Archive for the ‘Drugs B’ Category

Generic Name
Butenafine (We-TEN-uh-fens)
Brand Names
Mentax    Mentax-TC
Type of Drug Antifungal.
Prescribed For
Athlete’s foot, jock itch, and ringworm.
General Information
Butenafine hydrochloride works by blocking the natural synthesis of a chemical—ergosterol—essential to the cell membrane (outer skin) of the fungus cell. Butenafine may actually kill the fungus if enough of it is present. Some butenafine is absorbed into the bloodstream.
Cautions and Warnings
Do not use butenafine if you are allergic or sensitive to any of its ingredients.
Possible Side Effects
V Common: rash, burning, stinging, worsening of the infection, swelling, irritation, and itching.
Drug Interactions
When you apply butenafine to the skin, do not combine it with any other topical medication.
Usual Dose
Adult and Child (age 12 and over): Apply enough to cover the affected area and surrounding skin once a day for 2-4 weeks, or twice a day for one week. Wash your hands after each application.
Child (under age 12): not recommended.
Overdosage
Little is known about the effects of accidental ingestion. Call your local poison control center or hospital emergency room for more information. ALWAYS bring the prescription bottle or costz&”ey.
Special Information
This drug may irritate sensitive skin. Call your doctor if this happens—another medication may be more appropriate. Also call your doctor if you experience redness, itching, burning, blistering, swelling, or oozing.
Athlete’s foot is relatively common and may be caused by a number of different kinds of fungi. Do not use this drug without your doctor’s knowledge.
Butenafine is to be applied only to your skin. It should not be applied to other areas, including the eyes, nose, mouth, or vagina.
Do not bandage the area where the medication has been applied unless otherwise directed by your doctor.
If you apply the cream after bathing, be sure that your feet are completely dry, especially the areas between your toes. Do not wear socks made from wool or synthetic material or shoes that do not have adequate ventilation.
As is often the case when using an anti-infective, your symptoms may begin to improve before you have completed the full course of treatment. Be sure to use all of the medication as directed. If you are taking butenafine for jock itch or ringworm, wear loose-fitting clothing and keep the area cool and dry.
Call your doctor if the condition does not improve after 4 weeks of using the cream.
Special Populations
Pregnancy/Breast-feeding: Butenafine should only be used during pregnancy if absolutely necessary.
It is not known if this drug passes into breast milk. Nursing mothers who must use this drug should consider using infant formula.
Seniors: Seniors may use this medication without special precaution.

Generic Name
Buspirone (bue-SPYE-rove) OG
Brand Name  BuSpar
Type of Drug
Minor sedative and antianxiety drug.
Prescribed For
Anxiety and generalized anxiety disorders; also prescribed for the aches, pains, fatigue, and cramps of premenstrual syndrome (pMS).
General Information
Buspirone hydrochloride has a potent antianxiety effect. It is approved by the Food and Drug Administration (FDA) for short-term relief of anxiety, but it may apparently be used safely for more than 4 weeks. The exact way in which buspirone works is not known, but it seems to lack the addiction dangers associated with other antianxiety drugs, including benzodiazepines. It neither severely depresses the nervous system nor acts as an anticonvulsant or muscle relaxant, as other antianxiety drugs do. Minor improvement will be apparent after only 7-10 days of drug treatment, but the maximum effect does not occur for 3 or 4 weeks.
Cautions and Warnings
Do not take buspirone if you are allergic or sensitive to any of its ingredients.
Buspirone should be used cautiously by people with timer or kidney disease.
Buspirone does not have any antipsychotic effect and should not be taken for symptoms of psychosis.
Although buspirone has not shown a potential for drug abuse, you should be aware of this possibility.
Buspirone should not be used with monamine oxidase inhibitor (MAGI) antidepressants.
Possible Side Effects
♦    Most common: dizziness, drowsiness, nausea, and head-
ache.
•    Common: fatigue, nervousness, lightheadedness, excite-
ment, dry mouth, and insomnia.
•    Less common: heart palpitations, muscle aches and pains, tremors, rash, sweating, clamminess, rapid heartbeat, dif-
ficulty concentrating, anger or hostility, depression, loss of interest, diarrhea, constipation, vomiting, and blurred vision.
♦    Rare: 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
•    Combining buspirone with an MAGI antidepressant may produce severe hypertension and may be dangerous.
•    The effects of combining buspirone with other drugs that work in the central nervous system (CNS) are not known. Do not take other sedatives or antianxiety or psychoactive drugs with buspirone unless prescribed by a doctor familiar with your complete medical history.
•    Erythromycin, itraconazole, ketoconazole, clarithromycin, diltiazem, verapamil, fluvoxamine, and ritonavir may increase blood levels of buspirone. When used in combination, your buspirone dosage may need to be adjusted.
•    Buspirone may increase the side effects of haloperidol and diazepam.
•    Studies show that buspirone is not affected by alcohol, but this combination should still be used with caution because buspirone causes drowsiness and dizziness.
•    The combination of buspirone and trazodone may cause liver inflammation.
•    Combining rifampin with buspirone may decrease buspirone’s effectj\18″eSS.
Food Interactions
This drug may be taken either with or without food, but for the most consistent results, always take your dose at the same time of day in the same way—that is, with or without food. Avoid drinking large amounts of grapefruit juice with this drug.
Usual Dose
Adult: starting dosage-7.5 mg twice a day. Dosage may be increased gradually to 60 mg a day.
Overdosage
Symptoms of overdose are nausea, vomiting, dizziness, drowsiness, pinpointed pupils, and upset stomach. The overdose victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Buspirone may cause CNS depression, drowsiness, and dizziness. Be careful while driving or operating hazardous equipment. Avoid other CNS drugs and alcoholic beverages because they will enhance buspirone’s effects.
Contact your doctor if you become restless, develop uncontrolled or repeated movements of the head, face, or neck, or have any intolerable side effects.
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 go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Though buspirone has not been found to cause birth defects, be sure to inform your doctor if you are or might be pregnant while taking this drug. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known how much buspirone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Several hundred seniors participated in drug evaluation studies without any unusual problems. However, the effect of this drug in seniors is not well known, and special problems may surface, particularly in those with kidney or liver disease.

Generic Name
Bupropion (bue-PROE-pee-on) M
Brand Names
Budeprion    Wellbutrin SR
Budeprion XL    Wellbutrin XL
Wellbutrin    Zyban
Type of Drug
Antidepressant and smoking deterrent.
Prescribed For
Depression, seasonal affective disorder, and nicotine addiction.
General Information
Bupropion is used for major depression and seasonal affective disorder, and may work as a smoking deterrent by acting on key hormone systems in the brain. It works primarily on dopamine and noradrenaline, unlike the SSRI antidepressants, which primarily work on serotonin. Bupropion may not act until you have taken it for 2-4 weeks. The drug clears your system about 2 weeks after you stop taking it.
Cautions and Warnings
Do not take bupropion if you are allergic or sensitive to any of its ingredients.
Antidepressants have been associated with an increased risk of suicide, especially in children and teenagers. Suicide is always a risk in depressed people, who should only be allowed to have minimal quantities of medication in their possession. Clinical worsening of a depressed person’s condition may also occur early
therapy with anticlepressa”kS.
People with seizure disorders, people who have had a seizure in the past, and people with bulimia or anorexia nervosa should be very careful about taking bupropion because they are at a higher risk of having a seizure. About 4 in 1000 people taking bupropion in dosages up to 450 mg a day develop a seizure. The risk of developing a seizure increases by about 10 times with dosages between 450 and 600 mg a day. About half of the people who developed a seizure on bupropion had a risk factor such as a history of head injury, a previous seizure, or a nervous system tumor, or were taking another drug associated with increased seizure risk.
People with unstable heart disease or those who have had a recent heart attack should take this drug with caution because of possible side effects.
Many people taking bupropion experience some restlessness, agitation, anxiety, and sleeplessness, especially soon after they start taking the drug. Some even require sleeping pills to counter this effect, and others find the stimulation so severe that they have to stop taking bupropion.
Bupropion may trigger a manic episode in those with depression or bipolar disorder.
People taking bupropion may experience hallucinations, delusions, or psychotic episodes. Dosage reduction or drug withdrawal is usually necessary to manage these reactions.
One-quarter of those who take bupropion lose their appetite and 5 or more lbs. of body weight. People who have lost weight due to their depression should be cautious about taking bupropion.
People switching from bupropion to a monoamine oxidase inhibitor (MA01) antidepressant, or vice versa, should allow at least 2 weeks to pass between stopping one drug and starting the other.
People with kidney or liver disease require less bupropion at the beginning of treatment. Dosage should be increased cautiously.
An antidepressant other than bupropion should be seriously considered for people with a history of drug abuse because of the mild stimulation bupropion causes. These people may require larger-than-usual dosages, but they are still susceptible to seizures at these higher dosages.
Possible Side Effects
About 10% of people stop taking bupropion due to side effects.
♦ Most common: dry mouth; dizziness; rapid heartbeat; headache, including migraine; excessive sweating; nausea; vomiting; constipation; appetite loss; weight changes: sedation; agitation; sleeplessness; and tremors.
Possible Side Effects (continued)
V Less common’. upset stomach, diarrhea, increased appetite, menstrual complaints, impotence, urinary difficulties, slowness of movement, salivation, muscle spasms, warmth, uncontrolled muscle movement, compulsion to move around or change positions, abnormal heart rhythms, blood-pressure changes, heart palpitations, fainting, itching, redness and rash, confusion, hostility, loss of concentration, reduced sex drive, anxiety, delusions, euphoria (feeling “high”), fatigue, joint pain, fever or chills, respiratory infection, and visual, taste, and hearing disturbances.
Drug Interactions
•    Phenelzine (an MAGI) increases the risk of bupropion side effects. Allow at least 2 weeks to pass between stopping an MAGI and starting bupropion. Serious side effects can occur.
•    Carbamazepine may reduce blood concentrations of bupropion.
•    People taking both bupropion and levodopa + carbidopa or amantadine experience increased side effects. People taking these drugs should have their bupropion dosage increased gradually.
•    Ritonavir may significantly increase bupropion blood levels and the risk of side effects.
•    Don’t mix bupropion with other drugs that increase the risk of seizures—including tricyclic antidepressants, haloperidol, lithium, loxapine, molindone, phenothiazine sedatives, and thioxanthene sedatives.
•    Combining bupropion with a nicotine replacement drug can cause high blood pressure.
•    Combining bupropion with warfarin can increase the risk of side effects.
•    Do not comtImP. INO~bujfin and Zyban, as they contain the same active ingredient.
•    Alcohol should be avoided by people taking bupropion.
Food Interactions
Bupropion may be taken with food if it upsets your stomach.
Usual Dose
Depression
Adult: 200-450 mg a day; normal daily dosage is 300 mg. Child (under age 18): not recommended.
Smoking Cessation
Adult: 150 mg twice a day. Begin treatment while you are still
smoking.
Child (under age 18): not recommended.
Overdosage
Symptoms of overdose are likely to include severe side effects, such as seizures—present in a third of overdoses—hallucinations, loss of consciousness, and abnormal heart rhythms. Overdose victims should be taken to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Do not stop taking bupropion without your doctor’s knowledge. Suddenly stopping the drug may cause withdrawal reactions and side effects.
Call your doctor if you experience agitation or excitement, restlessness, confusion, difficulty sleeping, anxiety, panic attacks, sleeplessness, irritability, hostility, aggressiveness, acting impulsively, a manic reaction, deepening depression, suicidal thinking, fast or abnormal heart rhythm, severe headache, seizure, rash, fainting, or any unusual or persistent side effect.
Bupropion may make you tired, dizzy, or lightheaded. Be careful when driving or doing any task that requires concentration.
Alcohol, sedatives, and other nervous system depressants increase the depressant effects of this drug. Alcohol also increases the risk of a seizure.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose and you take it several times a day, take 1 dose as soon as you remember and another in 3 or 4 hours, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of using bupropion during pregnancy is not known. When your doctor considers this drug crucial, its potential benefits must be carefully weighed against its risks. Pregnant women trying to quit smoking should use non-drug methods until their pregnancy is completed.
Bupropion passes into breast milk. Nursing mothers who must use bupropion should use infant formula.
Seniors: Seniors with reduced kidney or liver function may require reduced dosage.

Type of Drug
Bowel Anti-Inflammatory Drugs (5-ASA Type)
Brand Names
Generic Ingredient: Balsalazide Colazal
Generic Ingredient: Mesalamine 0
Asacol    Pentasa
Canasa    Rowasa Lialda
Generic Ingredient: Olsalazine Dipentum
Prescribed For
Ulcerative colitis; rectal products prescribed for distal ulcerative colitis, proctitis, and proctosigmoiditis.
General Information
Chemical cousins of aspirin, these bowel anti-inflammatory drugs (5-ASA type) are used to treat symptoms of bowel inflammation. No one knows exactly how they work, but they are believed to have a local effect on the bowel. The tablet forms are made to delay drug release until they reach the colon. Little of the drug is absorbed into the blood; 70-90% remains in the colon.
Cautions and Warnings
Do not take bowel anti-inflammatories if you are allergic or sensitive to any of their ingredients or to aspirin. Although people who are sensitive or allergic to sulfasalazine have generally been able to tolerate mesalamine—which is an active agent in sulfasalazinethey should be cautious.
Bowel anti-inflammatories may worsev\ 4zo%Vis or cause cramping sudden abiboYrimall pain, bloody diarrhea, fever, headache, or rash. Stop taking the drug at once and call your doctor if any of these symptoms develop.
Some people taking mesalamine have developed kidney problems. People who have or have had kidney disease should be cautious about using these drugs. All people taking mesalamine should have kidney function tests before and during drug therapy.
Possible Side Effects
Bowel anti-inflammatories are generally well tolerated. Tablets and capsules have the most side effects, suppositories the least.
Tablets
♦    Most common: headache; abdominal pain, cramps, or discomfort; belching; nausea; sore throat; and generalized pain.
♦    Common: constipation, diarrhea, upset stomach, vomiting, muscle weakness, dizziness, fever, runny nose, rash, skin spots, achy joints, back pain, and stiff muscles.
✓    Less common: worsening of colitis, gas, runny nose, chills, sweating, feeling unwell, tiredness, acne, itching, arthritis, chest pain, conjunctivitis (pinkeye), painful menstruation, swelling, and flu-like symptoms.
♦    Rare: sleeplessness, hair loss, leg or joint pain, and urinary burning or infection. 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.
Capsules
♦    Less common: abdominal pain, cramps, or discomfort; diarrhea; nausea; headache; respiratory infection; rash; and skin spots.
♦    Rare: worsening of colitis, constipation, gas, vomiting, dizziness, fever, sleeplessness, belching, upset stomach, sweating, feeling unwell, tiredness, itching, acne, achy joints, leg or joint pain, muscle aches, conjunctivitis (pinkeye), swelling, and hair loss. 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.
Suppositories
✓    Common: headache.
✓    Less commQ(v, abdominal palecramps, or discomfort; diarrhea or frequent stools; worsening of colitis; flatulence or gas; nausea; rectal pain, soreness, or burning; dizziness; dry mouth; fever; sore throat; cold symptoms; acne; rash; skin spots; and swelling.
Possible Side  Effects (continued)
Rectal Suspension
♦    Common: abdominal pain, cramps, or discomfort; gas; nausea; headache; and flu-like symptoms.
• Less common: bloating; diarrhea; hemorrhoids; pain on enema insertion; rectal pain, soreness, or burning; dizziness; fever; feeling unwell; tiredness; cold symptoms; sore throat; itching; rash; skin spots; back pain-, leg pain: and joint pain.
♦    Rare: constipation, muscle weakness, sleeplessness, swelling, hair loss, and urinary burning or infection. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
None known.
Food Interactions
Take the tablet and capsule with food.
Usual Dose
Balsalazide
Tablets: 2250 mg 3 times a day for 8 weeks.
Mesalamine
Tablets: 800 mg 3 times a day for 6 weeks.
Once-daily tablets: 2-4 (1.2 mg each) once a day with a meal.
Capsules: 1000 mg 4 times a day for up to 8 weeks.
Suppositories: one 500-mg suppository twice a day for 3-6 weeks. Retain the suppository for 1-3 hours for maximum benefit.
Rectal Suspension: 1 bottle of suspension taken as an enema at bedtime every night for 3-6 weeks. The enema liquid should be retained for about 8 hours.
Olsalazine
k4kft, MO mg a day in 2 divided doses.
Overdosage
Symptoms are likely to include: ringing or buzzing in the ears, fainting or dizziness, headache, lethargy, confusion, drowsiness, sweating, rapid breathing, vomiting, and diarrhea. In case of overdose, call your local poison control center or hospital emergency room. You may be told to induce vomiting with ipecac syrup—available at any pharmacy—before taking the victim to the emergency room. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
The tablets and capsules must be swallowed whole. Call your doctor if they are visible in your stool. When using suppositories, handle them as little as possible to prevent melting.
Call your doctor if you develop chest pain, breathing or urinary difficulties, fever, unusual bleeding or bruising, worsening of colitis, or any bothersome or persistent side effects.
If you forget to administer a dose, do so as soon as you remember. If you take a tablet or capsule and it is within 4 hours of your next dose, skip the dose you forgot and continue with your regular schedule. If you take the suppositories or rectal solution and you do not remember until 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: Bowel anti-inflammatories can pass into the fetal circulation. When your doctor considers these drugs crucial, their potential benefits must be carefully weighed against their risks.
Small amounts of these drugs can pass into breast milk. Nursing mothers who must take these drugs should consider using infant formula.
Seniors: Seniors may use these drugs without special restriction.

Bosentan
Type of Drug     Endothelia receptor antagonist.
Prescribed For
Pulmonary arterial hypertension.
General Information
These drugs lower blood pressure by working on the endothelin system. Endothelia is a hormone that plays an important role in maintaining blood pressure. It is normally found in blood vessels, but endothelin levels are very high in the blood and lungs of people with pulmonary arterial hypertension. People with this condition have high blood pressure, trouble breathing, and get very tired even when walking or doing other moderate exercising. Pulmonary arterial hypertension can be fatal.
Cautions and Warnings
These drugs should not be used by those who are allergic or sensitive to any of their ingredients.
Bosentan can cause liver injury. People taking these drugs should have their liver enzymes checked monthly. Enzyme increases can be a sign of liver injury and may be a reason to stop taking bosentan.
These drugs are broken down in the liver. People with liver damage should take them with caution.
These drugs should not be taken during pregnancy as they are likely to cause birth defects (see “Special Populations”).
These drugs cause a reduction in red blood cells, leading to anemia. Larger doses of bosentan cause a greater loss of red blood cells.
Possible Side Effects
Ambrisentan
Most side effects are mild. Only stuffy nose increases with increased dosage.
V Most common: swelling k%) -aims or legs, stuffy nose, si1)u6fis, flushing, heart palpitations, abdominal pain, constipation, difficulty breathing, and headache.
Bosentan
♦ Most common: headache and sore throat and nose.
Drug Interactions
•    It is possible that bosentan may cause failure of hormonal contraceptives.
•    Cyclosporine, used to prevent transplant rejection, increases blood levels of bosentan and ambrisentan. Do not combine these drugs.
•    Mixing glyburide, an antidiabetes drug, with bosentan increases the risk of elevated liver enzyme levels. Do not combine these drugs.
•    Ketoconazole greatly increases blood levels of bosentan by slowing its breakdown in the liver.
•    Combining bosentan with a statin-type cholesterol - lowering drug such as simvastatin, lovastatin, or atorvastatin reduces the amount of statin drug in the blood. Dose increases may be needed.
•    Bosentan can reduce the amount of warfarin in the blood by
about 1/3. Changes in warfarin dosage may be needed.
•    Combining ambrisentan with atanazavir, clarithromycin, indinavir, itraconazole, ketoconazole, nelfinavir, ritonavir, omeprazole, saquinavir,or telithromycin may increase the amount of ambrisentan in the blood. Caution is advised.
•    Combining ambrisentan with rifampin may reduce the
amount of ambrisentan in the blood. Caution is advised.
Food Interactions
These drugs may be taken with or without food.
U’Suk Dose
Ambrisentan
Adult (age 18 and over): 5-10 mg once a day. Do not crush, split, or chew these tablets.
Child: not recommended.
Possible Side Effects (continued)
♦    Common: flushing, abnormal liver blood pressure, and heart
♦    Less common: upset stomach, tiredness.
ver function, leg swelling, palpitations.
, swelling, itching, anemia,
Bosentan
Adult (age 18 and over): 62.5 mg twice a day for 4 weeks, then
125 mg twice a day.
Child: not recommended.
Overdosage
Massive overdose may result in severe lowering of blood pressure, requiring emergency attention. The most common effects associated with overdosage are headache, low blood pressure, increased heart rate, and nausea and vomiting. Overdose victims should be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Do not stop taking these drugs without gradually reducing the dosage as instructed by your doctor.
If you forget to take 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. Do not take a double dose.
Contact your doctor at once if you develop severe itching, yellowing of the skin or eyes, tiredness, swelling in the arms or legs, nausea, vomiting, fever, or abdominal pain.
Doctors must enroll in special restricted distribution programs before they can prescribe these medicines, because of the risks of liver injury and birth defects associated with them. These medicines are not available in regular pharmacies but are mailed to you from a central pharmacy only after the testing and other program requirements have been met by your doctor.
Special Populations
Pregnancy/Breast-feeding: These medicines are very likely to cause major birth defects and should not be taken by pregnant women. Women must be sure they are not pregnant before beginning these treatments.
Women should also use non-hormone contraceptives while on these drugs. Hormone-based contraceptives such as birth control pills, injections, and implants may not work in women taking Wst m or ambrisentan.
It is not known if either of these medicines passes into breast milk. Nursing mothers should use infant formula.
Seniors: The greater chance of kidney, liver, and cardiac function side effects in seniors may affect drug dosage. Seniors may also experience more swelling in the arms or legs.

Bisphosphonates (bis-FOS-fun-ates)
Brand Names
Alendronate Sodium Fosamax
Alendronate Sodium  Cholecalciferol Fosamax Plus D
Etidronate Disodium (9 Didronel
lbandronate Sodium Boniva
Risedronate Sodium 91 Ar.Wm~
Risedronate Sodium  Calcium Carbonate Actonel with Calcium
Tiludronate Disodium Skelid
Prescribed For
Prevention and treatment of osteoporosis (a condition characterized by loss of bone mass due to calcium depletion) in postmenopausal women and in older men; Paget’s disease of bone; and high blood calcium associated with high dosages of corticosteroid treatments and cancer.
General Information
Bisphosphonates have been used for many years to treat a variety of conditions associated with low bone mass caused by calcium depletion. They work on cells called osteoclasts that normally break down bone tissue, making bones stronger by preventing loss of bone mass. In osteoporosis, bones become weak and brittle, increasing the risk of spine, hip, and other bone fractures that are a major cause of death and disability in older women. Etidronate has been used occasionally in children, but these drugs generally are not considered safe for use in children.
Cautions and Warnings
Do not use any bisphosphonate if you are allergic or sensitive to any of its ingredients.
Do not use bisphosphonates if you have severe kidney disease or active stomach or intestinal disease such as difficulty swallowing, ulcers, or stomach irritation. Notify your doctor if you experience any gastrointestinal problems while taking bisphosphonates.
Osteonecrosis of the jaw (ONJ), a condition in which bones of the jaw lose their blood supply and eventually collapse, has been reported in people treated with bisphosphonates. Most cases of ONJ have been in cancer patients having dental procedures such as tooth extractions. People at risk may be those with cancer and those taking corticosteroids or those with poor oral hygiene.
Do not use ibandronate, alendronate, or risedronate it you cannot stand or sit upright for 30 minutes (see “Special Information”).
Bisphosphonates can cause low blood calcium and should not be used by people whose blood calcium is already low.
Bisphosphonates can cause severe and sometimes incapaciating bone,    muscle pain.
Possible Side Effects
Side effects are generally mild and similar to those reported by people taking an inactive placebo (sugar pill).
Possible Side Effects (continued)
Alendronate
♦    Most common: pain.
✓    Common: abdominal pain and discomfort, gas, stomach ulcers, and back pain.
✓    Less common: upset stomach, constipation, diarrhea, nausea, difficulty swallowing, muscle pain, headache, flu-like symptoms, accidents, and swelling in the arms or legs.
♦    Rare: vomiting and changes in taste. Contact your doctor it you experience any side effect not listed above.
Etidronate
✓    Most common: fever.
✓    Common: nausea, excess fluids, and flu-like symptoms.
♦    Less common: convulsions, constipation, inflammation of the lining of the mouth, changes in liver function, low blood levels of magnesium or phosphate, breathing difficulties, and changes in sense of taste.
✓    Rare: allergic reactions. Contact your doctor if you experience any side effect not listed above.
lbandronate
✓    Most common: upper respiratory infection, back pain, bronchitis, and upset stomach.
♦    Common: arm or leg pain, muscle pain, headache, pneumonia, and urinary infections.
✓    Less common: dizziness, fainting, pain due to nerve lesions, weakness, allergic reactions, diarrhea, vomiting, dental problems, stomach pain, low blood cholesterol, joint problems, arthritis, and sore throat.
✓    Rare: eye problems have occurred with other drugs in this group but not with ibandronate. Contact your doctor if you experience any side effect not listed above.
Risedronate
✓    Most common:    qlaftea, abdominal pain, rash, and severe joint pain.
✓    Common: chest pain, dizziness, swelling in the arms or legs, constipation, nausea, sinus irritation, and bone pain.
✓    Less common: leg cramps, weakness, bronchitis, poor vision in one eye, dry eyes, ringing or buzzing in the ears, Possible Side Effects (continued)
parathyroid gland problems, infection, rash and other skin problems, tooth problems, and vitamin D deficiency.
♦    Rare: fatigue and drug reactions, including swelling of the
tongue and throat with difficulty breathing, generalized rash,
and some blisters. Contact your doctor if you experience
any side effect not listed above.
Tiludronate
♦    Most common: diarrhea and nausea.
✓    Common: headache, upset stomach, respiratory infection, runny nose, fluid in the lungs, and sinus irritation.
✓    Less common: vomiting, dizziness, tingling in the hands or feet, coughing, sore throat, gas, aches and pains, cataracts, eye redness, glaucoma, rash, skin disorders, tooth problems, swelling, infection, vitamin D deficiency, and muscle aches.
♦    Rare: tiredness, high blood pressure, fainting, appetite loss, constipation, abdominal pain, and sleeplessness. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Antacids, calcium, and iron-containing supplements and foods can interfere with the absorption of bisphosphonates. Separate doses of these drugs and foods and a bisphosphonate by at least 30 minutes.
•    Separate doses of tiludronate and aluminum-containing antacids by 1 hour.
•    Aspirin can interfere with the absorption of tiludronate.
•    Indomethacin can increase the amount of tiludronate absorbed into the blood by 2-4 times.
•    Bisphosphonates may increase the gastrointestinal-irritating effects of aspirin, ibuprofen, and other NSAWDs.
•    Drugs that reduce the amount of stomach acid, including ranitidine, cimetidine, and omeprazole, may increase the amount of ibandronate in the blood, but the degree of increase is not clinically important.
•    Etidronate may affect the action of warfarin.
•    Bisphosphonates reduce the ability of teriparatide to build new bone.

Food Interactions
Take these medicines with plain water. Food and drink—even mineral water, orange juice, or coffee—interfere with the absorption of these drugs. Take alendronate or risedronate every morning at least 30 minutes before eating, drinking, or taking other medications. Etidronate should be taken on an empty stomach 2 hours before a meal. lbandronate should be taken as soon as you wake up and 1 hour before you eat or take any other medications, vitamins, or supplements. Tiludronate should be taken when you first wake up; wait 4 hours before eating breakfast.
Usual Dose
Alendronate
10-40 mg a day; or 35-75 mg once weekly. not recommended.
Alendronate + Calcium
70 mg/2800 IU once weekly. not recommended.
Etidronate
up to 4.5 mg per lb. a day to start, gradually increasing to no more than 9 mg per lb. per day.
not recommended.
lbandronate
2.5 mg.once a day: or one 150 mg tablet once a month. not recommended.
Risedronate
5-30 mg a day; or 35 mg once weekly. not recommended.
Tiludronate
400 mg a day.
not recommended.
Overdosage
Little is known about the effeckS,zA USP*nosphonate overdose.
Other symptoms include upset stomach, heartburn, ulcer, and irritation of the esophagus. Milk or antacids may reverse these effects. These drugs can irritate the esophagus. Do not let the victim lie down or vomit. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Food interferes with the effectiveness of these drugs. Carefully follow the directions in “Food Interactions” above.
Do not suck on any of these tablets or allow them to dissolve in your mouth because they can cause mouth sores.
To reduce the risk of stomach and throat irritation, do not lie down for at least 30 minutes after taking alendronate or risedronate. Do not lie down for 60 minutes after taking ibandronate.
Separate doses of calcium, iron, and vitamin D supplements from those of a bisphosphonate by at least 2 hours. 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. If you forget a morning dose and take it later in the day, you must still follow the instructions in “Food Interactions” about avoiding food.
Special Populations
Pregnancy/Breast-feeding: Bisphosphonates cause abnormal bone development in animal fetuses and are toxic to pregnant animals. 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 bisphosphonates pass into breast milk. Since these drugs affect bone formation, nursing mothers who must take a bisphosphonate should use infant formula.
Seniors: Seniors may use these drugs without special restriction.

Bisoprolol (bye-SOPE-roe-lol) 91
Brand Name
Zebeta
Combination Product
Generic Ingredients: Bisoproldl + Hydrochlorothiazide (0 Ziac
Type of Drug
Beta-adrenergic blocking agent.
Prescribed For
High blood pressure; may also be used for angina pectoris, and stable congestive heart failure.
General Information
Bisoprolol fumarate is one of many beta-adrenergic blocking drugs, or beta blockers, which interfere with the action of a specific part of the nervous system. Beta receptors are found all over the body and affect many body functions. Each beta blocker has particular characteristics that make it more suitable for certain conditions or people. Hydrochlorothiazide is a diuretic that lowers blood pressure.
Cautions and Warnings
Do not use bisoprolol if you are allergic or sensitive to it or other beta blockers.
Beta blockers should not be used by people with a slow heart rate, a condition called heart block (a disorder of the heart’s conduction system), or those in cardiac shock or overt heart failure_
Peoplewith angina who take bisoprolol for high blood pressure risk aggravating their angina if they suddenly stop taking the drug. These people should have their dosage reduced gradually over 1-2 weeks.
Bisoprolol should be used with caution if you have liver or kidney disease, because your ability to eliminate the drug from your body may be impaired.
People with chronic bronchitis or emphysema should use bisoprolol with caution.
Bisoprolol reduces the amount of blood pumped by the heart with each beat. This blood flow reduction may aggravate the condition of people with poor circulation or circulatory disease.
If you are undergoing major surgery, your doctor may want you to stop taking bisoprolol at least 2 days before surgery.
People with a history of severe anaphylactic reaction to allergens may be unresponsive to usual doses of epinephrine while taking beta blockers.
Possible Side Effects
Side effects are relatively uncommon and usually mild. T Mrnk common: impotence.
V Less common: unusual tiredness or weakness, slow heartbeat, heart failure, dizziness, breathing difficulties, bronchospasm, depression, confusion, anxiety, nervousness, sleeplessness, disorientation, short-term memory loss, Possible Side Effects (continued)
emotional instability, cold hands and feet, constipation, diarrhea, nausea, vomiting, upset stomach, increased sweating, urinary difficulties, cramps, blurred vision, rash, hair loss, stuffy nose, facial swelling, aggravation of lupus erythematosus, itching, chest pain, back or joint pain, colitis, drug allergy (symptoms include fever and sore throat), and liver toxicity.
Drug Interactions
•    Bisoprolol may interact with surgical anesthetics to increase the risk of heart problems during surgery. Some anesthesiologists recommend gradually stopping the drug by 2 days before surgery.
•    Bisoprolol may interfere with the normal signs of low blood sugar and with the action of oral antidiabetes drugs.
•    Bisoprolol increases the blood-pressure-lowering effects of other blood-pressure-reducing agents, including clonidine, guanabenz, and reserpine, and calcium channel blockers, such as nifedipine.
•    Aspirin-containing drugs, indomethacin, sulfinpyrazone, and estrogen drugs may interfere with the blood-pressurelowering effect of bisoprolol.
•    Cocaine may reduce the effectiveness of all beta blockers.
•    Bisoprolol may worsen the problem of cold hands and feet associated with taking ergot alkaloids, used to treat migraine. Gangrene is possible in people taking both an ergot and bisoprolol.
•    Calcium channel blockers, diphenhydramine, flecainide, contraceptive drugs, quinolone antibacterials, and quinidine may increase the amount of bisoprolol in the bloodstream and lead to increased bisoprolol effects.
•    Bisoprolol may increase the effects of ephedrine. Initially, high blood pressure wvd they a slow heart rate may result.
6 Combining beta blockers with lidocaine can increase lidocaine levels, possibly leading to toxicity.
•    Beta blockers taken with prazosin may increase the side effect of lightheadedness upon standing up that prazosin can produce.
•    Beta blockers may block the effects of epinephrine.
Smoking makes the liver break this drug down more quickly. If you stop smoking while taking bisoprolol, your daily dose
may have to be reduced.
Food Interactions
This drug may be taken without regard to food or meals.
Usual Dose
Adult: starting dose-5 mg once daily. The daily dose may be gradually increased up to 20 mg. Maintenance dose-5-10 mg once daily. People with kidney or liver disease may need only 2.5 mg a day to start. Seniors should be treated cautiously; they may respond to lower doses.
Child: not recommended.
Overdosage
Symptoms of overdose include changes in heartbeat—unusually slow, unusually fast, or irregular—severe dizziness or fainting, breathing difficulties, bluish fingernails or palms, low blood pressure, heart failure, shock, and seizures. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Do not stop taking bisoprolol unless directed to do so by your doctor. It is meant for continuous use. Abrupt withdrawal may cause chest pain, breathing difficulties, increased sweating, and unusually fast or irregular heartbeat. Dosage should be reduced gradually over a period of about 2 weeks when bisoprolol treatment is stopped.
Call your doctor at once if you develop back or joint pain, breathing difficulties, cold hands or feet, depression, rash, or changes in heartbeat. Bisoprolol may produce an undesirable lowering of blood pressure, leading to dizziness or fainting: call your doctor if this happens to you. Also call your doctor if you experiem:.epeisistent or bothersome anxiety, diarrhea, constipation, impotence, headache, itching, nausea or vomiting, nightmares or vivid dreams, upset stomach, trouble sleeping, stuffed nose, frequent urination, unusual tiredness, or weakness.
Bisoprolol may cause drowsiness, dizziness, blurred vision, or lightheadedness. Be careful when driving or performing complex It is best to take bisoprolol at the same time every day. If you forget a dose, take it as soon as you remember. If it is within 8 hours of 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: Infants born to women who took a beta blocker while pregnant had lower birth weights, low blood pressure, and reduced heart rates. Bisoprolol should be avoided by pregnant women and women who might become pregnant while taking it.
It is not known if bisoprolol passes into breast milk. Nursing mothers taking bisoprolol should use infant formula.
Seniors: Seniors taking bisoprolol may be more likely to suffer from cold hands and feet, reduced body temperature, chest pain, general feelings of ill health, sudden breathing difficulties, increased sweating, or changes in heartbeat.

Brand Name
BiDil
Generic Ingredients
Isosorbide Dinitrate Hydralazine Hydrochloride Type of Drug
Vasodilator combination. Prescribed For
Heart failure in black patients, in combination with other heart-failure treatments.
General Information
BiDil is a combiRatiZ0 101 Iwo drugs that dilate (open) both arter-
2nd veins. It is the first drug product to be specifically approved for people in a single racial group for any indication. The 2 ingredients in BiDil have been available generically for years and are prescribed for a variety of uses. Isosorbide dinitrate is prescribed for angina, heart failure, and spasms of the esophagus. Hydralazine hydrochloride is prescribed to treat high blood pressure and heart failure. When people with heart failure take this drug combination, it makes it easier for the heart to pump blood throughout the body by widening arteries and veins.
Cautions and Warnings
Do not take BiDil if you are allergic or sensitive to any of its ingredients.
Do not use erectile dysfunction drugs with BiDil.
This drug may be inappropriate for you if you have had a recent heart attack or have cardiomyopathy (loss of blood-pumping ability due to damaged heart muscle) or low blood pressure, especially postural low blood pressure (symptoms include dizziness or fainting when rising from a sitting or lying position).
Long-term administration of more than 200 mg a day of hydralazine may produce symptoms of lupus erythematosus (a chronic condition affecting the body’s connective tissue), including muscle and joint pain, skin reactions, fever, kidney inflammation, and anemia, although they usually disappear when the drug is discontinued. Report any fever, chest pain, feelings of ill health, or other unexplained symptoms to your doctor. The risk of developing lupus increases with higher dosages; approximately 5 out of 100 and 10% of people taking 200 mg a day of hydralazine develop lupus. The daily dosage of hydralazine when you take BiDil can be as high as 225 mg.
Hydralazine may cause a very rapid heartbeat, potentially leading to angina pain or a heart attack.
Taking pyridoxine (vitamin B6) may relieve tingling or numbness in the hands or feet caused by hydralazine.
Possible Side Effects
✓    Most common: headache and flushing—which should disappear after your body adjusts to the drug—nausea, dizziness, weakness, and chest pain.
✓    COmmQR*, k(a% UM16 pressure.
✓    Less common: blurred vision and dry mouth; sinus irritation, rapid heartbeat, heart palpitations, high blood sugar, runny nose, numbness or tingling in the hands or feet, vomiting, and high blood-fat levels.
Possible Side Effects (continued)
V Rare-. flushing, tearing, itching, or redness of the eyes, trem-
ors, muscle cramps, depression, disorientation, anxiety,
itching, rash, fever, chills, occasional hepatitis (symptoms
include yellowing of the skin or whites of the eyes), con-
stipation, urinary difficulties, and adverse effects on nor-
mal blood composition. Other side effects may affect any
organ or organ system. Contact your doctor if you experi-
ence any side effect not listed above.
Drug Interactions
•    Do not take sildenafil, vardenafil, or taldenafil with Bidil. The combination can result in a rapid and potentially fatal drop in blood pressure.
•    Taking this drug with a monoamine oxidase inhibitor antidepressant may increase the blood-pressure-lowering effect of the hydralazine component of BiDil. This combination should be used with caution.
•    Do not self-medicate with over-the-counter appetite suppressants and cough, cold, and allergy remedies, since many contain ingredients that may aggravate heart disease.
•    Taking this drug with large amounts of alcohol may rapidly lower blood pressure, resulting in weakness, dizziness, and fainting.
Food Interactions
Take this drug on an empty stomach. It is unknown how food affects BiDil.
Usual Dose
Adult: 1 or 2 tablets 3 times a day, 1 hour before or 2 hours after eating.
Overdosage
There have been no reports of BiDil overdose. Symptoms of INID11
overdose would be related to the Specific effects of each active in-
2ind can include reduced oxygen supply to heart muscle,
leading to a heart attack, abnormal heart rhythms, and profound
shock. Fainting, coma, and death may follow unless the victim is
treated. Overdose victims must be taken to a hospital emergency
room at once. ALWAYS bring the prescription bottle or container.
Special Information
Avoid alcohol.    headache, dizzi-
Call your doctor if you develop a persistent hea    ,
ness, facial flushing, blurred vision, or dry mouth.
It is important to make sure you drink plenty of fluids every day and pay attention to hot weather and exercise situations in which you might lose unusual amounts of fluids and salts. Fluid loss may lead to low blood pressure, dizziness, and possibly fainting.
If you forget to take a dose of BiDil, 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
PregnancylBreast-feeding., Isosorbide dinitrate crosses into the fetal circulation, and hydralazine can cause low blood pressure in pregnant women and their babies. The potential benefits of B01 must be carefully weighed against its risks when your doctor considers this drug crucial.
it is not known if BiDil passes into breast milk. Nursing mothers who must take it should consider using infant formula. Seniors: Specifics about how seniors react to this drug are not
known. The lowest effective dose of BiDil should always be used, especially in people with reduced kidney and/or liver function.