Posts Tagged ‘doctor’

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

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

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

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

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

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

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

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

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

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

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

Generic Name
Captopril (KAP-toe-pril)
Brand Name  Capoten
Combination Products
Generic Ingredients: Captopril + Hydrochlorothiazide [M Capozide
Type of Drug
Angiotensin-converting enzyme (ACE) inhibitor.
Prescribed For
High blood pressure and heart failure; diabetic kidney damage and post-heart attack management; also used for kidney hyperten-Sion, the management of people with a high risk of heart disease, chronic kidney disease, the prevention of a second stroke, and high blood pressure associated with other medical conditions, such as scleroderma and Takayasu’s disease.
General Information
Captopril and other ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin 11, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, helps to reduce blood pressure, and relieves the symptoms of heart failure. Captopril also affects the production of other hormones and enzymes that participate in the regulation of blood-vessel dilation. Captopril usually begins working about 1 hour after it is taken.
In addition to its labeled uses, captopril has been studied in the diagnosis of certain kidney diseases and of primary aldosteronism; in the treatment of rheumatoid arthritis; in swelling and fluid accumulation; in Bartter’s syndrome; in Raynaud’s disease; and in post–heart attack treatment when the function of the left ventricle is affected.
Cautions and Warnings
Do not take captopril if you are allergic or sensitive to any of its ingredients. Severe sensitivity reactions can occur in hemodialysis patients or in those undergoing venom immunization.
People with impaired kidney function should not take captopril unless other anti hypertensives have not worked or have had unacceptable side effects.
Swelling of the face, extremities, or throat has been known to occur with captopril, which can be dangerous (see “Special Information”).
Although not common, captopril may cause very low blood pressure. It may also affect your kidneys, especially if you have congestive heart failure. Your doctor should check your urine for protein content during the first few months of captopril treatment. Captopril may cause a decline in kidney function.
Captopril may affect white-blood-cell counts, possibly increaSlN I)Ur susceptibility to infection. Your doctor should monitor your blood counts periodically.
Captopril can cause serious injury or death to the fetus if taken during pregnancy. Pregnant women should not take captopril.
ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.
Possible Side Effects
♦    Most common: rash, itching, and cough that usually goes away a few days after you stop taking the drug.
✓    Less common: dizziness, tiredness, sleep disturbances, headache, tingling in hands or feet, chest pain, heart palpitations, feeling unwell, abdominal pain, nausea, vomiting, diarrhea, constipation, appetite loss, dry mouth, breathing difficulties, and hair loss.
♦    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
•    The blood-pressure-lowering effect of captopril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid blood-pressure drop should be used with caution if you are taking captopril.
•    Combining 325 mg of aspirin a day with captopril carries a higher risk of death than taking lower doses (less than 160 mg a day). People taking aspirin to prevent a heart attack should use the lower dose.
•    Captopril may increase the effects of lithium; this combination should be used with caution.
•    Mixing any ACE inhibitor with an NSAID pain reliever can increase the chances of kidney failure.
•    Severe sensitivity reactions can occur in those taking allopurinol.
•    Captopril may increase blood-potassium levels, especially when taken with dyazide or other potassium-sparing diuretics.
•    Antacids and captbe taken at least 2 hours apart. 1 tapsaicin may trigger or aggravate the cough associated with captopril.
•    Inclomethacin may reduce the blood-pressure-lowering effect of captopril.
•    Phenothiazine sedatives and antivomiting agents may increase the effects of captopril.
•Probenecid increases captopril’s effect as well as the chance of side effects.
•    The combination of allopurinol and captopril increases the chance of an adverse drug reaction.
•    Captopril may affect blood levels of digoxin. More digoxin in
the blood increases the chance of digoxin-related side ef-
fects, while less digoxin in the blood can compromise its
effectiveness.
Food Interactions
Captopril should be taken 1 hour before a meal.
Usual Dose
Adult: 25 mg 2 or 3 times a day to start. Dosage may be increased to 450 mg a day in divided doses, if needed. Dosage must be tailored to your needs. People with poor kidney function must take lower doses.
Child: 0.14-0.28 mg per lb. of body weight, 3 times a day. Infant: 0.07-0.14 mg per 1b. of body weight.
Overdosage
The principal effect of captopril overdose is a rapid drop in blood pressure, which may lead to dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Captopril may cause swelling of the face, lips, hands, and feet. This swelling may also affect the larynx (throat) and tongue and interfere with breathing. If this happens, go to a hospital emergency room at once. Call your doctor if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, a persistent rash, or losses in the sense of taste.
People who are already taking a diuretic (an agent that increases urination) may experience a rapid blood-pressure drop after their first dose of captopril or when their captopril dose k!Z,iTlr_Teased. To prevent this, your doctor may tell ‘you to stop taking your diuretic or to OYtM8 _’ your salt intake 2 or 3 days before starting captopril. The diuretic may then be restarted gradually.
You may get dizzy if you rise to your feet too quickly from a sitting or lying position when taking captopril.
Avoid strenuous exercise or very hot weather because heavy sweating or dehydration may lead to a rapid drop in blood pressure.
Avoid over-the-counter stimulants that can raise blood pressure while taking captopril, including diet pills and decongestants. Also, do not use potassium supplements or salt substitutes containing potassium without consulting your doctor.
If you forget to take a dose of captopril, take it as soon as you remember. If it is within 4 hours of your next dose, take 1 dose immediately and another in 5 or 6 hours, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: ACE inhibitors can cause fetal injury or death. Women who are or might be pregnant should not take ACE inhibitors. If you become pregnant, stop taking captopril and call your doctor immediately.
Small amounts of captopril pass into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors may be more sensitive to the effects of captopril due to age-related declines in kidney or liver function.

Generic Name
Capecitabine (ca pe-SE-ta h -been)
Brand Name
XelVA
Type of Drug  Antimetabolite.
Prescribed For
Breast cancer and colorectal cancer.
General Information
Capecitabine is prescribed for stages of breast and colorectal cancer in place of 5-FU, an injected drug that has been the basis for many chemotherapy programs. Capecitabine is converted in the body to 5-FU. Unlike many anticancer medications, capecitabine can be taken by mouth and has relatively few serious side effects.
Cautions and Warnings
Do not take capecitabine if you are allergic or sensitive to any of its ingredients or to 5-FU.
People taking warfarin or certain other blood-thinning medications are at risk of potentially fatal bleeding when capecitabine is added to their therapy. People taking these medications together should be closely monitored for changes in their response to the blood thinner.
People with liver disease should be carefully monitored by their doctors because capecitabine’s effect on the liver is not known.
This drug is largely eliminated through the kidneys. People with severe kidney disease should not take it. Dose adjustments are required for those with moderate kidney disease.
Capecitabine may reduce fertility.
Capecitabine use is associated with heart and blood-vessel disease.
Capecitabine may cause severe diarrhea. Call your doctor if you experience symptoms (see “Special Information”).
Jaundice has occurred in patients taking capecitabine requiring an interruption of medication until symptoms resolved.
Possible Side Effects
✓    Most common: diarrhea, constipation, nausea, vomiting, mouth sores, abdominal pain, hand-and-foot syndrome (see “Special Information”), inflammation of the skin, tingling or pain in the hands or feet, fatigue, loss of appetite, low blood-cell counts, eye irritation, and fever.
✓    Common: upset, &~)MaCb, nail problems, headache, dizziness, sleeplessness, dehydration, swelling, muscle aches, and pain in the arms or legs.
✓    Less common and rare side effects can affect the stomach and intestines, skin, nervous system, tear ducts, lungs and Possible Side Effects (continued)
respiratory system, heart and blood vessels, blood, urinary and reproductive tracts, liver, and other organs. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Combining antacids and capecitabine can increase the amount of drug absorbed by about 20%. Separate doses of antacids and capecitabine by 2 hours.
•    Leucovorin (a drug used in cancer treatment) increases the side effects of 5-FU. This combination has caused death in several seniors.
•    Combining capecitabine with warfarin can cause excessive bleeding.
•    When combining capecitabine with phenytoin, doses of phenytoin may need to be reduced due to an increase in side effects.
Food Interactions
Capecitabine should be taken within 30 minutes of a meal to avoid stomach problems.
Usual Dose
Adult (age 18 and over): 3000-5600 mg a day, depending on height and weight, in 2 doses. Capecitabine is used in 3-week cycles: 2 weeks on the drug, followed by 1 week off. Dosage may be reduced by 50% in people who experience severe side effects.
Child (under age 18): not recommended.
Overdosage
Symptoms include nausea, vomiting, diarrhea, bleeding and reduced blood-cell counts, and stomach irritation. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Stop taking capecitabine and call your doctor if you have 4-6 more bowel movements a day than normal, vomit 2-5 times in 1 day, or become very nauseous. Depending on the severity of your symptoms, your doctor may reduce your dosage.
Capecitabine has caused hand-and-foot syndrome. Symptoms of this condition include numbness, tingling, pain, swelling, redness, and skin loss and blistering of the hands or feet. Stop taking the drug and call your doctor if you experience any of these Symptoms.
People who develop stomatitis (symptoms include swelling, pain, or sores in the area of the mouth or tongue) should stop taking the drug and call their doctor at once.
Call your doctor, but do not stop taking the drug, if you develop a fever of 100.5°F or higher or other signs of infection.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose right away and space the remaining daily dosage evenly throughout the day. Go back to your regular schedule the next morning. Call your doctor if you miss more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: Capecitabine can harm the fetus. Its potential benefits must be carefully weighed against its risks when capecitabine is considered crucial by your doctor. Effective contraception is absolutely necessary while taking this drug.
It is not known if capecitabine passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more sensitive to side effects, especially diarrhea and other stomach problems.

Generic Name
Calcitonin (kal-sih-TOE-nin)
General Information
Calcitonin helps to strengthen bone by adding more calcium to it and slowing the natural process by which bone is broken down. The calcitonin used in this drug is essentially identical to human calcitonin except that it is more potent. It is a synthetic version of the natural calcitonin found in salmon. Calcitonin can increase bone density and reduce the risk of fractures of the vertebrae (bones that comprise the spinal column), which are associated with back pain and loss of height. Calcitonin has been available for years as an injection, but the development of the nasal spray makes the drug easier to use.
Cautions and Warnings
Do not use calcitonin if you are allergic or sensitive to any of its ingredients. Although serious allergic reactions were reported with the injectable form, none have occurred with the nasal spray.
Changes in the tissues lining your nose are possible with longerm use of this product. An initial nasal examination and then peiodic examinations are recommended.
Possible Side Effects
V Most common: stuffy nose, runny nose, and other nasal symptoms; and back pain.
V Less common: joint pain, nosebleed, and headache.
Drug Interactions
None known.
Food Interactions
None known. Usual Dose
Adult: I spray (200 IU) a day. Child: not recommended.
Little is known about the effects of calcitonin overdose or accidental ingestion. Nausea and vomiting have been reported after high doses. Call your local poison control center for more information. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Alternate nostrils daily when using the nasal spray.
Before you take your first dose, you must activate the pump. Hold the bottle upright and press the two white arms toward the bottle 6 times until a faint spray is emitted. Once this occurs, the pump is activated and ready for use. It is not necessary to reactivate the pump every day.
Store new, unassembled bottles in the refrigerator. Keep the bottle in use at room temperature and discard after 30 days.
If you forget to administer a dose of the nasal spray, do so as soon as you remember. If it is almost time for the next dose, skip the dose you forgot and continue with your regular schedule. Call your doctor if you forget 2 or more doses.
Call your doctor if you develop severe nose irritation or any unusual or intolerable symptom. Follow your doctor’s recommendations regarding calcium and vitamin D supplements. This drug is not intended to replace the need for dietary calcium.
Special Populations
Pregnancy/Breast-feeding: calcitonin does not cross into the fetal circulation, though animal studies have associated the injectable form of the drug with low birth weight. This drug is recommended for use during pregnancy only if its possible benefits outweigh its risks.
It is not known if calcitonin passes into breast milk, though animal studies have shown that it reduces the amount of milk produced. Nursing mothers who must use calcitonin should consider using infant formula.
Seniors: Seniors may use this product without special precaution.

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

Generic Name
Brimonidine (brim-ON-ih-dene) (9
Brand Name  Alphagan P
Type of Drug Alpha agonist.
Prescribed For
Glaucoma and ocular hypertension (high pressure inside the eye).
General Information
Brimonidine tartrate stimulates alpha-2 receptors in the eye and lowers pressure there. The maximum effect occurs 2 hours after the drops are administered. Brimonidine reduces the amount of aqueous humor (liquid) produced inside the eye and increases the rate at which fluid flows out of the eyeball. That portion of brimonidine that finds its way into the bloodstream is broken down by the liver.
Cautions and Warnings
Do not use brimonidine if you are allergic or sensitive to any of its ingredients.
People with kidney or liver disease should use this drug with caution. People with cardiovascular disease should exercise caution with this medication because it can affect blood pressure. It should be used with caution in people with depression, cerebral or coronary insufficiency, and Raynaud’s disease. Brimonidine may cause fatigue, drowsiness, and dizziness or fainting when rising from a sitting or lying position.
Brimonidine’s effectiveness may decrease over time. Your doctor should check your eye pressure periodically to make sure the drug is still working.
Possible Side Effects
✓    Most common: dry mouth; redness, burning, and stinging of the eye: headache; blurred vision; sensation of something in the eye; drowsiness; and eye allergy and itching.
♦    Common: staining or erosion of the cornea, unusual sensitivity to bright light, eyelid redness or swelling, eye pain or ache, dry eye, respiratory symptoms, dizziness, eye irritation, upset stomach, weakness, abnormal, and muscle
✓    Less common: crusty deposit on the eyelid, eye bleeding, abnormal taste sensation, sleeplessness, eye discharge, high blood pressure, anxiety, depression, heart palpitations, dry nose, and fainting.
Drug Interactions
•    Brimonidine may enhance the effects of alcohol, barbiturates, sedatives, anesthetics, beta-blocking drugs, blood-pressurelowering drugs, and cardiac glycosides.
•    Tricyclic antidepressants can increase the breakdown of brimonidine.
e    Do not combine brimonidine with monoamine oxidase inhibitor antidepressants.
Usual Dose
Adult and Child (age 2 and older): 1 drop in the affected eye every 8 hours, 3 times a day.
Child (under age 2): not recommended.
Overdosage
Little is known about the effects of accidental ingestion. Victims should be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
If you wear soft contact lenses, wait at least 15 minutes between the time you put the drops in your eye and when you put your lenses in.
To prevent possible infection, do not allow the dropper to touch your fingers, eyelids, or any surface. Wait at least 5 minutes before using any other eyedrops.
Brimonidine may make you drowsy. Be careful while driving or doing anything else that requires concentration while you are taking this drug.
It is important that brimonidine be used according to your doctor’s directions. If you forget to administer a dose of brimonidine, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: A small amount ,31 brimonidine may 1pa’SSWAOThe circulation of the fetus. Pregnant women should use this drug with care.
It is not known if this drug passes into breast milk. Nursing mothers who must use this drug should consider using infant formula.
Seniors: Seniors may use brimonidine without special precaution.

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