Posts Tagged ‘s system’

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

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

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

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

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

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

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

Generic Name
Buspirone (bue-SPYE-rove) OG
Brand Name  BuSpar
Type of Drug
Minor sedative and antianxiety drug.
Prescribed For
Anxiety and generalized anxiety disorders; also prescribed for the aches, pains, fatigue, and cramps of premenstrual syndrome (pMS).
General Information
Buspirone hydrochloride has a potent antianxiety effect. It is approved by the Food and Drug Administration (FDA) for short-term relief of anxiety, but it may apparently be used safely for more than 4 weeks. The exact way in which buspirone works is not known, but it seems to lack the addiction dangers associated with other antianxiety drugs, including benzodiazepines. It neither severely depresses the nervous system nor acts as an anticonvulsant or muscle relaxant, as other antianxiety drugs do. Minor improvement will be apparent after only 7-10 days of drug treatment, but the maximum effect does not occur for 3 or 4 weeks.
Cautions and Warnings
Do not take buspirone if you are allergic or sensitive to any of its ingredients.
Buspirone should be used cautiously by people with timer or kidney disease.
Buspirone does not have any antipsychotic effect and should not be taken for symptoms of psychosis.
Although buspirone has not shown a potential for drug abuse, you should be aware of this possibility.
Buspirone should not be used with monamine oxidase inhibitor (MAGI) antidepressants.
Possible Side Effects
♦    Most common: dizziness, drowsiness, nausea, and head-
ache.
•    Common: fatigue, nervousness, lightheadedness, excite-
ment, dry mouth, and insomnia.
•    Less common: heart palpitations, muscle aches and pains, tremors, rash, sweating, clamminess, rapid heartbeat, dif-
ficulty concentrating, anger or hostility, depression, loss of interest, diarrhea, constipation, vomiting, and blurred vision.
♦    Rare: Rare side effects can occur in almost any part of the
body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Combining buspirone with an MAGI antidepressant may produce severe hypertension and may be dangerous.
•    The effects of combining buspirone with other drugs that work in the central nervous system (CNS) are not known. Do not take other sedatives or antianxiety or psychoactive drugs with buspirone unless prescribed by a doctor familiar with your complete medical history.
•    Erythromycin, itraconazole, ketoconazole, clarithromycin, diltiazem, verapamil, fluvoxamine, and ritonavir may increase blood levels of buspirone. When used in combination, your buspirone dosage may need to be adjusted.
•    Buspirone may increase the side effects of haloperidol and diazepam.
•    Studies show that buspirone is not affected by alcohol, but this combination should still be used with caution because buspirone causes drowsiness and dizziness.
•    The combination of buspirone and trazodone may cause liver inflammation.
•    Combining rifampin with buspirone may decrease buspirone’s effectj\18″eSS.
Food Interactions
This drug may be taken either with or without food, but for the most consistent results, always take your dose at the same time of day in the same way—that is, with or without food. Avoid drinking large amounts of grapefruit juice with this drug.
Usual Dose
Adult: starting dosage-7.5 mg twice a day. Dosage may be increased gradually to 60 mg a day.
Overdosage
Symptoms of overdose are nausea, vomiting, dizziness, drowsiness, pinpointed pupils, and upset stomach. The overdose victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Buspirone may cause CNS depression, drowsiness, and dizziness. Be careful while driving or operating hazardous equipment. Avoid other CNS drugs and alcoholic beverages because they will enhance buspirone’s effects.
Contact your doctor if you become restless, develop uncontrolled or repeated movements of the head, face, or neck, or have any intolerable side effects.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Though buspirone has not been found to cause birth defects, be sure to inform your doctor if you are or might be pregnant while taking this drug. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known how much buspirone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Several hundred seniors participated in drug evaluation studies without any unusual problems. However, the effect of this drug in seniors is not well known, and special problems may surface, particularly in those with kidney or liver disease.

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.

Chemical Intolerance
`To start with, I just used to get this irritation in my throat when I was reading a magazine. Over the years it got much worse, and there was a dreadful burning feeling, not

just in my throat now, but also in my eyes and nose. Sometimes I could scarcely breathe. My doctor said it couldn’t be magazines and diagnosed asthma. Twenty years on, I can’t

look at a magazine, even for a few minutes, and other things affect me now too. If I go in a room with a photocopier running I start to choke and can’t breathe. Whenever I

describe this problem to anyone — apart from the doctor, that is — they almost always say they know someone else who has a similar problem. But the doctors still say that what

happens to me can’t happen.’
Mary has chemical intolerance, which is also known as chemical sensitivity, environmental Illness or idiopathic environmental intolerances. It is a condition that arouses more

passionate controversy than any other described in this book. Many believe that it simply does not exist, or rather that people who claim to have chemical intolerance are

actually victims of psychological problems, which express themselves as physical symptoms. Careful studies show that, while some people with supposed chemical intolerance do

fall into this category, others do not – they have no psychiatric problems, but they do appear to have valid symptoms when exposed to certain synthetic chemicals.
`People with MCS are desperate. They will go to great lengths and do almost anything to find a doctor, anyone, who believes them.’ So speaks one sufferer from MCS (Multiple

Chemical Sensitivity), the most extreme form of chemical intolerance. It is often severely disabling, with symptoms such as exceptional fatigue, nausea, headaches, poor memory

and concentration, dizziness. muscle aches, joint pain, chest pain and digestive problems. Those with MCS react to a very wide range of chemicals, and very often to foods and

food additives as well.
These severely affected patients are a small minority, however, and many more people are like Mary, with sensitivity to just one or two types of chemical exposure. Surveys in

the United States suggest that about 30% of the population are affected in this way. The authors of one such survey note that ‘the widespread idea that chemical sensitivity is a

condition of educated, urban housewives was not supported by our study. The region surveyed was rural… and individuals who reported chemical sensitivity were found in all age,

gender, income, race and employment groups.’
The chemical exposures that are identified as triggering symptoms include:
• perfumes
• pesticides
• cigarette smoke
• paint fumes
• petrol
• exhaust fumes
• cleaning products
• newspaper ink
• plastics, especially those with a strong smell
• glossy paper (e.g. In magazines).
Typical symptoms, in those with sensitivity to just one or two chemical products, are:
• a blocked or runny nose
• sore throat
• irritation of the eyes
• sinus pain and congestion
• headache
• breathlessness and wheezing
• nausea
• skin rashes
• extreme fatigue
• dizziness.
How does chemical intolerance begin?
For some of those with MCS, the problems began with a sudden over-exposure to a toxic chemical, such as a chemical spill, or pesticides from a crop-spraying plane. Others are

first affected by regular doses of pesticide at lower levels, such as spray drift from nearby fields or from a neighbour’s garden. It seems as if, for these people, their inborn

ability to detoxify both natural and manmade toxins is overwhelmed by an unusually heavy exposure, and never fully recovers. Although there have been no systematic studies of

this – it is difficult to imagine how they could be done –the wealth of well-documented cases is convincing. And studies of those exposed to high levels of pesticides in

accidents at work support the idea that this can cause lifelong sensitivity to very small doses of some synthetic chemicals. Sensitivity to alcohol and caffeine usually

increases enormously too.
In some cases, classical allergies also feature in the range of symptoms for those with MCS. If they had an allergic tendency before the accidental exposure to pesticides, this

is especially likely: after the accident, along with chemical intolerance, they have far more pronounced allergic reactions to common allergens.
The loss of tolerance to everyday chemicals may be related to some kind of damage to the enzymes in the liver that carry out the important task of detoxifying toxins that enter

the bloodstream. This detoxification system evolved to deal with natural toxins, such as those in plant foods, and those produced by bacteria living naturally in the gut. These

enzymes can also detoxify the widely used synthetic chemicals, when these are encountered in relatively small amounts, but the enzymes are overwhelmed by large doses.
Chronic Fatigue Syndrome (CFS)
This is a disease that probably has multiple causes rather than a single cause. The main symptom is fatigue that is not relieved by rest. Many people with CFS also have a

slightly raised temperature, problems with concentration and memory, headaches, sore throat and swollen lymph nodes (’swollen glands’). The lymph nodes are part of the immune

system, so this symptom suggests some disturbance of immune function. Other findings, related to immune cells in the blood, also support this idea. However, there are often

minor abnormalities in the brain as well, with some loss of the insulating material around the nerves (myelin).
For many patients, the disease develops in the wake of a viral infection, but for others the origin may be unclear. Whatever the origin of the disease, avoiding synthetic

chemicals is very helpful in many cases. Some sufferers also find an elimination diet helpful (see pp. 194-7). Doctors working in this area say that there is no sharp

demarcation between patients with Chronic
Fatigue Syndrome (CFS) and those with MCS.
Autism
In the search for a cause of autism, many possibilities are being investigated. The consensus now is that there is a genetic predisposition which, when combined with certain

trigger factors, leads to autism.
What are those trigger factors? Some researchers suggest that autistic children have poorly performing detoxification enzymes and are therefore sensitive to synthetic chemicals,

both in food and the environment. The suspicion is that these chemicals affect the developing nervous system.
Other researchers pinpoint food as the culprit. They believe that children who develop autism are affected by exorphins (see p. 76) produced from the proteins in wheat and/or

milk, and that these damage the child’s developing nervous system. There are claims that a dairy-free and gluten-free diet can help, but that it must be ultra-strict to work,

and may need to continue for at least six months before any improvement occurs. You must have your doctor’s approval for this.
Before starting them on such a diet, some doctors also give a course of anti-fungal drugs to those autistic children who have been treated repeatedly with antibiotics. This

combined treatment is reported to have very good effects for some children.
Treatment
Assuming that you really do have chemical intolerance rather than some deep-rooted psychological problem – and you have to be honest with yourself here, because otherwise you

will never get better – then careful avoidance of the offending synthetic chemicals is the only effective treatment. If you have eliminated everything that obviously affects you

and are not much improved, then try tackling common indoor pollutants (see pp. 128-30) as well.
Such measures are of value to some with chemical intolerance but may not be adequate for those most severely affected. If you need to take more radical steps, you may benefit

from the bedding, paints and other household items manufactured for those with chemical sensitivity. Once you reduce the level of synthetic chemicals in your everyday

environment, you may find that you can tolerate occasional exposures much more.
Some doctors recommend taking supplements of vitamins and minerals to speed your recovery. These (especially antioxidants – see p. 206) may be helpful for some people, but be

sure to get nutritional advice from someone with good medical qualifications, rather than a self-styled ‘nutrition therapist’.
Neutralisation therapy (see p. 211) seems to be effective for some people with chemical intolerance, but you will still need to avoid the offending substances. Hyperventilation

(see p. 236) can make chemical intolerance much worse.