Posts Tagged ‘dizziness’

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

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

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

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

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

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

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

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

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

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

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

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

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

Generic Name
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.

Type of Drug
Carbonic-Anhydrase Inhibitors,
Eyedrops (kar-BON-ik an-HYE-drase)
Brand Names
Generic Ingredient: Dorzolamide Trusopt
Generic Ingredient: Brinzolamide Azopt
Combination Product
Generic Ingredients: Dorzolamide + Timolol Cosopt
Prescribed For  Glaucoma.
General Information
These drugs are similar to acetazolamide, a carbonic-anhydrase inhibitor taken by mouth. Carbonic anhydrase is an enzyme found in many parts of the body, including the eyes. By blocking the effects of this enzyme, dorzolamide and brinzolamide slow the production of fluid inside the eye, reducing pit:ssure. This cffc,, i3 usetul in ir83t
ino, open-angle glaucoma because the disease is characterized by elevated eye pressure. Dorzolamide and brinzolamide are sulfonamides, or sulfa drugs, and although they are administered topically, they affect the body systemically.
Cautions and Warnings
Do not use these drugs if you are allergic or sensitive to any of their ingredients or to other sulfa drugs. Small amounts of these drugs enter the bloodstream. Rarely, people using them experience side effects or allergies associated with sulfa drugs.
These drugs have not been studied in people with very poor kidney or liver function. Since these drugs are eliminated via the kidneys, people with impaired kidney function should use an alternate glaucoma medication.
These drugs have not been studied in people with acute angle-closure glaucoma.
See Timolol, page 1129, for more information on the combination product Cosopt.
Possible Side Effects
Dorzolamide
✓    Most common: eye burning, stinging, or discomfort and a bitter taste in the mouth immediately after administering the eyedrops.
✓    Less common: allergic reactions, conjunctivitis (pinkeye), blurred vision, tearing, dry eye, and increased sensitivity to bright light.
♦    Rare: headache, nausea, weakness, tiredness, rash, and kidney stones. Dorzolamide can cause the same types of side effects as other sulfa drugs, but this is very unlikely. Contact your doctor if you experience any side effects not listed above.
Brinzolamide
♦    Common: blurred vision and a bitter, sour, or unusual taste in the mouth.
♦    Less common: eyelid inflammation; conjunctivitis (pink-
eyeY, nsh; dry eye; sensation of something in the eye;
headache; eye redness, itching, discharge, or pain; and
runny nose.
✓    Rare: allergic reactions, hair loss, chest pain, diarrhea, nausea, sore throat, tearing, itchy rash, double vision, dizziness, Possible Side Effects (continued)
dry mouth, breathing difficulties, upset stomach, tired eyes, kidney pain, cornea problems, and formation of a crust or sticky sensation around the eyelid. Brinzolamide can cause the same types of side effects as other sulfa drugs, but this is very unlikely. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• If you are using more than 1 eyedrop product, separate doses of these drugs by at least 10 minutes.
Usual Dose
Adult: 1 drop in the affected eye 3 times a day. Overdosage
Accidental ingestion of a bottle of dorzolamide or brinzolamide may affect blood levels of potassium and other electrolytes. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor and stop using your eyedrops if you develop any unusual eye reaction or condition, including swollen eyelids and conjunctivitis (pinkeye).
Vision may be temporarily blurred when using the eyedrops. Use caution when driving or operating machinery.
If you wear soft contact lenses, take them out before using the eyedrops and put them back in 15 minutes after a dose.
To prevent infection, do not allow the eyedropper tip to touch your fingers, eyelids, or any surface. Wait at least 10 minutes before using any other eyedrops.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Very high dosages of dorzolamide or brinzolamide caused birth defects in animal studies. While the risks of using these drugs during pregnancy are small in people, pregnant women should use dorzolamide or brinzolamide only after discussing its potential benefits and risks with their doctors.
it is not known if these drugs pass into breast milk. Nursing mothers who must use either drug should use infant formula.
Seniors: Seniors may be more sensitive to side effects.

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.

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.

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.