Posts Tagged ‘irritation’

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

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

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

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

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

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

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

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

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

Generic Name
Clemastine (KLEH-mas-tene) A
Brand Names
DayHist-1    Tavist-1
Tavist    Tavist Allergy
Combination Pr(3dUtj
Generic Ingredients: Acetaminophen + Clemastine + Pseudoephedrine
Tavist Allergy/Sinus/Headache
Type of Drug  Antihistamine.
Prescribed For
Sneezing, stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergies and for other symptoms of allergies such as rash, itching, and hives.
General Information
Antihistamines generally work by blocking the release of naturally occuring histamine (a chemical released by body tissue during an allergic reaction) from cells at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes. Clemastine fumarate is less sedating than most antihistamines, but not less sedating than astemizole, cetirizine, or loratadine.
Cautions and Warnings
Clemastine should not be taken if you are allergic or sensitive to any of its ingredients.
People with asthma or other deep-breathing problems, heart disease, high blood pressure, diabetes, enlarged prostate, glaucoma, stomach ulcers or other stomach problems, and hyperthyroidism should use clemastine with caution because its side effects can aggravate these problems.
Possible Side Effects
✓    Most common: drowsiness; headache; weakness; nervousness; stomach upset; nausea; vomiting; cough; stuffy nose; diarrhea; constipation; sore throat; nosebleeds; and dry mouth, nose, or throat.
✓    Less common: allergic reaction (symptoms include rash, itching, hives, and breathing difficulties), sleeplessness, menstrual irregularities, muscle aches, sweating, tingling in the hands or feet, frequent urination, visual disturbances, and ringing or buzzing in the ears.
Drug Interactions
•    Cbrnbining clemastine with alcohol, sedatives, sleeping pills, or other nervous system depressants may increase the depressant effects of clemastine. Do not combine these drugs.
•    The effects of oral anticoagulant (blood-thinning) drugs may be decreased by clemastine. Do not take this combination without your doctor’s knowledge.
Monoamine oxidase inhibitor antidepressants may increase the drying and other effects of clemastine. This combination can also worsen urinary difficulties.
e When taking antihistamines on a regular basis, notify your doctor if you are taking large amounts of aspirin. Effects of too much aspirin may be masked by the antihistamine.
Food Interactions
Clemastine is best taken on an empty stomach at least 1 hour before or 2 hours after eating; it may be taken with food if it upsets your stomach.
Usual Dose
Adult and Child (age 12 and over): 1.34 mg twice a day up to 8.04 mg of the syrup or 2.68 mg of the tablets in 24 hours.
Child (age 6-12) (syrup only): 0.67 mg twice a day or up to 4.02 mg a day.
Overdosage
Overdose is likely to cause severe side effects. Overdose victims should be given ipecac syrup—available at any pharmacy—to induce vomiting and should then be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Clemastine may make it difficult for you to concentrate or perform complex tasks such as driving a car. Be sure to report any unusual side effects to your doctor
Antihistamines may occasionally produce excitability, particularly in children.
If you forget to take a dose of clemastine, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
PregnancylBreast-feedj(IV. DO not take any antihistamines without WU ‘Obtlor’s knowledge if you are or might be pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of clemastine pass into breast milk. Nursing mothers who must take clemastine should use infant formula.
Seniors: Seniors are more sensitive to side effects.

Generic Name
Clindamycin (klin-duh-MYE-sin)
Brand Names
Cleocin    Clindesse
Cleocin T    Clindets
Clinda-Derm    Evoclin Clindagel
Type of Drug  Antibiotic.
Prescribed For
Serious bacterial infections. The vaginal cream is used to treat bacterial vaginosis. Topical clindamycin is used to treat acne and rosacea.
General Information
Clindamycin is one of the few oral drugs that is effective against anaerobic bacteria, which grow only in the absence of oxygen and are often found in infected wounds, lung abscesses, abdominal infections, and infections of the female genital tract. It also works against bacteria usually treated with penicillin or erythromycin, including serious respiratory tract infections. Clindamycin may be useful for treating certain skin or soft tissue infections. It kills the bacteria that frequently cause acne.
Clindamycin is not used to treat vaginal fungus or yeast infections.
Cautions and Warnings
Do not take clindamycin if you are allergic or sensitive to any of its ingredients or to lincomycin, another antibiotic.
People with asthma or a history of allergies should use clindamycin capsules with caution.
Clindamycin can cause a severe intestina(kmkation called colitis, which can be fatal. Signs of colitis are diarrhea, blood in the Stool, and abdominal cramps. Any form of this drug, including products applied to the skin and the vaginal cream, can provoke colitis. Because of this, clindamycin should be reserved for serious infections or those that cannot be treated with other drugs.
Clindamycin should be used with caution if you have gastrointestinal disease or kidney or liver disease.
Possible Side Effects
Capsules
✓    Most common: stomach pain; nausea-, vomiting-, diarrhea,
in up to 20% of people; and pain when swallowing.
♦    Less common: itching; rash; signs of serious drug sensitivity, such as difficulties breathing and yellowing of the skin or the whites of the eyes; colitis, (see “Cautions and Warnings”); effects on blood components; and joint pain.
Topical Lotion
♦    Most common: dry skin, redness, burning, peeling, oily skin, and itching.
♦    Less common: diarrhea, abdominal pain, upset stomach, and colitis (see “Cautions and Warnings”).
Vaginal Cream
♦    Most common: vaginal itching or irritation; thick, white vaginal discharge; and pain during intercourse.
♦    Less common: nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, headache, vertigo, and colitis (see “Cautions and Warnings”).
Drug Interactions
•    Do not combine clindamycin and erythromycin.
•    The absorption of clindamycin capsules into the bloodstream is delayed by Kaolin-Pectin Suspension (prescribed for diarrhea). Separate these drugs by at least 1 hour.
•    clindamycin should be used with caution by people also using neuromuscular agents.
Food Interactions
Take the oral medication with a full glass of water or with food to prevent irritation of the stomach and intestine.
Usual Dose
Capsules
MUIV ) 50-450 mg every 6 hours.
Child (under age 16): 3.5-11 mg per lb. of body weight a day, in 3-4 doses. For severe infections, at least 37.5 mg 3 times a day, regardless of weight.
Foam: Dispense enough to cover the affected area(s) onto a cool surface (the foam will melt on contact with warm skin). Use fin-gertips to massage small amounts into the affected area(s) until the foam disappears.
Suppositories: Insert 1 suppository a day for 3 consecutive days.
Topical Lotion: Wash the skin and pat dry before application. Apply enough to cover the affected area(s) with a thin coat twice a day.
Vaginal Cream: Insert 1 applicator’s worth at bedtime for 7 consecutive days, except for Clindesse, which requires one applicator’s worth once at any time of day.
Overdosage
clindamycin overdose may lead to severe diarrhea and other drug side effects. Do not treat this diarrhea on your own. Discontinue use of this drug and call your local poison center for information. If you go to an emergency room for treatment, ALWAYS bring the prescription bottle or container.
Special Information
Prolonged or unsupervised use of clindamycin may lead to secondary infections from susceptible organisms. such as fungi. Take this drug for the full course of therapy as indicated by your physician.
If you develop severe diarrhea or abdominal pain, call your doctor at once. Call your doctor immediately if you experience breathing difficulties or jaundice (yellowing of the skin or whites of the eyes).
Women using the vaginal cream should not have vaginal intercourse or use other vaginal products such as tampons or douches until treatment is complete.
Use of latex condoms or diaphragms within 72 hours following treatment with the vaginal creams or suppositories is not recommended. These products may decrease the efficacy of condoms or diaphragms.
The topical lotion is for external use only. Avoid contact with your eyes or mucous membranes.
If you miss a dose of oral clindamycin, take it as soon as you rememlae~. SSW19 almost time for your next dose of clindamycin, double that dose and go back to your regular dosage schedule.
Special Populations
Pregnancy/Breast-feeding: This drug crosses into fetal blood circulation. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
clindamycin passes into breast milk. Nursing mothers who must take oral clindamycin should use infant formula.
Seniors: Seniors with other illnesses may be unable to tolerate diarrhea and other clindamycin side effects.

Generic Name
Clonazepam (klon-A-zeh-pam)
Brand Name  Klonopin
Type of Drug  Anticonvulsant.
Prescribed For
Petit mal and other seizures and panic attacks; also prescribed for periodic leg movements during sleep, speaking difficulty associated with Parkinson’s disease, acute manic episodes, nerve pain, and schizophrenia.
General Information
Clonazepam is a benzodiazepine drug. Clonazepam is not used as a sedative or hypnotic. It is used only for the uses described above in people who have not responded to other drug treatments. Tolerance to the effects of clonazepam commonly develops within about 3 months of use. Your doctor may raise your clonazepam dosage periodically to maintain the drug’s effect.
Cautions and Warnings
Do not take clonazepam if you are allergic or sensitive to any of its ingredients or any other benzodiazepine.
When stopping clonazepam treatments, the drug must be discontinued gradually. Abrupt discontinuance of clonazepam may lead to drug withdrawal symptoms including severe seizures, tremors, abdominal or muscle cramps, vomiting, whet increased sweating.
IJSIF,l OfMazeparn with caution if you have a chronic respiratory illness, since the drug tends to increase salivation and other respiratory secretions and can make breathing more labored.
Avoid using clonazepam if you have severe depression, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, alcoholism, or kidney disease. These conditions may exacerbate the depressive effects of benzodiazepines, and such effects may be detrimental to your overall
condition.
Clonazepam can aggravate narrow-angle glaucoma, but if you have open-angle glaucoma, you may take it.
Possible Side Effects
♦    Most common: drowsiness, poor muscle control, and behavioral changes.
✓    Rare: Rare side effects can occur in almost any part of the body but are most likely to affect mental function, stomach and intestines, urinary function, blood, and liver. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    The depressant effects of clonazepam are increased by sedatives, sleeping pills, narcotic pain relievers, antihistamines, alcohol, monoamine oxidase inhibitor antidepressants, tricyclic antidepressants, and other anticonvulsants.
•    Mixing valproic acid and clonazepam may produce severe petit mal seizures.
•    Smoking, phenobarbital, phenytoin, carbamazapine, and rifampin may reduce clonazepam’s effectiveness.
•    Clonazepam may increase the requirement for other anticonvulsant drugs in people who suffer from multiple types of seizures.
•    The effects of clonazepam may be prolonged when it is taken with cimetidine, contraceptive drugs, disulfiram, fluvoxamine, isoniazid, oral antifungal medications (e.g. ketoconazole), metoprolol, probenecid, propoxyphene, or propranolol.
•    Theophylline may reduce clonazepam’s sedative effects.
•    Separate antacids from y<3kwc_%1Dnazepam dose by at least 1 bZldi %prevent them from interfering with clonazepam being absorbed into the bloodstream.
•    Clonazepam may increase blood levels of digoxin and the risk of digoxin toxicity.
•    Clonazepam may decrease the effect of levodopa + carbidopa.
Food Interactions
Clonazepam is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
Clonazepam is available in either tablets or orally disintegrating tablets, called wafers. Wafers should not be opened until immediately before the dose is to be taken. Do not push the wafer through the foil. Use dry hands to remove the wafer. The wafer will disintegrate quickly in saliva.
Seizures
Adult and Child (age 10 and over): starting dose    0.5 mg 3 times a day. The dose is increased by 0.5-1 mg every 3 days until seizures are controlled or side effects develop. The maximum daily dose is 20 mg.
Panic attacks
Adult and Child (age 10 and over): starting dose-0.25 mg twice daily. The dose is increased to 1 mg a day after 3 days. Most people do not require a higher dose.
Child (under age 10 or below 66 Ms.): starting dose-0.0220.066 mg per lb. of body weight a day in divided doses. Dosage can be increased gradually to a daily dose of 0.22-0.44 mg per lb. of body weight.
Other uses for clonazepam involve doses from 0.5-16 mg a day, depending on the condition and its severity. Clonazepam dosage must be reduced in people with impaired kidney function.
Overdosage
Overdose may cause confusion, coma, poor reflexes, sleepiness, low blood pressure, labored breathing, and other depressive effects. If the overdose is discovered within a few minutes and the victim is still conscious, it may be helpful to induce vomiting with ipecac syrup—available at any pharmacy. Overdose victims must be taken to a hospital emergency room. ALWAYS bring the prescription bottle or contai”iaT.
Special Information
Clonazepam may interfere with your ability to drive or perform other complex tasks because it can cause drowsiness and difficulty in concentrating.
Your doctor should perform periodic blood counts and liver function tests while you are taking this drug to check for possible
side effects.
Do not suddenly stop taking clonazepam—severe seizures may result. The dosage must be discontinued gradually by your doctor.
If you miss a dose by 1 hour or less, take it right away. Otherwise, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Carry identification or wear a bracelet indicating that you have a seizure disorder for which you take clonazepam.
Special Populations
Pregnancy/Breast-feeding: Clonazepam crosses into the fetal circulation and can affect the fetus. Women who are or might be pregnant should avoid it. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Some reports suggest a strong link between anticonvulsant drugs and birth defects, though most of the information pertains to phenytoin and phenobarbital, not clonazepam. It is also possible that the epileptic condition itself or genetic factors common to people with seizure disorders may figure in the higher incidence of birth defects.
Clonazepam may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of this drug—especially dizziness and drowsiness—and may require smaller doses.

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.

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

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

HEARTBURN
-Try limiting high-carb foods
• Stimulate saliva with gum ****
• Sip chamomile or ginger tea ****
• Swallow a little mustard or vinegar
• Drink baking soda dissolved in water ****
• Chew calcium carbonate antacid ****
•Control acid with Pepcid Complete ***
• Suppress acid with Prilosec OTC ***
Humans have suffered from heartburn for all of history prednisolone syndrome death . Hippocrates warned in 400 BC that eating cheese after a full meal could cause indigestion, especially if accompanied by wine propecia finasteride 5mg .”O Centuries ago, doctors called it dyspepsia, from Greek words meaning difficult to digest propranolol package insert . These days, drug companies stress an even scarier name: gastroesophageal reflux disease (GERD) metoprolol drug side effects .
Whatever you call it, heartburn is unpleasant topical verapamil . It can ruin the memory of a great dining experience zyrtec breastmilk .And trying to sleep with a burning sensation in the middle of your chest can be difficult at best and impossible at worst multiple sclerosis and use of cipro . Reflux can also lead to more serious conditions paxil cr buy online without prescription . The longer irritating stomach contents stay in contact with the delicate tissue of the esophagus, the more damage they do cephalexin side effect . Repeated exposure to this noxious nastiness can cause scarring, stricture, and abnormal cell growth depakote small vessel brain . Most worrisome of all is the risk of esophageal cancer lithium and bupropion .
Let’s be perfectly clear zovirax ointment 15g for cold sores . Anyone who experiences prolonged bouts of heartburn must be seen by a competent gastroenterologist fora thorough workup prescribing information famvir . This is not a do-it-yourself project!
The underlying cause of GERD is more mysterious than you would think amaryl patient advice including side effects . Commercials for antacids or powerful prescription reflux drugs often blame heartburn on excess stomach acid, as if Mother Nature made a giant mistake losartan genetic . But we’re supposed to have acid in our stomachs lithium ionen akku . Starting some 350 million years ago, virtually all animal species evolved sophis-COMPLICATIONS OF GERD
• Esophageal narrowing (stricture)
• Chronic cough
• Laryngitis
• Asthma
• Pneumonia
• Barrett’s esophagus (scarring)
• Esophagealcancer
ticated systems for creating strong stomach acid ivermectin injection for dogs .”‘ -Halibut make hydrochloric acid in their stomachs ibuprofen anti-inflammatory good for brain . So do dogs, cats, cows, birds, frogs, snakes, and salamanders caffeine’s gi effects . Just because drug companies have figured out ways to shut down acid production with medications such as omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium) does not mean this is the only way to combat heartburn tramadol without a prescription .
Stomach acid is essential for digesting food and facilitating the absorption of certain nutrients azithromycin and counterindications . The acid environment in the stomach also creates a barrier against infection side effect for zocor . We swallow germs every day from our food and other sources sucralfate food . But it is hard for bacteria to survive in the stomach if there is a hostile acidic environment ovulation test results while on clomid . Trying to prevent the creation of stomach acid is like fighting back the tide casodex rebate . We’re not at all certain that long-term acid suppression is always such a good idea caffeine and endometriosis .
HEARTBURN OR HEART ATTACK?
WIhIngh heartburn is rarely considered a life-threatening condition, there are times when vague upper gastrointestinal tract symptoms indicate a heart attack in progress liquid dostinex . This may be especially true for women, who do not always
experience “classic” heart attack discomfort canon nb-2lh lithium rechargeable battery . If you have any reason to suspect you’re having a heart attack, call 911 and hightail it to the hospital norvasc hot flashes .
Lazy LES
The real cause of heartburn is a lazy muscle at the end of the esophagus (food tube), just above the stomach lithium minning company . Normally, food is chewed, swallowed, and pushed into the stomach past a one-way valve called the lower esophageal sphincter (LES) does penicillin treat candidiasis . This muscular sphincter is not supposed to let food or gastric juice (which contains hydrochloric acid and digestive enzymes) back up into the esophagus, where it does not belong zebeta dosage .
Imagine that you are holding a balloon filled with air order sildenafil doctor . Just like your stomach, there is more pressure inside the balloon than outside prevacid who can take this product . As long as your fingers tightly pinch the little neck end of the balloon, no air can escape prilosec prescription strenght . But if you loosen your grip, air begins to seep out generic viagra soft tabs . In the same way, if the LES relaxes, stomach contents can escape into the esophagus lotrel rx . For reasons that are not completely understood, this muscle can lose its contractility and allow reflux to occur lipitor confusion . Many medications, including diazepam (Valium), nitroglycerin, and progesterone, may contribute to LES laziness toradol shelf life .
Food Fight
People are frequently given lots of advice about what not to eat to avoid heartburn generic of omnicef . Dietary dogma has it that fatty food is bad news cialis canadian geneic . Cheese, for example, is considered a major problem, just as Hippocrates suggested back around 400 BC pepcid rebate coupons . The trouble is, there just haven’t been any good studies to prove that fatty foods should be forbidden estradiol levels during fet cycle . Investigators who actually performed a study to determine if a high-fat meal was a culprit came up empty:3K
In summary, our study did not provide evidence for an increase in gastro-oesophageal reflux after fatty foods, at least for the first 3 postprandial [after eating> hours, suggesting that the relationship between fat and induction of heartburn in reflux disease is more complex than commag(y thought celebrex drug elderly program .~~6
—R how long does 50mg zoloft last . Penagini
So fatty foods may not really be as bad as everyone thought, at least in terms of heartburn bacterial overgrowth and metronidazole . Doctors have long believed that many other foods can also make the LESrelax and contrib- ute to GERD boniva lawsuit uveitis . But a thoughtful review of the medical literature now calls this belief into question levaquin problems . People suffering from heartburn have been warned to avoid spicy foods, citrus fruits, chocolate, mint, coffee, tea, and alcohol rimonabant fda report . There is, however, little scientific evidence that avoiding these foods and beverages reduces reflux cilostazol 50mg .384 If you find that mint or coffee causes you distress, by all means avoid it claritin and benadryl . If it doesn’t bother you, relax and enjoy it prednisone sedation danger . Each person is different, so you may have to keep a food diary and a record of your symptoms to identify your particular nemesis fluoxetine long term side effects .
Despite the lack of solid scientific evidence, many people maintain that highly acidic foods make them uncomfortable zoloft and pain medication . Things like coffee, tomatoes, citrus juices, colas, sauerkraut, and wine may produce irritation of the stomach and esophagus as well as urinary tract discomfort caffeine and rum . Not surprisingly, many folks give up some of their favorite foods because of the unpleasant consequences loratadine claritin safe during pregnancy . Prelief (calcium glycerophosphate) reduces the acid content of such foods and provides elemental calcium buspar anti-anxiety side effects . In addition, it may help relieve bladder symptoms associated with acidic foods intas strattera for sale online . Losing weight may also be important in preventing reflux scleroderma and clindamycin .
Although most physicians warn against -fatty foods, they rarely mention carbohydrates singulair in the news . But we have heard from many readers that a typical American high-carb diet can also cause gastric grief treating anxiety attack with wellbutrin .
Years ago, I was overweight and had high blood pressure citalopram hydrobromide effects and side effects . So my doctor put me on a diet is tramadol a opiet . When I reached a plateau, the doctor told me to cut out bread ursodiol safety data sheet . It worked snort paroxetine . I lost the desired amount and my blood pressure normalized propecia and liver function test .
During this diet, I found that I could eat corn or wheat chips in place of bread and continue to lose weight testosterone enanthanate . / love them, so I ate lots celexa diahrea .
Looking back, I began having indigestion about the same time, though I didn’t make the connection brand of coffee most caffeine . This indigestion occurred nearly every evening for several years vytorin updates .
Recen(IV (developed borderline high blood sugar, and my doctor recommended that I cut down on carbohydrates zoloft 150mg . I cut out the chips completely, and my indigestion disappeared paroxetine medicamento . I don’t mean it diminished, I mean it totally stopped glaxo smith kline imuran usa . I have not had indigestion since diclofenac and sekisui .
We do not think this reader was imagining things finasteride ringing effects . Many people have told us that when they go on an Atkins- or South Beach—type diet their heartburn disappears actos drug . If you search the medical literature, you will discover that as far back as 1972 researchers reported that a low-carb diet was far superior to a “gastric” diet for heartburn relief traumatic brain injury baclofen .385 In those days a gastric diet was likely bland: low in fat, low in acid, and restricted in coffee and alcohol xlpharmacy fexofenadine 60mg .
Another small study (2001) confirms these observations testosterone side-effects in women . Duke University physicians carefully observed several patients on a low-carbohydrate diet polski nolvadex . They reported that “carbohydrates may be a precipitating factor for GERD symptoms and that other classic exacerbating foods such as coffee and fat may be less pertinent when a low-carbohydrate diet is followed natural sources viagra .-386 Follow-up research has produced more provocative data suggesting that a low-carb approach reduces acid splash-back into the esophagus and eases GERD symptoms for over- weight patients diflucan and trileptal .
2
Treating Heartburn
The saying goes that when all you have is a hammer, every-
thing looks like a nail breastmilk procardia . Drug companies have been very good at developing acid-suppressing drugs, so they have decided that heartburn is a disease of excess acid terbinafine symptoms . Never mind that stomach acid is important in digesting food and serving as a barrier against bacterial infection boniva and complications .
There’s another thing drug companies don’t mention does aleve cause facial swelling . Acid is not the only irritating chemical in your stomach prednisolone adverse reactions . Gastric juice contains a witches’ brew of compounds ultram product information . A digestive enzyme called pepsin can be irritating to delicate tissue in the esophagus no overnight prescription soma . Bile acids that aid in digestion get into the esophagus during reflux and can also be quite irritating colorado imitrex website .388 And bacteria that flourish in the stomach during acid suppression may create carcinogenic chemicals such as nitrosamines and acetaldehyde loratadine and pregnancy .389
Since we don’t have drugs to neutralize these chemicals, they continue to allpel the esophagus during reflux remeron hypertension . Because You may not “feel” these pasties the way you feel acid, they are left to silently do damage during usual drug treatment tramadol cod florida . If the real goal, however, is to keep all these irritating contents of the stomach out of the esophagus, perhaps there are some other tricks to try clomid multilple births .
There used to be an interesting drug called cisapride (Propulsid) mycin ending antibiotics antibiotics . It worked reasonably well to increase the strength of
the lower esophageal sphincter tetracyclines antibiotics . In addition, the drug helped the stomach empty dose doxycycline lyme disease dogs . These two actions made cisapride a logical choice to fight reflux by keeping stomach contents out of the esophagus generic bupropion side effect . Unfortunately, this medicine had a fatal flaw rosiglitazone arrhythmia . It could occasionally cause life-threatening heart rhythms (torsades de pointes), especially when taken with certain other medications weight gain paroxetine . Because the FDA was unsuccessful at keeping physicians and pharmacists from prescribing and dispensing incompatible drugs with cisapride, the feds decided that this heartburn drug needed to be removed from the market active ingredient sildenafil citrate .
Another medicine with a somewhat similar effect that has been prescribed for reflux is metoclopramide (Reglan) hoodia lipitor drug interaction . Unfortunately, it also has some nasty side effects, including drowsiness, dizziness, mental depression, suicidal thoughts, confusion, fatigue, insomnia, headache, hallucinations, and involuntary muscle movements that may sometimes be irreversible greek coffee caffeine heart problems . Not surprisingly, Reglan is not one of our favorite drugs rash wont heal diflucan .
There is a new prescription heartburn medication that we are quite excited about, though subaction showcomments cialis thanks remember . At the time of this writing it has not been approved for sale in the United States, but it is very popular in Japan and India zyprexa psycotic reactions . Itopride (sold in India as Itoz) appears to be quite effective against symptoms of indigestion (bloating, nausea, fullness, and pain) as well as heart-
burn generic wellbutrin xl anti-depressent . 390 lansoprazole side effects back pain . 91
We are intrigued by this drug because it is a “prokinetic” agent dogs skin darkening prednisone . That means it speeds emptying of food from the stomach and may also enhance muscle tone in the esophagus, helping clear out acid and preventing it from splashing back sprinkles prevacid . It may turn out to be especially beneficial for diabetics, who often have difficulty with “gastric emptying using viagra after prostate surgery .” Unlike cisapride, itopride does not appear to cause irregular heart rhythms lou gehrig’s and lipitor . Other side effects are relatively rare, and the drug appears to be well tolerated rx plan for altace .
Soothing Heartburn with Saliva
One of the cheapest and most effective remedies for heartburn is produced by our own bodies cetirizine hydrochloride side effect . It is as simple as spit psychogenic polydipsia and prevacid . We stumbled across this approach in 1984, when researchers reported in the New England Journal of Medicine that “residual acid [in the esophagus> is neutralized by swallowed saliva norvasc buy .”39′ Not only does saliva buffer acid, swallowing also increased the muscular contractions of the esophagus, moving acid (and other unpleasantness) back into the stomach where it belongs cheap nolvadex online cheap .
Scientists have looked for easy ways to increase saliva production cellcept suppliers . What they came up with is as simple as chewing sugarless gum bedroom withdraw from lexapro .93-34 More important, however, is whether chewing gum can relieve heartburn pfizer lipitor atorvastatin . British researchers discovered that chewing gum could double the flow of saliva and shorten the amount of time the lower esophagus is bathed in acid a trusted site to buy prozac .They concluded that “chewing gum might be a non-pharmacological treatment option for some patients with symptomatic gastro-oesophageal reflux wellbutrin work .”395
Yeah! I finally found out why my “home remedy” works prednisone without prescription .
I’m a nurse and have often given chewing gum to a patient who complains of indigestion allergic reaction to claritin . I’d tell them this helps me amoxicillin dosage 500 mg . It often seemed to help them price of pentasa . Now you’ve told me what’s behind it—thanks!
Another group of researchers asked patients who suffered from symptoms of heartburn to chew sugarless gum (Orbit) for 30 minutes after eating a high-fat meal prednisone central obesity . They found that acid was washed out of the lower esophagus much more quickly when people chewed gum ractions ziac zocoor . TWo-thirds of these patients had significant improvement in their heartburn symptoms zocor versus vitamin d . The researchers concluded that “the use of chewing gum with other conservative measures could provide a comparatively safe and effective method of controlling acid reflux and SyMptorriS naltrexone multiple sclerosis .,,396
Most people do not know about this incredibly easy and inexpensive remedy because there are no TV commercials promoting the benefits of a pack of gum against heartburn baclofen research . Chewing gum makers cannot advertise this benefit because they would run afoul of the FDA requip and mood disorders . And drug companies certainly have nothing to gain if people use chewing gum instead of high-priced
Saliva
Saliva is free, helps neutralize acid, and washes irritating, stomach contents out of the esophagus and back where they belong buy ranitidine drug . There are no side effects or downsides cialis drug sample viagra .
Ways to stimulate saliva production: chew sugarless gum or suck on lozenges or something sour how lithium .
acid suppressors sulfisoxazole trimethoprim . Doctors may not know about the substantial research supporting this home remedy meloxicam chiens . It may seem wimpy compared to prescribing potent and pricey drugs furosemide breast cancer .
If you walk and chew gum at the same time, you may get a little added benefit side effects of the medication paxil . Investigators found that walking after a study breakfast of bacon, eggs, toast, and coffee helped reduce heartburn symptoms among those with reflux can wellbutrin cause joint pain . Chewing gum for 1 hour, however, worked even better and the effect lasted longer-3 hours compared to 1 hour for walking the testosterone dilema . Although the researchers did not combine the two, we think it might be a very sensible approach to take a walk after eating and chew gum at the same time clozapine registry problems .
Sucking on hard candy also stimulates saliva production ofloxacin generic name . If you really want to liven up your taste buds and create astonishing amounts of saliva, search out the cough lozenges called Fisherman’s Friend very high capacity lithium cell . These lozenges have been made by Loft-house of Fleetwood in Lancashire, England metoclopramide 5 mg side effects . since 1865 (www nexium heart trouble . fishermansfriend zocor free samples .com) hpv zovirax . They are all natural and contain menthol, capsicum (essence of hot peppers), eucalyptus oil, and natural licorice warfarin dark stool . This is an acquired taste, however, and will not be to everyone’s liking all about prozac . Too much licorice for a long time could have negative health consequences risperdal drug facts . We don’t know how much licorice is in Fisherman’s Friend prescription clomiphene . The company also makes a menthol eucalyptus sugar-free chewing gum that might be worth a try prozac used for . serenity natural lithium .
Tea for Tummy Trouble
Anything that washes stomach acid and other digestive juices out of the esophagus is beneficial lyme erythromycin . Sipping tea slowly might be just the ticket, especially if the tea is herbal and has calming properties dangers evista . People have used all sorts of preparations to soothe an upset stomach, including anise seeds, caraway seeds, catnip, lemon balm, licorice, and sage seamus moore viagra song . But our two favorite herbs are chamomile and ginger combining lexapro and st john’s wort . They have been used for cenWfie,S all around the world to relieve indigestion accutane the second time .

Ginger
Chinese healers have used ginger for thousands of years novo trazodone . Studies show that it can relieve symptoms of nausea and vomiting associated with motion sickness generic silagra 238 . It works best if you sip it slowly as a tea or in real ginger ale (Carver’s Original or Blenheim) nolvadex omnadren . Ginger cookies and candied ginger may also do the job zyprexa and aplastic anemia .
Side effects: Allergy is uncommon metronidazole vaginal .
Downside: Those taking blood thinners like warfarin (Coumadin), Plavix, or even aspirin may be more vulnerable to bleeding compazine in pregnancy .
Cost: Approximately $5 to $8 for a month’s supply of ginger tea
After 1 month of adding about 3 tablespoons of the cinnamon-ginger drink to my tea in the morning and at night, my low-density lipoprotein cholesterol levels had dropped 30 points, blood sugar dropped 10 points, and the heartburn was in control tell me about clomid .
This cinnamon-ginger tea has sugar, unfortunately bacteria led to penicillin researchers . A simpler alternative is to add a piece of candied ginger to tea hypersecretion of thyroxine .
The ginger is amazing for heartburn and the Chinese have used it for centuries for motion sickness can you give glyburide without food .
If tea is not your thing, you may want to opt for other forms of ginger advair diskus generic . Readers have shared that candied ginger relieved reflux and “stomach burn” just as well as acid-suppressing drugs piroxicam digemid . And while we cannot endorse eating the Garbs found in cookies, we found this report intriguing: “Since I have had a problem with Prevacid, I tried ginger, both in ginger snaps and as crystallized ginger free samples of zocor . It’s been working like a charm fanta pineapple caffeine .”
Mustard tor Heartburn?
Just about the last thing we would ever consider for heartburn is mustard allegra d 24 mg . It seems like a spicy food would only make matters worse amoxicillin trihydrate . And yet enough people have shared their enthusiasm for mustard that we cannot ignore this odd remedy prescription for macrobid .
My husband and I use a teaspoon of yellow mustard to relieve heartburn flutamide medication . I was in a chat room a while ago when one of the chat-ters complained about her heartburn can you overdose from prozac . Another said, “Try mustard lipitor jarvek .” We all thought this was ludicrous, but she did try it and it helped caffeine pills and college students .
The next time my husband had one of his terrible roll-on-thefloor-in-agony bouts of heartburn, I suggested mustard fed ex tramadol . I figured it couldn’t hurt any more than what he already had is relafen a narcotic . Amazingly, it worked, faster than Turns or DiGel albuterol how long in urine . Our friends have had good results also venlafaxine for dogs .
Some folks are not going to be able to stomach mustard truth about avandia . ‘The spiciness is just too much for them valtrex expiration . But mustard may stimulate saliva and work in a similar manner as chewing gum adderall and abilify . When we checked with one of the world’s leading experts on herbs, James Duke, PhD, he suggested that turmeric, the spice that makes mustard yellow, has ingredients that are beneficial for the digestive tract antabuse implant .
* * a
O lopressor antidepressant . 1 was interested in your column about the person who used yellow mustard for indigestion advantages of accutane . I want to provide some positive feedback: I tried the mustard remedy for indigestion over the last couple of days and am amazed and delighted that it works!
A cholesterol drugs pravastatin . You are not the only one who has remarked on this home remedy:
“I was fascinated to read that someone else takes yellow mustard for heartburn weight gain after stopping wellbutrin . I stumbled onto this remedy myself years ago: I noticed several things that often caused me heartburn sarah by allegra goodman summary . But when I put mustard on them, I was fine beta carotene and coumadin . Now when I experience heartburn, I put some yellow mustard on saltines and get relief famvir lunesta myonlinemeds biz nexium yasmin .”
%to
Vinegar
If you think mustard makes no sense for heartburn, then you will think we are totally crazy to mention vinegar robaxin info . After all, drug companies have been promoting antacids and acid-suppressing drugs for decades misoprostol use . Consuming acid (vinegar is acetic acid) would seem like the last thing one would want to do when dealing with heartburn accutane clavaris sotret buy without prescription . Of course, that assumes that acid somehow contributes to reflux raloxifene evista . But if the theory is wrong, then perhaps this remedy might have some merit percocet and robaxin .
A doctor advised a family friend to take a tablespoon of vinegar for heartburn relief I tried 2 teaspoons of apple cider vinegar and it worked interigo keflex . It tastes strong for a few minutes and I thought the heartburn was worse will penicillin react with methadone . Then the pain went away for good do it yourself testosterone booster .
We admit that it sounds strange, but others have shared similar success signs of caffeine withdrawal . We would discourage anyone from sipping pure apple cider vinegar, however canada pharmacies allegra d 24 . It’s just way too strong clindamycin in renal insufficiency . Perhaps diluting it in water would make it easier to swallow accutane infertility . One reader offered something even more bizarre than dilute vinegar wheatgrass vs coumadin . She combined vinegar and baking soda, which seems counterintuitive how much does lithium cost . But who knows, it might help someone clomid and delay period .
0 0 0
Q buy diflucan samples . 1 used to have real bad heartburn until I remembered a home remedy my mother used to make is seroquel used for alcolic treatment . I mix a couple ounces of water, an ounce of apple cider vinegar, and a teaspoon of sugar until the sugar dissolves androstenedione conversion to testosterone . Then I add half a teaspoon of baking soda, stir it briefly and drink immediately roxithromycin half life . This offers fast relief signs of testosterone cancer .
A side effects of sildenafil . Thanks for an inexpensive remedy for heartburn dosage for prednisone for dogs . Baking soda is a time-honored approach to neutralizing stomach acid that has splashed into the esophagus and is causing heartburn celexa warning .
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If apple cider vinegar seems just too strange for you, maybe an apple a day could keep reflux at bay previcid nexium . At least that’s what we have heard allergy mediciation comparable to zyrtec d .
Recently I have had terrible episodes of acid reflux 2 testosterone kit cream for men . I have tried raising the top of our bed, not eating 3 hours before going to sleep, and cutting out citrus, tomato products, caffeine, and alcohol prozac works grat . But nothing worked metoprolol bronchial .
My doctor gave me a prescription for Nexium, but before I tried it, someone told me that an apple helps acid reflux vardenafil mexico . I had a bag of apples in my refrigerator, so I decided to try this approach prilosec and beta bolckers . I ate the apple with the peel right after dinner and to my amazement I did not have any heartburn that night I have been eating an apple every night for the past 10 nights and have not had one episode of heartburn levoxyl recalls 2007 .
We have no scientific explanation for why apples, apple cjder vinegar, or even lemon juice in water might be helpful against heartburn mens health levitra .They probably won’t work for everyone, but some people report benefit brain fog from arimidex . They are inexpensive and worth a try just on the off chance that they might do the trick tenormin side affescts .
Hot Peppers for Indigestion?
If mustard and vinegar seem too scary for you, please skip this section plastic cyclosporine . Although people who frequently suffer from indigestion are usually advise6*to avoid spicy food, some pepperheads maintain that hot peppers don’t trigger stomach upset abuse prilosec . They insist that the “burn” may actually be beneficial omeprazole usage . And they may be right lexapro side effects drug . There is some research suggesting that capsaicin (the hot stuff in hot chile peppers) can protect the stomach lining toprol buy . 398
0 0 0
0 aricept pain . My brother-in-law is addicted to hot peppers how long for seroquel to work . He puts Tabasco on everything, and I can’t figure out how he avoids heartburn lexapro and focalin . Spicy foods give me indigestion, but he claims hot peppers are good for the stomach viagra dicount . Is he nuts?
A clomid twin parents . Your brother-in-law actually has some science on his side avelox adverse side effects . Italian researchers wrote a letter to the New England Journal of Medicine’”" reporting that red pepper 913WdILIT In capsules reduced indigestion symptoms (stomachache, fullness, and nausea) by 60 percent soma gupta . In this small, double-blind, placebo-controlled study, a look-alike placebo reduced these symptoms by only half as much flomax use for woman . The researchers concluded that “although larger trials with standardized materials are needed, capsaicin could represent a potential therapy for functional dyspepsia metformin abortin .” 400
Capsaicin is the ingredient in hot peppers that is believed to be responsible for this effect zoloft better than prozac . It is used in topical creams to relieve pain finasteride hair loss . A study in rats demonstrated that capsaicin can reduce damage to the stomach lining that aspirin or alcohol causes mechanism of action remeron .401

co-fluampicil -tablets of flucloxacillin and ampicillin
co-flumactone Tablets of spironolactone and hydrochlorothiazide.
colchicine The alkaloid obtained from meadow saffron. It is used in acute gout. Dose: 500mg every 2 hours until relief is obtained. A total dose of 10mg should not be exceeded, but relief of pain or the onset of vomiting or diarrhoea usually renders full doses unnecessary. It is also used prophylactically in doses ol’500pg 2 or 3 times a day during early treatment with allopurinol, probericcid and sulphiripyrazone. Gire is necessary in the elderly, and in renal impairment. See page 140 and’I'able 17.
corticotrophin The adrenocorticotrophic hormone of the anterior pituitary gland. It stimulates the production of corticosteroid hormones by the adrenal cortex. It is now used mainly as a test of adrenocortical function. See tetracosactrin.
Hydrocortisone.
cortisone one of the corticosteroids secreted by the adrenal cortex. Although it is rapidly absorbed orally, it is inactive until converted in the liver to hydrocortisone. It therefore has the actions, uses and side-effects of hydrocortisone, which is often the preferred corticosteroid. It should be noted that cortisone is of no value for topical application. See hydrocortisone, page 250 and Table 36.
colestipol An exchange resin used in hyperlipidaemia that acts by binding with bile salts in the gut and preventing their reabsorption, and so indirectly lowers the plasma level of cholesterol.
Dose: 10-30g daily. May interfere with the absorption of many drugs. (Colostid). See page 146 and Table 20.
colfoseeril A pulmonary surfactant used in the respiratory distress syndrome of the new-born. (Exosurf). See beractant.
colistin An antibiotic used mainly for bowel sterilization.
Dose: 4.5-9 mega-units daily. In systemic gram-negative infections 2 mega-units 8-hourly by injection have been used, but less toxic antibiotics are now preferred. Colonlycin).
collodion When applied to the skin, it dries to form a flexible film, and is used as a vehicle for the extended local application of drugs such as salicylic acid.
co-phenotrope tablets of diphenoxylate
and atropine. (Lomotil; Tropergen).
co-prenozide Tablets of oxprenolol and cyclopenthiazide. (Trasidex).
co-proxamol Tablets  and paracetamol. (Distalgesic).
corticosteroids Hormones secreted by the cortex of the suprarenal gland. The principal hormone is hydrocortisone but more potent synthetic derivatives such as dexamethasone are also in use.
co-tenidone Tablets of atenolol and chlorthaliclone. (Tenoretic).
co-triamterzide Tablets of hydrochlorothiazide and triannerine. (Diazide).
co-trimoxazole A mixture of trimethoprini and sulpliaiiietlioxazole. Trimethoprim, like the sulphonamides, interferes with the folic acid cycle of bacterial metabolism, but at a different point, and the mixture has an increased antibacterial action. It was once widely used, but is now advised only for Prieunjocystis carinii pneumonia. Occasionally given in acute bronchitis and urinary infections when no other drug is acceptable.
Dose: 120 nig/kf; daily lot- 14 days; 960 ing 12-hourly by i.v. infusion. (Bactrin); Septrin).
coumarins Compounds that depress the formation in the liver of prothrombin and other blood coagulation factors. See warfarin and phenindione.
counter-irritants Substances, also referred to as rubifacients, that, when applied to the skin, produce a mild, local irritation and inflammation, and give symptomatic relief in painful conditions of the muscles and joints. Creams and liniments containing methyl salicylate, turpentine, capsicum resin and menthol are examples of rubifacients.
crisantaspase Asparagine is an aminoacid essential for the development of some malignant cells. Crisantaspase is an enzyme, also known as asparaginase, that breaks down asparagine, and so has an indirect cytotoxic action. It is used to induce remission in acute lymphoblastic leukaemia in children.
Dose: (after pre-treatment with other drugs): 1000 units/kg by slow i.v. injection daily for 10 days. Side-effects include anaphylactic reactions, and skin tests to detect hypersensitivity
are essential before initial and re-treatment. (Erwinase).
crotamiton An ascaricide and antipruritiL. Used by local application as cream or lotion (10%) in the treatment of scabies and itching conditions. (Eurax).
crystal violet A dyestuffwith a selective action against Gram-positive organisms and yeasts. Used as a 0.5% solution for infected skin conditions, and for skin
preparation.
cyanocobalamin The anti-anaemic factor present III liver. It is specific in the treatment of pernicious anaemia and its neurological complications, and of value in some other anaernias due to nutritional deficiencies.
Dose: in pernicious anaemia, I Ing by i.m. injection at monthly intervals. It has been largely replaced by hydroxocobalamin, which has a more prolonged action. (Cytanien). See page 112 and’I'able 3.
cyclizine An antihistamine, used mainly in I ravel sickness and nausea generally. Also useful in vertigo.
Dose: 100-150 mg daily. Side-effects include dryness of the mouth, headache and drowsiness. (%Ialoid).
cyclopenthiazide A thiazide diuretic with the actions, uses and side-effects of bend roll tiazide.
Dose: I mg initially, 250-500mg daily or on alternate days, in the morning, according to need. (Navidrex). See page 148 and Table 21.
cyclopentolate An anticholinergic agent use(] to produce cycloplegia and mydriasis. The action is more rapid and less prolonged than atropine, particularly in children. (Mydrilate).
cyclophosphamide A widely used alkylating
cytotoxic agent, active orally and by injec-
tion. Used in I lodgkin’s disease, chronic
lymphocytic leukaemia and lymphomas. Dose: 100-300 Ing daily, orally or i.v., or 300 mg-1 g weekly. A high fluid intake is necessary, as a metabolite may cause hacm- ( )rrhagic cystitis, and it is sometimes used with mesna to reduce the risk of such cystitis. Nausea and vomiting are common side-effects, as is epilation with high doses. (Endoxana). See page 122 and Table 8.
cyclopropane An inhalation anaesthetic of high potency with which induction and recovery are rapid. It causes some respiratory depression and cardiac irregularities, and its administration requires care. It is used with closed-circuit apparatus as it forms an explosive mixture with air and oxygen. Supplied in orange-coloured cylinders.
cycloserine An antibiotic used in
pulmonary tuberculosis when standard drugs are ineffective. Occasionally used in urinary infections.
Dose: 250-750 mg daily. Side-effects include drowsiness, vertigo and rash. See page 170 and Table 31.
cyclosporin An antibiotic with a powerful inuininosuppressant action. It is used under expert control to prevent graft rejection in organ and bone marrow transplantation, and in the prevention of graft-versus-host disease (GVI-ID). Prolonged therapy over some months may be required. Side-effects may include tremor, gastrointestinal disturbance, hypertrichosis and nephrotoxicity (Neural; Sandinimun).
cyproheptadine A compound with antihistamine and antiserotonin properties. Sonic allergic reactions are due not only to histamine, but also to serotonin, and cyproheptadine is useful in conditions not responding completely to an antihistamine. Dose: 4-20 ing daily. It has been used as an appetile stimulant in doses of 12 mg daily and in refractory migraine. (11criactin). See page 110 and Table 2.
cyproterone An anti-androgen used to reduce libido in sexual deviants. Dose: 50-100 nig daily. It is also used in the palliative treatment of prostatic carcinoma, particularly in advanced cases that have become resistant to other therapy. Dose: 300 mg daily.

A-Z Principal Drugs (antidepressants - astemizole)
antidepressants The drugs used in the treatment of depression fall into two main groups, the so-called tricyclic antidepressants and the monoamine oxidase inhibitors (MA01s). (Unrelated drugs include lithium carbonate, used only for the prophylaxis and treatment of manic depressive illness.) The tricyclic group, which also includes sonic other compounds with a similar action, appear to act by blocking the neuronal uptake of central transmitters such as noradrenaline and serotonin. They are more widely used than the MAOIs because they are more generally effective, and interact less extensively with other drugs and certain foods. The tricyclic drugs are widely used in endogenous depression, particularly when sleep disturbances are present, but the onset of action is slow, and improvement may not commence until after 2-4 weeks of treatment. Extended therapy is usually required to avoid the risk of a relapse, and patients should be advised accordingly. Sonic tricyclic antidepressants, such as amitriptyline, have a sedative action of value when anxiety is a complicating factor, whereas a less sedating drug such as imipramine may be useful in patients exhibiting apathy and withdrawal. Some of the side-effects, such as dryness of the mouth, are linked with their anti-
cholinergic activity, but tolerance may develop with continued treatment. They also influence the cardio-vascular system and may cause arrhythmias, tachycardia and hypotension, and may interfere with the action of some antihypertensive drugs, although the response to beta-blocking agents is unaffected. Care is necessary in cardiac disease, and with the elderly initial doses should be low. The use of tricyclic antidepressants in epileptic patients may result in a lowering of the convulsive threshold. See page 128 and Table 11.
antidiabetic agents Diabetes mellitus is a deficiency disease due to a lack of insulin, and is characterized by an excessive level of glucose in the blood and urine. Treatment is either replacement therapy with daily injection of insulin, or orally by hypoglycaemic agents such as chlorpropamide. Such agents act by stimulating insulin secretion and release by the beta-cells of the pancreas, and are ineffective in the absence of such cells. See page 132 and Tables 12 & 13.
anti-D(Rh.) immunoglobulin An ininiurioglobulin that is given to a rhesus-negative mother to prevent her forming anti-bodies against fetal rhesus-positive cells which may pass into the maternal circulation during childbirth or abortion and which, in a later pregnancy, could cause haemolytic disease.
Dose: 504) units Lin. within 60-72 hours of delivery or abortion. Doses of 1250 units are given prophylactically. It is of no value it’given after anti-D antibodies have been formed. The inimunoglobulin has also been given after the transfusion of rhesus-incompatible blood. (Partobulin).
antiemetics Nausea and vomiting may be due to several causes, including stimulation of the chemoreceptor trigger zone in the reticular formation of the brain. Man), antiemetics have some degree of central activity, and in some cases their action may be mediated by blocking the effects of dopamine on the trigger zone. Effective drugs include some antihistamines and sonic phenothiazine-based tranquillizers such as prochlorperazine. The alkaloid hyoscine is widely used in travel sickness. More powerful drugs such as domperidone, metoclopramide, nabilone and ondansetron, are of value in the control of the severe nausea and vomiting induced by cytotoxic drugs. The use of antiemetics in early pregnancy requires great care, and is seldom essential.
antiepileptics See anticonvulsants, page 136 and’] able 15.
antihistamines Drugs such as promethazine are of value in conditions associated with the release of histamine from mast cells, such as hayfever, rhinitis, urticaria, pruritus, insect bites and stings. They are also useful in drug allergies. Some antihistamines also have antienietic properties, and are useful in travel sickness. Although all antihistamines have the same basic action, the degree and duration of response and the severity of side-effects may vary. Some antihistamines pass easily into the central nervous system arid are more likely to cause drowsiness. Others may have reduced anticholinergic properties, and cause less dryness of the mouth and blurring of vision. Care is necessary in epilepsy, glaucoma, hepatic disease or prostatic enlargement. See page 110 and Table 2.

antihypertensive agents See page 148 and Table 2 1.
anti-inflammatory agents See non-steroidal anti-inflammatory drugs (NSAIDS) and page 165 and Table 29.
antimetabolites Cytotoxic drugs that appear to act by combining irreversibly with cell enzymes, and so prevent cell division. Methotrexate and mercaptopurine are examples. See page 122 and Table 8.
dermatology and pruritus as oily calamine lotion. Arachis oil enema is used to soften impacted faeces.
argipressin A synthetic form of vasopressin.
artificial tears Some chronic sore eye con clitions may occur in rheumatoid arthritis, and may be due to tear deficiency. Solutions of itypromellose or polyvinylalcohol, sometimes referred to as’artificial tears’, are useful as a bland lubricant to replace the tear deficiency. (Isopto; Hypotears).
antimuscarinic agents See anticholinergic agent” page 160 and Table 26.
antineoplastic agents Anti-cancer drugs. See page 122 and ‘rabic 8.
antipsychotic agents See pages 117 & 1(,8, and Tables 5 & 30.
antitetanus immunoglobulin aulloglobulin obtained from plasma is used in injured patients who have not previously been immunized, and when tetanus is a definite risk. Dose: 250 units jan. A course of tetanus vaccine should also be commenced,
antitubercular agents See rifampicin, page 170 and I able 31.
antiviral agents See page 144 and Table 19.
anxiolytics See page H 7 and Table 5.
apomorphine A morphine derivative formerly used as a powerful emetic, but now considered to be too toxic. Occasionally used in the hospital treatment of parkinsonism. (Britaject).
apraclorildine A clonidine derivative used as eye drops I 9A, to control intraocular
pressure during ophthalmic surgery. Some absorption may occur, so care is necessary in severe cardiovascular disease. (lopidine).
aprotinin An inhibitor of the proteolytic enzyme plasmin, obtained from bovine lung tissue. It is used in the severe haemorrhage due to hyperplasminaemia.
Dose: 500 000-1 000 000 units by i.v. infu.ioll. (Trasylol).
arachis oil Groundnut or peanut oil. It has
emollient properties, and is used in
ascorbic acid (vitamin C) Present in many citrus fruits. Deficiency is not uncommon in the elderly receiving inadequate diets. Severe deficiency causes scurvy, once the bane of seafarers.
Dose: for prophylaxis 25-75 mg daily; therapeutic dose 200-500 mg daily. Doses of 4 g daily are given for acidification of the urine. Claims that vitamin C prevents colds are unproven.
asparaginase Crisantaspase. See page 122 and Table 8.
aspirin (acetylsalicylic acid) Widely used as a mild analgesic and anti-inflammatory agent, often in association with other drugs such as paracetamol and codeine. Dose: 1.2-4 g daily, but in acute rheumatoid conditions doses of 4-8 g daily have been given. Long-term treatment with (loses of 75 mg daily are given liar the prophylaxis of cardiovascular disease. Side-effects include gastric irritation with some blood loss, hyperventilation, and bonitos, with the risk of deafness, may occur with high doses. Aspirin may cause rash and bronchospasm in asthmatic and other sensitive patients. As aspirin is now thought to be associated with Reye’s syndrome, the drug should not be given to children under 12 years of age unless specifically indicated. Aspirin may increase the effects of certain hypoglycaemic and anticoagulant drugs.
astemizole An antihistamine with an extended action and reduced sedative effects.
Dose: Wring once daily before food, and must not be exceeded. Higher doses may cause cardiotoxic side-effects such as ventricular tachycardia. Arrhythmias may follow combined treatment with many other drugs. (Hismanol; Pollen-ese). See page 110 and Table 2.

A-Z Principal Drugs (Alprazolam - Aminophylline)

alprazolam

A benzodiazepine used in the shors-term treatment of anxiety and anxiety with depression.
Dose: 0.75-3 mg daily. Side-effects include dizziness and ataxia. Care is necessary in pulmonary insufficiency. (Xanax). See page H 7 and Table 5.
alprostadil A preparation of prostaglandin li, for i.v. use in maintaining the patency of the ductus arteriosus in neonates with congenital heart lesions requiring surgical correction. The improvement in circulation so obtained permits diagnosis while surgery is being considered.
Dose: 50-100 ng/kg/min i.v. under strict control. Apnoea may occur, usually within an hour of the injection, requiring immediate ventilatory assistance. Bradycardia and hypotension may also occur. (Prostin VR).
alteplase A form of human plasminogen activator with a selective fibrinolytic action on blood-clot-bound plasminogen. It is of value in the early treatment (6 hours) of acute thrombosis, myocardial infarction and pulmonary embolism.
Dose: 10 mg initially by slow i.v. injection; then 90 mg over 3 hours by i.v. infusion. Side-effects are nausea, vomiting and local bleeding. (Actilyse). See streptokinase.
aluminium The powdered metal is used as a skin protective in ileostomy, as Baltimore paste, also known as Compound Aluminium Paste.
aluminium acetate An astringent used as an 8% solution for ear drops in otitis externs. A weak solution (0.65%) is used as a lotion in exudative eczematous states and in suppurative conditions.
aluminium chloride An antiperspirant used in the treatment of axillary hyperhydrosis by the local application of a 20% alcoholic solution. Over-use may cause skin irritation. (Anhydrol; Driclor).
aluminium hydroxide An antacid with a prolonged action.
Dose: as a gel, 7.4-15 ml, or as 500 mg tablets, to be chewed or crushed before swallowing. Best given between meals and at night. May interfere with the absorption of some other drugs. (Aludrox).
alverine An antispasmodic with a local action on intestinal smooth muscle.
Dose: used in irritable bowel syndrome in doses of 60-360 ing daily. (Spasmonal). See page 134 and “Cable 14.
amantadine An antiviral drug thought to act by inhibiting the penetration of the virus into the host cell, and used for the prophylaxis and treatment of influenza. It is also used with levodopa in the treatment of parkinsonism, but it may relieve the rigidity more than the tremor.
Dose: 200 mg daily. Many side-effects are dose-related. (Synimetrel). See page 160 and Table 26.
amethocaine Powerful local anaesthetic, used [or anaesthetic of mucous
membranes 1-2% solution, eve drops 0.25-1 %. As spray for throat before endoscopy, etc, a 0.5% solution may be used. Hypersensitivity and allergic reactions may occur as with other local anaesthetics. Also used as 1% cream for pruritus ,i nd other skin conditions.
amifostine An organic thiophosphoric acid used to reduce neut ropen ia -associated risks of infection after cyclophosphamide and platinum treatment of ovarian cancer. Dose: by i.v. infusion 910 mg/m: daily .10 minutes before chemotherapy.
I lypotension is a side-effect that may limit treatment. (Ethyol).
amikacin A semi-synthetic antibiotic similar in actions and uses to gentamicin, but more resistant to enzyme inactivation. Mainly used in the short-term treatment of serious infections due to Gram-negative, gen tain ici it -resistant organisms.
Dose: 15 ing/kg daily by i.m. injection or i.v. infusion, up to a total treatment dose of 15 g. Side-effects include ototoxicity, drug fever, rash and nausea. Dose should be reduced in renal impairment. (Amikin).
amiloride A potassium-conserving diuretic ,,uh an action on the distal tubule similar to that of spironolactone, although it is not an inhibitor of aldosterone. It is used in
hypertension and heart failure, often with a thiazide diuretic to obtain a more balanced response.
Dose: 5-20 ing daily. Rash is an occasional side effect. See page 148 and Table 2I.
amino acids Certain amino acids are essential for the formation of protein. When oral nutrition is not possible, amino acid preparations may be given by i.v. i ritusion. and such therapy call be extended if necessary to provide total parenteral nutrition by the addition of glucose, electrolytes, fats and vitamins as specially prepared solutions. [it hospitals, a 24-hour supply for total parenteral nutrition can be provided in a single large container and patients may be taught to administer total parenteral nutrition at home. Representative amino-acid products for i.v. infusion are Aminoplex, Perfusin, Synthamin and Varnin.
arninobenzoic acid An absorbent of some of Elie erythema-producing ultra-violet light waves of sunlight. it is present in sonic suit screen preparations.
aminoglutethimide An inhibitor of adrenal steroid and oestrogen biosynthesis. It is used in the control of post-menopausal oestrogen-dependent mammary carcinoma and in the treatment of advanced prostatic carcinoma.
Dose: 250 mg daily, increased, if necessary, to I g daily. Supplementary corticosteroid therapy is essential. Side-effects include drowsiness, rash and drug fever. (()j iineten). See page 122 and Table 8.
aminoglycosides A group of antibiotics that includes amikacin, gentamicin, netilmicin, lobramycin, kanamycin, streptomycin, neomycin and framycetin. They act mainly against Gram-negative bacilli, although they are also active against some Gram-positive organisms. Kanamycin and streptomycin are also active against Mycobacterhan tuberciaosis.'rhe aminoglycosides are not absorbed orally and when injected they are more toxic than most other antibiotics, and in renal impairment care is necessary, as the plasma concentration of the antibiotic may rise to an ototoxic or nephrotoxic level. The toxicity may also be increased by diuretics of the frusemide type. Measurement of plasma levels is essential in high dosage or continued therapy. Gentamicin is the most widely used aminoglycoside for systemic infections, and neomycin and framycetin, being too toxic for systemic use, are of value in skin infections.
may be given by slow i.v. injection. It is not suitable for Liu. administration. Sustained release oral products available cause less gastric disturbance. (Pecram; I'llyllocontin). See page 118 and 'rable 6.
amiodarone An iodine-containing anti-arrhythmic agent of value in all types of paroxysmal tachycardia, especially when the condition is resistant to other drugs. Dose: 600 ing daily for I week; maintenance (lose: 200 ing or less daily. When a rapid response is required, 5 mg/kg may be given by i.v. infusion under cardiac monitoring. it is contraindicated in bradycardia, pregnancy and thyroid disorders, and care is necessary in hepatic impairment. Pulmonary alveolitis, corneal microdeposits and photosensitivity have been reported as side-effects. (Cordarone).
amitriptyline A tricyclic antidepressant similar in action to imipramine, but it also has anxiolytic and sedative properties. Dose: in depression complicated by anxiety, 30-150 mg daily initially; maintenance dose: 20-100 mg daily; sometimes as a single nightly dose to reduce daytime sedation. Lower doses are often adequate in elderly patients. Dose by injection, 40-80 nig daily. Full benefit may not be achieved for some weeks and prolonged therapy may be necessary to avoid relapse. Withdrawal of the drug should be gradual. Atnitriptyline is also used in nocturnal eneuresis in children. Dose: 25-50 mg daily. Side-effects include dryness of the mouth, sedation and cardiac arrhythinias. It is contraindicated in glaucoma, prostatic hypertrophy and after recent myocardial infarction. Mcnti7o];Tryptizol). See page 128 and Table 11.
amlodipine A calcium channel blocking agent used in hypertension and myocardial ischaemia associated with angina.
Dose: 5-10 mg as a single daily (lose. Side-effects are headache, dizziness, flushing and oedema. Care is necessary in renal impair nient. (Istin). See page 148 and Table 21.
ammonium chloride A mild expectorant present in Ammonia and Ipecacuanha Mixture.
aminophylline A derivative of theophylline with a similar bronchodilater action. It i,, used chiefly in asthma, cardiac oedema and congestive heart failure.
Dose: 300 nig-1.2g orally daily; 5 nig/kg