Posts Tagged ‘formula’

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

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

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

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

Brand Name
BiDil
Generic Ingredients
Isosorbide Dinitrate Hydralazine Hydrochloride Type of Drug
Vasodilator combination. Prescribed For
Heart failure in black patients, in combination with other heart-failure treatments.
General Information
BiDil is a combiRatiZ0 101 Iwo drugs that dilate (open) both arter-
2nd veins. It is the first drug product to be specifically approved for people in a single racial group for any indication. The 2 ingredients in BiDil have been available generically for years and are prescribed for a variety of uses. Isosorbide dinitrate is prescribed for angina, heart failure, and spasms of the esophagus. Hydralazine hydrochloride is prescribed to treat high blood pressure and heart failure. When people with heart failure take this drug combination, it makes it easier for the heart to pump blood throughout the body by widening arteries and veins.
Cautions and Warnings
Do not take BiDil if you are allergic or sensitive to any of its ingredients.
Do not use erectile dysfunction drugs with BiDil.
This drug may be inappropriate for you if you have had a recent heart attack or have cardiomyopathy (loss of blood-pumping ability due to damaged heart muscle) or low blood pressure, especially postural low blood pressure (symptoms include dizziness or fainting when rising from a sitting or lying position).
Long-term administration of more than 200 mg a day of hydralazine may produce symptoms of lupus erythematosus (a chronic condition affecting the body’s connective tissue), including muscle and joint pain, skin reactions, fever, kidney inflammation, and anemia, although they usually disappear when the drug is discontinued. Report any fever, chest pain, feelings of ill health, or other unexplained symptoms to your doctor. The risk of developing lupus increases with higher dosages; approximately 5 out of 100 and 10% of people taking 200 mg a day of hydralazine develop lupus. The daily dosage of hydralazine when you take BiDil can be as high as 225 mg.
Hydralazine may cause a very rapid heartbeat, potentially leading to angina pain or a heart attack.
Taking pyridoxine (vitamin B6) may relieve tingling or numbness in the hands or feet caused by hydralazine.
Possible Side Effects
✓    Most common: headache and flushing—which should disappear after your body adjusts to the drug—nausea, dizziness, weakness, and chest pain.
✓    COmmQR*, k(a% UM16 pressure.
✓    Less common: blurred vision and dry mouth; sinus irritation, rapid heartbeat, heart palpitations, high blood sugar, runny nose, numbness or tingling in the hands or feet, vomiting, and high blood-fat levels.
Possible Side Effects (continued)
V Rare-. flushing, tearing, itching, or redness of the eyes, trem-
ors, muscle cramps, depression, disorientation, anxiety,
itching, rash, fever, chills, occasional hepatitis (symptoms
include yellowing of the skin or whites of the eyes), con-
stipation, urinary difficulties, and adverse effects on nor-
mal blood composition. Other side effects may affect any
organ or organ system. Contact your doctor if you experi-
ence any side effect not listed above.
Drug Interactions
•    Do not take sildenafil, vardenafil, or taldenafil with Bidil. The combination can result in a rapid and potentially fatal drop in blood pressure.
•    Taking this drug with a monoamine oxidase inhibitor antidepressant may increase the blood-pressure-lowering effect of the hydralazine component of BiDil. This combination should be used with caution.
•    Do not self-medicate with over-the-counter appetite suppressants and cough, cold, and allergy remedies, since many contain ingredients that may aggravate heart disease.
•    Taking this drug with large amounts of alcohol may rapidly lower blood pressure, resulting in weakness, dizziness, and fainting.
Food Interactions
Take this drug on an empty stomach. It is unknown how food affects BiDil.
Usual Dose
Adult: 1 or 2 tablets 3 times a day, 1 hour before or 2 hours after eating.
Overdosage
There have been no reports of BiDil overdose. Symptoms of INID11
overdose would be related to the Specific effects of each active in-
2ind can include reduced oxygen supply to heart muscle,
leading to a heart attack, abnormal heart rhythms, and profound
shock. Fainting, coma, and death may follow unless the victim is
treated. Overdose victims must be taken to a hospital emergency
room at once. ALWAYS bring the prescription bottle or container.
Special Information
Avoid alcohol.    headache, dizzi-
Call your doctor if you develop a persistent hea    ,
ness, facial flushing, blurred vision, or dry mouth.
It is important to make sure you drink plenty of fluids every day and pay attention to hot weather and exercise situations in which you might lose unusual amounts of fluids and salts. Fluid loss may lead to low blood pressure, dizziness, and possibly fainting.
If you forget to take a dose of BiDil, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Never take a double dose.
Special Populations
PregnancylBreast-feeding., Isosorbide dinitrate crosses into the fetal circulation, and hydralazine can cause low blood pressure in pregnant women and their babies. The potential benefits of B01 must be carefully weighed against its risks when your doctor considers this drug crucial.
it is not known if BiDil passes into breast milk. Nursing mothers who must take it should consider using infant formula. Seniors: Specifics about how seniors react to this drug are not
known. The lowest effective dose of BiDil should always be used, especially in people with reduced kidney and/or liver function.

Investigating Food Intolerance

COLICKY BABIES
If you have followed the measures described on pp. 78-9 but have had little or no success in reducing colic symptoms so far, it makes sense to look into the possibility of a food sensitivity reaction (either intolerance or a mild allergy) to food proteins. This is a very different problem from lactose intolerance (an inability to digest the milk sugar, called lactose, due to a shortage of lactase - see p. 79), although the two can get entangled, creating a complex and confusing set of responses.
The complications arise because, when there is diarrhoea as a result of allergy or intolerance (or from any other cause, including infections) it temporarily strips the gut of its lactose-digesting capacity. This problem is called secondary lactase deficiency, and it will correct itself quite quickly once the real cause of the diarrhoea is eliminated.
Unfortunately, the routine medical tests for lactase deficiency do not distinguish between this temporary problem and the much rarer primary lactase deficiency, which is inherited and life-long.
So if your child has had these routine tests, and you have been told that they show primary lactase deficiency, it remains possible that the real problem is a reaction to milk proteins (or proteins from other foods), and that the lactose intolerance is an effect of this, which adds to the diarrhoea, but is not the root cause of it. If so, eliminating the offending food from the baby’s diet (or the mother’s) will produce impressive results, whereas reducing or eliminating lactose only helps a little.
The purpose of the dietary investigations described here is to discover which foods are causing problems for your baby. In the case of bottle-fed babies, the answer is usually cow’s milk – and this is often the culprit for breast-fed babies too, but not necessarily.
For a breast-fed baby it can be any food that the mother is eating. A tiny proportion of what the mother consumes goes through into the breast milk, and these few molecules of food are enough to provoke a reaction in the child.
Bottle-fed babies
For bottle-fed babies, proceed as follows:
•    Change to an alternative milk-free formula (see box on p. 66). Wait two weeks before concluding that there is no improvement – recovery can take time – and try another type of formula before you decide this is not the answer.
•    If there is no joy with alternative infant formula, consider the possibility of relactation: stimulating the flow of your own breast milk once again. Breast-feeding support groups (see page 255) can give you advice. Avoid all dairy products while breast-feeding and take a calcium supplement.
For babies who are old enough, and who have severe symptoms, early weaning is one option, but this must be done very carefully:
•    Keep all dairy products out of the baby’s diet – read labels carefully on prepared foods and know all the different names used for milk (see page 173). Test beef cautiously as it shares some proteins with milk.
•    To avoid new food sensitivities developing, keep eggs, fish. wheat, chocolate and oranges off the menu until the child’s first birthday, then introduce them gradually. Avoid peanuts and other nuts for three years if possible.
•    Keep maize (corn) out of the diet for the first six months, because it is a common ingredient in formula feeds, and the child may have become sensitive to it. Note that some medicines contain corn syrup, but this will only affect those who are very sensitive. A pharmacist can check the full list of ingredients in medicines, and suggest alternatives.
•    No food should be given to the baby every day, or in large amounts. You can use unusual starchy foods, such as sweet potatoes, yams, culnoa and millet (see p. 195), to ring the changes. These all make excellent baby foods.
•    Never force a child to eat any food that is disliked. Try serving it again, once or twice, but give up if there are still fierce objections to the smell or taste – these are often a sign of intolerance or allergy.
•    Ask your doctor to refer you to a paediatric nutritionist so that the diet can be checked. A calcium supplement will probably be needed. Other vitamins or minerals may also be lacking.
Breast-fed babies
For breast-fed babies, the approach is quite different – the main focus here is on what you, the mother, eat and drink.
Firstly, start keeping a food diary, and a record of the baby’s symptoms. Are there any detectable patterns? Does the colic get worse if you drank red wine on the previous day, for example? Note that sometimes the time-gap is more than a day, but it should be reasonably consistent for any one food.
At the same time, eliminate all items other than breast milk from the baby’s diet, including:
•    any solids (e.g. baby foods)
•    fruit juice
•    medicines or vitamin drops that contain other ingredients (e.g. colouring or corn syrup)
•    nipple creams containing arachis oil (peanut oil).
Ask your doctor or pharmacist for alternative versions of medicines or vitamins, without added ingredients. Give boiled water to make up for fruit juice. Wait a week or so to see if things improve.
For the next stage, cut out coffee, tea and all alcoholic drinks. Allow a week for this, and continue with the food/symptom diary meanwhile. If there is no improvement, go on to the next stage, while still avoiding coffee, tea and alcohol.
For the next stage, compile a list of suspect foods, based on your food diary. Add to this list:
•    cow’s milk and all milk products
•    any foods that you craved when pregnant
•    any foods that you normally eat in large amounts
•    anything you dislike but have been eating because it’s ‘good for you’ or ‘good for the baby’
•    any of the following foods if you eat them regularly: eggs, wheat, oranges and other citrus fruits (lemons, grapefruit etc.), tree nuts, peanuts, fish, chocolate, chicken and beef.
Once you have your list prepared, talk to your doctor. Say that you would like to try eliminating cow’s milk for two weeks to start with, and then – if the colic has not cleared up – all the other foods on your list as well (again, for two weeks). You will need to take a calcium supplement. If there is strong opposition to your plans, based on a fear that your diet will be inadequate, ask for a referral to a nutritionist. Obviously this needs to be arranged promptly. The fear of under-nutrition, which is dangerous for both yourself and the baby, is a very reasonable one, but with sensible precautions any mother can safely carry out this investigation.
Eat at home during this time, as you cannot possibly know all the ingredients in cafe or restaurant meals. Read the labels on packaged meals and watch out for synonyms (see pp. 172-4).
If your baby recovers, and you want to pinpoint the problem food so that your diet becomes less restricted, you can test foods individually. Wait until there has been no sign of colic for a week. Choose one food and eat a portion every day for a week. If the colic does not reappear, cut out this food again and choose a second food to test – again, eat this daily for a week. Stop eating the food sooner if the colic returns. (Foods that proved safe can be reintroduced again later, but you need a break after the testing week.) Test cow’s milk last.
Some babies get better during the exclusion phase but do not respond to any of the foods when tested. The temporary break from the problem food seems to be all they need to lose their sensitivity. In such cases, the mother can go back to an unrestricted diet, but not to exactly the kind of diet she ate before – no food should be eaten every day, nor in large quantities, or the colic may return.
Many babies get over their sensitivity after one or two months without the problem food, so it is worth testing again after a while, especially if you are eating a very restricted diet.
Where cow’s milk turns out to be the offender, goat’s milk or sheep’s milk might be tolerated, but wait until the baby is completely free of symptoms and experiment cautiously. Alternatively, drink one of the new milk substitutes now available (see p. 183).
If the baby clearly responds to a food in the mother’s diet (for example, cow’s milk or peanuts), this food should be given cautiously when first introduced to the child after weaning, in case he or she has a true allergy to it. An allergy test may be helpful in deciding whether to introduce the food at all.