Posts Tagged ‘brand names’

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.

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.

Type of Drug
Cephalosporin Antibiotics
(CEF-uh-loe-SPOR-in)
Brand Names
Cefaclor 91 Raniclor
Cefadroxil Duricef
Cefdinir Omnicef
Cefditoren Pivoxil
Spectracef
Cefixime Suprax
Cefpodoxime Proxetil 91 Vantin
Cefprozil Cefzil
Ceffibuten Cedax
Cefuroxime Axetil 90 Ceftin
Generic Ingredient: Cephalexin 91 Panixine Disperdose    Keflex
Prescribed For  Bacterial infections.
General Information
These antibiotics are related to cephalosporin C, which is similar to penicillin and is isolated from the Cephalosporium acremonium fungus. Of the more than 20 different antibiotic drugs derived from cephalosporin C, only those that are taken by mouth are included in The Pill Book. Most common infections can be treated with these antibiotics, but they are not interchangeable. Your doctor must select the appropriate antibiotic for a particular infection.
Cautions and Warnings
Do not take cephalosporin antibiotics if you are allergic or sensitive to any of their ingredients. Up to 15% of people allergic to penicillin may also be allergic to cephalosporins. The most common cephalosporin allergic reaction is a hive-like rash condition with redness over large aceas 0 the body. Other sensitivity reac161011S Include general rash, fever, and joint aches or pain. Such reactions generally begin after a few days of taking the antibiotic and resolve within a few days after the antibiotic is stopped.
Prolonged or repeated use of a cephalosporin may lead to a secondary infection not susceptible to the antibiotic.
Occasionally, people taking a cephalosporin develop colitis. Call your doctor if you develop severe diarrhea while taking one of these drugs.
People with poor kidney function may require less medicine to treat their infections. Rarely, people taking a cephalosporin have had a seizure, especially those with kidney disease whose dose was not reduced.
Some injectable cephalosporins have caused blood-clotting problems. This has not occurred in people taking an oral drug.
Rarely, severe anemia occurs in people taking cephalosporin antibiotics. Report any signs of anemia (such as pale skin color, weakness, tiredness, difficulty breathing, and abnormal heart rhythms) to your doctor.
Cefprozil oral suspension contains phenylalanine and cannot be taken by people with phenylketonuria (PKU disease).
Possible Side Effects
Most side effects are mild.
✓    Most common: diarrhea, headache, abdominal pain, constipation, gas, upset stomach, nausea, vomiting, itching, and rash.
✓    Less common: dizziness, tiredness, weakness, tingling in the hands or feet, confusion, appetite loss, changes in taste perception, and genital and anal itching. Colitis may develop.
Cefaclor may cause serum sickness (symptoms include fever, joint pain, and rash). cephalosporins may cause changes in blood cells, kidney problems, liver inflammation, and jaundice, but these side effects are rarely a problem with oral cephalosporins.
Drug Interactions
•    Antacids can reduce the amounts of cefaclor, cefdinir, cefditoren pivoxil, and cefpodoxime proxetil in the blood. Do not take antacids within 2 hours of these antibiotics.
•    Cimetidine, famotidine, ranitidine, or nizatidine can reduce the effectiveness of cefpodoxime proxetil, cefditoren pivoxil, and cefuroxime axetil—do not combine these drugs.
•    Iron and iron-fortified foods may interfere with the absorption of cefdinir. Separate your iron dose from the antibiotic by at least 2 hours. Iron-fortified infant formula does not have this effect.
•    Probenecid may increase blood levels of some cephalosporins.
•    Potent (loop-type) diuretics can lead to kidney damage if mixed with a cephalosporin antibiotic.
Food  Interactions
Generally, cephalosporins may be taken with food or milk if they upset your stomach. Cefditoren pivoxil should be taken with a meal. Food increases the absorption of cefpodoxime proxetil and cefuroxime axetil.
Usual Dose
Ceftibuten
Adult and Child (age 12 and over): 400 mg once a day for 10 days. Child: 4 mg per lb. of body weight, up to 400 mg, once a day.
Cefuroxime Axetil
Adult and Child (age 13 and over): 250-1000 mg a day in 1-2 doses.
Child (age 3 months-12 years): tablets-125-250 mg every
12 hours. Liquid-9-13 mg per lb. of body weight every 12 hours.
Cephalexin
Adult: 1000-4000 mg a day in divided doses, usually 250 mg every 6 hours, or 500 mg every 12 hours.
Child: 11-23 mg per lb. of body weight a day in divided doses. The dose may be increased to 46 mg per lb. of body weight for middle-ear infections.
Overdosage
Common symptoms of overdose are nausea, vomiting, and upset stomach. These can often be treated with milk or an antacid. Cephalosporin overdoses are generally not serious; contact a hospital emergency room or local poison control center for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop severe abdominal cramps or diarrhea. Stop taking this drug and immediately call your doctor if you experience fever, chest tightness, breathing difficulties, redness, muscle aches, or swelling.
You must take the full course of treatment prescribed—even if you feel better in 2 or 3 days—to obtain the maximum benefit from any antibiotic.
Proper diagnosis is key to the effectiveness of an antibiotic: Do not take any antibiotic without consulting your doctor.
You should be aware that all cephalosporins may cause false results for certain urine tests for sugar. Cefuroxime may cause false results for blood sugar. Diabetics taking cephradine should not change their diet or diabetes medication without consulting their doctor.
If you miss a dose that you take once a day, take it as soon as you remember. If it is almost time for your next dose, take the dose you forgot right away and your next one 10-12 hours later. Then go back to your regular schedule. If you take the medication twice a day, take the dose you forgot right away and the next dose 5-6 hours later. Then go back to your regular schedule. If you take the medication 3 or more times a day, take the dose you missed right away and your next dose 2-4 hours later. Then go back to your regular schedule.
Most cephalosporin liquids must be kept in the refrigerator to maintain their strength. Only cefixime liquid does not require refrigeration. All of the liquid cephalosporins have a very limited shelf life. Do not keep any of these liquids beyond the 10 days-2 weeks specified on the label. Follow your pharmacist’s storage instructions.
Special Populations
Pregnancy/Breast-feeding: These drugs are considered relatively safe during pregnancy, though small amounts pass into the fetus. Little information is available about the newer members of the group. Also, cephalosporins pass more quickly out of the bodies of pregnant women. cephalosporins should only be used during pregnancy after carefully weighing their potential benefits against their risks.
Small amounts of most cephalosporin antibiotics pass into breast milk. Nursing mothers who must take a cephalosporin should use infant formula.
Seniors: Seniors may require a lower dosage if they have reduced kidney function.
Cefaclor
250 mg every 8 hours, or 375-500 mg every 12 hours.  9 mg per lb. of body weight a day, in 2-3 equal doses.
Cefadroxil
1-2 g a day. in 1-2 doses.
13 mg per lb. of body weight a day, in 1-2 doses.
Cefdinir
Adult and Child (age 13 and over): 600 mg a day, in 1-2 doses. Child (age 6 months-12 years): 6.5 mg per lb. of body weight a day in 1-2 doses.
Cefditoren Pivoxil
Adult and Child (age 12 and over): 200-400 mg twice a day for 10 days.
Cefixime
400 mg a day, in 1-2 doses.
3.5 mg per lb. of body weight a day, in 1-2 doses.
cefpodoxime Proxetil
Adult and Child (age 13 and over): 200-400 mg a day, in 1-2 doses. Child (age 5 months-12 years): 5 mg per Yo. of body weight a day
in 1-2 (dvsin. Maximum daily dose for middle-ear infections is
400 mg; 200 mg for sore throat or tonsillitis.
Cefprozil
Adult and Child (age 13 and over): 500-1000 mg a day.
Child (age 6 months-12 years): 7-13 mg per lb. of body weight a day in 1-2 doses.

Generic Name
Carvedilol (car-VAY-dih-lol)
Brand Names
Coreg    Coreg CR
Type of Drug  Alpha-beta-adrenergic blocker.
Prescribed For
Heart failure, high blood pressure, angina pain, and cardiomyopathy.
General Information
Carvedilol was the first beta blocker approved for heart failure. It is also the only beta blocker approved for severe heart failure.
Carvedilol blocks both the alpha- and beta-adrenergic portions of the central nervous system. This dual action reduces the amount of blood pumped with each heartbeat and also decreases the risk of tachycardia (very rapid heartbeat). Carvedilol’s beta-blocking effects begin within an hour of taking the first dose; maximum blood-pressure-lowering occurs after 1 or 2 weeks. The drug also causes blood vessels to dilate (widen), allowing the heart to pump blood more efficiently.
Cautions and Warnings
Do not take carvedilol if you are allergic or sensitive to any of its ingredients, or if you have AV block, sick sinus syndrome or severe bradycardia (slow heart rate) without the use of a pacemaker.
Carvedilol should not be taken 13y patients with bronchial disease, qQQkVaS thronic bronchitis, emphysema, or asthma.
Carvedilol therapy should not be stopped suddenly due to the risk of worsening the heart condition.
In studies, carvedilol caused mild and reversible liver injury in about 1 of every 100 people who took it. Those with severe liver disease should not take this medication. Call your doctor at once if you develop signs of liver damage (symptoms include severe itching, dark-colored urine, flu-like symptoms, appetite loss, and yellowing of the skin or whites of the eyes).
Check with your doctor about continuing carvedilol if you are to receive general anesthesia; heart function that is depressed by anesthetics can worsen if carvedilol is used at the same time.
Make sure your doctor knows if you have diabetes. Carvedilol can mask signs of low blood sugar and may increase the effects of insulin or oral antidiabetes drugs, making it more difficult to recover from the effects of low blood sugar.
Carvedilol can mask symptoms of an overactive thyroid gland. Abruptly stopping carvedilol can trigger an attack of hyperthyroidism.
Possible Side Effects
Most side effects are considered mild or moderate.
✓    Most common: dizziness, sleepiness or sleeplessness, diarrhea, abdominal pain, slow heartbeat, dizziness when rising from a sitting or lying position, swelling of the hands or feet, sore throat, breathing difficulties, tiredness, back pain, urinary infection, and viral infection.
✓    Less common: extra heartbeats; palpitations; blood-pressure changes; fainting; reduced blood supply to the arms and legs (symptoms include aches, cramps, pain, or tiredness on walking, or pain in the foot, thigh, hip, or buttocks); tingling in the hands or feet; reduced sensation; depression; nervousness; constipation; gas; liver irritation; cough; impotence and reduced sex drive in men; itching; rash; visual difficulties; ringing or buzzing in the ears; high blood cholesterol, sugar, or uric acid; anemia; weakness; hot flushes; leg cramps; dry mouth; not feeling well; sweating; and muscle ache.
✓    Rare: Rare side effects can affect the heart, mental status, the respiratory tract, the urinary tract, and the kidney. It can also cause hair loss, weight gain, high blood-triglyceride levels, low blood-platelet counts, and sugar in the urine. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Carvedilol increases the effects of insulin and oral antidiabetes drugs. People taking this combination must monitor their blood sugar levels regularly. Call your doctor if there is any change from your normal pattern.
•    Carvedilol increases the effects of verapamil, diltiazem, and similar calcium-channel blocking drugs.
•    Monoamine oxidase inhibitor antidepressants may increase the effects of carvedilol.
•    Carvedilol increases the blood-pressure-lowering effect of clonidine. People taking this combination may need less clonidine to control their pressure.
•    Carvedilol increases the amount of digoxin in the blood by about 15%. Your digoxin dosage may have to be adjusted.
•    Cimetidine increases the amount of carvedilol absorbed into the blood by about 30%, but the importance of this interaction is not clear.
•    Rifampin reduces the amount of carvedilol in the blood by about 70%. Dosage adjustment is necessary.
•    Do not consume alcohol (including medicines that contain alcohol) within 2 hours of taking carvedilol.
Food Interactions
Take carvedilol with food to reduce the risk of dizziness or fainting.
Usual Dose
Heart Failure
Adult: 3.125 mg twice a day for 2 weeks. Dose may be doubled every 2 weeks to the highest level tolerated. Maximum daily dosage is 25 mg twice a day in people weighing less than 187 lbs., and 50 mg twice a day in people who weigh more.
High Blood Pressure and Cardlomyopathy
Adult: 6.25 mg twice a day to start, increased to 25 mg twice a day if needed.
Senior: Seniors may require smaller doses than younger adults. Child (under age 18): not recommended.
Overdosage
~3%rdose may lead to very low blood pressure (symptoms include dizziness and fainting), slow heartbeat and other cardiac symptoms, including shock and heart attack, breathing difficulties, bronchial spasm, vomiting, periods of unconsciousness, and seizures. Overdose victims must be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Carvedilol should be taken continuously. Do not stop taking it without your doctor’s knowledge, because abrupt withdrawal may cause chest pain, breathing difficulties, increased sweating, and unusually fast or irregular heartbeat. The dose should be gradually reduced over a period of about 2 weeks.
People taking carvedilol may become dizzy or faint when rising quickly from a sitting or lying position. If this happens to you, sit or lie down until you feel better. Carvedilol can also cause drowsiness, lightheadedness, or blurred vision. Be careful when driving or doing any task that requires concentration.
Contact lens wearers are more likely to experience dry eyes with carvedilol.
Swallow extended-release tablets whole; do not crush or break them.
It is best to take carvedilol at the same time each day. If you forget a dose, take it as soon as you remember. If it is within 4 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: Animal studies indicate that carvedilol passes into the fetal bloodstream and may interfere with pregnancy. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if carvedilol passes into human breast milk, though it passes into rat breast milk. Beta-blocking drugs like carvedilol may affect babies’ hearts. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more likely to develop dizziness and may require reduced dosage.

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.

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.

Steroid inhalers
Most asthmatics nowadays are given a steroid inhaler at some point, as part of their asthma treatment (see p. 160). It will probably be a low-dose inhaler, and the risks of side effects from this are very small. Even at higher doses, inhaled steroids are relatively safe. Many people are unnecessarily afraid of inhaled steroids and refuse to use them until their asthma becomes really incapacitating. It is important not to delay using an inhaled steroid for too long, as this could cause permanent damage to the airways: inflammation eventually thickens the airway wall, leaving it less flexible and therefore less capable of widening.
For side effects of inhaled steroids see p. 145, and for common brand names see p. 147.
Steroid tablets
These are usually a treatment of last resort. But when you need them you need them – and if your asthma has got badly out of control, they can, quite literally, be a life-saver. On the other hand, if there are any other means by which you can tackle your asthma, so that you do not need steroid tablets again in the future –avoiding allergens and irritants, for example, or using other preventer treatments – those means should definitely be taken.
For side effects of steroid tablets see pp. 141-3, and for common brand names see p. 147.
Cromoglycate-type drugs
For asthma, these drugs are taken by inhalation only. They work by blocking the allergic reaction (see p. 148), and are therefore a type of preventer drug.
Cromoglycate-type drugs are usually inhaled four times a day, although your doctor may recommend more frequent inhalations to begin with. Once your asthma is well controlled, you may be able to reduce the dosing regime to three times a day, or possibly twice a day: ask your doctor’s advice about this.
Should you decide to stop taking these drugs at some point, talk to your doctor first. It is generally best to reduce the dose gradually, over a period of 7-10 days. Some asthmatics need to introduce (or reintroduce) steroids at this time, to maintain control of the airway inflammation.
Side effects
When inhaled, cromoglycate-type drugs can produce short-lived irritation in the throat, which may lead to coughing. This sometimes develops into temporary bronchospasm, causing you to wheeze, but this is really only a minor side effect – it does not indicate that the drug is making your asthma worse.
Asthmatics are sometimes advised to use a short-acting
beta-2 reliever (such as Ventolin) before their cromoglycate inhaler, to overcome this problem. However, this would involve using the beta-2 reliever four times a day, which is no longer considered a good idea (see pp. 153-4). Talk to your doctor again if you have been given this advice.
Inhalers that combine sodium cromoglycate with a short-acting beta-2 reliever (e.g. Aerocrom) are not recommended for the same reason.
A better way around the problem of throat irritation may be to switch to an aerosol inhaler, because the irritation is much less than with dry-powder inhalers. Using a spacer along with the aerosol inhaler (see p. 162) will help even more.
Serious side effects of these drugs are very rare (see p. 149). For common brand names, see p. 148.