Generic Name
Glatiramer (glah-TYE-ram-er)
Brand Name  Copaxone
Type of Drug
Relapsing-remitting multiple sclerosis (MS) therapy.
Prescribed For  MS.
General Information
Glatiramer is a mixture of several amino acids. It is thought to work by modifying the immune processes responsible for MS. In studies, people who took the drug for over a year were twice as likely to be relapse-free as those who took a placebo (sugar pill).
Cautions and Warnings
Do not use this drug it you are allergic or sensitive to any of its ingredients or to mannitol.
About 10% of people who self-administer glatiramer experience a post-injection reaction with symptoms that include flushing, chest pain, heart palpitations, anxiety, breathing difficulties, closing of the throat, and an itchy rash. These symptoms usually go away without treatment. This reaction generally occurs after several months of drug therapy, though it may occur earlier.
About 21 % of the people who took glatiramer in drug studies had chest pain, but the exact relationship of this pain to use of glatiramer could not be determined. Report any chest pain to your doctor at once.
Glatiramer may make you more sensitive to sunlight.
Because it interferes with immune response, glatiramer may increase your risk of developing infections and tumors.
Glatiramer may interfere with kidney function.
Possible Side Effects
V Most common: infections, weakness, pain, chest pain, flu-like symptoms, back pain, flushing, heart palpitations, anxiety, muscle stiffness or spasticity, an urgent need to urinate, swollen lymph glands, injection-site reactions
Possible Side Effects (continued)
(including pain, inflammation, itching, an unknown mass at the injection site, welts, skin marks, and bleeding), breathing difficulties, runny nose, and joint pain.
¦    Common: fever, neck pain, facial swelling, bacterial infection, migraine, rapid heartbeat, tremors, fainting, appetite loss, vomiting, general stomach disorders, vaginal infection, painful menstruation, black-and-blue marks, swelling in the arms or legs, bronchial irritation, spasm of the larynx, and ear pain.
V Less common: chills, cysts, agitation, foot drop, nervousness, rolling eyeballs, rapid eye movement, confusion, speech problems, cold sores, redness, itchy rash, skin nodules, stomach pain and irritation, and weight gain.
¦    Rare: Other side effects can occur in almost any part of the body, including the heart and blood vessels, digestive system, blood and lymph systems, muscles and bones, respiratory system, kidney, reproductive system, and eyes. Contact your doctor if you experience any side effect not listed above.
Food and Drug Interactions None known.
Usual Dose
Adult (age 18 and over): 20 mg a day by injection under the skin. Child (under age 18): not recommended.
Overdosage
Little is known about the effects of glatiramer overdose. Call you local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
This medication is given by injection. For information on how to properly administer this drug, see page 1242.
Store unused glatiramer in the refrigerator before it is mixed with the diluent supplied by the manufacturer. Do not use any other diluent. The mixed injection must be used right away.
Suggested injection sites are the arms, abdomen, hips. and thighs. Be sure to rotate injection sites.
Glatiramer works best if given at the same time each day.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose. Call your doctor if you miss more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: The safety of using glatiramer during pregnancy is not known. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if glatiramer passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may use glatiramer without special restriction.

Type of Drug
Glitazone Antidiabetes Drugs
(GLIT-uh-zone)
Brand Names
Rosiglitazone Maleate Avandia
Combination Products
Pioglitazone Hydrochloride + Metformin Hydrochloride
ACTOplus Met
Pioglitazone Hydrochloride + Glimepiride Duetact
Rosiglitazone Maleate + Metformin Hydrochloride
Nnndamet
Rosiglitazone Maleate + Glimepiride Avandaryl
Prescribed For  Type 2 diabetes.
General Information
The glitazones reduce the amount of sugar produced by the liver and increase insulin sensitivity of muscle, liver, and fat cells. They may also help to control blood-fat levels, which are often elevated in diabetes. Glitazones work by affecting genes responsible for controlling the use of sugar and fat in the body, making cells more sensitive to insulin. They are effective for people with type 2 diabetes, whose cells do not respond well to insulin. Glitazones only work when insulin is present. They do not increase the amount of insulin made in the pancreas. Glitazones can be used alone or combined with other diabetes drugs. Studies have indicated that taking rosiglitazone can delay or prevent type 2 diabetes in people with pre-diabetes.
Cautions and Warnings
Do not take these drugs if you are sensitive or allergic to any of their ingredients or to related drugs. Glitazones may cause fluid retention, worsening or leading to heart failure. Some studies have indicated the risk of heart attack may be increased in people taking rosiglitazone. Other studies have shown that pioglitazone decreases the risk of heart attack. The effects of these drugs on the heart are still being investigated.
Glitazones are broken down in the liver; people with liver disease should not take them. Liver enzyme monitoring is recommended for all people taking a glitazone. People taking pioglitazone and rosiglitazone have experienced liver failure, though no direct causal effect of the drug has been established.
Glitazones may raise blood levels of cholesterol and other blood fats.
These drugs can trigger ovulation. Premenopausal women who are not ovulating may be at risk of becoming pregnant.
Glitazones can cause weight gain, which increases with dosage.
Rosiglitazone may increase the risk of broken bones in the hands, arms, or feet.
Women may achieve maximum benefit with smaller dosages.
Possible Side Effects
Pioglitazone
In studies, the side effects of pioglitazone were about the same as those for a placebo (sugar pill).
Possible Side Effects (continued)
¦    Most common: upper respiratory infections, headaches, and sinus irritation.
?    Common: muscle aches, tooth problems, and sore throat.
?    Less common: anemia and swollen legs or arms.
¦    Rare: swelling below the surface of the skin, especially around the eyes and lips; yellowing of the skin or whites of the eyes, hepatitis, and liver failure. Contact your doctor if you experience any side effect not listed above.
For additional side effects of ACTOplus Met, see Metformin (page 696). For additional side effects of Duetact, see Sulfonylurea Diabetes Drugs (page 1065).
Rosiglitazone
•    Common: upper respiratory infections, accidental injuries, and headache.
•    Less, common: swollen legs or arms, back pain.
•    Rare: swelling below the surface of the skin, especially around the eyes and lips; may also affect the hands, feet and throat. Also, hives, anemia, blurry or distorted vision, and low blood sugar. Contact your doctor if you experience any side effect not listed above.
For additional side effects of Avandamet, see Metformin (page 696). For additional side effects of Avandaryl, see Sulfonylurea Diabetes Drugs (page 1065).
Drug Interactions
•    Mixing gemfibrozil (for very high triglycerides) with a glitazone increases the amount of the glitazone absorbed into the body. A reduction in the dose of the glitazone may be needed if you start taking gemfibrozil.
•    Rifampin can reduce the amount of a glitazone that is absorbed by the body, possibly leading to higher blood sugar levels.
•    Ketoconazole may significantly increase the amount of pioglitazone in the body. Other drugs that may have a similar effect but have not yet been studied include itraconazole, erythromycin, calcium channel blockers, corticosteroids, cyclosporine, protease inhibitor anti-HIV drugs, tacrolimus, triazolam, and trimetrexate.
•    Mixing pioglitazone with atorvastatin may reduce the amount of either drug in the body.
•    Pioglitazone may reduce the effectiveness of contraceptive drugs containing norethindrone and ethinyl estradiol. Higher-dose contraceptives or another contraceptive method may be needed.
•    Pioglitazone may stimulate the breakdown of other drugs also metabolized in the liver.
•    Taking rosiglitazone and insulin may increase the risk of fluid retention and heart failure.
For additional drug interactions for Avandamet and ACTOpius Met, see Metformin (page 696). For additional drug interactions for Avandaryl and Duetact, see Sulfonylurea Diabetes Drugs (page 1065).
Food Interactions
Grapefruit juice may interfere with the breakdown of pioglitazone in the liver. Otherwise, these drugs may be taken with or without food, except for Avandaryl, which should be taken with the first meal of the day.
Usual Dose
Adult
Pioglitazone: 15-45 mg once a day.
Rosiglitazone: 8 mg once a day or in divided doses. ACTOplus Met: 15/500 mg-45/2550 mg once or twice a day. Avandamet: 2/500 mg-4/1000 mg twice a day.
Avandaryl: 4/1 mg-8/4 mg with the first meal of the day. Duetact: 30/2 mg-30/4 mg once a day.
Child: not recommended. Overdosage
Little is known about the effects of glitazone overdose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
ISID’atial Information
Diet, calorie control, exercise, and weight loss are essential to controlling type 2 diabetes. Do not depend solely on this drug to manage your condition.
Alcohol, smoking, age, and race do not affect the way that glitazones are processed in the body.
Call your doctor if you develop symptoms Of liver disease, including nausea, vomiting, abdominal pain, fatigue, appetite loss, or dark-colored urine.
See your doctor for regular monitoring of blood sugar, glycosylated hemoglobin (a more sensitive indicator of long-term diabetes control), and liver function.
If you forget a dose of any of these medicines, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding: The safety of using glitazones during pregnancy is not known. Most experts recommend that diabetes be controlled with insulin during pregnancy.
It is not known if glitizones pass into breast milk. Nursing mothers who must take it should consider using infant formula.
Seniors: Seniors may take this drug without special restriction.

Generic Name
Guanabenz (GWAN-uh-benz) 9)
Type of Drug  Anti hypertensive.
Prescribed For  High blood pressure.
General Information
Guanabenz acetate works by depressing the central nervous system by stimulating certain receptors. Initially, guanabenz reduces blood pressure without a major effect on blood vessels; however, btAqAum use of guanabenz may result in the dilation (widening) of blood vessels and a slight slowing of pulse rate. Guanabenz may be taken alone or with a thiazide diuretic.
Cautions and Warnings
Do not take guanabenz if you are allergic or sensitive to any of its ingredients.
People with severe kidney or liver disease should take this drug with caution. Guanabenz should also be used with caution by people who have had a recent heart attack or stroke.
Drug Interactions
•    Other blood-pressure-lowering agents such as beta blockers increase the effect of guanabenz.
•    The sedating effects of guanabenz are increased by combining it with sedatives, sleeping pills, or other centralnervous-system (CNS) depressants, including alcohol.
•    People taking this drug for high blood pressure should avoid over-the-counter drugs that might aggravate their condition, including decongestants, cold and allergy remedies, and diet pills—all of which may contain stimulants.
Food Interactions
This drug is best taken on an empty stomach, but it may be taken with food if it upsets your stomach.
Usual Dose
Adult: 4 mg twice a day to start, increased gradually to a maximum dose of 32 mg twice a dwy—though doses this large are rarely needed.
Child (under age 12): not recommended.
Overdosage
Overdose causes sleepiness, lethargy, low blood pressure, irritability, pinpoint pupils, and reduced heart rate. Overdose victims should be made to vomit with ipecac syrup—available at any
swollen effects increase with dosage. siness, sedation, dry mouth, dizziness, ache.
st pain; swelling in the hands, legs, or ns or abnormal heart rhythms; stom- pain or discomfort; nausea; diarrhea; ion; anxiety; poor muscle control; de- sleeping; stuffy nose; blurred vision; ains; breathing difficulties; frequent uri- sex drive; impotence; unusual taste in ollen and painful breasts in men.
Possible Side Effects
Risk and severity of sid
• Most common: drowsiness
and headache. • Less common: ches
heart palpitation
•    or abdominal vomiting; constipation
difficulty muscle aches and pains
•    decreased the mouth; and
pharmacy—but call your doctor or poison control center first. If you must go to a hospital emergency room, ALWAYS bring the prescription bottle or container.
Special Information
Take guanabenz exactly as prescribed for maximum benefit. If any side effect becomes severe or intolerable, contact your doctor.
Guanabenz often causes tiredness or dizziness; avoid alcohol because it increases these effects. Take care when driving or doing anything that requires concentration.
Do not stop taking guanabenz without your doctor’s approval. Suddenly stopping this drug may cause a rapid increase in blood pressure. Dosage must be gradually reduced by your doctor.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose. Call your doctor if you miss 2 or more consecutive doses.
Special Populations
PregrianCylBreast-feeding, Guanabenz may affect the fetus. ii should be avoided by women who are or might be pregnant. When guanabenz is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if guanabenz passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more sensitive to the sedating and bloodpressure-lowering effects of guanabenz.

Generic Name
Haloperidol (hal-oe-PER-ih-dol) [M
Brand Name
Haldol         Type of Drug .
Butyroqhv)mearibpsychotic.

Prescribed For
Psychotic disorders, including Tourette’s syndrome; severe behavioral problems in children; short-term treatment of hyperactive children; chronic schizophrenia; vomiting; treatment of acute psychiatric situations; and phencyclidine (PCP) psychosis.
General Information
Haloperidol is one of many nonphenothiazine agents used to treat psychosis. These drugs are equally effective when given in therapeutically equivalent doses. The major differences are in the type and severity of side effects. Some people may respond well to one and not at all to another. Haloperidol acts on a portion of the brain called the hypothalamus. It affects parts of the hypothalamus that control metabolism, body temperature, alertness, muscle tone, hormone balance, and vomiting. Haloperidol is available in liquid form for those who have trouble swallowing tablets.
Cautions and Warnings
Haloperidol should not be used by people who are allergic or sensitive to any of its ingredients.
People with very low blood pressure, Parkinson’s disease, or blood, liver, heart, or kidney disease should avoid this drug.
If you have glaucoma, epilepsy or a history of seizures, ulcers, or difficulty urinating, haloperidol should be used with caution and under strict supervision of your doctor.
If haloperidol is used to control mania in bipolar disorder, a rapid depressive mood swing may occur.
Haloperidol can upset the body’s temperature-regulating mechanism creating a risk for heat stroke or dehydration.
Haloperidol may cause dystonia, tardive dyskinesia, or neuroleptic malignant syndrome, all serious conditions.
Possible Side Effects
V Most common: drowsiness, blurred vision, constipation, diarrhea, dizziness, dry mouth, headache, loss of appetite, nausea, stomach pain, or sleeplessness.
V Less common: jaundice (yellowing of the whites of the eyes or skin), which may occur in the first 2-4 weeks. The jaundice usually goes away when the drug is discontinued, but there have been cases in which it did not. if gou notice this effect, develop fever, or generally feel unwell, contact your doctor immediately. Other less common side effects are changes in components of the blood, including anemias; raised or lowered blood pressure; abnormal heartbeat; restlessness; anxiety; euphoria (feeling “high”); depression; confusion; acne-like skin reactions; excessive salivation;
Possible Side Effects (continued)
breast engorgement; development  of breast tissue in males; vomiting; excessive sweating-, menstrual irregularities; impotence; and breathing difficulties.
¦ Rare: neurological effects such as spasms of the neck muscles, severe stiffness of the back muscles, rolling back of the eyes, convulsions, difficulty in swallowing, and symptoms associated with Parkinson’s disease. These effects usually disappear after the drug has been withdrawn; however, symptoms of the face, tongue, or jaw may persist for years, especially in seniors with a long history of brain disease. If you experience any of these effects, contact your doctor immediately. Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Be cautious about taking haloperidol with barbiturates, sleeping pills, narcotics or other sedatives, tricyclic antidepressants, alcohol, or any other medication that may produce a depressive effect.
•    Combining haloperidol with carbamazepine may decrease the effectiveness of haloperidol requiring a dosage adjustment.
•    The use of azole antifungal agents (e.g. ketoconazole) may cause an increase in haloperidol side effects, possibly requiring adjustments in haloperidol doses.
•    Anticholinergic drugs may reduce the effectiveness of haloperidol and increase the risk of side effects.
•    Severe low blood pressure or heartbeat irregularities may occur if haloperidol is combined with epinephrine or dopamine.
•    Taking lithium together with haloperidol may lead to disorientation, loss of consciousness, ry uncontrolled muscle Mwments.
•    Combining fluoxetine with haloperidol may increase the effects of haloperidol.
•    Haloperidol may increase the effects of antihypertensive drugs.
•    Haloperidol may affect phenytoin levels, as well as levels of
other antipsychotic drugs.
•    Careful dosage monitoring is required if haloperidol is taken
with rifampin.
Food Interactions
Haloperidol is best taken on an empty stomach, but you may take it with food if it upsets your stomach.
Usual Dose
Psychotic disorders
Adult: starting dose-0.5-2 mg 2 or 3 times a day. Some patients may need 3-5 mg 2 or 3 times a day. Rarely, some patients may require up to 100 mg a day.
Child (age 3-12 or 33-88 lbs.): starting dose-0.5 mg a day. Dosage may be increased in 0.5-mg steps every 5-7 days. Child (under age 3): not recommended.
Tourette’s syndrome
Adult: starting dose    0.5-1.5 mg 3 times a day; up to 10 mg a day may be needed.
Child (age 3-12 or 33-88 lbs.): 0.02-0.03 mg per lb. a day. The same dosages apply to children with behavioral disorders or hyperactivity.
Overdosage
Symptoms of overdose are depression, extreme weakness, tiredness, desire to sleep, coma, lowered blood pressure, uncontrolled muscle spasms, agitation, restlessness, convulsions, fever, dry mouth, and abnormal heart rhythm. The patient should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
This medication may cause drowsiness. Use caution when driving or operating hazardous equipment; also, avoid alcoholic beverages while taking it.
Haloperidol may cause unusual sensitivity to the sun. It may aIF4Q WVR your urine reddish-brown or pink.
If dizziness occurs, avoid sudden changes in posture and avoid climbing stairs.
Avoid extreme heat while taking haloperidol. This medication may make you more prone to heat stroke.
If you forget to take a dose of haloperidol, take it as soon as you remember. Take the rest of the day’s doses evenly spaced throughout the day. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Serious problems have been seen in pregnant animals given large amounts of haloperidol. Although haloperidol has not been studied in pregnant women, you should avoid this drug if you are or might be pregnant.
Haloperidol passes into breast milk. Nursing mothers who must use this medication should use infant formula.
Seniors: Seniors are more sensitive to the effects of this medication and usually require 1/4-1/2 the usual adult dose. Seniors are also more likely to develop side effects.

Brand Name
Helidac
Generic Ingredients
Bismuth Subsalicylate + Metronidazole + Tetracycline
The information in this profile also applies to the following drug:
Generic Ingredients: Bismuth Subcitrate Potassium + Metronidazole + Tetracycline
Pylera
Type of Drug  Antibacterial combination.
Prescribed For  Duodenal ulcers.
General Information
Research has shown that the bacterium Helicobacter pylori is usually present in ulcer disease and some forms of gastritis. Drugs used to treat the H. pylori infection are prescribed along with a drug that alleviates ulcer symptoms by blocking stomach acid. There are a variety of approaches to treating ulcers by using combinations of various antibiotic and acid-blocking drugs. Helidac combines 3 drugs with antibacterial or antibiotic action. This combination generally works by disrupting the cell walls of the bacterium and interfering with its ability to make proteins or duplicate
itself. It is often prescribed together with ranitidine, cimetidine, or another acid Mocker. Other treatments use other drug comb-
nations.
Cautions and Warnings
Do not take Helidac if you are allergic or sensitive to any of its
ingredients.
Do not take Helidac if you have severe liver or kidney disease. People with less severe liver disease may require a reduced dosage.
Rarely, bismuth causes severe nervous system toxicity. Symptoms go away after the drug is stopped.
Bismuth subsalicylate can cause dark stools or darkening of the tongue. This darkening of stools is not dangerous; however, be aware that blood in the stool often manifests as blackening of the stool.
Children or teenagers who have or are recovering from chickenpox should not use Helidac because it contains a small amount of salicylate, which is related to aspirin. Children or teenagers who take aspirin or a salicylate may develop Reye’s syndrome: symptoms include nausea and vomiting.
Bismuth can also cause ringing in the ears, especially if taken along with another aspirin-containing drug.
Metronidazole can cause convulsive seizures and nervous system effects including numbness or tingling in the arms, legs, hands, or feet. The risk of developing these effects increases with dosage and duration of use. Call your doctor at once if you experience any of these effects.
Metronidazole should be taken with caution by people who have had blood diseases or nervous system disorders, such as seizure disorders.
Candida infections may worsen while you are taking metronidazole.
Other infections, called superinfections, can develop while you are taking tetracycline. If this happens, your doctor will discontinue Helidac and prescribe a different drug to treat your H. pylori infection, ;a% %0M as another drug to treat the superinfection.
Tetracycline should not be used in children under age 8 due to the risk of tooth discoloration.
People taking tetracycline can develop pseudotumor cerebri (pressure inside the brain), the symptoms of which are usually headache and blurred vision. Symptoms usually go away when the drug is stopped, but permanent damage can result.
Tetracycline may increase your sensitivity to the sun; use sun-
screen and wear protective clothing.
Tetracycline may make contraceptive drugs less effective. Another or additional forms of contraceptive should be used.
Possible Side Effects
?    Most common: nausea and diarrhea.
?    Less common: abdominal pain, blood in the stool, head-
ache, anal discomfort, appetite loss, dizziness, tingling in
the hands or feet, vomiting, muscle weakness, constipa-
tion, sleeplessness, pain, and respiratory infections.
For more information on possible side effects, see Metronidazole, page 718, and Tetracycline Antibiotics, page 1103.
Drug Interactions
•    Tetracycline antibiotics, which are bacteriostatic, may interfere with the action of bactericidal (bacteria-killing) agents such as penicillin. You should not take both kinds of antibiotics for the same infection.
•    Antacids, mineral supplements, and multivitamins containing bismuth, calcium, zinc, magnesium, and iron can reduce the effectiveness of tetracycline. Separate doses of your antacid, mineral supplement, vitamin with minerals, or sodium bicarbonate and Helidac by at least 2 hours.
•    Tetracycline and metronidazole may each increase the effect of anticoagulant (blood-thinning) drugs such as warfarin. An adjustment in the anticoagulant dosage may be required.
•    Cimetidine can increase metronidazole blood levels. Your metronidazole dosage may be reduced if you are also taking cimetidine.
•    Tetracycline should not be used with methoxyflurane due to the risk of a toxic interaction.
•    Tetracycline may increase blood levels of digoxin in a small number of people, leading to possible digoxin side etezks. (” %kjMt pelop% 1his’interaction with digoxin can occur for months after tetracycline has been stopped. If you are taking this combination, watch carefully for digoxin side effects and call your doctor if any develop.
•    Tetracycline may reduce diabetic insulin requirements. If you are using this combination, be sure to carefully monitor your blood-sugar level.
•    Tetracycline may increase or decrease lithium blood levels. Metronidazole raises lithium blood levels, effects, and toxicity.
•    Combining alcohol and metronidazole may cause abdominal cramps, nausea, vomiting, headaches, and flushing. Modification of the taste of alcohol has also been reported. Metronidazole should not be used if you are taking disulfiram (a drug used to maintain alcohol abstinence) because the combination can cause confusion and psychotic reactions.
•    Phenobarbital and other barbiturates can decrease metronidazole’s effectiveness.
•    Drugs that cause nervous system toxicity, such as mexiletine, ethambutol, isoniazid, lincomycin, lithium, pemoline, and long-term high-dose pyridoxine (vitamin 136) should not be taken with metronidazole because of the increased risk of nervous system side effects.
•    Metronidazole may increase phenytoin blood levels and the risk of phenytoin side effects; your doctor may need to adjust your phenytoin dosage.
Food Interactions
Do not take this drug with milk or dairy products. Helidac should be taken with meals and at bedtime.
Usual Dose
Helidac
Adult: Each dose consists of 4 pills. Take all 4 pills, 4 times a day for 14 days with a full glass of water. Take your acid blocker according to your doctor’s directions.
Child: not recommended.
Pyles
Adult: 3 pills 4 times a day for 10 days with a full glass of water. Take your acid blocker according to your doctor’s directions. Child: not recommended.
Overdosage
All 3 in(aMd1K1t ,in Helidac can be dangerous if taken in overdose, but salicylate poisoning is the most threatening. Symptoms of salicylate toxicity are rapid or heavy breathing, nausea, vomiting, ringing or buzzing in the ears, high fever, lethargy, rapid heartbeat, and confusion. Other more serious symptoms may develop. Take the victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Tetracycline can reduce the effectiveness of contraceptive drugs; you should use backup contraception while taking Helidac. Breakthrough bleeding is also possible.
Bismuth can cause a temporary darkening of your tongue or stool. This is a harmless effect. Stool darkening should not be confused with blood in the stool, which turns it black.
Avoid alcohol while taking Helidac and for 1 day after you stop taking it.
Call your doctor if you develop ringing in the ears. This can be a sign of salicylate toxicity from the bismuth.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Helidac should not be taken by pregnant women. Tetracycline affects bone and tooth development in the fetus.
Tetracycline and metronidazole pass into breast milk. Tetracycline interferes with the development of the child’s skull, bones, and teeth, and metronidazole also may cause side effects in the baby. Nursing mothers who must take Helidac should use infant formula.
Seniors: Seniors may take this drug without special restriction.

Conception is a complex process that depends on everything working properly at a number of stages. Firstly, your hormone balance must be correct so that the egg develops normally. Secondly, you must be ovulating so that the egg is released. Thirdly, you must have sex at the right time in your cycle (there may be only two or three days a month when you are fertile). In addition, your partner must have a good sperm count and possess healthy sperm, which are capable of penetrating your cervical mucus to reach the egg. Then the egg has to be captured by the fallopian tube and be fertilised. Finally, once the egg has been fertilised, the embryo has to implant securely in the lining of the womb, which needs the right levels of the hormone progesterone to maintain the pregnancy. No wonder they talk about the miracle of life!
It’s daunting to think about the number of things that can go wrong. But, as we have seen, there are many simple ways in which you can dramatically improve your chances of getting pregnant.
In this section of the book I outline all the different factors that can undermine your fertility.The list may seem long but it is important to identify the particular combination of factors that may be undermining your and your partner’s health and wellbeing.
You may have been given the impression that there is no medical reason – and therefore no Solution – for your problem. But when you read this section you will realise that nothing could be further from the truth.

Nutrition
You are what you eat. Or, to put it another way, if you put poor-quality petrol in a high-performance car, like a Rolls-Royce or a Porsche, it may run for a while but eventually it will become less productive and less efficient. It is exactly the same with the human body.You need top-grade `fuel’ to function properly, and to produce healthy eggs or sperm. To a very large extent, your fertility depends on what you eat.
Food Isn’t What it Used to Be
One of the problems is that nowadays we eat a lot of convenience and refined foods that have been stripped of essential nutrients during manufacturing. For example, 80 per cent of zinc is removed from wheat during the milling process to ensure that a loaf of bread has a longer shelf life.’
The soil our food is grown on is so lacking in nutrients due to overuse and commercial farming methods, that even what we regard as ‘healthy’ foods — vegetables, for instance — may not contain the amounts of minerals we expect to get from them. If you have been dieting for a number of years (either restricting your food intake or trying different diet drinks or pills), you could well be deficient in a number of vitamins and minerals.
The well-balanced diet is a myth. We simply do not get all the nutrients we need from our food. This was confirmed by a National Food Survey conducted in 1995 which found that the average person in Britain was grossly deficient in six out of the eight vitamins and minerals surveyed. Fewer than one in ten people received the RDA (Recommended Daily Allowance) for zinc, which is the most important mineral for both male and female fertility.

Put this lack of nutrients together with all the additives, preservatives and pesticides (see Chapters 4 and 5) in your food and you can see that your fertility may well be compromised on a daily basis. Chemicals like pesticides are known to affect fertility, others will affect your general health, and this in turn can reduce your ability to conceive. Scientists may know the toxic effects of one particular chemical but what they don’t and can’t know for certain is the effect of being exposed to a cocktail of these substances.
Balancing the Scales
Your weight is crucial for your fertility. Being very underweight or very overweight can make conception difficult or impossible. So it’s important that your weight is within a certain range in order to give you the best chance of conceiving.
Nature gave women proportionately more body fat for a specific purpose, in order to reproduce and then feed our young. That is why fat accounts for 27 per cent of an average woman’s body weight, while it is only 15 per cent for a man.
Fat is essential to fertility and it is necessary in order to ovulate.Young girls do not begin to menstruate until their bodies are composed of at least 17 per cent fat.
Underweight
If a woman’s body fat drops too low, then her periods can stop. This low level of body fat may be caused by excessive exercise, as sometimes happens with ballet dancers or athletes who have very tough physical regimes.’
Infertility can also be caused by excessive dieting. When a woman is anorexic, for instance, her periods stop.’ With so much publicity about anorexia and an increasing number of young women falling victim to the ,slimmer’s disease’, the long-term damage to fertility caused by drastic weight loss is well-known. But not so many people realise that being overweight can also affect fertility.
Overweight
If a woman is overweight it can stop her ovulating. Studies have shown that just losing a small amount of weight, 10 per cent, for instance, can be enough to increase fertility by stimulating ovulation, improving hormone balance and making periods more regular.”‘
In another study, on women who previously did not ovulate, 11 out of 12 conceived naturally after exercising and dieting over a period of six months to get their weight down.”
Fortunately your dietary intake is fully within your control, and eating the right food may be the single most important thing you can do to achieve a successful pregnancy. Later (in Chapter 7) I will explain how the right  fertility. -Ig it nutrition can give you and your partner optinitini health and fertility.

Alcohol, Smoking and Drugs
Most of us know that smoking and drinking alcohol when pregnant can be very harmful to the baby. But what most couples don’t realise is that smoking and alcohol could actually be stopping them conceiving a baby because it reduces their fertility. The good news is that the negative effects are not permanent and simply stopping will dramatically improve your chances.
Alcohol
Research has shown that drinking alcohol causes a decrease in sperm count, an increase in abnormal sperm and a lower proportion of motile
sperm.12
Alcohol also affects a man’s fertility by changing his hormone levels because it can alter the way testosterone is produced and then released.” Because alcohol affects the liver (the organ which normally clears out any excess hormones), a man who drinks alcohol may accumulate small amounts of female hormones (men produce `female’ hormones, just as women produce testosterone). These female hormones can lower sperm production and potency.
In addition, alcohol stops absorption of nutrients like zinc which is one of the most important minerals for male fertility. Zinc is found in high concentrations in the sperm. Adequate levels of zinc are needed to make the outer layer and tail and are therefore essential for healthy sperm. If you reduce the amount of zinc in a man’s diet, his sperm count goes down.”
Finally, alcoliol reduces fertility in nianirrials, and studies show that women who drink heavily may stop ovulating and menstruating, and take longer to conceive.”

How Much is Too Much?
A study of 430 women demonstrated that drinking more than 5 units of alcohol (equal to five glasses of wine) a week could stop women conceiving. Researchers discovered that the women in the survey who drank less than 5 units a week were twice as likely to get pregnant within six months compared with those who drank more. A study published in the British !Medical Journal concluded that women should be ‘warned to avoid alcohol when trying to conceive’.”
The fact is that drinking any alcohol can reduce your fertility by half— and the more you drink, the worse the impact on your chances of conception.”
Studies have also shown a strong relationship between alcohol and miscarriages. Women who have a drink every day have a much higher risk of miscarriage (2.5 times more) than non-drinkers.” The same study found that if the woman was a drinker and a smoker her chance of a miscarriage was four times higher.
Smoking
There is so much information available nowadays about the risks of lung cancer, emphysema and other life-threatening conditions and most people are aware of the detrimental effects of smoking when pregnant. I know how shocked many of us feel when we see a heavily pregnant woman standing with a cigarette in her hand.Yet most people are not aware of the impact smoking can have on a couple’s fertility. It’s not surprising that tobacco has such an effect — it contains more than 4,000 compounds, including carbon monoxide, oxide of nitrogen, ammonia, aromatic hydrocarbons, hydrogen cyanide, vinylchloride, nicotine, lead and cadmium.
Although many women smokers resolve to give up when they get pregnant, they don’t realise that by smoking they are reducing their chances of getting pregnant in the first place. Not only that but you don’t usually know that you are pregnant for the first couple of weeks and the baby will be taking in all that tobacco smoke in the meantime.
The man’s fertility is also affected by smoking — it decreases his sperm Count, makes his sperm more sluggish, increases the number of abnormal sperm and reduces his testosterone levels.
In addition, smoking reduces the level of vitamin C in the bloodstream. Lack of vitamin C encourages sperm to clump together (a process known Alcohol, Smoking and Dru
as agglutination) instead of moving forward to fertilise the egg. One study showed how male fertility was improved by giving men 500mg of vitamin C twice a day.”
Smoking has definitely been linked with infertility in women.” It can even bring on an early menopause, which is an especially important consideration for older women trying to conceive who may be racing against time.” If you are a smoker, you should ask yourself why you are taking something into your body that is bringing you nearer to the menopause
—and infertility?
Recreational Drugs
The use of marijuana and cocaine has increased steadily over the years to the point where, for some people, it is part of everyday life. Although still illegal, recreational drug use is increasingly socially acceptable. That does not mean it is healthy or safe. The fact is that these drugs can compromise both your and your partner’s fertility. But, as with alcohol and tobacco, you can stop using recreational drugs and negate the damage to your fertility in a relatively short space of time.
If you continue to use them during a pregnancy, of course, it can have disastrous effects on your developing baby.
The Effects of Some Common Recreational Drugs
•    Marijuana can lower a man’s levels of FSH and LH, two hormones needed to produce sperm. It can also lower his libido.” For the woman, marijuana can lead to irregular periods, reducing fertility and sometimes even stopping ovulation.”
•    Cocaine users will have a lower sperm count, poorly moving sperm and a high rate of abnormal sperm.21
•    Heroin can cause a decrease in testosterone levels.2`
•    Cocaine and heroin, taken together, will make it harder for a woman to conceive and she is more likely to have a miscarriage, a stillbirth or a baby born with a malformation.21

Medicines
If you or your partner are taking medication while you are trying to conceive you should speak to your doctor about which drugs are medically essential and which are not. Some drugs have a direct effect on fertility and you do need to discuss this with your GR
Many drugs can affect not only the man’s sperm but also his ejaculatory function and libido. Some medicines may even cause impotence. These drugs can include sulphasalazine (used to treat irritable bowel), nitrofti•antoln, tetracyclines, cimetidine, ketoconazole, tricyclic antidepressants, monoamine oxidase inhibitors and propranol.”
In addition, medication given for conditions like gout or high blood
pressur can interfere with fertility. And non-steroidal anti-infianiniatory drugs (often used for arthritis) can stop ovulation.”

Over the last two decades, there has been a significant rise in the number of couples experiencing fertility problems:
•    Sperm counts have dropped by 50 per cent in the last ten years.’
•    Men are showing an increasing number of sperm abnormalities.
•    A quarter of all couples planning a baby have trouble conceiving.
•    It is not uncommon for a couple without any fertility problems to take two to three years to conceive.
•    One in four women miscarry. Some experience repeated miscarriages – as often as ten times.
•    More and more couples are turning to fertility treatments to enable them to have a family.
•    Of the couples who seek medical help, 30 per cent are told they have ‘unexplained infertility’ for which the doctors can offer no treatment.
If you are reading this book, you or your partner may have experienced problems trying to have a baby. You may have gone through fertility treatments that failed. Or you may just be worried that nothing is happening. I see hundreds of couples every year who are trying to conceive and I fully understand their unhappiness and frustration at not being able to achieve something that most of us grew up believing would happen whenever we wanted.
But, as the above statistics reveal, you are not alone. There is an epidemic of infertility and subfertility – and in many cases the doctors do not know the answers.
But, before we discuss these issues, I want to say:
Don’t lose heart
I believe that getting yourself and your partner into optimum health, usin the four-month programme outlined in this book, will give you the best possible chance of having that longed-for, healthy baby.
I don’t just believe it — I know it. By the time you have finished readin), this book, I hope I will have inspired you and your partner to take contrd of your health and fertility.
Nature is wonderfully clever. At this particular moment you may not think so, because on the most fundamental level, reproduction, it seems to have let you down. But the purpose of this book is to encourage you to restore your own and your partner’s fertility to its proper ‘natural’ state by simple lifestyle and dietary changes that eliminate toxins from your bod i and ensure that you have the level of nutrients needed for conception.
Fundamentals of Health
In the animal world, fertility is paramount for the survival of any specie However, the human race today has a number of fertility problems. Men are showing sperm abnormalities (such as sperm with two heads or sperm tha-:
are so sluggish they cannot reach the egg). Some women have a number Or menstrual cycles during which they do not ovulate; or, when fertilisation happens, the embryo does not implant in the womb.
To explain these anomalies, we have to go back to the foundations 0: health.The egg and sperm are only as healthy as the man and woman who produce them. If there are any problems with either the egg or the sperm. however subtle, nature will either try to stop fertilisation occurring or, if i does take place, a miscarriage may follow.
One reason why so many couples are diagnosed with ‘unexplained infer - tility’ is that doctors cannot put it down to a specific, observable medical cause. But I believe that infertility is a multi-factorial problem and should be investigated that way. That means looking at a variety of issues, such a, nutrition, alcohol and smoking habits, levels of lead and other toxic metals pesticides, food additives, genito-urinary infections, allergies, stress and other hazards of modern life.That means your partner taking a close look a: his health and nutrition as well (in four out of ten cases of infertility, the problems are on the male side). The fact is that our modern ‘unnatural lifestyle, combined with the nutrient depletion of much of our food, ha;
left many of us deficient in the vitamins and minerals we need for successful babymaking.
Any specialist who works in a zoo, or breeds champion dogs, cattle or racehorses, will tell you that optimum nutrition is essential. But, while the fertility clinic business is booming (with desperate couples lining up for treatment), there isn’t much incentive to look at whether simple factors, like a deficiency of zinc for instance, may be the main reason for unexplained infertility.
Learning From the Past
We should learn from the folic acid story, which really demonstrates the importance of nutrition and how a crucial deficiency identified by researchers as being responsible for birth abnormalities was ignored by doctors for years.
In 1991 the Medical Research Council (MRC) finally published a study which showed that supplementing with folic acid during preconception and pregnancy could prevent the reccurrence of spina bifida in babies.’ Yet the damaging effects of a folic acid deficiency had been recognised three decades earlier, after rats were born with malformations (including neural tube defects) and other problems (such as club foot and cleft palate) in folic acid trials.’
This knowledge, which could have prevented a great deal of heartache, had been around for over 30 years and yet women were not told to take folic acid for decades.These early findings were confirmed again in humans in 1981 trials that looked at the effects of folic acid on the prevention of spina bifida.’
Even as recently as 1993 the Daily Mail ran an article asking ‘Could this vitamin save your baby?” It said, `The fact that a supplement which can stop women having spina bifida babies remains the best kept secret of preconceptual care has now prompted sharp criticism from the medical world: ‘
Cynically, one might suppose that if folic acid had not been a simple easy-to-obtain supplement but a highly profitable pharmaceutical drug we would all have known about it years ago. You cannot patent a nutrient so there is no commercial incentive to investigate and promote it.
But the big lesson we should learn from the folic acid story is that our diet — what we eat or don’t eat — is absolutely crucial to our fertility.
How to Use This Book
Folic acid is only the tip of the iceberg. Medical and scientific literature contains a great deal of information that call help couples who are having difficulty conceiving or who have had previous problems such as miscarriages and malformations. This book presents that information in an easyto-understand form so that you call use it yourself. Having this knowledge will help you gain control of your own health and fertility.
By following the advice in this book you can increase your fertility anc reduce the possibility of miscarriage. liven if you have a condition like blocked fallopian tubes (which means that you need IVF treatment in order to have a chance of conceiving), this book will increase your chance of success. With assisted conception techniques it is still vital for the sperm anc the egg to be as healthy as possible.
As you read the recommendations, you’ll realise that the changes you make to increase your fertility are the same as those that will protect you from miscarriage and help you produce a healthy baby. They are also, quite simply, recommendations that will improve your general health. The advice
is so logical and makes such sense that you will probably wonder why nc one has told you all this before.
Finding that you can’t conceive when you want is a real shock and it is not something that many of us want to talk about even to our close friends and families. GPs and consultants are busy people and, all too often, overworked. The minute you come out of the consulting room you think of .1 dozen other things you wanted to discuss. There just isn’t time to talk in as much depth as you would like. Yet you want to find out as much as you can.This book is designed to answer your specific queries as well as present a comprehensive self-help programme that will give you and your partner the best chance of conceiving.
•    Section 1 outlines the different aspects of your life and health that could be causing your and your partner’s problem. This will help you identify what may be going wrong.
•    Section 2 explains how you can help improve your and your partner’s fertility, concentrating particularly on good nutrition and Supplementing your diet.This is one of the most crucial sections in the book because it could be the key to solving your infertility problem by making some simple changes that are entirely within your own control.
•    Section 3 explains what tests are available to help you identify any medical cause of infertility. It is important that your partner understands that lie must also be involved in this process.
•    Section 4 describes the different fertility treatments available in the UK and reveals some heartening evidence that you and your partner can dramatically improve your chances of having successful fertility treatment, if you should need it, by following the advice in this book.
•    Section 5 discusses the problem of miscarriage in depth and shows how you can help yourself overcome it.
•    Section 6 puts it all into practice – and shows you how to organise your self-help programme for those vital months of preparation.This is really the most essential part of the book.
•    Section 7 tells you how to care for yourself in pregnancy so as to ensure that you Krill have a healthy baby.
I believe that any couple planning to have a baby would benefit from following the kind of recommendations outlined in this book – not just Couples who have had problems conceiving.
If all this sounds too hard to stick to, just think how important it is … We plan our holidays and we train for a career so why should we expect to just have babies without any proper planning or preparation.- This preconception care period of three or four months shapes your baby’s future, both physically and mentally, so it could be the most important bit of planning you ever do in your life. My aim is to help you and your partner to optimum health to give you both the best chance of having a healthy baby. As a bonus, following these recommendations will make you both feel better, fitter and more energetic.
Self-help Strategies
Most couples who seek fertility treatment find out a great deal about sophisticated medical technologies but very little about the relatively simple measures they themselves can take to improve their chances of conceiving. These highly effective self-help strategies include easily implemented dietary and lifestyle changes. Such measures cost little or nothing, their success has been scientifically documented, and yet most of these couples will not have been told about them.Why on earth is this–
The cynical answer is that infertility has become `big business’.As Professor Robert Winston points out in his book Making Babies, there are now at least 21 IVF units in London alone. And more and more units are opening because they are ‘highly profitable in the private sector’. Couples who desperately want to have a baby are very vulnerable. Even though some IVF units have extremely low success rates, such couples are still willing to gamble a great deal of time and money in order to try to conceive.
In contrast, there are no big financial gains to be made in helping couple to look at their lifestyle or to correct their vitamin and mineral deficiencies Yet this approach makes such sense, and has been shown to give an unprecedented success rate.
Over the last 20 years, Foresight has pioneered an approach to fertility that looks at the fundamentals of health, including lifestyle, diet, pollutants, infections and environmental and occupational hazards and gives an unprecedented 80 per cent success rate. Researchers from the University of Surrey followed the progress of 367 couples over a period of three years (1990-3). The women were aged between 22 and 45, and the men were aged 25 to 59. In all, 37 per cent of the couples had a history of infertility, and 38 per cent had experienced between one and five miscarriages (others had had other problems, including still births, malformations and low birth-weight babies).
Many of the couples were older, coming to the trial as a1ast resort’.They were all asked to eliminate smoking and alcohol, and to follow the recommendations outlined in this book (such as buying organic food, having infections checked and having mineral analysis). All the couples were given personal supplement programmes and were then re-tested to make sure their levels had returned to normal.
By the end of the three-year trial, 89 per cent (327 of the couples) had given birth. Out of those couples with a previous history of infertility, 81 per cent conceived and had babies. Out of those who had experienced a previous miscarriage, 83 per cent had a baby within the three years of the Study, without experiencing another miscarriage.
Of the 327 babies born to the couples in the study, no baby was born before 36 weeks and none was lighter than 51b 2oz (2.368kg).There were no miscarriages, perinatal deaths or malformations. The national average for miscarriages is one in four so one could at least have expected 80 miscarriages, but there were none. No baby was admitted to a special care baby unit.
A number of the couples had already tried IVF – sometimes two or three times – without success.Yet 65 per cent of this group conceived naturally on the Foresight programme without needing another IVF cycle.
These results are undeniably impressive and speak for themselves. Yet sceptics maintain that they are ‘too good to be true’.To date, the results have been published in the Journal of Nutritional and Environmental Medicine but not in a standard medical journal.’ This is because, in order to be accepted by a medical journal, there must be a control group.
Ina normal double-blind placebo controlled trial, to assess the efficacy of a headache remedy, for example, volunteers are randomly assigned to either a control group (placebo) or a treatment group (headache remedy). The volunteers don’t know if they are taking the placebo or the remedy, and nor does the scientist running the trial. All the volunteers in the treated group get the same dose of headache remedy.
However, in this study each person was given an individual supplement programme according to their needs. So they were all taking different dosages and supplements, depending on how deficient or toxic they were.
This is an important point because the double-blind placebo controlled trial is the ‘gold standard’ in medicine but it cannot take into account that we are all unique and that we may need different treatments to increase our fertility. And it is this ‘individually tailored’ approach which I believe is the key to finding a natural solution to infertility. The fact is that 37 per cent of the couples in this study had an established history of fertility problems and had undergone medical investigation. They did something different – changed their dietary habits and lifestyle – and then conceived. The information contained in this book explains in detail my enhanced version of this preconception programme.
It worked for them. It could work for you.

Generic Name
Deferasirox (deh-fur-ASS-sih-rox)
Brand Name Exjade
Type of Drug
Iron chelating agent. Prescribed For
Chronic iron overload. General Information
Deferasirox binds with iron in stored in the liver. It can also bind small amounts of zinc and copper but the importance of these effects are not known. Almost 3/4 of every dose is absorbed into the bloodstream. Most of the drug is broken down in the liver and passes out of the body in the feces. Women clear this drug from their bodies 17.5% slower than men, but this has not affected how it is used or the doses given.
Cautions and Warnings
Do not take deferasirox if you are allergic or sensitive to any of its ingredients. Most reactions occur within the first month of treatment.
People with liver disease should have monthly blood tests while taking deferasirox.
Kidney failure has developed in people taking deferasirox with fatal results in some cases. People with or those who are at risk of kidney failure should have routine kidney monitoring while taking this medication. People who are at risk for kidney failure in-ciudes seniors, those with kidney disease, and people taking medicines that affect kidney function. Dose adjustment may be needed.
Deferasirox has been associated with potentially severe reduced white-blood-cell and platelet counts, usually in people with preexisting blood disorders.
Rarely, deferasirox has caused hearing loss and eye problems. You should have a full hearing and eye exam before starting on this drug and once a year thereafter.
Skin rash can occur with this medicine. If it is severe, the drug may have to be temporarily stopped. It may be restarted at a lower dosage.
Possible Side Effects
♦    Most common: fever, headache, abdominal pain, cough, sore throat, nasal irritation, diarrhea, flu symptoms, nausea, and vomiting.
✓    Common: respiratory infections, bronchitis, runny nose, rash, upper abdominal pain, joint pain, back pain, tonsillitis, and ear infection.
✓    Less common: itching.
✓    Rare: stomach pain, swelling in the arms or legs, sleep disorder, skin color changes, dizziness, anxiety, gallstones, fatigue, early cataract and hearing loss, some visual haziness, and other eye disorders. Contact your doctor if you experience anything unusual.
Drug Interactions
•    Do not mix antacids containing aluminum with deferasirox. They can prevent it from being absorbed.
Food Interactions
This drug should be taken at the same time every day on an empAq stomach, 30 minutes before eating.
Ustlak 13bSe
Adult and Child (age 2 and over): 9-13.6 mg per lb. of body weight once a day. Dose adjustments will be made according to your response. See “Special Information” for a specific instructions on how to take these tablets.
Overdosage
Large doses of 2-3 times the prescribed amount taken for several weeks with no adverse effects have occurred. Overdose symptoms include hepatitis (mild fever, muscle or joint aches, nausea, vomiting, appetite loss, slight abdominal pain, diarrhea, and fatigue) and some drug side effects. Take the victim to a hospital emergency room for treatment because the heart may be affected. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor at once if you develop a severe skin rash.
You must have regular vision and hearing tests while taking deferasirox.
Deferasirox tablets should not be chewed or swallowed whole. They must first be mixed completely in 1/2-1 glass of water, orange juice, or apple juice. The tablet will not dissolve but tablet particles will become suspended in the liquid. Drink the resulting sus-Pension immediately. If there is anything left in the glass after drinking the suspension, add a small amount of liquid, mix it with the remaining tablet particles and drink it.
This drug can cause dizziness. Be cautious while driving, operating machinery, or doing anything that requires intense concentration.
If you forget a dose, take it as soon as you remember. If it is almost time for the next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: There are no studies of ranolazine in pregnant women or of its effect on the developing fetus. Pregnant women should take this drug only if its potential benefits outweigh the risks.
This drug may pass into breast milk. Nursing mothers should consider using infant formula.
Seniors: Seniors may experience more drug side effects than younger adults due to greater chances of reduced kidney, liver, and heart function; other diseases; or drug side effects.

Generic Name
Desmopressin (dez-moe-PRES-in)
Brand Names
DDAVP Minirin
Type of Drug
Pituitary hormone replacement.
Stimate
Prescribed For
Nighttime bed-wetting and diabetes insipidus (central or cranial diabetes); also used to control bleeding in certain forms of hemophilia A and von Willebrand’s disease.
General Information
Desmopressin acetate is a synthetic version of antidiuretic hormone (ADH). When ADH is lacking, the body has difficulty retaining fluid. People lacking ADH experience excessive thirst, increased urination, and dehydration; desmopressin controls these symptoms. When used for nighttime bed-wetting, desmopressin should be used in conjunction with behavioral or other non-drug therapies.
Cautions and Warnings
Do not take desmopressin if you are allergic or sensitive to any of its ingredients.
People, especially children and seniors and people with cystic fibrosis and electrolyte imbalances, should only drink enough fluid to satisfy their thirst while taking desmopressin because of the risk of water intoxication, which can result in seizures that could lead to coma. People with coronary artery disease, heart disease, or high blood pressure should use this drug with caution.
Heart attacks and St&D’KeS after treatment with desmopressin MV~bEbn reported in people at risk for them, but there is no definite link to desmopressin use.
People using desmopressin should have their urine checked regularly by their doctor. Your doctor should also check for nasal swelling, congestion, and scarring.
Drug Interactions
experience in blood pressure, loss of sodium, symptoms include coma, confusion, ng headache, decreased urination, rapid
zures), edema, stomach or abdominal dness or flushing of the skin, passing ain, and stuffy or runny nose. Contact perience any side effect not listed above.
Possible Side Effects
V Rare: slight increase
intoxication (
drowsiness, continuin
gain, and seizures)
nausea, rednes
vulvar pain
doctor if you
•    Desmopressin may increase the effects of other drugs that raise blood pressure. This only happens with large dosages.
•    Chlorpropamide and carbamazepine may increase the effects of desmopressin.
Food Interactions None known.
Usual Dose
Nasal Solution—Nighttime Bed-Wetting
Adult and Child (age 6 and over): 20 mcg (0.2 mL) at bedtime. Child (under age 6): not recommended.
Nasal Solution—Diabetes Insipidus
Adult: 0.1-0.4 mL a day in 1-3 doses.
Child (age 3 months-12 years): 0.05-0.3 mL a day in 1-2 doses.
Tablets—Nighttime Bed-wetting
Adult and Child (age 6 and over): Begin with 0.2 mg at bedtime, adjusting to individual need up to 0.6 mg.
Child (under age 6): not recommended.
Tablets—Diabetes Insipidus
Adult: Begin with 0.05 mg twice a day. Daily dosage should be increased according to individual need, up to 1.2 mg a day divided into 2-3 doses.
Child (age 4 aid over): Begin with 0.05 mg and adjust according to individual need.
Child (under age 4): not recommended.
Overdosage
Symptoms include headache, difficulty breathing, abdominal cramps, nausea, and facial flushing. Call your doctor or a hospi-tal emergency room if you suspect an overdose. Because there is no known antidote to desmopressin, your dosage may be temporarily reduced until overdose symptoms subside. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop headache, breathing difficulties, heartburn, nausea, abdominal or stomach cramps, or vulvar pain.
The Stimate Nasal Solution spray pump and Minirin spray must be primed before its first use. To prime the pump, press down 4 times. Stimate delivers 25 doses per bottle. Throw away the bottle after 25 doses have been used, because anything remaining after the 25th dose is likely to deliver less drug than is needed.
If you forget a dose of desmopressin, take it as soon as you remember. If you don’t remember until your next dose, skip the forgotten dose and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of using desmopressin during pregnancy is not known, though it has been used to treat diabetes insipidus in pregnant women without apparent harm to the fetus. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Desmopressin may pass into breast milk. Nursing mothers who must use this drug should use infant formula.
Seniors: Seniors should avoid drinking too much fluid while taking desmopressin.

Generic Name
Diazepam (dye-AZ-uh-pam) rVg_l
Brand Names
Diastat    Valium
Diazepam Intensol    Valrelease
The information in this profile also applies to the following drugs:
Lorazepam &
Ativan    Lorazepam Intensol
Oxazepam M
Type of Drug  Benzodiazepine sedative.
Prescribed For
Anxiety, tension, fatigue, agitation (particularly due to alcohol withdrawal), muscle spasm, and seizures; also prescribed for irritable bowel syndrome and panic attacks.
General Information
Diazepam and other benzodiazepines directly affect the brain. They can relax you and make you more tranquil or sleepy, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant.
Cautions and Warnings
Do not take diazepam if you know you are allergic or sensitive to any of its ingredients or to another benzodiazepine drug, including clonazepam.
Diazepam can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
Other conditions in which diazepam should be avoided are severe depression, severe lung disease, steep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney disease. In all of these conditions, the depressive effects of diazepam may be enhanced or could be detrimental to your overall condition.
Diazepam should not be taken by psychotic patients. It is not effective for them and can trigger unusual excitement, stimulation, and rage.
Diazepam is not intended for more \han 3-4 months of continuous use. Your comikkni) should be reassessed before continuing YOU( MS-16cation beyond that time.
Diazepam may be addictive. It should be used with caution in people with a history of drug dependence.
Drug withdrawal may develop if you stop taking it after only 4 weeks of regular use but is more likely after longer use. It may start with anxiety and progress to tingling in the hands or feet, sensi-tivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating, and changes in mental state. Your dosage should always be reduced gradually to prevent drug withdrawal symptoms.
Possible Side Effects
Y Most common: mild drowsiness during the first few days of therapy. Weakness and confusion may occur, especially in seniors and in those who are sickly. If these effects persist, contact your doctor.
♦ Less common: depression, lethargy, disorientation, headache, inactivity, slurred speech, stupor, dizziness, tremors, constipation, dry mouth, nausea, inability to control urination, sexual difficulties, irregular menstrual cycle, changes in heart rhythm, low blood pressure, fluid retention, blurred or double vision, itching, rash, hiccups, nervousness, hysteria, psychosis, inability to fall asleep, and occasional liver dysfunction. If you have any of these symptoms, stop taking the drug and contact your doctor at once.
•    Rare: Rare side effects can affect your heart, stomach and intestines, urinary tract, blood, muscles, and joints. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Diazepam is a central-nervous-system depressant. Avoid alcohol, other sedatives, narcotics, barbiturates, monoamine oxidase inhibitor antidepressants, antihistamines, and antidepressants. Taking diazepam with these drugs may lead to excessive depression, drowsiness, or difficulty breathing.
•    Smoking may reduce diazepam’s effectiveness by increasing the rate at which it is broken down by the body.
•    Effects of diazepam may be prolonged when taken with cimeti(1(m,, Contraceptive drugs, disulfiram, fluoxetine, isoniazid, ketoconazole, rifampin, metoprolol, probenecid, propoxyphene, propranolol, and valproic acid.
•    Theophylline may reduce the sedative effects of diazepam.
•    If you take antacids, separate them from your diazepam dose by at least 1 hour to prevent them from interfering with the passage of diazepam into the bloodstream.
•    Diazepam may increase blood levels of digoxin and the chances for digoxin toxicity.
•    Levodopa + carbidopa’s effects may be decreased if it is taken with diazepam.
Combining diazepam and phenytoin may increase phenytoin blood concentrations and the risk of phenytoin toxicity.
Food Interactions
Diazepam is best taken on an empty stomach, but it may be taken with food if it upsets your stomach.
Usual Dose
Solution or Tablets
Adult’. 2-40 mg a day. Dosage must be adjusted to individual response for maximum effect. In seniors, less of the drug is usually required to control tension and anxiety.
Child (6 months and over): 1-2.5 mg 3 or 4 times a day; more may be needed to control anxiety and tension.
Child (under 6 months): not recommended.
Rectal Gel
Adult and Child (age 12 and over): 0.09 mg per lb. of body weight. Approximate dosage: 5 mg if 31-60 lbs., 10 mg if 61 -110 lbs., 15 mg if 111-165 lbs., or 20 mg if 166-244 lbs.
Child (age 6-11): 0.14 mg per lb. of body weight. Approximate dosage: 5 mg if 22-40 lbs., 10 mg if 41-82 lbs., 15 mg if 83-121 lbs., or 20 mg if 122-163 lbs.
Child (age 2-5): 0.23 mg per lb. of body weight. Approximate dosage: 5 mg if 13-24 lbs., 10 mg if 25-49 lbs., 15 mg if 50-73 lbs., or 20 mg if 74-97 lbs.
An extra 2.5 mg of the rectal gel may be given if a more precise dosage is needed or as a partial replacement for people who do not retain the full dosage after it is first inserted rectally.
Overdosage
SYMPUns of overdose include confusion, sleepiness, poor coordination, lack of response to pain, loss of reflexes, shallow breathing, low blood pressure, and coma. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.

Generic Name
Cromolyn (KROE-inuh-lin) [9
Brand Names
Crolom    Intal
Gastrocrom    Opticrom
The information in this profile also applies to the following drugs:
Nedocromil
Alocril    Tilade
Type of Drug
Allergy preventive and antiastk)m-aft_.
Prescribed For
Prevention of severe allergic reactions, including asthma, runny nose, and mastocytosis; also prescribed for food allergies, eczema, dermatitis, chronic itching, and hay fever. It may be used to treat and prevent chronic inflammatory bowel disease. The eyedrops are used to treat conjunctivitis (pinkeye) and other eye irritations.
General Information
Unlike antihistamines, which work against histamine that has been released into the system, cromolyn sodium prevents allergy, asthma, and other conditions by stabilizing mast cells, a key component in any allergic reaction because they release histamine. Cromolyn prevents the release of histamine and other chemicals from mast cells. The drug works only in the areas to which it is applied; only 7-8% of an inhaled dose and 1 % of a swallowed capsule is absorbed into the blood. Even the oral capsules, which one would normally expect to be absorbed into the blood, treat only gastrointestinal -tract allergies. Cromolyn products must be used on a regular basis to be effective in reducing the frequency and intensity of allergic reactions.
Cautions and Warnings
Do not take cromolyn if you are allergic or sensitive to any of its ingredients. Rarely, people have experienced severe allergic attacks after taking cromolyn.
cromolyn should never be used to treat an acute allergy attack. It is intended only to prevent or reduce the number of allergic attacks and their intensity. Once the proper dosage level has been established for you, reducing that level may result in a recurrence of attacks.
People with kidney or liver disease require reduced dosage.
Cough or bronchial spasm may occasionally occur after the inhalation of a cromolyn dose. Severe bronchospasm is rare.
cromolyn aerosol should be used with caution in people with abnormal heart rhythm or diseased coronary blood vessels because of a possible reaction to the propellants used in the product.
Possible Side Effects
V Most common: rash and itching. Headache and diarrhea (for capsules). Watery, itchy, dry, or puffy eyes; and iztjes (for eyedrops). Most capsule and eyedrop side effects are mkw and may be attributable to the underlying condition; a variety have been reported but cannot be tied conclusively to the drug.
V Less common: local irritation, including nasal stinging, sneezing, tearing, cough, and stuffy nose; urinary difficulty or frequency; dizziness; headache; joint swelling; muscle Possible Side Effects (continued)
pain-, a bad taste in the mouth; sore throat-, nosebleeds’, abdominal pain-, and nausea.
♦ Rare: severe drug reactions, consisting of coughing, difficulty in swallowing, hives, itching, breathing difficulties, or swelling of the eyelids, lips, or face. Contact your doctor if you experience any side effect not listed above.
Drug Interactions None known.
Food Interactions
Inhaled or swallowed cromolyn products should not be mixed with any food, juice, or milk. The nasal and eye products may be taken without regard to food or meals.
Usual Dose
Inhaled Capsules or Solution
Adult and Child (age 2 and over): starting close-20 mg 4 times a day. Children under age 5 may inhale cromolyn powder if their allergies are severe. The solution must be given with a power-operated nebulizer and face mask. Handheld nebulizers are not adequate. To prevent exercise asthma, 20 mg may be inhaled up to 1 hour before exercise.
Aerosol
Adult and Child (age 5 and over): up to 2 sprays 4 times a day, spaced equally throughout the day. To prevent exercise asthma, 2 puffs may be inhaled up to 1 hour before exercise.
Nasal Solution
Adult and Child (age 6 and over): 1 spray in each nostril 3-6 times a day at regular intervals. First blow your nose, and then inhale the spray.
Oral Capsules
MAI and Child (age 12 and over): 2 dissolved capsules 4 times a day taken a half hour before meals and at bedtime.
Child (age 2-12): 1 dissolved capsule (100 mg) 4 times a day a half hour before meals and at bedtime. Dosage may be increased to about 13-18 mg per lb. of body weight in 4 equal doses.
Child (under age 2): about 10 mg per lb, of body weight a day divided into 4 equal doses. This product is recommended in infants
and young children only if absolutely necessary.
Eyedrops
Adult and Child (age 4 and over): 1-2 drops in each eye 4-6 times
a day at regular intervals. Overdosage
No action is necessary other than medical observation. Call your local poison control center or a hospital emergency room for more information. ALWAYS bring the prescription bottle or container.
Special Information
Cromolyn is taken to prevent or minimize severe allergic reactions. It is imperative that you take cromolyn products on a regular basis to provide equal protection throughout the day.
If you are taking cromolyn to prevent seasonal allergies, it is essential that you start taking the medication before you come into contact with the cause of the allergy and that you continue treatment while you are exposed to it.
Cromolyn oral capsules should be opened and their contents mixed with about 4 oz. of hot water. Stir until the powder completely dissolves and the solution is completely clear, then fill the rest of the glass with cold water. Drink the entire contents of the glass. Do not mix the solution with food, juice, or milk.
Do not wear soft contact lenses while using cromolyn eyedrops. The lenses may be replaced a few hours after you stop taking the drug. To prevent contamination, do not touch the applicator tip to any surface including the eyes or fingers.
Call your doctor if you develop wheezing, coughing, a severe drug reaction (see “Possible Side Effects”), rash, or any bothersome or persistent side effect.
Call your doctor if your symptoms do not improve or if they worsen.
If you forget to administer a dose, do so as soon as you remember and sqa(ZRMBmn-maining daily dosage evenly throughout ‘i!M day. Do not take a double dose.
Special Populations
PregnancylBreast-feeding. In animal studies, very large dosages of cromolyn administered by vein have affected the fetus, though no birth defects were reported. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed
against its risks.
It is not known if cromolyn passes into breast milk. Nursing
mothers who must use cromolyn should use infant formula. Seniors: Older adults with reduced kidney or liver function may require lower dosages.

Generic Name
Cyclobenzaprine (sye-cloe-BEN-zuh-prene) M
Brand Names Amrix
Type of Drug
Skeletal muscle relaxant.
Flexeril
Prescribed For
Serious muscle spasm and acute muscle pain; also used to treat fibrositis (muscular rheumatism).
General Information
Cyclobenzoprine hydrochloride is used to treat severe muscle spasms; it is prescribed as part of a coordinated program of rest, physical therapy, and other measures.
Cautions and Warnings
Do not take cyclobenzaprine if you are allergic or sensitive to any of its ingredients.
This drug should not be taken for several weeks following a heart attack or by people with abnormal heart rhythms, heart failure, heart block (disruption of the electrical impulses that control heart rate), or hyperthyroidism (overactive thyroid gland).
Cyclobenzaprine should be avoided by people with urinary retention, glaucoma, UC 1ntlreased eye pressure.
W)t arug may increase the chances of cavities or gum disease. Cyclobenzaprine is intended only for short-term use of 2-3 weeks.
Cyclobenzaprine is chemically similar to tricyclic antidepressants and may produce some of the more serious side effects associated with those drugs. Abruptly stopping cyclobenzaprine may cause nausea, headache, and feelings of ill health; this is not a sign of addiction.
Drug Interactions
•    The effects of alcohol, sedatives, or other nervous system depressants may be increased by cyclobenzaprine.
•    Cyclobenzaprine may increase some side effects of atropine, ipratropium, and other anticholinergic drugs.
•    The combination of cyclobenzaprine and a monoamine oxidase inhibitor antidepressant may produce very high fever, convulsions, and possibly death. Do not take these drugs within 14 days of each other.
•    Cyclobenzaprine may increase the effects of haloperidol, loxapine, molindone, pimozide, anticoagulant (blood-thinning) drugs, anticonvulsants, thyroid hormones, antithyroid drugs, phenothiazines, thioxanthenes, and nasal decongestants such as naphazoline, oxymetazoline, phenylephrine, and xylometazoline.
•    Barbiturates and carbamazepine may counteract the effects of cyclobenzaprine.
•    Fluoxetine, ranitidine, cimetidine, methylphenidate, estramustine, estrogens, and contraceptive drugs may increase the effects and side effects of cyclobenzaprine.
•    Cyclobenzaprine may counteract the effects of cto(\idine, guanadrel, and guanethidine.
Food Interactions  None known.
Usual Dose
Adult and Child (age 15 and over): 5-10 mg 3 times a day. Child (under age 15): not recommended.
above.    drowsiness, and dizziness.
le weakness. fatigue, nausea, consti-
ch, unpleasant taste, blurred vision,
ess, and confusion.
cts can occur in almost any part of the doctor if you experience any side ef- e.
Possible Side Effects
♦    Most common: dry
♦    Less common: muscl
upset stomach
nervousness, • Rare: Rare side effects
body. Contact your
fect not listed Overdosage
Cyclobenzaprine overdose may cause confusion, loss of con- centration, hallucinations, agitation, overactive reflexes, fever or vomiting, rigid muscles, and other side effects of the drug. It may also cause drowsiness, low body temperature, rapid or irregular heartbeat and other kinds of abnormal heart rhythms, heart failure, dilated pupils, convulsions, very low blood pressure, stupor, coma, and sweating. Overdose victims must be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Cyclobenzaprine causes drowsiness, dizziness, or blurred vision in more than 40% of people who take it, which may interfere with the ability to perform complex tasks like driving or operating equipment. Avoid alcohol, sedatives, and other nervous system depressants because they can enhance sedative effects of cyclobenzaprine.
Call your doctor if you develop rash; hives; itching; urinary difficulties; clumsiness; confusion; depression; convulsions; difficulty breathing; irregular heart rate; chest pain; fever; yellowing of the skin or whites of the eyes; swelling of the face, lips, or tongue; or any other persistent or bothersome side effect.
If you forget a dose of cyclobenzaprine, take it as soon as you remember. If you take cyclobenzaprine once a day and it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. If you take cyclobenzaprine twice a day and it is almost time for your next dose, take 1 dose as soon as you remember, another in 5 or 6 hours, and then go back to your regular schedule. If you take cyclobenzaprine 3 times a day and it is almost time for your next dose, take 1 dose as soon as you remember, another in 3 or 4 hours, and then go back to your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: -The safety of cyclobenzaprine in ‘jftg)T)1 women has not been established. Cyclobenzaprine should only be used if the potential benefits outweigh the risks.
It is not known if cyclobenzaprine passes into breast milk, but antidepressants with a similar chemical structure do pass into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors are more likely to be sensitive to the effects of cyclobenzaprine. Use of Amrix in particular is not recommended
in the elderly.

Generic Name
Cyclosporine (sye-kim-SPQR-in)
Brand Names
Gengraf Neoral
Type of Drug  Immunosuppressant.
Restasis Ophthalmic Emulsion Sandimmune
Prescribed For
Kidney, heart, or liver transplantation; also used for bone-marrow, heart-lung, and pancreas transplants; also prescribed for patchy hair loss, rheumatoid arthritis, aplastic anemia, atopic dermatitis, Beh~et’s disease, cirrhosis of the liver, ulcerative colitis, dermatomyositis, eye symptoms of Graves’ disease, insulin-dependent diabetes, kidney inflammation, multiple sclerosis (MS), severe psoriasis and psoriasis-related arthritis, myasthenia gravis, pemphigus, sarcoidosis of the lung, and pyoderma gangrenosum. Cyclosporine eye emulsion is prescribed for dry eyes.
General Information
Cyclosporine is used to prevent rejection of transplanted organs. It works by blocking the activity of T-cells, which protect the body against invading microorganisms or foreign substances. Cyclosporine also prevents the production of a substance known as interieukin-11 that activates T-cells. In 1995, a new form of Cyclosporine called Neoral, a microemulsion, was introduced by its manufacturer. This form is as safe and effective as the original product but is better absorbed into the bloodstream and requires less medication to achieve the same effect. Cyclosporine eye emulsion treats dry eye caUV ,d by inflammation of the cornea and tissue kWA1 Covers the white part of the eye. It reduces inflammation and allows tears to form and flow.
Cautions and Warnings
Cyclosporine should be prescribed only by doctors experienced in immunosuppressive therapy and the care of organ-transplant patients. Sandimmune is always used with corticosteroid drugs like prednisone. Neoral and Gengraf have been used with a corticosteroid and azathioprine, an immune suppressant. When combined with other immune suppressants, cyclosporine must be used with great care because oversuppression of the immune system may lead to lymphoma or extreme susceptibility to infection.
Sandimmune, the original oral form of cyclosporine, is poorly absorbed into the bloodstream; it must be taken in a dosage that is 3 times greater than the injectable dosage. People taking this drug by mouth for a long period of time should have their blood checked for cyclosporine levels so that the dosage may be adjusted if necessary. Since more of both Gengraf and Neoral is absorbed into the blood you will probably need less of it. Do not substitute Neoral or Gengraf for Sandimmune; they are not equivalent to each other.
cyclosporine causes kidney toxicosis (kidney poisoning)—different from transplant rejection—in 25-35% of people taking it to prevent organ rejection. Mild symptoms usually start after about 2 or 3 months of treatment. Reducing drug dosage may control this effect. In one study, clonidine skin patches used before and after surgery decreased toxic risks to the kidney.
Liver toxicosis is seen in about 5% of transplant patients taking cyclosporine. It usually appears in the first month and may be controlled by reducing dosage.
Convulsions may develop, especially in people also taking high dosages of corticosteroids. Other nervous system side effects are listed below (see “Possible Side Effects”).
In one study, cyclosporine increased cholesterol and other blood-fat levels. It is not known how this affects people who take the drug on a long-term basis.
There is conflicting information on how cyclosporine affects blood sugar. Kidney-transplant patients taking the drug have developed insulin-dependent diabetes, which is related to the dosage of cyclosporine and reverses itself when you stop taking the drug. On the other hand, cyclosporine preserves the function of insuli(Nproducing cells in the pancreas and has allowed many insulin-dependent diabetics t0 11ve Without taking insulin.
UVb vaccines should not be given to people taking cyclosporine.
Do not use cyclosporine eye drops if you have an eye infection.
Small amounts of cyclosporine eye emulsion may be absorbed
into the bloodstream, but the risk of body-wide side effects is small.
Possible Side Effects
V Most common: Cyclosporine is known to be toxic to the kidneys. Your doctor will carefully monitor your kidney function while you are taking it. Other side effects are high blood pressure, increased hair growth, infection, and enlargement of the gums. Lymphoma may develop in people whose immune systems are excessively suppressed.
V Less common: tremors, cramps, acne, brittle hair or fingernails, convulsions, headache, confusion, diarrhea, nausea or vomiting, tingling in the hands or feet, facial flushing, reduced white-blood-cell and platelet counts, sinus inflammation, swollen and painful male breasts, drug allergy (symptoms include rash, itching, hives, and breathing difficulties), conjunctivitis (pinkeye), fluid retention and swelling, ringing or buzzing in the ears, hearing loss, high blood sugar, and muscle pain.
♦    Rare: blood in the urine, heart attack, itching, anxiety. depression, lethargy, weakness, mouth sores, difficulty swallowing, intestinal bleeding, constipation, pancreas inflammation, night sweats, chest pain, joint pain, visual disturbances, and weight loss. Contact your doctor if you experience any side effect not listed above.
Cyclosporine Eye Drops
♦    Most common: burning sensation.
✓    Less common: red-eye, discharge from the eye, overflow of tears, eye pain, a feeling of something in the eye, itching, stinging, and visual disturbances, usually blurring.
Drug Interactions
•    Cyclosporine should be used carefully with other kidney-toxic drugs including nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, ac\d s0indac; ciprofloxacin; gentamicinjQtswnydin; vancomycin; trimethoprimsUM,M1~0oxazole; melphalan; amphotericin B; ketoconazole; azapropazon; colchicine; diclofenac; cimetidine; ranitidine; and tacrolimus.
•    Drugs that may increase blood levels of cyclosporine include contraceptive drugs; amiodarone; diltiazem; nicardipine; verapamil; fluconazole; itraconazole; ketoconazole; azithromycin; clarithromycin; erythromycin; quinapristin and dalfopristin; methylprednisolone—this combination also causes convulsions; allopurinol; bromocriptine; colchicine; imatinb-, danazol; and metoclopramide. With ketoconazole, your doctor may use this drug interaction to reduce your cyclosporine
dosage.
•    Drugs that decrease cyclosporine levels and may lead to organ rejection include octreotide, orlistat, sulfinpyrazone, ticlopidine, terbinafine, nafcillin, rifampin, carbamazepine, phenobarbital, phenytoin, and St. John’s wort. Rifabutin may also decrease concentrations of cyclosporine and should be used with caution.
•    Cyclosporine interferes with the body’s ability to clear digoxin, prednisolone, and statin drugs. People taking any of these drugs who start on cyclosporine must have their drug dosage reduced.
•    Combining cyclosporine and nifedipine may lead to gum overgrowth.
•    Cyclosporine increases blood potassium. Excessive blood-potassium levels may be reached if cyclosporine is taken with enalapril, lisinopril, a potassium-sparing diuretic such as spironolactone, salt substitutes, potassium supplements, or high potassium—low sodium—food.
•    Psoriasis patients using other immunosuppressant drugs or receiving radiation therapy should not take cyclosporine due to the danger of infection.
•    Cyclosporine prevents the normal body response to live vaccines. People taking cyclosporine should be vaccinated only after specific discussions with their doctors. You must wait for a period of several months to several years after stopping the medication before vaccination may be considered again.
Food Interactions
Cyclosporine may be taken with fMd 1111 upsets your stomach. For optimal QftlaWr~T)ess, avoid eating a fatty meal within half an hour of taking Neoral.
You may mix Neoral in a glass—not a paper or plastic cup—with room-temperature orange or apple juice or chocolate milk to make it taste better. Do not drink grapefruit juice because it speeds the breakdown of cyclosporine. Drink immediately after mixing, then put more juice or chocolate milk in the glass and drink it to be sure that the entire dose has been taken. Neoral should not be taken with unflavored milk because it may be unpalatable.
Usual Dose
In general, the usual dosage of Neoral is lower than Sandimmune, but dosage must be individualized for you by your doctor. Do not substitute one brand for the other.
Sandimmune
Adult: The usual oral dosage of cyclosporine is 6-8 mg per lb, of body weight a day. The first dose, typically 15 mg per lb., is given 4-12 hours before the transplant operation or immediately after surgery. This dosage is slowly reduced to 11-22 mg per lb. of body weight.
Child: Similar dosages are usually prescribed, but because children tend to release the drug from their bodies faster than adults, larger and more frequent doses may be needed.
Neoral and Gengraf
Adult: In newly transplanted patients, the usual oral dosage of Neoral is 3-4 mg per lb. of body weight a day divided into 2 doses. The initial oral dose of Gengraf is the same as for Sandimmune. The first dose is given 4-12 hours before the transplant operation or immediately after surgery. This dosage is continued after the operation for 1-2 weeks and then slowly reduced to maintain a target amount of cyclosporine in the body. Dosage may vary according to the organ transplanted.
In people being treated for rheumatoid arthritis or psoriasis, the initial dose of Neoral and Gengraf is 1.13 mg per lb. of body weight increased gradually to a maximum of 1.8 mg per lb. of body weight.
Child: Similar dosages are usually prescribed but, because children tend to release the drug from their bodies faster than adults, larger and more frequent doses may be needed.
cyclosporine Eye Emulsion
One drop in the affected eye(s) every Q hours. Before using, rotate and turn the vial Over a few times until you have a uniform, lft8, opaque fluid inside. If you use artificial tears, allow 15 minutes between products. Discard the open vial immediately after use.
Overdosage
Overdose victims may be expected to develop side effects and symptoms of extreme immunosuppression. Induce vomiting with ipecac syrup—available at any pharmacy—which is recommended up to 2 hours after the overdose was taken. Call your doctor or local poison control center before inducing vomiting. If you must go to a hospital emergency room, ALWAYS bring the prescription
bottle or container.
Special Information
Call your doctor at the first sign of fever; sore throat; tiredness’, weakness’, nervousness; unusual bleeding or bruising; tender or swollen gums; convulsions; irregular heartbeat; confusion; numbness or tingling of your hands, feet, or lips; breathing difficulties; severe stomach pain with nausea; or blood in the urine. Other side effects such as shaking or trembling of the hands, increased hair growth, acne, headache, leg cramps, nausea, or vomiting are less serious but should be brought to your doctor’s attention, particularly if they are bothersome or persistent.
Maintain good dental hygiene while taking cyclosporine and use extra care when brushing and flossing because the drug increases your risk of oral infection. cyclosporine may also cause swollen gums. See your dentist regularly.
Continue taking your medication as long as your doctor prescribes it. Do not stop taking it without your doctor’s knowledge. If you cannot take one of the oral forms, cyclosporine can be given by injection.
Do not keep either brand of the oral liquid in the refrigerator. After the bottle is opened, use the medication within 2 months. At temperatures below 68°F, Neoral can form a gel and a light sediment can form in Sandimmune. These do not affect the potency of either product. They can still be used and are effective.
If you forget a dose, take it as soon as you remember if it is within 12 hours of your regular dose. If not, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
For cyclosporine eye emulsion, each small plastic container is meant to be used once and then thrown away along with any remaining medication. Do not allow the tip of the disposable vial to touch 0Z QyE or any surface, as this may contaminate the emulsion.
Patients with decreased tear production typically should not wear contact lenses. But those that do must remove them before using cyclosporine eye emulsion. Lenses may be reinserted 15 minutes after using the medicine.
Special Populations
Pregnancy/Breast-feeding: In animal studies cyclosporine damages the fetus. Though a small number of pregnant women have taken cyclosporine without major problems, it is recommended that pregnant women avoid cyclosporine. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
cyclosporine passes into breast milk. Nursing mothers who must take cyclosporine should use infant formula.
Seniors: Due to decreased kidney function, seniors are more susceptible to kidney toxicosis.

Generic Name
Darunavir (dah-ROON-uh-vere)
Brand Name Prezista
Type of Drug  Protease inhibitor.
Prescribed For
Advanced human immunodeficiency virus (HIV) infection that has not responded to other protease inhibitors.
General Information
Part of the multidrug “cocktail” responsible for important gains in the fight against acquired immunodefiency syndrome (AIDS), darunavir is a member of a group of anti-HIV drugs called protease inhibitors. These drugs work at the end of the HIV reproduction process, whet) proteins are “cut” into strands of exactly tht VbYrect size to duplicate HIV. An enzyme known as protease cuts the protein. Protease inhibitors prevent the mature HIV virus from being formed by inhibiting this cutting process. Proteins that are cut to the wrong length or that remain uncut are inactive.
Darunavir must be taken with a low dose of ritonavir, another protease inhibitor, to extend the action of darunavir in the body.
Without ritonavii, darunavir would be eliminated too rapidly to be effective. Darunavir must also be accompanied by at least 2 other AIDS antivirals. Protease inhibitors revolutionized HIV treatment because, when taken in combination, they reduce the amount of HIV virus in the bloodstream to levels that are often undetectable by current methods—CD4 (immune system) cell counts and viral load (amount of virus in the blood) measurements. Multiple-drug therapy has transformed HIV from a fatal disease to a manageable chronic illness.
Cautions and Warnings
Do not take darunavir if you are allergic or sensitive to any of its ingredients, to sulfa drugs, or to ritonavir.
Darunavir can cause a severe or life-threatening rash.
If a serious toxic reaction occurs while taking darunavir, you should stop the drug until your doctor can determine the cause or until the reaction resolves itself. Then treatment can be resumed.
This drug is primarly broken down in the liver. Use caution if you have moderate to severe liver disease.
Darunavir may raise your blood sugar, worsen your diabetes, or bring out latent diabetes. People with diabetes who take darunavir may need the dosage of their antidiabetes medication adjusted.
People with hemophilia may be more likely to bleed while taking a protease inhibitor.
The HIV virus may become resistant to darunavir or other protease inhibitors. For this reason it is essential that you take darunavir exactly according to your doctor’s directions.
Protease inhibitors can cause body fat redistribution, including increased fat deposits in the upper back and neck, breast and around the back, chest, and stomach. Fat may be lost from the legs, arms, and face. Some people with HIV and a history of an opportunistic infection may develop signs and symptoms of the infection soon after anti-HIV treatment is started. This is called immune reconstitution syndrome.
Darunavir is involved in many drug interactions. Check with your doctor before adding angt ng new to your treatment program.
Possible Side Effects
V Most common: diarrhea, nausea, headache, and common cold symptoms.
of constipation.
Drug Interactions
•    Do not take any of the following medicines with darunavir + ritonavir: astemizole, terfenidine, ergot-based drugs for migraine headache, cisapride, pimozide, midazolam, or triazolam. Mixing these drugs with darunavir + ritonavir can result in very high blood levels and serious side effects.
•    Carbamazepine, phenobarbital, phenytoin, rifampin, and St. John’s wort can substantially reduce blood levels of darunavir. Do not mix these medicines.
•    Lopinavir + ritonavir and saquinavir can significantly reduce blood levels of darunavir. Darunavir significantly increases blood levels of lopinavir + ritonavir. Do not mix these drugs.
•    Mixing darunavir with indinavir can increase blood levels of both drugs.
•    Darunavir + ritonavir does not appear to affect blood levels of atazanavir, nor does atazanavir appear to affect blood levels of darunavir + ritonavir. It may be possible to combine these two protease inhibitors.
•    Taking darunavir with tenofovir can increase blood levels of both drugs. These drugs can be combined with no dose adjustments, though it is necessary to watch carefully for kidney damage related to tenofovir.
•    Darunavir can increase blood levels of efavirenz and efavirenz reduces darunavir levels. These medicines should be mixed with caution.
•    Darunavir increases nevirapine blood levels but the raMUNnation can be taken with no dose a-Syoslment.
•    If didanosine (SWpat 01 a darunavir + ritonavir treatment pro~ram, it must be taken on an empty stomach, 1 hour before or 2 hours after darunavir + ritonavir, which should be taken with food.
•    Darunavir increases blood levels of clarithromycin, itraconazole, and ketoconazole. Daily dosage of itraconazole and ketoconazole should not exceed 200 mg. No clarithromycin
Possible Side Effects (continued)
♦    Less common:    abdominalinal pain, and
♦    Rare: Rare side effects can occur in almost any part
body. Contact your doctor if you
ou experience any side ef
fect not listed above.
adjustment is necessary in people with normal kidney function.    the Darunavir + ritonavir may reduce vonconazole levels in t e
blood. Do not mix these medicines.
•    Darunavir + ritonavir can increase rifabutin levels in the blood-
stream. Rifabutin can also reduce darunavir levels in the
bloodstream. If rifabutin is mixed with darunavir + ritonavir,
the rifabutin dose should be 150 mg every other day.
•    Caution should be exercised when combining darunavir + ritonavir with calcium channel blockers such as felodipine, nifedipine, and nicardipine.
•    Darunavir increases blood levels of the heart antiarrhythmic drugs bepridil, lidocaine, and quinidine. These drugs should be used together with caution and only in situations where blood levels of the heart drugs can be monitored regularly.
•    Darunavir + ritonavir can reduce blood levels of warfarin. It is necessary to monitor warfarin levels while taking this combination.
•    Darunavir + ritonavir can raise blood levels of the tricyclic antidepressant desipramine and the tetracyclic antidepressant trazodone. Dosage reduction is recommended.
•    Darunavir + ritonavir may reduce blood levels of the SSRI antidepressants sertraline and paroxetine. SSRI doses may have to be increased to account for this effect.
•    Darunavir + ritonavir can drastically increase the blood levels of some statin-type cholesterol-lowering drugs, substantially increasing the risk of statin side effects. Simvastatin, pravastatin, and lovastatin should not be mixed with darunavir + ritonavir. It is also possible to take darunavir + ritonavir with atorvastatin, although it can increase the level of atorvastatin in the bloodstream. If atorvastatin is prescribed, it is best to begin with 10 mg a day and slowly increase the dose as necessary. Little is known about how darunavir + ritonavir affects rosuvastatin. The safest statin to take with darunavir + ritonavir is fluvastak”.
•    Darunavir + ritonaxk Can increase blood levels of inhaled MT lCosteroids dexamethasone and fluticasone, the anti-rejection drugs cyclosporine, tacrolimus, and sirolimus. The corticosteroids reduce darunavir blood levels, interfering with its effectiveness.
•    Darunavir + ritonavir can reduce methadone levels in the bloodstream. Methadone dose adjustment may be needed.
•    Darunavir + ritonavir reduces the effectiveness of some contraceptive drugs by decreasing the amount of the hormones ethinyl estradiol and norethindrone in the bloodstream. Women mixing these medicines should use additional contraceptive measures (e.g., condoms).
•    Protease inhibitors may drastically increase blood levels of erectile dysfunction drugs sildenafil, vardenafil, and tadalafil, increasing the risk of side effects including low blood pressure, visual changes, and persistent, painful erection.
•    Dexamethasone may reduce blood levels of darunavir.
Food Interactions
Take darunavir with food. The amount of darunavir absorbed into the blood is vastly reduced when it is taken on an empty stomach, thus negating its antiviral effects.
Usual Dose
Adult: 600 mg (2 300-mg tablets) with 1 00 mg ritonavir twice a day. Do not chew these tablets.
Child: not recommended.
Overdosage
Little is known about the effects of darunavir overdose, but 3200 mg of darunavir has been given to study volunteers with no adverse effects. Call your local poison center or hospital emergency room for more information. If you take the victim to a hospital emergency room, ALWAYS bring the prescription bottle or container.
Special Information
Darunavir is not a cure for HIV. It will not prevent you from transmitting the HIV virus to another person; you must still practice safe sex. You may still develop opportunistic infections or other complications associated with advanced HIV disease.
The long-term effects of this drug are not known.
It is imperative for you to take this medication exactly according to your doctor’s instructions. Do not skip any doses. Skipping doses of darunavir increases the risk that you will become resistant k,3 ft drug. If you forget a dose of darunavir or ritonavir and remember within 6 hours, take it as soon as you remember and then continue with your regular schedule. If 6 hours have passed since the time when you should have taken your medicine, skip the forgotten dose and take your next dose at the regular time. Do not take a double dose.
Special populations
Pregnancy/Breast-feeding: Animal studies with darunavir reveal no damage to the fetus, but there are no data on how this drug affects pregnant women. Darunavir should only be used during pregnancy after carefully weighing its potential benefits against its risks.
It is not known if darunavir passes into breast milk. Nursing mothers with HIV should use infant formula, regardless of whether they take this drug, to avoid transmitting the virus.
Seniors: Seniors can take this drug without special precaution.

Type of Drug
corticosteroids, Oral (kor-tih-koe-STER-oids)
Brand Names
Betamethasone Celestone
Gerzq(t St D?Pdient: Budesonide Entocort EC
Cortisone Acetate &I
Dexamethasone EQ Mymethasone
Fludrocortisone
Hydrocortisone Cortef
Methylprednisolone 19 Medrol
Prednisolone 10
Orapred    Pediapred
Orapred ODT    Prelone
Prednisone 0 Prednisone Intensol    Sterapred
Prescribed For
A wide variety of disorders from rash to cancer, including adrenal disease, adrenal hormone replacement, bursitis, arthritis, severe skin diseases including psoriasis and other rashes, severe or disabling allergies, asthma, drug or serum sickness, attacks of multiple sclerosis, severe respiratory diseases including pneumonitis, blood disorders, gastrointestinal (GI) disease including ulcerative colitis and Crohn’s disease, and inflammation of the nerves, heart, or other organs. Dexamethasone is also used to treat mountain sickness, vomiting, bronchial disease in premature babies, excessive hairiness, and hearing loss associated with bacterial meningitis. Fludrocortisone is used to treat Addison’s disease and for symptomatic orthostatic hypotension. Prednisone is used to improve strength and function of some muscular dystrophy patients. Methylprednisolone is used to decrease mortality in some patients suffering from severe alcoholism and chronic active hepatitis.
General Information
Produced by the adrenal gland, natural corticosteroids are hormones that affect almost every body system. The major dMeyences among corticosteroid drugs are potency and variation in secondary effects, 0OZ10r preference and past experience with a Mftosferoid usually determine which drug to prescribe for a specific disease.
Cautions and Warnings
Do not use an oral corticosteroid if you are allergic or sensitive to any of its ingredients.
Corticosteroids may mask symptoms of an infection. Because these drugs compromise the immune system, new infections may occur during corticosteroid treatment; when this happens, a relatively minor infection that would respond to ordinary treatment can turn serious. Corticosteroids may impair immune response to hepatitis B, prolonging recovery. They may reactivate dormant amebiasis (a parasitic infection). Corticosteroids should not be taken if you have a fungal blood infection, because they can allow the infection to spread more easily. They should be used with caution by people with herpes eye infection, tuberculosis or in any other bacterial, fungal, or viral infections.
Long-term use of any corticosteroid may increase the risk of developing cataracts, glaucoma, or eye infections, especially viral or fungal.
When stopping a corticosteroid, dosage must be reduced gradually under a doctor’s supervision—otherwise you may experience adrenal gland failure.
If you are taking large corticosteroid doses. you should not receive any live virus vaccine because corticosteroids interfere with the body’s reaction to the vaccine.
Hydrocortisone and cortisone may lead to high blood pressure. Other corticosteroids are less likely to affect blood pressure.
Corticosteroids should be used with caution if you have severe kidney disease.
High-dose or long-term corticosteroid therapy may aggravate or worsen stomach ulcers. This may occur when total dosage reaches 1000 mg of prednisone, 150 mg of betamethasone or dexamethasone, 5000 mg of cortisone. 4000 mg of hydrocortisone, 1000 mg of prednisolone, or 800 mg of methylprednisolone.
People who have recently stopped taking a corticosteroid and are going through a period of stress may need small doses of a rapid-acting corticosteroid, such as hydrocortisone, to get them through this period. Call your doctor if you think you might be experiencing this kind of stress reaction.
Use corticosteroids with caution if you have had a recent heart attack or have, Colitis, heart failure, high blood pressure, blood-clotting tendencies, thrombophlebitis, osteoporosis, antibiotic-resistant infections, Cushing’s disease, myasthenia gravis, metastatic cancer, diabetes, underactive thyroid disease, cirrhosis of the liver, or seizure disorders.
corticosteroid psychosis (symptoms include euphoria or feeling “high,” delirium, sleeplessness, mood swings, personality changes, and severe depression) may develop in people taking dosages greater than 40 mg a day of prednisone. These symptoms may also develop with other corticosteroids taken in equivalent doses (see “Usual Dose” for relative equivalencies). Symptoms of corticosteroid psychosis usually develop within 15-30 days of beginning treatment. These symptoms may also be linked to other factors—women and those with a family history of psychosis are more at risk.
Corticosteroids can cause loss of calcium, which may result in bone fractures and aseptic necrosis of the femoral and humorai heads (a condition in which the large bones in the hip degenerate from loss of calcium).
Prednisone may aggravate emotional instability.
Corticosteroids do not cure multiple sclerosis (MS) or slow its progression, though they may speed recovery from attacks of the disease.
. Corticosteroid products often contain tartrazine dyes and sulfite preservatives. Many people are allergic to these chemicals.
Possible Side Effects
✓    Most common: headache, respiratory infections, acne, and bruising.
✓    Common: water retention (swollen ankles), back pain, heart failure, upset stomach (possibly leading to stomach or duodenal ulcer), potassium loss, dizziness, fatigue, insomnia, weight gain, increased appetite, nausea, stomach gas, abdominal pain, general pain, muscle weakness, loss of muscle mass, slowed healing of wounds, increased sweating, allergic rash, itching, convulsions, excess hair growth, and worsening of a pre-existing psychiatric condition.
✓    Less common: irregular menstruation; slowed growth in children, particularly after lengthy periods of corticosteroid treatment; adrenal or pituitary gland suppression; diabetes; drug sensitivity or allergic reactions; blood clots; moon face; feeling unwell; euphoria; mood swings; personality Changes; and severe depression.
♦    Rare: Rare side effects can appear in any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Tell your doctor if you are taking any oral anticoagulant (blood-thinning) drug. If you begin taking a corticosteroid, your anticoagulant dosage may have to be adjusted.
•    Combining a corticosteroid and a diuretic such as hydrochlorothiazide may cause loss of blood potassium. Low blood potassium may increase the side effects of digitalis drugs.
•    Contraceptive drugs, estrogen, erythromycin, azithromycin, clarithromycin, and ketoconazole may increase the risk of corticosteroid side effects.
•    Barbiturates, aminoglutethimide, phenytoin and other hydantoin anticonvulsants, rifampin, ephedrine, colestipol, and cholestyramine may reduce the effectiveness of corticosteroids.
•    Corticosteroids may decrease the effects of aspirin and other salicylates, growth hormones, and isoniazid.
•    Combining a corticosteroid and a theophylline drug may require a dosage adjustment of either or both drugs.
•    Corticosteroids may interfere with laboratory tests. Tell your doctor if you are taking any of these drugs so that tests are properly analyzed.
•    Limit your intake of alcohol while on oral corticosteroids.
Food Interactions
Take corticosteroids with food or a small amount of antacid to avoid stomach upset. If stomach upset continues, notify your doctor. Grapefruit juice doubles the amount of some oral corticosteroids absorbed into the blood.
Usual Dose
Once-daily doses should be taken in the morning. Dosages vary greatly and depend upon the specific disease being treated. Dosages for infants and children should be individualized according to severity of disease and response to treatment.
Betamethasone: starting dosage-0.6-7.2 mg a day. Maintenance 1609age-0.6-7.2 mg a day.
Budesonide: 9 mg a day.
Cortisone: starting dosage-25-300 mg a day. Maintenance dosage-25-300 mg a day.
Dexamethasone: 0.75-9 mg a day. Daily dosage sometimes exceeds 9 mg. A temporary dosage increase may be necessary it you are experiencing emotional stress. In alternate-day therapy, twice the usual daily dose is taken every other day.
Hydrocortisone: 20-240 mg a day.
Methylprednisolone: starting dosage-4-48 mg or more a day. Maintenance dosage varies. A temporary dosage increase may be necessary if you are experiencing emotional stress. in alternate-day therapy, twice the usual daily dose is taken every other day.
Prednisone and Prednisoione: 5-60 mg a day. Daily dosage sometimes exceeds 60 mg. A temporary dosage increase may be necessary if you are experiencing emotional stress. In alternate-day therapy, twice the usual daily dose is taken every other day.
Equivalent doses: Using 5 mg of prednisone as the basis for comparison, equivalent doses of other corticosteroids are 0.6 mg-0.75 mg of betamethasone, 25 mg of cortisone, 0.75 mg of dexamethasone, 20 mg of hydrocortisone, 4 mg of methylprednisolone, and 5 mg of prednisolone.
Overdosage
Symptoms of overdose are anxiety, depression or stimulation, joint or muscle pain, blurred vision, stomach bleeding, increased blood sugar, high blood pressure, and water retention. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Do not stop taking this medication without your doctor’s knowledge. Suddenly stopping any corticosteroid drug may have severe consequences; the dosage must be gradually reduced by your doctor.
G& your doctor if you develop unusual weight gain, black or tarry stools, swelling of the feet or legs, muscle weakness, vomiting of blood, menstrual irregularity, prolonged sore throat, fever, cold or infection, appetite loss, nausea and vomiting, diarrhea, weight loss, weakness, dizziness, or low blood sugar.
If you take several doses a day and forget a dose, take the dose you forgot as soon as possible. It it is almost time for your next dose, skip the one you forgot and double the next dose. If you take 1 dose a day and forget a dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
If you take a corticosteroid every other day and forget a dose, take it immediately if you remember it in the morning of your regularly scheduled day. If it is much later in the day, skip the dose you forgot and take it the following morning, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Studies have shown that long-term corticosteroid therapy at high dosages may cause birth defects, as may chronic corticosteroid use during the first 3 months of pregnancy. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Corticosteroids taken by mouth may pass into breast milk. Most nursing mothers who must take a corticosteroid should use infant formula, though low dosages of some of these drugs may be taken for short periods while breast-feeding. Consult your doctor.
Seniors: Seniors are more likely to develop high blood pressure while taking an oral corticosteroid. Older women are more susceptible to osteoporosis (a condition characterized by loss of bone mass due to depletion of minerals, especially calcium) associated with high dosages of oral corticosteriods. Lower dosages are just as effective in seniors and cause fewer side effects.

Type of Drug
Corticosteroids, Topical
(kor-tih-koe-STER-oids)
Brand NameS
CLASS 1–Super-potent topical products
Betamethasone Dipropionate gel, ointment 0.05% 91
Diprolene gel/ointment
C/obetasol Propionate 0.05% cream, foam, gel, lotion, shampoo, ointment 19
Clobex    Olux
Cormax    Olux E
Embeline    Temovate Embeline E
Difforasone Diacetate ointment 0.05% RE Olux-E Foam    Psorcon E
Fluocinonide cream 0.1 % 0 Vanos
Flurandrenolide tape 4 MCgICM2 Rfl Cordran Tape
Halobetasol Propionate cream/ ointment 0.05%
Ultravate
CLASS 2—High-potency topical products  Amcinonide ointment 0.1 % (0
Betamethasone Dipropionate cream 0.05%
Diprolene AF
Generic Ingredients: Betamethasone Dipropionate (0.064%) + Calcipotriene (0.005%) ointment
Taclonex
Desoximetasone Cream, ointment 0.25% and 0.05%; 0.05% gel DG
Topicort    Topicort LP
Generic 10gVEOUnt.- Diflorasone Diacetate cream, ointment 0.05% 91
Apexicon    Florone E
Apexicon E    Maxiflor
Florone    Psorcon
Fluocinonide cream, gel, ointment,
solution 0.05% 9
Lidex    Lidex E
Halcinonide cream, ointment, solution 0.1 % Halog
Mometasone Furoate ointment 0.1 % 91 Elocon
Triamcinolone Acetonide ointment 0.5% RE
CLASS 3—Upper mid-strength topical products  Amcinonide lotion 0.1 % 0
Betamethasone Dipropionate cream 0.05% (a
Diprolene    Teladar
Maxivate
Generic Ingredient.- Betamethasone Valerate ointment 0.1 %
Fluocinofone Acetonide [’61 Capex Shampoo
Fluticasone Propionate cream 0.05% 9 Cutivate
Triamcinolone Acetonide cream 0.5%
Delta-Tritex    Kenonel
Flutex    Triacet
Kenalog Cream    Triderm Kenalog-H
CLASS 4—Mid-strength topical products  Amcftnide cream 0.1% D3
Betamethasone Dipropionate lotion 0.05% and foam 0.12%®
Diprosone    Maxivate Lotion
Luxiq Foam
Desoximetasone cream 0.05% 19 Topicort
Fluocinolone Acetonide
Synalar Ointment 0.025%    Synalar-HP Cream 0.2%
Flurandrenolide ointment 0.05% Cordran
Fluticasone Propionate lotion 0.05% Cutivate
Hydrocortisone Valerate ointment 0.2% ED Westcort
Mometasone Furoate cream, lotion, solution 0.1
Elocon
Prednicarbate ointment 0.1 % 10 Dermatop E
Triamcinolone Acetonide 0.1 %
Aristocort A    Delta-Tritex Cream
Aristocort Cream and    Kenalog
Ointment    Triderm
CLASS 5—Lower mid-strength topical products  Betamethasone Valerate cream, lotion 0.1
Beta-Val    Dermabet
Betatrex    Valnac
Clocortolone Pivalate cream 0.1 % Cloderm
Desonide ointment 0.0511/0
Desonate    Tridesilon
UnOwen    Verdeso Foam Lokara
Fluocinolone Acetonide cream 0.025% 91 Synalar
Flurandrenolide cream, lotion M Cordran Lotion 0.05% Cordran SP 0.05% Cordran Ointment 0.25%
Fluticasone Propionate ointment 0.005% Cutivate
Hydrocortisone Butyrate Cream, ointment, solution 0.1 0
Locoid
Hydrocortisone Probutate 0.1% Pandel
Hydrocortisone Valerate cream 0.2% RE Westcort
Prednicarbate Cream 0.1 % RE Dermatop E
CLASS 6—Mild topical products
Alclometasone Dipropionate cream, ointment 0.05% 91
Aclovate
Desonide cream, lotion 0.05% DesOwen    Tridesilon Lokara
Fluocinolone Acetonide cream, shampoo, solution 0.01%
Derma-Smoothe/FS Oil    FS Shampoo
Flurosyn    Synalar
Flurandrenolide cream DG Cordran SP 0.025%
Generic Ingredient., Triamcinoione Acetonide cream 0.1 % MS10cort
Triamcinolone Acetonide cream 0.025% Flutex    Triacet
Kenalog
CLASS 7—Least potent topical products  Hydrocortisone A
1% HC    HydroSkin
Ala-Cort    HydroTex
Ala-Scalp    Hytone
Alcortin    Ivy Soothe
Analpram-HC    Maximum Strength Bactine
Anusol-HC    Maximum Strength Cortaid
Cetacort    Maximum Strength Cortaid
Cortaid Intensive Therapy    Faststick
Cortizone-5    Maximum Strength
Cortizone-10    KeriCort-1 0
Cortizone-10 Plus    Nutracort
Cortizone-10 Quickshot    Procort
Cortizone for Kids    Proctocream-HC
Delcort    Proctofoam-HC
Extra Strength CortaGel    Stie-cort
Hemril    Synacort
Hi-Cor 1.0    Tegrin HC
Hi-Cor 2.5    Texacort Hycort
Hydrocortisone Acetate cream, ointment 0.5% and 1%G
Cortef Feminine Itch    Lanacort
Corticaine    Maximum Strength Caldecort
Cortifoam    Micort-HC
Dricort    U-Cort Gynecort Female Creme
Prescribed For
Inflammation, itching, eczema, dermatitis, vitiligo (patchy loss of skin color), blistering skin diseases, lupus and other connective tissue diseases, psoriasis, and many other specialized skin problems; may also be used to Weal severe diaper rash.
General Information
Topical corticosteroids do not cure the underlying cause of skin problems, but they can relieve symptoms of rash, itching, or inflammation by interfering with the body mechanisms that produce them. You should never use a topical corticosteroid without your doctor’s knowledge because it could mask a symptom important in diagnosing your condition. Also, improper use of a topical corticosteroid could lead to unwanted and sometimes permanent side effects. In general, ointment forms of topical steroids are more potent and usually more effective than cream or lotion forms. Ointments are also less likely to cause allergic reactions because they contain fewer inactive ingredients.
Generic products in this group can vary in potency and produce different results from their brand-name counterparts, even though they contain the identical quantity of active ingredient. Topical steroids are rated from 1 (most potent) to 7 (least potent). Generally, products within a potency class are interchangeable. Ask your doctor or pharmacist which products are interchangeable. The lowest potency products are available without a prescription. Ointments tend to be more potent than creams and solutions and different product concentrations affect their classification.
Super-potent topical corticosteroids (class 1) should not be used on the face, neck, under the arms, or in the groin area. These products are generally reserved for situations in which less potent products have not worked. They should be used with caution, and should only be applied to the areas that are affected with the rash. Using a product in this category for longer than 2 weeks at a time increases the risk of permanent skin damage.
High-potency topical corticosteroids (classes 2 and 3) are best for the trunk, arms, and legs, but should not be used on the face, neck, under the arms, or in the groin area. Using a product in this category for longer than 2 weeks at a time increases the risk of permanent skin damage.
Intermediate-potency topical corticosteroids (classes 4 and 5) can be used in children for up to 1-2 weeks at a time. This type of medication is best for the trunk and extremities. It is safer for use on thin skin, and less effective on thicker skin.
Low-potency topical corticosteroids (classes 6 and 7) can be used on any part of the body, and can be used in children. They are the best choice for the face, uadera~m area, groin, neck, and i ftl Occluded areas such as skin folds.
Cautions and Warnings
Do not use a topical corticosteroid if you are allergic or sensitive to corticosteroids or to any ingredients of the aerosol, cream, gel, lotion, ointment, or solution. Do not use a topical corticosteroid as the sole treatment for bacterial skin infections such as impetigo, viral skin diseases such as herpes, fungal skin infections such as athlete’s foot, or known tuberculosis of the skin. These drugs should not be used in the ear if the eardrum is perforated. Do not use a topical corticosteroid on ulcerated skin, or to treat acne.
Skin problems can become less responsive with time if a product is applied continuously over a long period of time. This can re-
sult in a flare-up of the problem when the medication is stopped.
Using a less potent product may avoid this problem.
Rectal corticosteroid products should not be used if you have any serious bowel condition, including bowel perforation, obstruction, abscess, and systemic fungal infection.
The rectal foam is not expelled after it has been applied and may result in higher drug blood levels than those associated with rectal enema products. The risk of systemic (whole-body) side effects is greater when more of the drug enters the blood. If there is no improvement after 2 or 3 weeks of using a rectal corticosteroid, contact your doctor.
Using a topical corticosteroid around the eyes for prolonged periods may cause cataracts, glaucoma and/or permanent thinning and fragility of skin around the eyes where the corticosteroid is being applied.
Children may be more susceptible to serious systemic side effects from topical corticosteroids, including growth retardation, Cushing’s syndrome, and suppression of natural corticosteroid production, requiring a tapering of the medication, especially if the medications are applied to large areas over long periods. Super-potent topical corticosteroids are not recommended for children.
Possible Side Effects
♦ Most common: burning; itching; irritation; “steroid” acne; skin thinning, tightening, or discoloration; stretch marks; dry cracked skin; bruising; and secondary i0ection. These effects are more likely when the treated area is covered Stith al) occlusive bandage (one that prevents contact with water and air). Side effects are more likely with extended use of high-potency topical corticosteroid products and when the treated area is covered with a bandage that completely prevents skin contact with water and air.
Possible Side Effects (continued)
V Significant amounts of corticosteroids may be absorbed into the bloodstream if large amounts are used for long periods. This can result in systemic effects and may cause serious problems, particularly in people with liver disease. Systemic side effects include lightheadedness, hives, growth suppression, and adrenal suppression.
Drug Interactions None known.
Usual Dose
Adult
Cream, Ointment, Solution, Foam, and Aerosol: Apply a thin film to the skin 2-3 times a day. High- and super-potent products should be applied no more than twice a day, and should be used for short-term treatment, usually 2-3 weeks at a time. Some may have to be applied only once a day.
Rectal Enema: 100 mg nightly for 21 days.
Rectal Foam: 1 applicator’s worth, 1-2 times a day for 2-3 weeks.
Child: Dosages for children should be limited to the lowest possible potency.
Overdosage
Serious adverse effects are unlikely after accidental ingestion. Excessive use of large amounts of topical corticosteroids may cause overdose symptoms and require gradual discontinuation of the drug. Call your local poison control center or a hospital emergency room for more information. ALWAYS bring the prescription bottle or container.
Special Information
To prevent secondary infection, clean the skin before applying the drug. Apply a very thin film and rub in gently—effectiveness depends m contact area, not the thickness of the layer applied.
Do not wash, rub, or put clothing on the area until the medication has dried.
Topical corticosteroids have an additive effect: with continuous use, 1 or 2 applications a day may be as effective as 3 or more. Once the drug begins to take effect, your doctor may recommend reducing the dose to the minimum level needed to control the
condition.
Flurandrenolide tape comes with specific directions for use-, fol-
low them carefully.
If your doctor instructs you to apply plastic wrap or any other occlusive dressing, follow directions carefully. These dressings can increase the penetration of the drug into your skin by as much as 10 times, which may be a crucial element in the medication’s effectiveness. Occlusive dressings should not be used with any of the super-potent topical products.
If you are using one of these products for diaper rash, do not use tight-fitting diapers or plastic pants, which can cause too much drug to be absorbed into the blood.
Your doctor may prescribe a specific form of the product with good reason. Do not change forms without your doctor’s knowledge: a different form may not be as effective.
If you forget to administer a dose, do so as Soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not administer a double dose.
Special Populations
Pregnancy/Breast-feeding: Large amounts of corticosteroids applied to the skin for long periods of time may increase the risk of birth defects. When your doctor considers any of these drugs crucial, its potential benefits must be carefully weighed against its risks. Do not use any over-the-counter hydrocortisone product for more than a few days without your doctor’s knowledge.
Nursing mothers who must use a topical corticosteroid should consider using infant formula. If you apply a corticosteroid to the nipple area, be sure to completely clean the area prior to nursing. Nursing mothers should never use the highest potency corticosteroids (classes 1, 2 or 3) because of the risk of absorbing large amounts of drug into the system that could find its way into breast milk. Nursing mothers should discuss toqkoa1 corticosteroid use with their doctor befQ(e,applying any product.
Seniors: Seniors are more susceptible to high blood pressure and osteoporosis (a condition characterized by loss of bone mass due to depletion of minerals, especially calcium) associated with large dosages. These effects are unlikely with topical corticosteroids unless a high-potency medication is used over a large area for an extended period.

Brand Name
Cortisporin Otic
Generic Ingredients
Hydrocortisone + Neomycin Sulfate + Polymyxin B Sulfate RE
Other Brand Names
AK-Spore H.C. Otic    Octicair
Antibiotic    Otic-Care
Cortatrigen Ear Drops    Otocort
Drotic    Pediotic
Ear-Eze    UAD LazerSporin-C
Type of Drug
Antibiotic and corticosteroid combination.
Prescribed For
Superficial ear infection, ear inflammation or itching, and other outer ear problems.
General Information
Cortisporin Otic contains a corticosteroid to reduce inflammation and 2 antibiotics to treat local ear infections. This combination can be quite useful for local ear problems because of its dual method of action and its relatively broad applicability.
Cautions and Warnings
Do not use Cortisporin Otic if you are allergic or sensitive to any of its ingredients.
Cortisporin Otic is designed for use in the ear. It can be very damaging if placed into the eye.
Cortisporin should not be used if you have herpes simplex, vaccinia, or chickenpox. It also should not be used by patients sensitive to sulfite.
Cortisporin Otic should not be used iAyou have a perforated eardrum,
Possible Side Effects
V Local irritation, such as itching or burning, may occur as a drug sensitivity or allergic reaction.
Drug Interactions None known.
Usual Dose
3-4 drops in the affected ear 3-4 times a day. Treatment should not last beyond 10 days.
Overdosage
The amount of drug contained in each bottle is too small to cause serious problems. Call a hospital emergency room or your local poison control center for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Use only when prescribed by a physician. Overuse of this or similar products can result in the growth of new organisms, such as fungi. If new infections or problems appear, stop using the drug and contact your doctor.
Before administering drops, wash your hands, then hold the Closed bottle in your hand for a few minutes to warm it to body temperature. Shake well for 10 seconds. For best results, drops should not be self-administered, but given by another person. The person receiving the drops should lie on his or her side with the affected ear facing upward. Fill the dropper and instill the required number of drops directly in the ear canal.
If the drops are being given to an infant, hold the earlobe down and back to allow the drops to run in. If the drops are being given to an older child or adult, hold the earlobe up and back to allow them to run in. Do not put the dropper into the ear or allow it to touch any part of the ear or bottle. Keep the ear tilted for about 5 minutes after the drops have been put in or insert a soft cotton plug, whichever is recommended by your doctor.
If you forget to administer a dose of Cortisporin Otic, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedQ%e. Do not apply a double dose.
Special Populations
Pregnancy/Breast-feeding: There are no studies of Cortisporin Otic in pregnant women but it does contain a corticosteroid, which when used over long periods of time in other formulations may increase the risk of birth defects. This drug should only be used during pregnancy after carefully weighing it potential benefits against its risks. Nursing mothers who must take this drug should use in-Pant formula.
Seniors: Seniors may use this product without special restriction.

Brand Name
Cosopt
Generic Ingredients  Dorzolamide + Timolol
Type of Drug
Carbonic anhydrase inhibitor and beta blocker combination.
Prescribed For
Open-angle glaucoma and ocular hypertension.
General Information
Cosopt contains 2 glaucoma drugs that work in different ways. It is intended for people whose glaucoma does not respond to either drug used alone. Small amounts of dorzolamide and timololthe active ingredients in Cosopt–enter the bloodstream.
Cautions and Warnings
Do not use Cosopt if you are allergic or sensitive to any of its ingredients or cannot take sulfa drugs or beta blockers. Cosopt should not be used by people with bronchial asthma, severe chronic obstructive pulmonary disease, slow heart rate or heart block, heart failure, or who are in shock.
People with diabetes or an overactive thyroid should use Cosopt with caution since beta blockers can mask the signs of low blood sugar or hyperthyroidism.
Small amounts of both ingredients enter the bloodstream and can produce the same kinds of systemic (whole-body) reactions associated with larger dosages of either a sulfa drug or beta blocker. Stop using the drug at once and call your doctor if a serious reaction develops.
4lt?18b)ockers may have to be discontinued prior to major surgery because they can affect the heart’s ability to respond normally. Some people taking a beta blocker experience severe reductions in blood flow while undergoing general anesthesia.
Dorzolamide should not be used by people with kidney disease and has not been studied in people with liver disease.
People with a history of severe allergic reactions who take a beta blocker may be at increased risk of experiencing a reaction because the drug blocks part of the body’s natural allergic
response.
Timolol can worsen the muscle weakness that accompanies myasthenia gravis.
Possible Side Effects
♦    Most common: changes in sense of taste, especially bitterness or sourness; increased sensitivity to light; and a burning or stinging sensation in the eye.
♦    Common: eye redness, irritation, or itching, and blurred vision.
♦    Less common: abdominal pain, back pain, eyelid inflammation, bronchitis, cloudy vision, eye discharge or swelling, conjunctivitis (pinkeye), corneal erosion, corneal staining, lens cloudiness, cough, dizziness, dry eye, upset stomach, drug particles in the eye, eye pain, tearing, eyelid scaling, eyelid pain or discomfort, sensation of something in the eye, headache, high blood pressure, influenza, lens discoloration, nausea, sore throat, cataracts, sinus irritation, respiratory infection, urinary infection, visual problems, and retinal detachment.
•    Rare: slow heartbeat, heart block or failure, chest pain, stroke, depression, diarrhea, dry mouth, breathing difficulties, low blood pressure, stuffy nose, rash, tingling in the hands or feet, kidney stones, and vomiting. Contact your doctor if you experience any side effect not listed above.
See Dorzolamide, page 200, and Timolol, page 1129, for fur-
ther side effect information.
Drug Interactions
•    If you use more than 1 eyedrop medkc;a~mn, separate doses of these drugs tai z& Y@ast 10 minutes.
•    COSOpt can increase the effect of other carbonic anhydrase inhibitors.
•    Combining Cosopt with an oral beta blocker or another calcium antagonist may increase the risk of side effects, especially changes in heart rhythm and low blood pressure.
•    Do not combine Cosopt and another beta-blocking eyedrop.
•    Combining Cosopt and reserpine can lead to low blood pressure, slowing of heartbeat, and dizziness or fainting.
•    Combining Cosopt with digitalis and a calcium antagonist, or with quinidine, can slow heartbeat.
See Dorzolamide, page 200, and Timolol, page 1129, for further drug interactions.
Usual Dose
Adult: 1 drop in the affected eye twice a day. Child: not recommended.
Overdosage
Little is known about the effects of Cosopt overdose or accidental ingestion. Possible overdose symptoms include dizziness, headache, shortness of breath, slow heartbeat, breathing difficulties, heart attack, and nervous system effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Conjunctivitis (pinkeye) and eyelid reactions can occur due to an allergic reaction or as the result of local irritation. If you experience either of these problems, stop using the drug and call your doctor so that your condition can be evaluated.
To prevent infection, do not allow the eyedropper to touch your fingers, eyelids, or any surface. Wait at least 10 minutes before using any other eyedrops.
Cosopt contains benzalkonium chloride (a preservative), which may be absorbed by soft contact lenses. Remove your soft contact lenses before using the eyedrops; you may put them back in 15 minutes after a dose.
If you forget a dose of Cosopt, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule.
Store Cosopt away from sunlight.
Special Populations
Pregnancy/Breast-feeding: The safety of using Cosopt is not known. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if dorMlamidle passes into breast milk, though timolol does. Nursing mothers who must use Cosopt should use
infant formula.
Seniors: Seniors may use Cosopt without precaution.

Type of Drug
Corticosteroids, Eye Products
(kor-tih-koe-STER-oids)
Brand Names
Dexamethasone Maxidex
Dexamethasone + Ciprofloxacin Ciprodex
Dexamethasone + Tobramycin Tobradex
Dexamethasone + Neomycin Sulfate + Polymixin 8 Sulfate
Maxitrol
Fluorometholone
Flarex    FML Forte
FML
Fluorometholone + Tobramycin Tobrasone
Loteprednol Etabonate Alrex    Lotemax
Generic Ingredients: Loteprednol Etabonate + Tobramycin Zylet
Prednisolone Acetate OG
Econopred Plus    Pred Forte
Omnipred    Pred Mild
Prednisolone Acetate + Gentamicin Sulfate Pred G
Prednisolone Acetate + Sulfacetamide Sodium
Blepharnide    Blephamide S.O.P.
Generic Ingredients: Prednisolone Acetate + Neomycin Sulfate + Polymyxin B Sulfate
Poly-Pred
Prednisolone Sodium Phosphate LQ
Prednisolone Sodium Phosphate + Sulfacetamide Sodium
Vasocidin
Rimexolone Vexol
Prescribed For
Allergic and inflammatory eye conditions, and to speed healing after eye surgery or injury.
General Information
Corticosteroid eye products are prescribed for general relief of inflammation due to allergy and other causes. They are also used after eye surgery or serious eye injury to aid the healing process by reducing the natural inflammatory process. Very severe eye conditions that do not respond to these products may require treatment with corticosteroid drugs taken by mouth. Fluorometholone, medrysone, and prednisolone (up to 0.125%) are preferred for long-term treatment because they are least likely to raise the fluid pressure inside the eye. corticosteroid eye products have not been widely studied in children, though fluorometholone has been proven safe for use in children age 2 and over.
Cautions and Warnings
Do not use a corticosteroid eye product if you are allergic or sensitive to corticosteroids. These products should be used with caution if you have a fungal, herpes, tuberculosis, or viral infection of the eye, or have cataracts, glaucoma, or diabetes. Do not use any of these products without your doctor’s knowledge.
Long-term use of these products can lead to eye damage, including glaucoma, infection, and nerve damage.
Do not use any of these products in children without consultng a doctor.
Possible Side Effects
V Rare: watery eyes; glaucoma; optic nerve damage; gradual blurring, reduction, or loss of vision; eye pain or infections; drooping eyelid; eye burning, stinging, or redness; nausea; and vomiting. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Corticosteroids applied to the eye may interfere with the effect of antiglaucoma drugs.
•    The risk of raising fluid pressure inside the eye is increased when corticosteroid eye products are taken with anticholinergic drugs, especially atropine, over a long period of time.
Food Interactions  None known.
Usual Dose
Eyedrops: 1-2 drops several times a day.
Eye Ointment: Place a thin strip of ointment into the affected eye several times a day.
Overdosage
Swallowing a container of corticosteroid eyedrops or ointment usually does not produce serious effects. Call your local poison center or a hospital emergency room for more information. ALWAYS bring the prescription container.
Special Information
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule.
To prevent infection, keep the eyedropper from touching your fingers, eyelids, or any surface. Wait at least 5 minutes before using any other eyedrops.
If the brand you are taking contains benzalkonium chloride, wait at least 15 minutes before inserting contact lenses. In some cases, you may be instructed not to wear contact lenses for the duration of treatment.
Special Populations
Pregnancy/Breast-feeding: Using large amounts of corticosteroid eyedrops during pregnancy may affect the adrenal gland of the fetus. When your doctor considers one of these products crucial, its potential benefits must be carefully weighed against its risks.
Oral corticosteroids pass into breast milk, but it is not known if this is also true of corticosteroid eyedrops. Nursing mothers who must use one of these medications should use infant formula.
Seniors: Seniors may use these products without special precaution.

Type of Drug
corticosteroids, Inhalers
(kor-tih-koe-STER-oids)
Brand Names
Generic Ingredient., Beclomethasone Dipropionate OVAR 40    OVAR 80
Budesonide
Pulmicort Flexhaler    Pulmicort Respules
Generic Ingredients: Budesonide + Formoterol Symbicort
Ciclesonide Alvesco
Flunisolide
AeroBid    Aerospan HFA
Fluticasone Propionate Flovent Diskus    Flovent HFA
Fluticasone Propionate + Salmeterol Xinafoate
Advair Diskus    Advair HFA
Mometasone Furoate Asmanex Twisthaler
Triamcinolone Acetonide Azmacort
Prescribed For
Chronic asthma and bronchial disease.
General Information
Corticosteroid inhalers relieve the symptoms associated with asthma and bronchial disease by reducing inflammation of bronchial mucous membranes, making it easier to breathe. Corticosteroid inhalers produce the same treatment effect as oral corticosteroids, with some important differences. Because inhalers deliver the drug directly to the lungs, smaller dosages can be used. They also have fewer side effects because little of the drug reaches the bloodstream. Corticosteroid inhalers can prevent asthma attacks if used regularly but do not relieve them once they start.
Cautions and Warnings
Do not use a corticosteroid inhaler if you are allergic or sensitive to any of its ingredients.
Corticosteroid inhalers should not be used as the primary treat- MV)~ of severe asthma. They are recommended only for people who take prednisone or another oral corticosteroid, or for people who do not respond to other asthma drugs. These drugs cannot relieve asthma attacks once they start.
In people with asthma, death from adrenal gland failure has occurred during and after switching from an oral corticosteroid to an inhaler. Adrenal function is impaired for several months after the
switch.
Those who use any corticosteroid product, including inhalation, are more likely to have reduced immune system function. This reduces the body’s ability to fight infection from any source, including chicken pox, shingles, and measles. Adults who have not had these viral infections should take care to avoid becoming infected while using any corticosteroid product. Do not receive a live virus vaccine while taking corticosteroids of any kind, as they interfere with the body’s reaction to the vaccine.
Combining an oral corticosteroid with a corticosteroid inhaler may cause pituitary gland suppression.
During a period of severe stress, you may have to switch to an oral corticosteroid if the inhaler does not control your asthma. During periods of stress or a severe asthmatic attack, people who have stopped using an inhaler should ask their doctors about taking an oral corticosteroid.
corticosteroid inhalers may be associated with immediate or delayed drug reactions, including breathing difficulties, rash, and bronchospasm.
Use corticosteroids with caution if you have respiratory tuberculosis, herpes of the eye, a bacterial, fungal, or parasitic infection, or any other untreated systemic infection.
The combination products Advair and Symbicort both contain beta-2 agonists. In some asthma patients, beta-2 agonists may increase the risk of asthma-related death. See Formoterol, page 509, and Salmeterol, page 1013, for more information on these drugs.
Possible Side Effects
V Most common: dry mouth, hoarseness, rash, bronchospasm, respiratory infections, fungal infection of the mouth, runny nose, headache, upset stomach, and palpitations.
V Rare: depression, cough, wheezing, infection, and facial swelling. Cough and wheezing are probably caused by an ingredient in the inhaler other than the corticosteroid itself. GW20 your doctor if you experience any side effect not listed above.
Drug Interactions
• Ketoconazole may increase blood levels of budesonide and fluticasone.
•    Using an inhaled corticosteroid and an oral corticosteroid together may increase the effect of both drugs. Use with
caution.
•    See Formoterol, page 509, for further drug interactions for the
combination product Symbicort.
•    See Salmeterol, page 1013, for further drug interactions for
the combination product Advair. Food Interactions
None known.
Usual Dose
geclomethasone
Adult and Child (age 13 and over): 2 inhalations (84 mcg) 3-4 times a day, or 4 inhalations twice a day. People with severe asthma may take up to 16 inhalations a day.
Child (age 6-12): 1-2 inhalations 3-4 times a day.
Child (under age 6): not recommended.
Budesonide
Adult: starting dose-200-400 mcg (1-2 inhalations) twice a day. Do not exceed 800 mcg a day.
Child (age 6 and over): 200 mcg (1 inhalation) twice a day. Do not exceed 400 mcg a day.
Child (under age 6): not recommended.
Budesonide Respules
Child (age 1-8): 1-2 ml once or twice a day via jet nebulizer connected to an air compressor.
Child (under age 1): consult your doctor.
Budesonide and Formoterol Inhalation
Adult and Child (age 12 and over): 2 inhalations morning and evening.
Child (under age 12): not recommended.
Ciclesonide
Adult and Child (qla 12 and over): 1-2 inhalations once a day. Mlld (under age 12): not recommended.
Flunisolide
Aerobid
Adult and Child (age 16 and over): 2 inhalations (500 mcg) morning and evening. Do not exceed 8 inhalations a day.
Child (age 6-15): 2 inhalations (500 mcg) morning and evening. Do not exceed 4 inhalations a day.
Child (under age 6): not recommended.
Aerospan HFA
Adult and Child (age 12 and over): 160-320 mcg morning and
evening.
Child (age 6-11): 80-160 mcg morning and evening. Child (under age 6): not recommended.
Fluticasone Inhalation
Adult and Child (age 12 and over): 88-660 mcg twice a day. Child (6-12): 88-440 mcg twice a day.
Child (under age 6): not recommended.
Fluticasone Diskus
Adult and Child (age 12 and over): 100-1000 mcg twice a day. Child (age 4-11): 50-100 mcg twice a day.
Child (under age 4): not recommended.
Fluticasone and Salmeterol
Advair Diskus
Adult and Child (age 12 and over): 1 inhalation morning and evening.
Child (under age 12): not recommended.
Advair HFA
Adult and Child (age 12 and over): 2 inhalations morning and evening.
Child (under age 12): not recommended.
Mometasone Furoate
Adult and Child (age 12 and older): 1-4 inhalations a day. If you take this drug only once a day, it should be taken in the afternoon or evening. Otherwise, doses should be divided between the morning and evening.
Child (under age 12): not recommended.
Triamcinolone
AdWAVi6 Child (age 13 and over): 2 inhalations (200 mcg) 3-4 times a day. Do not exceed 16 inhalations a day without your doctor’s knowledge.
Child (age 6-12): 1-2 inhalations (100-200 mcg) 3-4 times a day. Do not exceed 12 inhalations a day.
Child (under age 6): not recommended.
Overdosage
Serious adverse effects are unlikely. Excessive use of large amounts of an inhaled corticosteroid may cause overdose symptoms and require gradually stopping the drug. Call your local poison control center or a hospital emergency room for more information.
Special Information      People using both a corticosteroid inhaler and a bronchodilator, such as albuterol, should use the bronchodilator first, wait a few minutes, and then use the corticosteroid inhaler. This allows more corticosteroid to be absorbed.
These drugs are for preventive therapy only and will not affect an asthma attack. Inhaled corticosteroids must be taken regularly, as directed. Wait at least 1 minute between inhalations.
To properly take this medication, thoroughly shake the inhaler if it is one that must be shaken. Take a drink of water to moisten your throat. Place the inhaler 2 finger-widths away from your mouth and tilt your head back slightly. While activating the inhaler, take a slow, deep breath for 3-5 seconds. then hold your breath for about 10 seconds, and finally breathe out slowly. Allow at least 1 minute between puffs. Rinse your mouth after each use to reduce dry mouth and hoarseness.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose. Tell your doctor or pharmacist if you forget to take more than 1 dose.
Special Populations
Pregnancy/Breast-feeding: corticosteroids may cause birth defects or interfere with fetal development. When any of these drugs is considered crucial by your doctor, its potential benefits Must be carefully weighed against its risks.
It is not known if inhaled corticosteroids pass into breast milk, though oral corticosteroids do. Nursing mothers who must take an inhaled corticosteroid should use infant formula.
StniOrs: Seniors may use corticosteroid inhalers without special restriction. Tell your doctor if you have bone or bowel disease, colitis, diabetes, glaucoma, fungal or herpes infections, high blood pressure, high blood cholesterol, an underactive thyroid, or heart, kidney, or liver disease.

Type of Drug
Corticosteroids, Nasal
(kor-tih-koe-STER-oids)
Brand Names
Wectomethasone Dipropionate Beconase AQ
Budesonide Rhinocort
Ciclesonide Omnaris
Flunisolide RE Nasarel
Fluticasone Furoate Veramyst
Fluticasone Propionate Flonase
Mometasone Furoate Monohydrate Nasonex
Triamcinolone Acetonide Nasacort AQ
Prescribed For
Rhinitis (nasal inflammation) associated with seasonal or chronic allergy and other causes; also used to prevent recurrence of nasal polyps.
General Information
Nasal corticosteroids are used to treat severe symptoms of seasonal allergy that have not mSpDrided to other drugs such as deQQQgtS%TAS. ‘They work by reducing inflammation of the mucous membranes that line the nasal passages, making it easier to breathe. These drugs may take several days to produce an effect. Some nasal corticosteroids are approved for both allergic and non-allergic rhinitis.
Cautions and Warnings    __  allergic or sensitive Do not use a nasal corticosteroid if you ate alle
to corticosteroids. Rarely, serious and life-threatening drug-sensitivity reactions have occurred.
very rarely, deaths caused by failure of the adrenal gland have occurred in people taking adrenal corticosteroid tablets or syrup who were switched to a nasal corticosteroid. This is a rare complication and usually results from stopping the liquid or tablets suddenly instead of gradually.
Combining prednisone or another oral corticosteroid with a nasal corticosteroid may cause pituitary gland suppression, although nasal corticosteroids alone rarely cause this problem.
Use nasal corticosteroids with caution if you have tuberculosis, chicken pox, measles, shingles, or any serious fungal, bacterial, or viral infection.
Do not receive a live virus vaccine while taking corticosteroids of any kind, as they interfere with the body’s reaction to the vaccine.
Rarely, nasal Candida infections develop in people using a nasal corticosteroid. These infections may require treatment with an antifungal drug, as well as the discontinuance of the nasal corticosteroid.
During a period of severe stress, you may have to switch to an oral corticosteroid drug if the nasal form does not control your symptoms.
Children using nasal corticosteriods may experience reduction in growth velocity.
Possible Side Effects
✓    Most common: mild irritation of the nose, nasal passages,
and throat; burning; stinging; dryness; and headache.
♦    Less common: lightheadedness, nausea, nosebleed or bloody mucous, unusual nasal congestion, bronchial asthma, sneezing attacks, runny nose, sore throat, and loss of the sense of taste.
✓    Rare: ulcers 0 Vie nasal passages, watery eyes, vomiting. hypersensitivity reactions (symptoms include itching, rash, swelling, bronchospasms, and breathing difficulties), nasal infection, wheezing, perforation of the wall between the nostrils, and increased eye pressure. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Do not use fluticasone propionate with ritonavir.
•    Ephedrine, phenobarbital, and rifampin may decrease the effect of nasal corticosteroids.
•    Use caution when combining ketoconazole with any nasal corticosteroid.
Usual Dose
Beclomethasone
Adult and Child (age 13 and over): 1 spray (42 mcg) in each nostril 2-4 times a day.
Child (age 6-12): 1 spray (42 mcg) in each nostril 3 times a day. Child (under age 6): not recommended.
Budesonide
Adult and Child (age 6 and over): 2 sprays (64 mcg) in each nostril morning and evening, or 4 sprays in the morning.
Child (under age 6): not recommended.
Ciclesonide
Adult and Child (age 12 and over): 2 sprays (50 mcg/spray) in each nostril once a day.
Child (under age 12): not recommended.
Flunisolide
Adult and Child (age 15 and over): 2 sprays (50 mcg) in each nostril twice a day to start; may be increased up to 8 sprays a day in each nostril.
Child (age 6-14): 1 spray (25 mcg) in each nostril 3 times a day, or 2 sprays in each nostril twice a day.
Child (under age 6): not recommended.
Fluticasone Furoate
Adult and Child (age 12 and over): 2 sprays in each nostril once a date to start. Dose may be reduced to 1 spray in each nostril afer symptoms are controlled.
Child (age 2-11): 1    Yi) each nostril once a day.
C’%Ab junder age 2): riot recommended.
Fluticasone Propionate
Adult: 2 sprays (100 mcg) in each nostril once a day or divided in 2 doses, to start. Dosage may be reduced in half in a few days, if tolerated.
Child (age 4 and over): 1 spray (50 mcg) in each nostril once a day; may be increased to 2 sprays a day in each nostril, if needed. Child (under age 4): not recommended.
Mometasone
Adult and Child (age 12 and over): 2 sprays (100 mcg) in each nostril once a day; may be increased to 4 sprays a day in each nostril.
Child (under age 12): not recommended.
Triamcinolone
Adult and Child (age 13 and over): 2 sprays (220 mcg) in each nostril once a day; may be increased to 4 sprays a day in each nostril.
Child (age 6-12): 1 spray in each nostril once a day; may be increased to 2 sprays a day in each nostril, if needed.
Child (under age 6): not recommended.
Overdosage
Serious adverse effects are unlikely after accidental ingestion. Rarely, excessive use of large amounts of nasal corticosteroids may cause overdose symptoms such as irregular menses, acne, facial puffiness, and weight gain. These symptoms require gradual, not immediate, discontinuation of the drug. Call your local poison control center or a hospital emergency room for more information. ALWAYS bring the presciption container.
Special Information
It may be necessary to clear your nasal passages with a nasal decongestant before using a nasal corticosteroid to allow it to reach the mucous membranes.
Some of these drugs take 10-14 days to start working. Beclomethasone, budesonide, and triamcinolone work faster. in 3-7 days: ciclesonide starts working within 1 or 2 days and shows additional benefits after several weeks of use; in some cases, triamcinolone and budesonide provide relief in 12 hours. FWT isolide may take up to 2 weeks. Do not use -any of these drugs continuously for more tha”‘3 weeks unless you have experienced a def- fttlbenefit.
If you are using more than one spray at a time, wait at least 1 minute between sprays.
Nasal corticosteroids may cause irritation and drying of mucous membranes in the nose. Call your doctor if this effect persists or if symptoms get worse.
Call your doctor if you are exposed to measles or chicken pox while using an of these medicines.
People using a nasal corticosteroid to prevent the return of nasal polyps after surgery may experience nosebleeds because the drug can slow healing of the wound.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Taking large amounts of corticosteroids during pregnancy may slow fetal growth. While the small amount of drug absorbed into the blood after nasal application is unlikely to have any effect, consult your doctor before taking any corticosteroid if you are or might be pregnant.
Dexamethasone passes into breast milk. Nursing mothers who must use this drug should use infant formula. It is not known if other nasal corticosteroids pass into breast milk, though oral corticosteroids do. Nursing mothers should consider using infant formula.
Seniors: Seniors may use nasal corticosteroids without special restriction. Tell your doctor if you have bone or bowel disease, colitis, diabetes, glaucoma, fungal or herpes infections, high blood pressure, high blood cholesterol, an underactive thyroid, or heart, kidney, or liver disease.

Generic Name
colchicine (KOLE-chih-sene)
Type of Drug Antigout medication.
Prescribed For
Prevention and treatment of gouty arthritis; also prescribed for Mediterranean fever; chronic progressive multiple sclerosis; cirrhosis of the liver; biliary cirrhosis; Beh~et’s disease’, pseudogout (a condition caused by calcium deposits); amyloidosis; very low blood-platelet count (also known as ITP); skin reactions, including scleroderma, psoriasis, Sweet Syndrome, and other conditions; and nerve disability associated with chronic progressive multiple sclerosis.
General Information
While no one knows exactly how colchicine works, it appears to help people with gout by reducing the inflammatory response to uric acid crystals that form inside joints and by interfering with the body’s mechanism for making uric acid. Unlike drugs that affect uric acid levels, colchicine does not block the progression of gout to chronic gouty arthritis; it will, however, relieve the pain of acute attacks and lessen the frequency and severity of attacks. It has no effect on other kinds of pain.
Cautions and Warnings
Do not use colchicine if you are allergic or sensitive to any of its ingredients or you suffer from any serious blood, kidney, liver, stomach, or cardiac condition.
Vomiting, abdominal pain, diarrhea, nausea, kidney damage, and blood in the urine may occur with colchicine, especially at maximum doses. This can worsen existing gastrointestinal (GI) or other conditions. Stop taking the medication and call your doctor if you develop one of these symptoms.
She weakness that people develop while taking colchicine is frequently related to high levels of colchicine in the blood caused by poor kidney function and improves without treatment 3-4 weeks after the drug is stopped. This reaction is often mistaken for other conditions.
Periodic blood counts should be done if you are taking
colchicine for long periods of time.
Colchicine interferes with the absorption of vitamin B12 by af-
fecting the lining of the GI tract.
Colchicine may affect the process of sperm generation in men. The safety and effectiveness for use by children have not been
established.
Possible Side Effects
V Common: vomiting, diarrhea, and abdominal pain may occur if you take maximum doses of colchicine for an acute gout attack. You may also experience severe diarrhea, kidney and blood-vessel damage, blood in the urine, and reduced urination.
✓    Less common: hair loss, rash, appetite loss, and muscle and nerve weakness.
✓    Rare: with long-term colchicine therapy—reduced whiteblood-cell and platelet counts, nerve inflammation, blood-clotting problems, rash, unusual bleeding or bruising, tingling in the hands or feet, red or purple spots under the skin, and other reactions. Colchicine may interfere with sperm formation. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Colchicine interferes with the absorption of vitamin B12.
•    Colchicine may increase sensitivity to central-nervoussystem depressants, such as sedatives and alcohol.
•    The following drugs may reduce colchicine’s effectiveness: anticancer drugs, bumetanide, diazoxide, thiazide diuretics, ethacrynic acid, furosemide, mecamylamine, pyrazinamide, and triamterene.
•    Taking phenylbutazone with colchicine increases the risk of side effects.
•    Mixing the anitiiofic clarithromycin with colchicine can lead to colchicine toxicity, especially in the elderly and those with kidney disease.
Food Interactions None known.
Usual Dose
Acute Gout Attack: 1-1.2 mg. This dose may be followed by 0.51.2 mg every 1-2 hours until pain is relieved or nausea, vomiting, or diarrhea occurs. The total dose needed to control pain and in-
flammation during an attack varies from 4-8 mg.
Gout Prevention: 0.5-1.8 mg daily. In mild cases, 0.5 mg or 0.6 mg may be taken 3-4 days a week.
Familial Mediterranean Fever: 1-2 mg a day.
Cirrhosis of the Liver: 1 mg a day for 5 days each week. Biliary Cirrhosis: 0.6 mg twice a day.
Amyloidosis: 0.5 mg 1-2 times a day.
Behqet’s Disease: 0.5-1.5 mg a day.
Pseudogout: 0.6 mg twice a day.
ITP: 1.2-1.8 mg a day for 2 weeks or more.
Scleroderma: 1 mg a day.
Sweet Syndrome: 0.5 mg 1-3 times a day.
Other Skin Disorders: up to 1.8 mg a day, depending on the specific condition.
Overdosage
The lethal dose is estimated at 65 mg, although people have died after taking as little as 7 mg at once. Usually 1-3 days pass between the time that an overdose is taken and symptoms begin. Overdose symptoms start with nausea, vomiting, stomach pain, diarrhea—which may be severe and bloody—and burning sensations in the throat or stomach or on the skin. If you think you are experiencing overdose symptoms, contact your doctor immediately, or go to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop rash, sore throat, fever, unusual bleeding or bruising, tiredness, weakness, numbness, or tingling. Seniors are move 4,ialy to develop drug side effects and should use this drug with caution.
Stop taking maximum doses of colchicine as soon as gout pain is relieved and reduce your dose to a maintenance level if your doctor has prescribed it for gout prevention. Stop taking the drug entirely and contact your doctor at the first sign of nausea, vomiting, stomach pain, or diarrhea.
If you forget a dose of colchicine, take it as soon as possible. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: colchicine can harm the fetus. Pregnant women should not take it unless the potential benefits clearly outweigh the risks.
It is not known if colchicine passes into breast milk. No problems with nursing infants are known, but nursing mothers who must take colchicine should consider using infant formula.
Seniors: Seniors, especially those with renal, hepatic, gastrointestinal, or heart disease, are more likely to develop side effects and should use colchicine with caution.

Type of Drug
Contraceptives
Plan B
Prescribed For
Prevention of pregnancy, endometriosis, excessive menstruation, and cyclic withdrawal bleeding. Ortho Tri-Cyclen and Estrostep may be prescribed for moderate acne in women over age 15.
General Information
Contraceptive drugs are synthetic hormones containing either progestin or a progestin-estrogen combination. The overall effects of any contraceptive are influenced by the interaction of all active ingredients, including those Huth -&))Otogenic and anti-estrogenic aqtk%(kkj.’%tte drugs are similar to natural female hormones, which cannot be used as contraceptives because very large dosages would be required. Synthetic hormones are more potent and are effective at smaller dosages. Contraceptive drugs work by preventing sperm from reaching the unfertilized egg, preventing the implantation of a fertilized egg in the uterus, or preventing ovula-tion (the release of an unfertilized egg from the ovaries). They prevent acne by balancing hormone levels.
When properly used, hormonal contraceptives can be 97-99% effective at preventing pregnancy. These products vary in their etfectiveness, and in the amount and type of estrogen or progestin used. The side effects of these drugs tend to increase with the amount of hormone they contain. While low hormone dosages are preferred, contraceptives with the smallest amounts of estrogen may be less effective in some women than others.
Single-phase products provide constant levels of estrogen and progestin throughout the entire month-long pill cycle. In 2-phase combinations, the amount of estrogen remains at a steady low level throughout the cycle, while progestin levels increase and then decrease. This variation in progestin allows normal changes to take place in the uterus. Three-phase products are meant to simulate the normal hormone cycle and reduce breakthrough bleeding. Throughout the cycle, estrogen levels remain the same while those of progestin change to create a 3-part wave pattern. The amount of estrogen in 3-phase products is considered low. Breakthrough bleeding may occur with the older combination products from day 8 through 16 of the cycle.
The mini-pill, a progestin-only product, may cause irregular menstrual cycles and may be less effective than estrogenprogestin combinations. Mini-pills may be recommended to older women or women who should avoid estrogens (see “Cautions and Warnings”).
The contraceptive patch releases small amounts of progestin and estrogen continuously over 3 weeks. The medication is absorbed into the blood vessels just below the skin. The patch works in the same way as contraceptive pills do.
The vaginal ring releases small amounts of etonogestrel, a progestin, and estradiol, an estrogen, in the vaginal canal over 3 weeks. The combination prevents pregnancy in the same way as combination pills do but may be less effective than contraceptive pills because some people find them harder to use.
Most contraceptive drugs are designed to simulate a normal Mt%VwM cycle. By not taking the hormones 1 week out of the month, you continue to have your regular period. In fact, these products are often used to stabilize a woman’s period. Two products, Seasonale and Seasonique, come in an 84-pill packet and are taken once a day for 3 months. This means you will only have your period once every 3 months. Another, Lybrel. is designed to be taken every day, eliminating monthly menstruation. Drosperinone, the progestin found in Yasmin and Yaz, has been found to relieve Premenstrual Syndrome (PMS) symptoms in addition to acting as an effective contraceptive hormone.
Levonorgestrel, a progestin, is used in implants that provide effective contraception for up to 5 years after surgical implantation under the skin of the upper arm or inside the uterus. Levonorgestrel implants should be replaced at least once every 5 years. Etonorgestrel implants are effective for 3 years. Implants can be removed at any time, reversing the contraceptive effect. The progestin intrauterine inserts provide effective contraception for about 1 year. The implant and intrauterine systems contain the same hormone found in the mini-pill and are associated with many of the same side effects and precautions as oral contraceptives.
Emergency contraceptives (sometimes referred to as the “morning-after pill”) contain high doses of estrogen and progestin. They are intended for use only after contraceptive failure or unprotected intercourse. They should never be taken by a pregnant woman.
Contraceptive drugs in any form are associated with risks. These risks are greatest in women over age 35 who smoke and have high blood pressure.
Cautions and Warnings
Do not take contraceptives if you are allergic or sensitive to them or any of their ingredients.
The risk of breast cancer may be slightly higher among current and recent users of combination oral contraceptives. This risk appears to decline after contraceptive use is stopped and is gone by 10 years after stopping combination contraceptive products. Breast cancers found in contraceptive users tend to be less advanced than those in non-contraceptive users.
You should not use contraceptive drugs if you are or might be pregnant, have had blood clots in veins or arteries, stroke, any blood-coagulation disorder, known or suspected cancer 0 the breast, sex organs, or liver. Products With more estrogen, or those t43.t jmmdr3higher sustained blood levels of estrogen, such as the contraceptive patch, are more likely to be associated with an increased risk of life-threatening blood clots.
Contraceptive drugs may cause eye lesions. Call your doctor at once if you develop visual difficulties of any kind.
Women taking the combination products Seasonale and Seasonique will have their period only once every 3 months and those taking Lybrel will not have a regular monthly period. It is absolutely essential for you to verify you are not pregnant if you think you may be pregnant for any reason.
The risks of contraceptive drugs increase if you are physically immobile or have asthma; cardiac insufficiency; epilepsy; migraine; kidney problems; a strong family history of breast cancer; benign breast disease; diabetes; endometriosis; gallbladder disease or gallstones; liver problems, including jaundice; high blood cholesterol; high blood pressure; estrogen or progestin intolerance; depression; tuberculosis; or varicose veins.
There is an increased risk of heart attack in women who have used contraceptive drugs for more than 5 years, or who are between age 40 and 49 and have other coronary risk factors such as smoking. obesity, high blood pressure, diabetes, and high blood cholesterol. This risk remains even after the medication is stopped.
Smokers in their mid-30s or older who use contraceptive drugs are 5 times more likely to have a heart attack than nonsmokers taking contraceptives and 10-12 times more likely to have a heart attack than nonsmokers who do not use the pill. Death due to circulatory disease also increases substantially in smokers taking contraceptive drugs, especially in women at least 35 years old. The risk of stroke is also increased in this group. Heavy smokers (more than 15 cigarettes a day) should not use hormonal contraceptives.
Women with a history of headaches, high blood pressure, or varicose veins should avoid estrogen-containing products, as Should older women and those who have experienced estrogen side effects.
Contraceptive drugs may mask the onset of menopause. Progestin-only products are associated with an increased risk of blood-clotting problems.
The progestin in Yasmin and Yaz raises blood potassium levels. Women with kidney, liver,,Dy adrenal gland disease should use eittlp_C pIrjdUcj with caution.
Intrauterine inserts have been associated with an increased risk of pelvic inflammatory disease (PID). The highest risk usually occurs within the first 20 days after insertion. Do not use intrauterine inserts if you have had an ectopic pregnancy.
Toxic Shock Syndrome has been associated with tampons, some barrier contraceptives, and the vaginal ring, although there is no proof that the product was the cause of the infection.
Possible Side Effects
♦ Common: Common side effects often result from using a product that is poorly suited to your body chemistry. Determining the right amount and type of hormone often minimizes these effects. If you are taking too much estrogen, you may experience nausea, bloating, high blood pressure, migraine, excess cervical mucous, skin discoloration, colon polyps, water retention, and swelling, or breast fullness or tenderness. Too little estrogen may cause early or mid-cycle breakthrough bleeding, spotting, or reduced periodic flow. Too much progestin is associated with weight gain and increased appetite, tiredness or fatigue, low periodic flow, acne, depression, breast regression, and androgen-related side effects (acne, oily scalp, hair loss, or excess hair growth). Too little progestin may cause late breakthrough bleeding, excessive periodic bleeding, or missed periods.
✓    Less common: abdominal cramps, infertility after discontinuance of the drug, breast tenderness, weight change, headache, rash, vaginal itching and burning, general vaginal infection, nervousness, dizziness, depression, cataracts, changes in sex drive, hair loss, and increased sensitivity to the sun.
✓    Rare: Women who use contraceptive drugs are more likely to develop several serious conditions, including blood clots in the deep veins, stroke, heart attack, liver cancer, gallbladder disease, and high blood pressure. Women who smoke cigarettes are at much higher risk for some of these adverse effects. Contact your doctor if you experience any side effect not listed above.
brug Interactions
•    Ampicillin, barbiturates, bexarotene, bosentan, carbamazepine, chloramphenicol, efavirenz, fluconazole, griseofulvin, ketoconazole, neomycin, nelfinavir, nitrofuratoin, oxcarbazepine, phenylbutazone, phenytoin, penicillin drugs, protease inhibitor drugs for HIV, rifampin, rifapentine, statin drugs (atorvastatin and rosuvastatin), St. John’s wort, sulfa drugs, tetracycline products, and sedatives can make all contraceptive drugs less effective. Use backup birth control while taking these medications together.
•    Contraceptive drugs may elevate blood levels of benzodiazepine sedatives and sleeping pills (midazolam, lorazepam, oxazepam, and temazepam), caffeine, cyclosporine, imatinib, metoprolol, corticosteroids, theophylline drugs, tizanidine, triptan-type migraine drugs, and tricyclic antidepressants, increasing the risk of side effects. Discuss mixing these medicines with your doctor. Dosage reductions may be needed.
•    Contraceptive drugs may increase the toxic liver effects of acetaminophen and reduce the drug’s effectiveness. Contraceptive drugs may increase or decrease the effect of anticoagulant (blood-thinning) drugs. Discuss the risks of this combination with your doctor.
•    Mycophenolate interferes with only those contraceptives that contain levonorgestrel (Alesse, Aviane, Lessina. Levora, Levlite, Lutera, Lybrel, Mirena, Nordette, Norplant II, Portia, Plan B, Seasonale, Seasonique, and Triphasil). Backup contraception is recommended.
•    Exenatide may reduce the effectiveness of contraceptive pills.
Take them at least 1 hour before an injection of exenatide.
•    Contraceptive drugs may reduce the effectiveness of clofibrate for elevated blood triglycerides, sulfonylurea drugs for diabetes, ursodiol for gallbladder disease, and pain relievers, including salicylates (aspirin).
•    Contraceptive drugs may increase blood-cholesterol levels and interfere with blood tests for thyroid function and blood sugar.
•    Acetaminophen may increase blood levels of ethinyl estradiol, a common contraceptive drug ingredient, increasing side effects and reducing contraceptive effectiveness.
•    Since Yasmin and Yaz raise blood potassium levels, nether should be used if you ate taking spironolactone or anD)ftr potassium-sparing diuretic, potassium supplements, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor antagonists, aldosterone antagonists, heparin, non-steroidal anti-inflammatory drugs (NSAIDs), or other medications on a long-term basis that may further increase potassium levels.
•    Contraceptive drugs may interfere with the effects of insulin
for diabetes.
•    Acitretin interferes with the contraceptive effect of progestin-
only mini-pills. It is not known if it also interferes with combination contraceptive drugs.
Food Interactions
None known. Usual Dose
Single-Phase, 2-Phase, and 3-Phase Combinations: The first day of bleeding is day 1 of the menstrual cycle. Beginning on the first day of the cycle, take 1 pill a day for 20-21 days according to the number of pills supplied by the manufacturer. If menstrual flow has not begun 7 days after taking the last pill, begin the next month’s cycle of pills. Some manufacturers recommend starting the pills on a Sunday to make it easy to remember to take them. In this case, start taking your pills on the first Sunday after your period begins. If menstruation begins on a Sunday, take the first pill that day.
Seasonale: Take 1 pink tablet every day for 84 consecutive days. Do not skip a day. Then, take 1 white pill a day for 7 days. Then, start a new pill cycle. You may be pregnant if you do not have a period while you are taking the white pills.
Seasonique: Take 1 light blue-green tablet containng levonorgestrel and ethinyl estradiol daily for 84 consecutive days, followed by 7 days of ethinyl estradiol tablets. Do not stop if spotting or breakthrough bleeding occurs. Report prolonged bleeding to your doctor.
Progestin-Only Mini-Pill: Take 1 pill every day.
Contraceptive Patch: Apply a new patch to the thigh, abdomen, or arm. Remove the patch after 3 weeks and then reapply a new patch after 1 week. Be sure to always apply a new patch on the same day of the week. If you are switching from birth control pmts, apply the first patch on the same day you would start a new cycle of pills.
Vaginal Ring: Keep the vaginal ring in the vaginal canal for 3 weeks. Remove it and put a new one in 1 week later. If you did not use a hormonal contraceptive in the previous month, insert the ring between day 1 and day 5 of your cycle.
If you are switching from a combination birth control pill, insert the ring anytime during the week after you took your last pill but before you would have started your next cycle of pills. No additional contraception is necessary.
If you are switching from a mini-pill, insert the ring on the day after you take your last mini-pill.
If you are switching from a progestin implant or an IUD, insert the ring on the same day your implant or IUD is removed.
If you are switching from a progestin injection, insert the ring on the same day you would have received your next injection.
If you are switching from a progestin-only mini-pill, implant, injection, or IUD, use another form of contraception for the first 7 days after you insert the ring.
Emergency Contraception: Emergency contraceptive kits have only a few pills. They should be taken with a full meal. Take half the pills (1 or 2 depending on the brand you use) within 72 hours of unprotected sex, however they are most effective when taken within the first 24 hours. Take the rest of the pills 12 hours after the first dose. Emergency contraceptives reduce the risk of pregnancy by 75%.
The pregnancy test in the kit can be used to determine if you became pregnant earlier in your cycle or during a previous cycle. If the test is positive, consult your doctor before taking emergency contraception. If you vomit within one hour of taking either dose, contact your doctor.
Overdosage
An overdose may cause nausea and withdrawal bleeding in adult women. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription package.
Special Information
Use backup birth control to prevent pregnancy in the first 3 weeks after you begin taking contraceptive drugs.
Contraceptive drugs do not protect against sexually transmitted diseases.
VM your pill at the same time each day to establish a routine and ensure maximum contraceptive protection.
Call your doctor immediately if you experience severe abdominal pain; severe or sudden headache; pain in the chest, groin, or leg, especially the calf; sudden slurring of speech; changes in vision; weakness, numbness, or pain in the arms or legs; coughing up of blood; loss of coordination; or shortness of breath. These symptoms may require emergency treatment.
Other problems that may require medical attention are bulging eyes; changes in vaginal bleeding; fainting; frequent or painful urination; a gradual increase in blood pressure; breast lumps or secretions; depression; yellowing of the skin or whites of the eyes; rash; redness or irritation; upper abdominal swelling, pain, or tenderness; an unusual or dark-colored mole; thick, white vaginal discharge; or vaginal itching or tenderness.
See your doctor for a check-up every 6-12 months.
Some manufacturers include 7 inert or iron pills in their packaging to be taken on days when the drug is not taken. This makes it easier for women to stay on schedule with their pills. The 7 pills bridge the gap between contraceptive cycles and allow women to take 1 pill every day without stopping.
For single- or 2-phase combinations: If you forget to take a pill for 1 day, take 2 pills the following day. If you miss 2 consecutive days, take 2 pills for the next 2 days. Then return to your schedule of 1 pill a day. If you miss 3 consecutive days, do not take any pills for the next 7 days and use another form of contraception; then start a brand new cycle.
Seasonale: The risk of pregnancy increases with each pink tablet you forget. Use another method of non-hormonal backup contraception any time you miss 2 or more pink tablets until you have taken a pink tablet every day for 7 consecutive days. You are protected against pregnancy if you miss 1 or more white tablets, as long as you begin taking the pink tablets again on the proper day.
Seasonique: The risk of ovulation and pregnancy increases with each forgotten light blue-green pill. If you miss 1 light blue-green pill, take it as soon as you remember and take the next pill at your regular time. This may mean you will take 2 pills on the same day. You don’t need to use a backup birth control method if you forget only 1 pill. If you forget 2 light blue-green pills in a row, take 2 pills on the day you remember and take 2 pills the ReYA day. -Then go back to taking 1 pill a day MMI you finish your pack. If you miss 2 01 MbreYight blue-green pills in a row, you must use non-hormonal backup contraception until you have taken a light blue-green pill daily for 7 days in a row. If you miss 1 or more yellow tablets, you are still protected against pregnancy provided you begin taking light blue-green pills again on the proper day.
For 3-phase combinations: If you forget to take a pill for 1 day, take 2 pills the following day. If you miss 2 consecutive days, take 2 pills for the next 2 days. Then return to your schedule of 1 pill a day. If you forget to take a pill for 3 days in a row, stop taking the drug and use an alternate means of contraception until your period starts. ALWAYS use a backup contraceptive method for the remainder of your cycle if you forget even 1 pill of a 3-phase combination.
If you forget to apply the contraceptive patch on the same day of the week once every 4 weeks, you risk a loss of effectiveness on the days after you should have applied it. If the patch comes off or is partially detached in mid-cycle, you must start a new 3-week cycle at once by removing the old patch and applying a new one.
If the vaginal ring is accidentally expelled during the 3 weeks it is normally retained, rinse it off with water and replace it within 3 hours. Do not use hot water. If the ring is not reusable, insert a new ring and continue with your regular schedule. If you do not replace the ring within 3 hours, its effectiveness may be reduced. If you are in week 3 of the cycle, throw the ring away; you may insert a new one immediately, which will begin a new 3-week cycle and cause you to skip a period. Or, you may wait a week, during which time you will have periodic bleeding, and insert a new ring no later than 7 days after the vaginal ring was expelled. This option should be chosen if you had used the ring for 7 days in a row before it was expelled.
If, when it is expelled, you are in week 1 or 2 of your cycle and the ring is out for more than 3 hours, reinsert it and use an additional form of contraceptive until the ring has been worn for 7 consecutive days. A vaginal ring may break and then slip out or cause discomfort. Throw the ring away if this happens.
Missing a pill reduces your protection. If you keep forgetting to take your pills, you must use another birth control method.
If you take drugs that reduce the effectiveness of contraceptive drugs (see “Drug Interactions”), use a backup contraceptive method during that cycle to PMNeiA accidental pregnancy.
GOOD tlL:Inlal hygiene is essential while taking contraceptive drugs. See your dentist regularly and brush and floss carefully because contraceptive drugs may increase the risk of an oral infection.
Contraceptive drugs may increase your sensitivity to the sun.
Wearing contact lenses may be uncomfortable while taking contraceptive drugs because the pills can cause minor changes in the shape of your eyes.
All contraceptive prescriptions come with a “patient package insert.” Read it thoroughly as it gives detailed information about the drug and is required by federal law.
Special Populations
PregnancylBreast-feeding., Contraceptive hormones cause birth defects and may interfere with fetal development. They are not safe for use during pregnancy. If you think you are pregnant, use another form of contraception and stop taking your birth control pills.
Contraceptive hormones pass into breast milk. Combination contraceptive products reduce the amount of milk produced. Nursing mothers who must use any of these drugs should use infant formula.
Seniors: These products are not intended for women who have completed menopause.

Generic Name
Clotrimazole (kloe-TRIM-uh-zole) 0
Brand Name Mycelex
The information in this profile also applies to the following drug:
Generic Ingredient: Sertaconazole Ertaczo
Type of Drug Antifungal.
Prescribed For
Fungal infections of the mouth, skin, and vaginal tract.
General Information
clotrimazole is useful against a variety of fungal organisms that other drugs do not affect. The exact way in which clotrimazole works is unknown. Sertaconazole is used for athlete’s foot in people age 12 and older with compromised immune systems.
Cautions and Warnings
Do not use this product if you are allergic or sensitive to any of its ingredients.
If clotrimazole causes local itching or irritation, stop using it. Do not use clotrimazole in your eyes.
Proper diagnosis is essential for effective treatment. Do not use this product without first consulting your doctor.
Possible Side Effects
Side effects are infrequent and usually mild.
Cream and Solution
V Most common: redness, stinging, blistering, peeling, itching, and swelling of local areas.
Vaginal Tablets
♦ Most common: mild burning, rash, mild cramps, and frequent urination. Your sexual partner may also experience some burning or itching.
Lozenges
V Most common: stomach cramps or pain, diarrhea, nausea, and vomiting.
Drug Interactions
None known.
Food %%ractions
The oral form of clotrimazole is best taken on an empty stomach, at least 1 hour before or 2 hours after meals. However, you may take it with food as long as you allow the lozenge to dissolve fully in your mouth.
Usual Dose
Topical Cream and Solution
Adult and Child (over age 2): Apply to clean, dry, affected areas morning and night for 7 consecutive days or as needed. For athlete’s foot and ringworm, use daily for 4 weeks. For jock itch, use daily for 2 weeks.
Vaginal Cream
Adult: 1 applicator’s worth at bedtime for 3-7 consecutive days.
Vaginal Tablet
Adult: 1 tablet inserted into the vagina at bedtime for 3 days, or 2 tablets a day for 3-7 consecutive days.
Lozenge
Adult and Child (over age 3): 1 lozenge 5 times a day for 2 weeks or more.
Overdosage
Little is known about the effects of clotrimazole overdose or accidental ingestion. Call your local poison control center for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
If treating a vaginal infection, you should refrain from sexual activity. Call your doctor if burning or itching develops or if the condition does not improve within 7 days.
If you are using the vaginal cream, you may want to wear a sanitary napkin to avoid staining your clothing. Do not use a tampon during treatment.
Dissolve the lozenge slowly in the mouth. This may take up to 30 minutes.
This medicine must be taken on consecutive days. If you forget a dose of oral clotrimazole, take it as soon as you remember. Do not double your dose.
When using clotrimazole for skin infections, do not cover the area with any kind of bandage unless directed to do so by your doctor. For athlete’s foot, wear well-fitting, ventilated shoes, and change your socks at least once a day.
clotrimazole is not effective on scalp or nails.
Special Populations
Pregnancy/Breast-feeding: Women who are or might be pregnant should talk to their doctor about the medication’s risks and benefits. Women who are in the first 3 months of pregnancy should use this drug only if directed to do so by their doctor. If you are pregnant, your doctor may want you to insert vaginal tablets by hand rather than use a vaginal applicator.
It is unknown whether the drug passes into breast milk. Use with caution or use infant formula.
Seniors: Seniors may use this medication without special precaution.

Generic Name
Clozapine (KLOE-zuh-pene) 03
Brand Names
Clozaril    FazaClo Orally Disintegrating Tablets
Type of Drug  Antipsychotic.
Prescribed For  Severe schizophrenia.
General Information
Clozapine is a unique antipsychotic that has the capacity to treat people who do not respond to or cannot tolerate other drugs. It works by a mechanism that differs from those of other antipsychotic drugs.
A very small number of people who take clozapine develop a rapid drop in their white-blood-cell count, known as agranulocytosis. This effect usually reverses itself when the drug is stopped, but the drug must be stopped as soon as it is discovered. An unusually large number of people who have developed clozapine algllaTwlocytosis in the United States are of Eastern European Jewish descent, but the association is not very strong. Most cases of agranulocytosis occur between week 4 and week 10 of treatment. It is essential that blood samples be taken approximately every week and for 4 weeks after the drug is stopped to watch for this effect. Because of the risk of agranulocytosis, clozapine should not be tried until at least 2 other antipsychotic medicines have failed.
Some people taking antipsychotic drugs develop tardive dyskinesia, a potentially irreversible condition marked by uncontrollable movements. Tardive dyskinesia has not been seen in patients taking clozapine, a major advantage of this drug over other antipsychotic medicines. However, there is still a risk that this set of symptoms could occur with clozapine.
Cautions and Warnings
Do not take clozapine if you are allergic or sensitive to any of its ingredients.
Women, seniors, people with serious illnesses, those who are emaciated. those with a history of diseases affecting the white blood cells, or those who are taking other medication that could affect white blood cells may be more susceptible to clozapine agranulocytosis.
Clozapine has been associated with increased mortality in seniors with dementia or Alzheimer’s disease. The specific causes of death related to clozapine and other atypical antipsychotic drugs were either due to a heart-related event or infection, mostly pneumonia. Clozapine should not be taken by those with dementia-related psychosis.
About 5% of people taking the drug experience a seizure in the first year of treatment. Seizure is most likely to occur at higher drug doses.
People with heart disease should be carefully monitored while on clozapine because of possible cardiac risks.
Clozapine may cause low blood pressure, especially at the beginning of therapy.
Clozapine has been associated with obesity, high cholesterol, high blood sugar, and diabetes. Diabetics and pre-diabetics (people with elevated blood sugar and a family history of diabetes) should be carefully monitored.
A serious set of side effects, known as neuroleptic malignant syndrome (NMS), includes a high lever and has been associated With clozapine when it is used together with lithium or other drugs. The symptoms that constitute NMS include muscle rigidity, mental changes, irregular pulse or blood pressure, increased sweating, and abnormal heart rhythm. NMS is potentially fatal and requires immediate medical attention.
Use this drug with caution if you have glaucoma, prostate
problems, or liver or kidney disease.
clozapine may interfere with mental or physical abilities because of the sedation it usually causes during the first few weeks
of treatment.
Possible Side Effects
✓    Most common: rapid heartbeat, low blood pressure, dizziness, fainting, drowsiness or sedation, salivation, and constipation.
✓    Less common: headache, tremor, sleep disturbance, restlessness, slow muscle motions, absence of movement, agitation, convulsions, rigidity, restlessness, confusion, sweating, dry mouth, visual disturbances, high blood pressure, nausea, vomiting, heartburn or abdominal discomfort, fever, and weight gain.
♦    Rare: agranulocytosis (symptoms include fever with or without chills, sore throat, and sores or white spots on the lips or mouth), tardive dyskinesia (symptoms include lip smacking or puckering, puffing of the cheeks, rapid or wormlike tongue movement, uncontrolled chewing motions, and uncontrolled arm and leg movements), and NMS (see “Cautions and Warnings”). Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Clozapine’s anticholinergic effects—blurred vision, dry mouth, and confusion—may be enhanced by interaction with other anticholinergics, such as tricyclic antidepressants like amitriptyline.
•    Drugs that reduce blood pressure may enhance the bloodpressure-lowering effects of clozapine.
•    Alcohol and other nervous system depressants, including benzQUIQOmrn and other antianxiety drugs, may enhance clozapine’s sedative action. At least 1 person has died as a result of combining diazepam and clozapine.
•    Combination contraceptive drugs may increase blood levels of clozapine leading to toxic side effects. Women starting on a combination contraceptive may need to have their clozapine dose adjusted.
•    Clozapine should not be used with ritonavir.
•    Cimetidine, caffeine, citalopram, ciprofloxacin, erythromycin, and ketoconazole may increase blood levels of clozapine resulting in increased side effects. Caution should be used with combining clozapine with paroxetine, fluvoxamine, or sertraline as similar reactions may occur, although these interactions are less well-defined.
•    Clozapine may increase blood levels of digoxin, warfarin, heparin, and phenytoin.
•    Use of clozapine with phenytoin, carbamazapine, and rifampin may cause decreases in blood levels of clozapine, reducing its effectiveness.
•    The combination of lithium and clozapine may cause seizures, confusion, and NMS (see “Cautions and Warnings”).
•    Cigarette smoking may alter clozapine dosage requirements.
•    Combining selective serotonin receptor inhibitors (SSRls) with clozapine may require a lower clozapine dosage.
Food Interactions None known.
Usual Dose
Tablets
Starting dose: 25 mg in divided doses twice a day; maintenance dose    generally, 300-450 mg a day in divided doses. Dosage may be increased gradually to a daily maximum of 900 mg in divided doses if required.
Orally Disintegrating Tablets
Starting dose: 12.5 mg once or twice a day increasing to 300450 mg a day in divided doses by the end of 2 weeks. Dosage may then be increased up to 900 mg a day in divided doses if required.
Overdosage
Symptoms of overdose are delirium, drowsiness, changes in heart rhythm, unusual excitement, nervousness, restlessness, hallucinations, excessive salivation, dizziness or fainting, slow or irregular breathing, and coma, Overdose victims must be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Clozapine may cause a fever during the first few weeks of treatment. Generally, the fever is not important, but it may occasionally be necessary to stop treatment due to a persistent fever.
Regular blood tests are necessary to monitor blood composition for any changes that might be caused by clozapine.
Call your doctor at once if you develop lethargy or weakness, a flu-like infection, sore throat, feelings of ill health, fever, sweating, muscle rigidity, mental changes, irregular pulse or blood pressure, mouth ulcers, or dry mouth that lasts for more than 2 weeks.
Dry mouth, a common side effect of clozapine, may be countered by using gum, candy, ice, or a saliva substitute such as Orex or Moi-Stir.
Do not stop taking clozapine without your doctor’s knowledge and approval, because a gradual dosage reduction may be necessary to prevent side effects.
Avoid alcohol or any other nervous system depressants while taking clozapine.
Some of the side effects of clozapine    drowsiness, blurred vision, and seizures—may interfere with the performance of complex tasks like driving or operating hazardous equipment.
While taking clozapine, rapidly rising from a sitting or lying position may cause you to become dizzy or faint.
If you take clozapine twice a day and forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose as soon as you remember and another in 5 or 6 hours, then go back to your regular schedule. If you take clozapine 3 times a day and forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose as soon as you remember and another in 3 or 4 hours, then go back to your regular schedule. Never take a double dose.
Orally disintegrating tablets should be left in the unopened blister until time of use. They should not be pushed through the foil. Just prior to use, peel the foil from the blister and gently remove the orally disintegrating tablet. Immediately place the tablet in the mouth, allow it to disintegrate and then swallow with saliva. No water is needed.
Special Populations
Pregnancy/Breast-feeding: This drug Should be used during PM Only if your doctor determines that it is absolutely necessary.
clozapine may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more sensitive to the side effects of clozapine, such as dizziness on rapidly rising from a sitting or lying po-sition, confusion, and excitability. Older men are also more likely to have prostate problems, a reason to be cautious with clozapine. Seniors with psychosis due to dementia who take clozapine are more likely to die from heart disorders and infections than those not taking it.

Generic Name
Codeine (KOE-deep) 0
Brand Name
Only available in generic form.
The information in this profile also applies to the following drugs: Generic Ingredient: Fentanyl
Actiq Lozenge on a Stick    Fentora Buccal Tablet
Duragesic (Patch)    lonsys (Patch)
Generic Ingredient: Morphine Sulfate 10
Avinza    Oramorph SR
Kadian    RMS Suppositories
MS Contin    Roxanol MSIR
Generic Ingredient: Oxycodone Hydrochloride RE
Combunox    OxyFAST
Endocodone    OxylR
M-Oxy    Percolone
OxyContin    Roxicodone Oxydose
Generic Ingredient: Oxymorphone Opana
Type Q( UTUg  Narcotic.
Prescribed For
Mild to severe pain, breakthrough cancer pain, and cough. Long-acting narcotics are meant only for people with chronic pain. Also prescribed for pain and anxiety in pediatric burn patients.
General Information
Codeine relieves pain and suppresses cough. The pain-relieving effect of 30-60 mg of codeine is equal to approximately 650 mg, or 2 tablets, of aspirin. Codeine may be less effective than aspirin for pain associated with inflammation because aspirin reduces inflammation and codeine does not. Codeine suppresses the cough reflex but does not cure the underlying cause of the cough. Other narcotic cough suppressants are stronger pain relievers, but codeine remains the best cough medication available.
Morphine sulfate is a pure narcotic that has been in use for many years. In addition to pain relief, morphine’s effects include drowsiness, mood changes, breathing difficulty, slowed movement of the gastrointestinal tract, nausea, vomiting, and changes in the endocrine and autonomic nervous systems. Morphine sulfate liquid, immediate-release tablets, and suppositories must be taken several times a day. The medication they contain is released immediately for absorption into the bloodstream. Extended- and controlled-release morphine products are designed to release some of the narcotic right away and the rest over a 24-hour period, allowing for less-frequent dosage.
Fentanyl is a potent pain reliever that can be substituted for other narcotic drugs. The patch form, which must be replaced about every 3 days, delivers fentanyl to the bloodstream at a steady rate. The lozenge has a shorter length of action than any other narcotic pain reliever, which makes it useful when given to children before surgery because it provides doctors with the flexibility to obtain maximum benefit with minimal side effects. The lozenge on a stick is used for breakthrough cancer pain as a booster for people already taking narcotic pain relievers. These forms should only be used under controlled circumstances because of the risk of side effects or overdose. Low dosages of fentanyl relieve pain—larger amounts cause loss of consciousness and breathing difficulties.
Oxycodone is a narcotic used to control moderate to severe pain. Most people take it together with aspirin (Percodan) or acetaminophen (Percocet), but it can be used by itself. This is a potent pain reliever that carries a risk (31 addiction with continued use.
Cautions and Warnings
Do not take narcotics if you are allergic or sensitive to any of their ingredients.
Long-term use of narcotics may cause drug dependence or addiction.
Use narcotics with extreme caution if you suffer from asthma or other breathing problems.
Narcotics may make it difficult to monitor the progress of people who have suffered head injuries and acute abdominal conditions.
Actiq contains fentanyl in an amount that can be fatal to children. Keep used and unused lozenges and lozenges on a stick out of reach of children.
Possible Side Effects
♦    Most common: lightheadedness, dizziness, sleepiness, nausea, vomiting, appetite loss, and sweating. If these occur, ask your doctor about lowering your dosage. Most of these side effects disappear if you lie down.
♦    Less common: euphoria (feeling “high”), headache, agitation, uncoordinated muscle movement, minor hallucinations, disorientation and visual disturbances, dry mouth. constipation, flushing of the face, rapid heartbeat, palpitations, faintness, urinary difficulties or hesitancy, reduced sex drive or impotence, itching, rash, anemia, lowered or raised blood sugar, and yellowing of the skin or whites of the eyes. Narcotic analgesics may aggravate convulsions in those who have had them.
More serious side effects of codeine are shallow breathing or breathing difficulties.
Drug Interactions
•    Avoid combining narcotics with alcohol, sleeping medications, sedatives, other depressant drugs, or non-prescription drugs that have alcohol as an ingredient. Alcohol speeds the release of morphine from Avinza. The mixture can result in a deadly narcotic overdose.
•    Narcotic analgesics should not be used at the same time as monoamine oxidase inhibitor antidepressants. Separate usage by at least 14 days.
•    Combining a narcotic pain reliever with an anticholinergic medication may result in severe constipation.
•    Combining a narcotic pain reliever with any other medication that lowers blood pressure can lead to excessive blood-pressure lowering. Avoid this combination.
•    Combining cimetidine with a narcotic pain reliever may cause confusion, disorientation, breathing difficulties, and seizure.
•    Reserpine, rifampin, and remifentanil may decrease the pain-relieving effects of morphine.
•    Fentanyl should be used with caution with azole antifungals (e.g. ketoconazole).
Food Interactions
Codeine may be taken with food to reduce upset stomach. Morphine capsules and the fentanyl patch may be used without regard to food.
Usual Dose
Dosing of narcotic pain medications is highly individualized based on patient tolerance and response to medication.
Codeine
Adult: 15-60 mg every 4-6 hours for relief of pain; 10-20 mg every few hours as needed to suppress cough.
Child: 1 mg per lb. of body weight every 4-6 hours for relief of pain; 2.5-10 mg every 4-6 hours to suppress cough.
Fentanyl Lozenge and Lozenge on a Stick
Adult: 200-1600 mcg. Dosage may be repeated up to 4 times daily. Allow the lozenge to dissolve in your mouth. DO NOT CHEW. Child: not recommended.
Fentanyl Patch: Apply to a clean and non-irritated patch of skin as directed, usually once every 3 days.
Morphine Extended-release and Controlled-release
Tablets and Capsules
Adult: 1-3 capsules a day, depending on the specific product and individual need.
Morphine Oral Liquid and Immediate-release Tablets Adult: 5-30 mg every 4 hours.
Morphine Suppositories
Adult: 5-30 mg several times a day.
Oxycodone
Adult: 10-30 mg every 4 hours as needed. OxyContin should be swallowed whole and not broken.
Child: not recommended.
Overdosage
Symptoms include breathing difficulties or slowing of respiration, extreme tiredness progressing to stupor and then coma, pinpointed pupils, no response to pain stimulation, cold and clammy skin, slowing of heartbeat, lowering of blood pressure, convulsions, and cardiac arrest. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Codeine is a respiratory depressant and affects the central nervous system (CNS), producing sleepiness, tiredness, or inability to concentrate. Be careful when driving or doing any task that requires concentration. Avoid alcohol.
Call your doctor if you develop breathing difficulties, constipation, dry mouth, or any bothersome or persistent side effect.
Apply the fentanyl patch only to non-irritated skin on a flat surface of the upper body. Hair at the application site should be clipped or cut, not shaved, before applying the patch. Do not use oils, soaps, lotions, alcohol, or anything else that might irritate the skin before applying the patch.
If you are taking a controlled-release narcotic product, do not crush, chew, or break the tablet or lozenge. Rapid release may result in a potentially fatal dose of the drug.
If you forget a dose of codeine, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Narcotics pass into the fetal circulation. Excessive use of them during pregnancy may cause drug dependence in newborns. Narcotics may also cause breathing difficulties in infants during delivery. Animal studies show that codeine may cause fetal harm. If given to a pregnant woman before cesarean section, fentanyl may cause drowsiness in newborns. When either of these drugs is considered crucial by your doctor, its potemt(a1 bel)elft must be carefully weighed against its risks.
Narcotics pass into breast milk. Nursing mothers who must take codeine should use infant formula.
Seniors: Seniors are more likely to be sensitive to side effects and should be treated with the smallest effective dosage.

Generic Name
Clonidine (KLAH-nih-dene)
Brand Names
Catapres-TTS-2
Catapres-TTS-1    Catapres-TTS-3
Type of Drug
Alpha receptor stimulant.
Prescribed For
High blood pressure, including hypertensive emergency (diastolic blood pressure over 120); also used for excess sweating, childhood growth delay, attention-deficit hyperactivity disorder (ADHD), Tourette’s syndrome, restless leg syndrome, schizophrenic psychosis, migraine, ulcerative colitis, painful or difficult menstruation, hot flashes related to menopause, diagnosis of pheochromocytoma (adrenal-gland tumor), kidney poisoning associated with cyclosporine, diabetic diarrhea, smoking cessation, methadone and opiate detoxification, withdrawal from alcohol and benzodiazepines such as Valium, nerve pain following herpes attack, and allergic reactions in the presence of asthma triggered by external sources.
General Information
Clonidine stimulates nerve endings in the brain called alphaadrenergic receptors. It reduces blood pressure by dilating (widening) blood vessels. Clonidine works quickly, decreasing blood pressure within 1 hour. The other uses of clonidine relate to its stimulation of alpha receptors in the body.
Cautions and Warnings
Do not take clonidine if you are allergic or sensitive to any of its ingredients.
People who have had a stroke or recent heart attack or who have cardiac insufficiency or chronic kidney failure should avoid taking clonidine.
Some people develop a tolerance of their clonidine dosage. If this happens, your blood pressure may increase and your doctor may prescribe a higher dose.
Never stop taking clonidine without your doctor’s knowledge. If you abruptly stop taking clonidine, you may experience an unusual increase in blood pressure accompanied by agitation, headache, nervousness, and severe reactions, possibly death. Restarting clonidine therapy or taking another antihypertensive can reverse these effects.
Clonidine may cause degeneration of the    See your eye doctor for regular GheCk Ups lfiyou are taking this drug.
); you require surgery, your doctor will continue your clonidine therapy until about 4 hours before surgery and resume it as soon as possible afterward.
People who develop skin sensitivity (symptoms include rash, itching, and swelling) to Catapres-TTS, the transdermal patch form of clonidine, may experience the same reactions with oral clonidine.
Possible Side Effects
Tablets
♦    Most common: dry mouth, drowsiness, dizziness, constipation, and sedation.
♦    Common: headache and fatigue. These effects tend to diminish within 4-6 weeks.
•    Less common: appetite loss, swelling or pain in the glands of the throat, nausea, vomiting, weight gain, blood-sugar elevation, breast pain or enlargement, worsening of congestive heart failure, heart palpitations, rapid heartbeat, painful blood-vessel spasm, abnormal heart rhythms, electrocardiogram changes, feeling unwell, changes in dream patterns, nightmares, difficulty sleeping, hallucinations, delirium, anxiety, depression, nervousness, restlessness, rash, hives, thinning or loss of scalp hair, difficult or painful urination, nighttime urination, retaining urine, decrease or loss of sex drive, weakness, muscle or joint pain, leg cramps, increased alcohol sensitivity, dryness and burning of the eyes, dry nose, loss of color, and fever.
Transdermal Patch
✓    Most common: dry mouth and drowsiness.
✓    Less common: constipation, nausea, changes in sense of taste, dry throat, fatigue, headache, lethargy, changes in sleep patterns, nervousness, dizziness, impotence, sexual difficulties, and mild skin reactions including itching, swelling, contact dermatitis, discoloration, burning, peeling, throbbing, white patches, and generalized rash. Rashes of the face and tongue have also occurred but cannot be specifically tied to transdermal clonidine.
Drug Interactions
•    Combining clonidine and a beta-adrenergic blocker may increase the severity of a drug-withdrawal reaction and rebound high MW pressure. This reaction may be very serious.
•    Combining verapamil and clonidine may lead to very low blood pressure and atrioventricular (AV) block (abnormality in heartbeat patterns). This reaction may be very serious.
O    Avoid alcohol, barbiturates, and sedatives because they increase the depressive effects of clonidine.
•    Tricyclic and other antidepressants, appetite suppressants, estrogens, stimulants, indomethacin and other nonsteroidal anti-inflammatory drugs (NSAIDs), and prazosin may counteract the effects of clonidine.
•    clonidine may reduce the therapeutic effects of levadopa +
carbidopa.
Food Interactions
The tablets are best taken on an empty stomach but may be taken with food if they upset your stomach.
Usual Dose
Tablets
Adult: high blood pressure-100 mcg twice a day to start; may be raised by 100 mcg a day until maximum control is achieved. Take no more than 2400 mcg a day. Other uses-100-goo mcg a day, or up to 0.8 mcg per lb. of body weight in divided doses. Seniors should start with a lower dose and increase more slowly.
Child: 50-400 mcg orally twice a day.
Transdermal Patch
Adult: 100 mcg delivered daily from a patch applied once every 7 days. Up to two 300-mcg patches may be needed to control blood pressure. Transdermal dosage exceeding 600 mcg a day has not been shown to increase effectiveness.
Child: not recommended.
Overdosage
Symptoms of overdose are slow heartbeat, central- nervous-system depression, very slow breathing, low body temperature, pinpoint pupils, seizures, lethargy, agitation, irritability, nausea, vomiting, abnormal heart rhythms, mild increases in blood pressure followed by a rapid drop in blood pressure, dizziness, weakness, loss of reflexes, and vomiting. Victims should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Gk’3t1161)e causes drowsiness in about 1/3 of people who take it. Be extremely careful while driving or performing any task that requires concentration. This effect is prominent during the first few weeks of clonidine therapy and then tends to decrease.
Do not take over-the-counter cough and cold medications unless directed by your doctor.
Call your doctor it you become depressed or have vivid dreams or nightmares while taking clonidine, or if you develop swelling in your feet or legs, paleness or coldness in your fingertips or toes, or any persistent or bothersome side effect.
Apply the transdermal patch to a hairless area of skin such as the upper arm or torso. Use a different skin site each time. If the patch becomes loose, apply the supplied adhesive directly over it. If the patch falls off before 7 days are up, apply a new one. Do not remove the patch while bathing.
If you forget a dose of oral clonidine, take it as soon as possible and then go back to your regular schedule. If you miss 2 or more consecutive doses, consult your doctor; missed doses may cause blood pressure increases and severe adverse effects. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Clonidine passes into the fetal bloodstream. Animal studies show that clonidine may damage the fetus in doses as low as 1/3 the maximum dose. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Clonidine passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more susceptible to the effects of this drug and should begin with lower doses.

Generic Name
Clopidogrel (kloe-PID-oe-grel) nQ
Brand Name  Plavix
Type lul Drug Antiplatelet.
Prescribed For
Heart attack and stroke prevention; also used for blood thinning after placement of a vascular stent.
General Information
Artery-clogging blood clots are often the cause of heart attacks and strokes. clopidogrel reduces the risk of both by helping prevent blood-clot formation. This drug thins the blood by making platelets—the cells that aggregate to form clots—less “sticky.” It starts working in as little as 2 hours after taking a single tablet. The drug’s blood-thinning effect lasts until inactivated platelets are replaced by the body. Studies suggest that clopidogrel is more effective than aspirin in preventing heart attack and stroke in people at risk. People taking clopidogrel after scent surgery usually take it for a relatively short period. Those taking it to prevent a heart attack or stroke must take it for life.
Cautions and Warnings
Do not take clopidogrel if you are allergic or sensitive to any of its ingredients or to ticlopidine, a related antiplatelet. These drugs can rarely cause a rapid drop in white-blood-cell count.
People with bleeding ulcers, brain hemorrhages, or other bleeding problems should use clopidogrel with caution.
Thrombotic thrombocytopenic purpura (TTP) is a rare but serious complication of clopidogrel, sometimes reported after less than 2 weeks of treatment. See your doctor right away if you develop a sudden fever, unusual bruising, nosebleeds, bleeding gums, or any other unusual symptoms. TTP reduces your platelet count, interfering with blood clotting, and affects white-blood-cell count.
People with liver problems should use clopidogrel with caution.
Possible Side Effects
✓    Most common: rash and other skin problems.
✓    Common: chest pain, accidents, flu-like symptoms, pain, headache, dizziness, abdominal pain, upset stomach, joint pain, back pain, black-and-blue marks, and respiratory infection.
✓    Less common: tiredness, Swollen arms or legs, high blood pressure, diarrhea, nausea, bleeding, nosebleeds, breathing difficulties, runny nose, coughing, bronchitis, high blood cholesterol, urinary infection, and depression.
✓    Rare: bleeding in the brain and stomach ulcer. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Clopidogrel may interfere with the body’s ability to break down fluvastatin, nonsteroidal anti-inflammatory drugs (NSAIDs), phenytoin, tamoxifen, tolbutamide, torsamide, and
warfann.
•    Combining clopidogrel and NSAIDs may increase blood loss and bleeding in the stomach and intestines.
•    Do not combine clopidogrel and other antiplatelet drugs or
the anticoagulant (blood thinner) warfarin unless you are
under your doctor’s direct supervision. This interaction may
prevent normal blood clotting and lead to severe bleeding
problems.
Food Interactions
Clopidogrel may be taken without regard to food or meals.
Usual Dose
Adult: 75 mg a day.
Overdosage
Little is known about the effects of clopidogrel overdose aside from reduced blood clotting. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Minor cuts may take longer to stop bleeding during treatment with clopidogrel. If you are having surgery, make sure your doctor knows you are taking clopidogrel. You may have to stop taking the drug I week before surgery.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding: The safety of using clopidogrel during pregnancy is not known. Other antiplatelet drugs, tike aspirin, are not used during pregnancy due to their possible effects on Mrjlher and fetus. When this drug is considered crucial by your doctor, its benefits must be carefully weighed against its risks.
Clopidogrel may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may take this drug without special precaution.

Generic Name
Clorazepate (klor-AZ-uh-pate) 99
Brand Names
Gen-Xene    Tranxene-SD
Tranxene    Tranxene T-Tab
Type of Drug
Benzodiazepine sedative.
Prescribed For
Anxiety, tension, fatigue, and agitation; symptoms of acute alcohol withdrawal; partial seizures; also prescribed for irritable bowel syndrome and panic attacks.
General Information
Clorazepate dipotassium is a benzodiazepine. Benzodiazepines directly affect the brain. They can relax you and make you more tranquil or sleepier, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant. Many doctors prefer benzodiazepines to other drugs that can be used to similar effect because they tend to be safer, have fewer side effects, and usually work as well, if not better.
Cautions and Warnings
Do not take clorazepate if you are allergic or sensitive to any of its ingredients or to another benzodiazepine drug, including clonazepam.
Clorazepate can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
Other conditions in which clorazepate should be avoided are: severe depression, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney diseaap_, to inOn of these conditions, the qq)NSSvve effects of clorazepate may be enhanced or could be detrimental to your overall condition.
Clorazepate should not be taken by psychotic patients because it is not effective for them and can trigger unusual excitement, stimulation, and rage.
Clorazepate is not intended to be used for more than 3-4 months at a time. Your doctor should reassess your condition before continuing your prescription beyond that time.
Clorazepate may be addictive. It should be used with caution in people with a history of drug dependence.
Drug withdrawal may develop if you stop taking it after as few as 4 weeks of regular use but is more likely after longer use. It may start with anxiety and progress to tingling in the hands or feet, sensitivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating, and changes in mental state. Your dosage should always be reduced gradually to prevent drug withdrawal symptoms.
Possible Side Effects
Weakness and confusion may occur, especially in seniors and in those who are more sickly.
✓    Most common: mild drowsiness during the first few days of therapy.
✓    Less common: confusion, depression, lethargy, disorientation, headache, inactivity, slurred speech, stupor, dizziness, tremors, constipation, dry mouth, nausea, inability to control urination, sexual difficulties, irregular menstrual cycle, changes in heart rhythm, low blood pressure, fluid retention, blurred or double vision, itching, rash, hiccups, nervousness, inability to fall asleep, and occasional liver and kidney dysfunction. If you have any of these symptoms, stop taking the medicine and contact your doctor immediately.
✓    Rare: Rare side effects can affect your heart, stomach and intestines, urinary tract, blood, muscles and joints. Contact your doctor if you experience any side effects not listed above.
Drug Interactions
•    Clorazepate is a central-nervous-system depressant. Don’t mix it with alcohol, other sedatives, narcotics, barbiturates, monoamine oxidase inhibitor and other antidepressants, and antihistamines. Taking Clorazepate with these drugs may result in excessive depression, tiredness, sleepiness, breathing difficulties, or related symptoms.
•    Smoking may reduce clorazepate’s effectiveness by in-
creasing the rate at which it is broken down by the body.
•    Clorazepate’s effects may be prolonged when it is mixed with cimetidine, contraceptive drugs, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranolol, rifampin, or valproic acid. Theophylline may reduce clorazepate’s sedative effects.
•    If you take antacids, separate them from your clorazepate dose by at least 1 hour to prevent them from interfering with the absorption of clorazepate into the bloodstream.
•    Clorazepate may increase blood levels of digoxin and the chances of digoxin toxicity.
•    The effect of levodopa + carbidopa may be decreased if it is taken together with clorazepate.
•    Combining clorazepate with phenytoin may increase phenytoin blood concentrations and the chances of phenytoin toxicity.
Food Interactions
Clorazepate is best taken on an empty stomach, but it may be taken with food if it upsets your stomach.
Usual Dose
Immediate-Release
Adult and Child (age 9 and over): 15-60 mg daily. The average dose is 30 mg in divided quantities, but dosage must be adjusted to individual response for maximum effect. Maximum recommended daily dose is 90 mg. For treatment of anxiety, clorazepate may be taken as a single dose at bedtime.
Child (under age 9): not recommended.
Sustained-Release
Adult: The sustained-release form of clorazepate may be given as a single dose, either 11.25 or 22.5 mg, once every 24 hours. Sustained-release tablets are not recommended for the initial dosage.
Child: not recommended.
Overdosage
Symptoms of overdose are confusion, sleepiness, poor coordination, lack of response to pain such as a pin prick, loss of reflexes, shallow breathing, low blood pressure, and coma. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Clorazepate can cause tiredness, drowsiness, inability to concentrate, or similar symptoms. Be careful if you are driving, operating machinery, or performing other activities that require concentration.
People taking clorazepate for more than 3 or 4 months at a time may develop drug withdrawal reactions if the medication is stopped suddenly (see “Cautions and Warnings”). Do not stop taking clorazepate or increase or decrease your dosage without first consulting your doctor.
If you forget a dose of clorazepate, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Clorazepate may cause birth defects if taken during the first 3 months of pregnancy. Avoid this drug if you are or might be pregnant.
Clorazepate may pass into breast milk. Nursing mothers who must take clorazepate should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of clorazepate and generally require smaller doses to achieve the same effect.