not to be used on infants under 6 months of age except under medical supervision.

4.3 Contraindications

Known sensitivity to phenothrin.

4.4 Special Warnings And Precautions For Use

Children under six months of age should only be treated under medical supervision.

Avoid contact with the eyes.

When Full Marks Mousse is used by a school nurse or other health officer in the mass treatment of large numbers of children, it is advisable that protective plastic or rubber gloves be worn.

Prolonged and repeated application should be avoided. Contains flammable alcohol. Avoid naked flames or lighted objects. Do not use artificial heat (e.g. electric hair dryers).

Full Marks Mousse contains alcohol which may cause wheezing in asthmatic patients or cause inflammation of the skin in patients with severe eczema. If such effects are apparent, patients should use a shampoo formulation.

The treatment may affect permed, pre-rinsed, bleached or coloured hair.

For external use only.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

None stated.

4.6 Pregnancy And Lactation

Long term studies have not been performed in humans, therefore as with all drugs, Full Marks Mousse should be used with caution in pregnant and lactating women.

4.7 Effects On Ability To Drive And Use Machines

None stated.

4.8 Undesirable Effects

Very rarely, skin irritation may occur. The treatment may affect pre-rinsed, permed, coloured or bleached hair. The alcohol content of the mousse may cause stinging or inflammation in patients with eczema.

4.9 Overdose

This product contains 30% alcohol. In the event of deliberate or accidental consumption, particularly by a child, empty stomach contents by gastric lavage and treat symptomatically as hypoglycaemia may occur.

5. Pharmacological Properties

5.1 Pharmacodynamic Properties

Phenothrin is a synthetic pyrethroid insecticide, highly effective against human lice but with an exceptionally low mammalian toxicity.

5.2 Pharmacokinetic Properties

Full Marks Mousse is applied topically to the affected area.

5.3 Preclinical Safety Data

Dermal irritation and eye irritation tests carried out in rabbits showed Full Marks Mousse to be a minimal irritant and did not produce positive criteria in any rabbit.

6. Pharmaceutical Particulars

6.1 List Of Excipients

Potassium citrate

Citric acid (anhydrous)

Emulsifying wax (non-ionic)

Purified water

Ethanol (denatured)

Butane 30

6.2 Incompatibilities

None stated.

6.3 Shelf Life

36 months unopened.

6.4 Special Precautions For Storage

Store at or below 25^oC. Do not puncture the can or expose to direct sunlight. Avoid naked flames or lighted objects. Do not use artificial heat (e.g. electric hair dryers). When empty, dispose of safely as normal household waste.

6.5 Nature And Contents Of Container

Aluminium monobloc aerosol cans with a mousse valve assembly, and a vertical foam spout and cap containing either 50g of product to treat one person, 2 x 50g to treat early re-infestation or 150g of product to treat four persons.

6.6 Special Precautions For Disposal And Other Handling

Not applicable.

7. Marketing Authorisation Holder

Seton Products Limited

Tubiton House

Oldham

OL1 3HS

8. Marketing Authorisation Number(S)

PL 11314/0102.

9. Date Of First Authorisation/Renewal Of The Authorisation

31/03/98

10. Date Of Revision Of The Text

10/05/2000

Maxiflor

Generic Name: diflorasone topical (dye FLOR a sone)

Brand Names: ApexiCon, ApexiCon E, Maxiflor, Psorcon E

What is Maxiflor (diflorasone topical)?

Diflorasone is a topical (for the skin) steroid. It reduces the actions of chemicals in the body that cause inflammation, redness, and swelling.

Diflorasone topical is used to treat the inflammation and itching caused by a number of skin conditions such as allergic reactions, eczema, and psoriasis.

Diflorasone topical may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Maxiflor (diflorasone topical)?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts or for longer than recommended. Topical steroid medicine can be absorbed through the skin, which may cause steroid side effects throughout the body.

Do not cover treated skin areas with a bandage or other covering unless your doctor has told you to. Plastic film covering (such as plastic wrap) is sometimes used when treating psoriasis. Follow your doctor's instructions.

If you are treating the diaper area of a baby, do not use plastic pants or tight-fitting diapers. Covering the skin that is treated with diflorasone topical can increase the amount of medicine your skin absorbs, which may lead to unwanted side effects.

Do not use this medication on a child without a doctor's advice. Children are more likely to absorb large amounts of a topical steroid through the skin. Steroid absorption in children may cause unwanted side effects, or a delay in growth with long-term use. Talk with your doctor if you think your child is not growing at a normal rate while using this medication over a long treatment period. Contact your doctor if your condition does not improve, or if you develop signs of a bacterial, fungal, or viral skin infection.

What should I discuss with my healthcare provider before using Maxiflor (diflorasone topical)?

Do not use this medication if you are allergic to diflorasone.

Before using diflorasone topical, tell your doctor if you are allergic to any drugs, or if you have any type of skin infection.

Also tell your doctor if you have diabetes. Topical steroid medicines absorbed through the skin may increase the glucose (sugar) levels in your blood or urine.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether diflorasone topical passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not use this medication on a child without a doctor's advice. Children are more likely to absorb large amounts of a topical steroid through the skin. Steroid absorption in children may cause unwanted side effects, or a delay in growth with long-term use. Talk with your doctor if you think your child is not growing at a normal rate while using this medication over a long treatment period.

How should I use Maxiflor (diflorasone topical)?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts or for longer than recommended. Topical steroid medicine can be absorbed through the skin, which may cause steroid side effects throughout the body.

Wash your hands before and after using diflorasone topical, unless you are using the medication to treat the skin on your hands.

Apply a small amount to the affected area and rub it gently into the skin. Do not use this medication over a large area of skin.

Do not cover treated skin areas with a bandage or other covering unless your doctor has told you to. Plastic film covering (such as plastic wrap, plastic gloves, or a shower cap) is sometimes used to cover areas of psoriasis that are treated with diflorasone topical. Follow your doctor's instructions.

Avoid plastic covering over skin lesions that are oozing or draining pus or any type of fluid.

If you are treating the diaper area of a baby, do not use plastic pants or tight-fitting diapers. Covering the skin that is treated with diflorasone topical can increase the amount of medicine your skin absorbs, which may lead to unwanted side effects.

Contact your doctor if your condition does not improve, or if you develop signs of a bacterial, fungal, or viral skin infection. It is important to use diflorasone topical regularly to get the most benefit.

If you are treating psoriasis, use the medication for at least a few days after the skin clears. Stopping too soon could cause a relapse.

To be sure this medication is not causing harmful effects with long-term use, you may need blood tests. Do not miss any scheduled appointments.

Store diflorasone topical at room temperature away from moisture and heat. Keep from freezing.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

An overdose of diflorasone is not expected to produce life-threatening symptoms. However, long-term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using Maxiflor (diflorasone topical)?

Diflorasone topical should not be used to treat any skin condition your doctor has not prescribed it for.

Avoid getting this medication in your eyes. If contact does occur, rinse with water. Do not use diflorasone topical on broken or infected skin. Also avoid using this medication in open wounds.

Maxiflor (diflorasone topical) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have severe irritation of any treated skin, or if you show signs of absorbing diflorasone topical through your skin, such as:

• 
  

  blurred vision, or seeing halos around lights;

  
  


• 
  

  mood changes;

  
  


• 
  

  sleep problems (insomnia);

  
  


• 
  

  weight gain, puffiness in your face; or

  
  


• 
  

  muscle weakness, feeling tired.

  
  

Less serious side effects may include:

• 
  

  mild skin itching, burning, or dryness;

  
  


• 
  

  thinning or softening of your skin;

  
  


• 
  

  skin rash or irritation around your mouth;

  
  


• 
  

  swollen hair follicles;

  
  


• 
  

  changes in color of treated skin;

  
  


• 
  

  blisters, pimples, or crusting of treated skin; or

  
  


• 
  

  stretch marks.

  
  

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Maxiflor (diflorasone topical)?

It is not likely that other drugs you take orally or inject will have an effect on topically applied diflorasone topical. But many drugs can interact with each other. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

More Maxiflor resources

• Maxiflor Side Effects (in more detail)
• Maxiflor Use in Pregnancy & Breastfeeding
• Maxiflor Drug Interactions
• Maxiflor Support Group
• 0 Reviews for Maxiflor - Add your own review/rating

• Maxiflor Advanced Consumer (Micromedex) - Includes Dosage Information


• Maxiflor Cream MedFacts Consumer Leaflet (Wolters Kluwer)


• Apexicon Prescribing Information (FDA)


• Apexicon E Prescribing Information (FDA)


• Florone Prescribing Information (FDA)


• Psorcon Monograph (AHFS DI)


• psorcon Prescribing Information (FDA)

Compare Maxiflor with other medications

• Atopic Dermatitis
• Eczema
• Psoriasis
• Skin Rash
• Urticaria

Where can I get more information?

• Your pharmacist can provide more information about diflorasone topical.

See also: Maxiflor side effects (in more detail)

Hismanal

Generic Name: astemizole (a STEH mih zole)

Brand Names: Hismanal

What is Hismanal (astemizole)?

Astemizole was withdrawn from the U.S. market in 1999.

Astemizole is an antihistamine. Antihistamines prevent sneezing, runny nose, itching and watering of the eyes, and other allergic symptoms.

Astemizole is used to treat allergies, hives (urticaria), and other allergic inflammatory conditions.

Astemizole may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Hismanal (astemizole)?

Astemizole was withdrawn from the U.S. market in 1999.

Do not take astemizole (Hismanal) with any of the following medicines: antifungal drugs such as ketoconazole (Nizoral) and itraconazole (Sporanox); antibiotics such as erythromycin (E.E.S., E-Mycin, Ery-Tab), clarithromycin (Biaxin), and troleandomycin (TAO); the malaria medicine quinine (Quinamm); or the medicine nefazodone (Serzone). Take astemizole on an empty stomach, 1 hour before or 2 hours after eating food. Do not take astemizole with grapefruit or grapefruit juice. Grapefruit products may increase amount of astemizole available in your body, which could lead to dangerous side effects.

Who should not take Hismanal (astemizole)?

You cannot take astemizole if you are taking any of the following medicines:

• 
  

  an antifungal drug including ketoconazole (Nizoral) or itraconazole (Sporanox);

  
  


• 
  

  an antibiotic including erythromycin (E.E.S., E-Mycin, Ery-Tab), clarithromycin (Biaxin), or troleandomycin (TAO);

  
  


• 
  

  the malaria medicine quinine (Quinamm); or

  
  


• 
  

  the medicine nefazodone (Serzone).

  
  

A dangerous side effect involving irregular heartbeats could occur if you take astemizole with any of the medicines listed above.

Before taking astemizole, tell your doctor if you have

• 
  

  asthma or another lung disease;

  
  


• 
  

  low potassium levels in your blood;

  
  


• 
  

  urinary retention or an enlarged prostate;

  
  


• kidney disease;


• liver disease; or


• 
  

  heart disease, especially an irregular heartbeat.

  
  

You may not be able to take astemizole, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Astemizole is in the FDA pregnancy category C. This means that it is not known whether astemizole will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. It is also not known whether astemizole passes into breast milk. Do not take astemizole without first talking to your doctor if you are breast-feeding a baby.

How should I take Hismanal (astemizole)?

Take astemizole once a day as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass (8 ounces) of water. Take astemizole on an empty stomach, 1 hour before or 2 hours after a meal. Do not take astemizole with grapefruit or grapefruit juice. Grapefruit products may increase amount of astemizole available in your body, which could lead to dangerous side effects. Do not crush, chew, or break the tablets. Swallow them whole.

Never take more of this medication than is directed by your doctor. Larger than prescribed doses of astemizole may result in irregular heartbeats, and rarely, death. If your symptoms are not being adequately treated, talk to your doctor.

Store astemizole at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of an astemizole overdose include headache, drowsiness, irregular heartbeats, nausea, and vomiting.

What should I avoid while taking Hismanal (astemizole)?

Use caution when driving, operating machinery, or performing other hazardous activities. Astemizole may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking astemizole. Do not take astemizole with grapefruit or grapefruit juice. Grapefruit products may increase amount of astemizole available in your body, which could lead to dangerous side effects.

Hismanal (astemizole) side effects

If you experience any of the following serious side effects, stop taking astemizole and call your doctor immediately or seek emergency medical attention:

• 
  

  an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

  
  


• 
  

  an irregular heartbeat;

  
  


• 
  

  fainting; or

  
  


• 
  

  seizures.

  
  

Other, less serious side effects may be more likely to occur. Continue to take astemizole and talk to your doctor if you experience

• 
  

  drowsiness or dizziness;

  
  


• 
  

  headache;

  
  


• 
  

  nervousness;

  
  


• 
  

  nausea, diarrhea, or abdominal discomfort;

  
  


• 
  

  dry mouth; or

  
  


• 
  

  dry skin or itchiness.

  
  

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Hismanal (astemizole)?

You cannot take astemizole if you are taking any of the following medicines:

• 
  

  an antifungal drug including ketoconazole (Nizoral) or itraconazole (Sporanox);

  
  


• 
  

  an antibiotic including erythromycin (E.E.S., E-Mycin, Ery-Tab), clarithromycin (Biaxin), or troleandomycin (TAO);

  
  


• 
  

  the malaria medicine quinine (Quinamm); or

  
  


• 
  

  the medicine nefazodone (Serzone).

  
  

A dangerous side effect involving irregular heartbeats could occur if you take astemizole with any of the medicines listed above.

Before taking this medication, tell your doctor if you are taking any of the following medicines:

• 
  

  an antifungal including fluconazole (Diflucan), miconazole (Monistat), or metronidazole (Flagyl);

  
  


• 
  

  a selective serotonin reuptake inhibitor (SSRI) including fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft);

  
  


• 
  

  a protease inhibitor including amprenavir (Agenerase), ritonavir (Norvir), indinavir (Crixivan), saquinavir (Invirase, Fortovase), or nelfinavir (Viracept); or

  
  


• 
  

  zileuton (Zyflo).

  
  

You may not be able to take astemizole, or you may require a dosage adjustment or special monitoring during your treatment if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with astemizole. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More Hismanal resources

• Hismanal Side Effects (in more detail)
• Hismanal Use in Pregnancy & Breastfeeding
• Drug Images
• Hismanal Drug Interactions
• Hismanal Support Group
• 0 Reviews for Hismanal - Add your own review/rating

Compare Hismanal with other medications

• Allergic Urticaria
• Allergies
• Urticaria

Where can I get more information?

• Your pharmacist has additional information about astemizole written for health professionals that you may read.

What does my medication look like?

Astemizole was withdrawn from the U.S. market in 1999.

See also: Hismanal side effects (in more detail)

pamabrom

Generic Name: pamabrom (PAM a brom)

Brand names: Aqua-Ban, Aqua-Ban with Pamabrom, Diurex Water Capsules, Diurex Aquagels

What is pamabrom?

Pamabrom is a diuretic (water pill). It works by increasing urination.

Pamabrom is used to treat bloating, puffiness, and other signs of water weight gain related to menstrual symptoms.

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

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

Do not use this medication if you are allergic to pamabrom or if you are unable to urinate.

Before using pamabrom, tell your doctor if you take any other diuretic (water pill), or if you have high blood pressure, heart disease, or kidney disease. If you have any of these conditions, you may need a dose adjustment or special tests to safely take pamabrom.

Use this medication as directed on the label, or as your doctor has prescribed. Do not use the medication in larger amounts or for longer than recommended.

Do not take more than 4 tablets in one day (24 hours).

What should I discuss with my health care provider before taking pamabrom?

Do not use this medication if you are allergic to pamabrom or if you are unable to urinate.

Before taking pamabrom, tell your doctor if you have high blood pressure, heart disease, or kidney disease. If you have any of these conditions, you may need a dose adjustment or special tests to safely take pamabrom.

Pamabrom may or may not be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while you are taking this medication. It is not known whether pamabrom passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take pamabrom?

Use this medication exactly as directed on the label, or as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended.

The usual dose of pamabrom is 1 tablet taken 4 times per day.

Do not take more than 4 tablets in one day (24 hours).

Pamabrom will cause you to urinate more than usual. This is a sign that the medication is working.

Store pamabrom at room temperature away from moisture and heat.

What happens if I miss a dose?

Since pamabrom is taken as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

What should I avoid while taking pamabrom?

Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are using pamabrom.

Pamabrom side effects

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

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.

What other drugs will affect pamabrom?

Ask your doctor before taking pamabrom if you also take any other diuretic (often used as blood pressure medication).

Diuretics include amiloride (Midamor, Moduretic), bumetanide (Bumex), chlorothiazide (Diuril), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Vasoretic, Zestoretic), indapamide (Lozol), metolazone (Mykrox, Zaroxolyn), spironolactone (Aldactazide, Aldactone), triamterene (Dyrenium, Maxzide, Dyazide), torsemide (Demadex), and others.

This list is not complete and there may be other drugs that can interact with pamabrom. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

More pamabrom resources

• Pamabrom Drug Interactions
• Pamabrom Support Group
• 0 Reviews for Pamabrom - Add your own review/rating

• Pamabrom

Compare pamabrom with other medications

• Abdominal Distension
• Edema
• Premenstrual Dysphoric Disorder
• Premenstrual Syndrome

Where can I get more information?

• Your pharmacist can provide more information about pamabrom.

Vancocin Capsules

Pronunciation: VAN-koe-MYE-sin
Generic Name: Vancomycin
Brand Name: Vancocin

Vancocin Capsules is used for:

Treating certain bacterial infections of the stomach or bowel.

Vancocin Capsules is an antibiotic. It works by killing sensitive bacteria.

Do NOT use Vancocin Capsules if:

• you are allergic to any ingredient in Vancocin Capsules

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

Before using Vancocin Capsules:

Some medical conditions may interact with Vancocin Capsules. 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, colitis or other inflammation of the bowel, or hearing problems

Some MEDICINES MAY INTERACT with Vancocin Capsules. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Aminoglycosides (eg, tobramycin) because the risk of kidney problems or hearing problems may be increased


• Methotrexate because the risk of its side effects may be increased by Vancocin Capsules

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

How to use Vancocin Capsules:

Use Vancocin Capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Vancocin Capsules by mouth with or without food.


• To clear up your infection completely, take Vancocin Capsules for the full course of treatment. Keep taking it even if you feel better in a few days.


• Continue to use Vancocin Capsules even if you feel well. Do not miss any doses.


• If you miss a dose of Vancocin Capsules, 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 Vancocin Capsules.

Important safety information:

• Vancocin Capsules only works against bacteria; it does not treat viral infections (eg, the common cold).


• Long-term or repeated use of Vancocin Capsules 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.


• Be sure to use Vancocin Capsules 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.


• Kidney problems, including reports of kidney failure, have occurred in patients taking Vancocin Capsules. These kidney problems can occur either during treatment or after treatment is stopped, although they have typically occurred within 1 week after Vancocin Capsules has been stopped. Contact your doctor right away if you experience decreased urination.


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


• Use Vancocin Capsules with caution in the ELDERLY; they may be more sensitive to its effects.


• Vancocin Capsules should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: It is not known if Vancocin Capsules can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Vancocin Capsules while you are pregnant. Vancocin Capsules is found in breast milk. Do not breast-feed while taking Vancocin Capsules.

Possible side effects of Vancocin Capsules:

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:

Back pain; gas; headache; nausea; stomach pain; tiredness; vomiting.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; decreased, difficult, or painful urination; fainting; fever, chills, or sore throat; flushing; red, swollen, or blistered skin; ringing in the ears, hearing loss, or other hearing changes; severe or persistent diarrhea; severe or persistent dizziness or light-headedness; shortness of breath; swelling of the hands, ankles, or feet; symptoms of low blood potassium levels (eg, irregular heartbeat; muscle pain, weakness, or cramping); unusual bruising or bleeding; wheezing.

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. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Vancocin side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of Vancocin Capsules:

Store Vancocin Capsules 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 Vancocin Capsules out of the reach of children and away from pets.

General information:

• If you have any questions about Vancocin Capsules, please talk with your doctor, pharmacist, or other health care provider.


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


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Vancocin Capsules. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Vancocin resources

• Vancocin Side Effects (in more detail)
• Vancocin Dosage
• Vancocin Use in Pregnancy & Breastfeeding
• Vancocin Drug Interactions
• Vancocin Support Group
• 0 Reviews for Vancocin - Add your own review/rating

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