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Friday, April 20, 2012

corticosteroid Rectal

Class Name: corticosteroid (Rectal route)

Commonly used brand name(s)

In the U.S.

Anucort-HC

Anu-Med HC

Anusol HC

Anusol-HC

Anuzone-HC

Colocort

Cortifoam

Encort

Hemril-30

Hemril-HC Uniserts

Proctocort

Procto-Kit 1%

Procto-Kit 2.5%

Proctosert HC

Proctosol-HC

Proctozone-HC

Rectasol-Hc

In Canada

Cortiment-10

Cortiment-40

Rectocort

Available Dosage Forms:

Enema

Cream

Suppository

Foam

Solution

Uses For This Medicine

Rectal corticosteroids are used to treat mild or moderate ulcerative colitis. They also may be used along with systemic (oral or injection) corticosteroids or other medicines to treat severe disease or mild to moderate disease that has spread too far to be treated effectively by medicine inserted into the rectum alone. Rectal corticosteroids also are used to help relieve swelling, itching, and discomfort of some other rectal problems, including hemorrhoids and inflammation of the rectum caused by radiation therapy.

Rectal corticosteroids are available only with your doctor's prescription.

Before Using This Medicine

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Children and teenagers who must use this medicine should be checked often by their doctor. Rectal corticosteroids may be absorbed through the lining of the rectum and, rarely, may affect growth, especially if used in large amounts or for a long time. Before using this medicine in children, you should discuss its use with the child's doctor.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of rectal corticosteroids in the elderly with use in other age groups, these medicines are not expected to cause different side effects or problems in older people than they do in younger adults.

Pregnancy

Betamethasone may change the number and ability of movement of sperm in men. Budesonide crosses the placenta. It is not known whether other rectal corticosteroids cross the placenta. Studies in animals have shown that budesonide, hydrocortisone, and hydrocortisone acetate cause birth defects. Rectal corticosteroids should not be used in large amounts or for a long time by women who are pregnant or who are planning to become pregnant.

Breast Feeding

It is not known whether rectal corticosteroids pass into breast milk. However, systemic (oral and injection) corticosteroids pass into breast milk and may cause problems with growth in nursing babies. It may be necessary for you to take a different medicine or to stop breast-feeding during treatment. Be sure you have discussed with your doctor the risks and benefits of using the medicine.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use of This Medicine

It is important that your doctor check your progress at regular visits.

For patients using the enema form of this medicine:

This medicine usually comes with patient directions. Read and follow them carefully before using this medicine.

For patients using the foam form of this medicine:

This medicine is used with a special applicator. Do not insert any part of the aerosol container into the rectum.

For patients using the suppository form of this medicine:

If the suppository is too soft to insert, chill it in the refrigerator for 30 minutes or run cold water over it before removing the wrapper.

To insert the suppository: First remove the wrapper and moisten the suppository with cold water. Lie down on your side and use your finger to push the suppository well up into the rectum.

Do not use rectal corticosteroids in larger amounts, more often, or for a longer time than your doctor ordered. To do so may increase the chance of absorption through the lining of the rectum and the chance of side effects.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For betamethasone

For enema dosage form:
- For ulcerative colitis:
  - Adults—The usual dose is 5 milligrams (mg) (1 unit), used as directed, every night for two to four weeks.
  - Children—Dose must be determined by your doctor.

For budesonide

For enema dosage form:
- For ulcerative colitis:
  - Adults—The usual dose is 2 milligrams (mg) (1 unit), used as directed, every night for four to eight weeks.
  - Children—Use and dose must be determined by your doctor.

For hydrocortisone

For enema dosage form:
- For ulcerative colitis:
  - Adults—The usual dose is 100 milligrams (mg) (1 unit), used as directed, every night for two or three weeks or until condition improves as determined by your doctor.
  - Children—Dose must be determined by your doctor.

For hydrocortisone acetate

For foam dosage form:
- For ulcerative colitis:
  - Adults—At first, 1 applicatorful, used as directed, one or two times a day for two or three weeks. Then, the dose may be decreased to 1 applicatorful every other day.
  - Children—Dose must be determined by your doctor.

For suppository dosage form:
- For ulcerative colitis:
  - Adults—The usual dose is 25 or 30 milligrams (mg) two times a day, in the morning and at night, for two weeks. In more severe cases, the dose may be 25 or 30 mg three times a day or 50 or 60 mg two times a day.
  - Children—Dose must be determined by your doctor.
- For inflammation of the rectum caused by radiation therapy:
  - Adults—The usual dose is 25 or 30 mg two times a day, in the morning and at night, for six to eight weeks.
  - Children—Dose must be determined by your doctor.
- For other rectal problems:
  - Adults—The usual dose is 20 to 30 mg a day for three days, or 40 to 80 mg a day as needed.
  - Children—Dose must be determined by your doctor.

For tixocortol

For enema dosage form:
- For ulcerative colitis:
  - Adults—The usual dose is 250 milligrams (mg) (1 unit), used as directed, at bedtime for twenty-one days in a row.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Do not puncture, break, or burn the rectal foam aerosol container, even when it is empty.

Precautions While Using This Medicine

Do not stop using this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are using before you completely stop using it.

Check with your doctor if your condition does not improve within 2 or 3 weeks or if it becomes worse.

Check with your doctor if you notice rectal bleeding, pain, burning, itching, blistering, or any other sign of irritation that you did not have before you started using this medicine.

Use of suppositories may cause staining of clothing or fabric.

Tell the doctor in charge that you are using this medicine:

Before having skin tests

Before having any kind of surgery (including dental surgery) or emergency treatment

If you get a serious infection or injury

Avoid close contact with anyone who has chickenpox or measles. This is especially important for children. Tell your doctor right away if you think you have been exposed to chickenpox or measles.

While you are being treated with this medicine, and after you stop taking it, do not have any immunizations without your doctor's approval.

For patients with diabetes:

This medicine may affect blood glucose (sugar) levels. If you notice a change in the results of your blood or urine sugar tests or if you have any questions, check with your doctor.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Less common or rare

Burning and itching of skin

chills

depression

diarrhea

false sense of well-being

fever

infection

mood swings

painful, red or itchy, pus-containing blisters in hair follicles

personality changes

rectal bleeding, burning, dryness, itching, or pain not present before therapy

sensation of pins and needles

stabbing pain

straining while passing stool (with tixocortol only)

Additional side effects may occur if you use this medicine for a long time. Check with your doctor as soon as possible if any of the following side effects occur:

Abdominal or stomach pain

acne

backache

coughing

coughing up blood

decreased resistance to infection

dryness of mouth

eye pain

filling or rounding out of the face

gradual blurring or loss of vision

headache

hunchback

increased thirst

irregular heartbeat

loss of appetite

menstrual irregularities

mood or mental changes

muscle cramps or pain

muscle weakness

nausea or vomiting

nonelevated blue or purplish patch on the skin

osteoporosis or bone fractures

pain in joints

pain or discomfort in the area of a vein

rapid weight gain

reddish purple lines on arms, face, legs, trunk, or groin

redness of eye

sensitivity of eye to light

shortness of breath

skin rash

slow wound healing

stunting of growth (in children)

swelling of feet or lower legs

trouble in sleeping

unusual decrease in sexual desire or ability in men

tearing of eyes

unusual increase in hair growth (especially on the face)

unusual tiredness or weakness

unusual weight loss

weak pulse

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common or rare

Dizziness

dry, scaly skin

increase in appetite

increased sweating

lightened skin color

passing of gas (with budesonide only)

sensation of spinning

thin, fragile skin

thinning hair on scalp

unusual weight gain

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

The information contained in the Thomson Healthcare (Micromedex) products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Healthcare does not assume any responsibility or risk for your use of the Thomson Healthcare products.

Thursday, April 19, 2012

Nitropress

Generic Name: Sodium Nitroprusside
Class: Direct Vasodilators
VA Class: CV490
CAS Number: 13755-38-9

Thoroughly review the package insert before administration.^b

Dilution

After reconstitution, sodium nitroprusside is not suitable for direct injection; must be diluted further with 5% dextrose injection before infusion.^b

Acid-base balance and venous oxygen concentrations should be monitored and may indicate cyanide toxicity; these tests alone should not be relied upon to guide therapy.^b

Hypotension

Can produce precipitous decreases in blood pressure; profound hypotension can lead to irreversible ischemic injury or death.^b

Administer in a setting with equipment and personnel available to continuously monitor blood pressure.^b

Cyanide Intoxication

Administration (except when used for short periods of time or at low infusion rates [e.g., ≤2 mcg/kg per minute or slower]) can result in the production of clinically important levels of cyanide ion, which can reach toxic or potentially lethal concentrations.^b

Infusions at the maximum recommended rate of 10 mcg/kg per minute should never last longer than 10 minutes; if after 10 minutes the blood pressure has not been adequately controlled, the infusion should be immediately discontinued.^b

Introduction

Vasodilating and hypotensive agent.^a ^b ²⁰⁷

Uses for Nitropress

Hypertensive Crises

For immediate reduction of blood pressure in hypertensive crises (hypertensive emergencies).^b ²⁰⁴ ²⁰⁷ Administer with other longer-acting hypotensive agents to minimize the duration of nitroprusside therapy.^b

Can be used for most hypertensive emergencies (e.g., hypertensive encephalopathy, MI, unstable angina pectoris, pulmonary edema, preeclampsia, stroke, head trauma, life-threatening arterial bleeding, aortic dissection).²⁰⁴ ²⁰⁷

May be considered in the treatment of hypertensive emergencies associated with stimulant (e.g., amphetamines, methamphetamines, cocaine, phencyclidine, ephedrine) toxicity.²⁰⁷

Caution if high intracranial pressure or azotemia is present.²⁰⁴

Acute severe hypertension in preeclampsia (e.g., persistent diastolic blood pressures of ≥105–110 mm Hg): Other antihypertensives (e.g., hydralazine) preferred; sodium nitroprusside reserved for treatment failures.²⁰⁴

Ischemic stroke: Clinical trials do not support immediate antihypertensive therapy in these patients.²⁰⁴

Contraindicated in compensatory hypertension (e.g., arteriovenous shunt or coarctation of the aorta).^b (See Contraindications under Cautions.)

Heart Failure and Low-Output Syndromes

Management of acute CHF.^b ²⁰⁷

Particularly useful in severe heart failure caused by regurgitant valvular lesions of aortic insufficiency and mitral regurgitation.²⁰⁶

Also particularly useful for afterload reduction to unload the left and subsequently right ventricle when left ventricular dysfunction is accompanied by right ventricular ischemia.^b ²⁰² Monitoring intra-arterial pressure is useful.²⁰²

Management of low-output syndromes associated with acute MI†; in many cases, other drugs (e.g., nitroglycerin, norepinephrine, dopamine, dobutamine) are preferred.²⁰²

In acute MI complicated by CHF, nitroglycerin is the preferred vasodilator.²⁰²

Not indicated for the treatment of CHF associated with reduced peripheral vascular resistance.^b (See Contraindications under Cautions.)

Controlled Hypotension

Used to produce controlled hypotension to reduce bleeding during surgery.^b

Nitropress Dosage and Administration

Administration

Administer by IV infusion only.^b

Administer in a setting with equipment and personnel available to continuously monitor blood pressure.^b

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by IV infusion using a controlled-infusion device to allow precise measurement of flow rate.^b

When used for the management of acute severe hypertension in preeclampsia, administer before induction of labor.²⁰⁴

Reconstitution

Dissolve 50 mg of sodium nitroprusside in 2–3 mL of 5% dextrose injection or sterile water for injection (without preservative).^a ^HID Bacteriostatic water for injection should not be used because preservatives increase the rate of nitroprusside decomposition.^a

Alternatively, reconstitute ADD-Vantage vials containing 50 mg according to the manufacturer’s directions.^a

Dilution

Add the initially reconstituted solution or the commercially available solution containing 50 mg to 250, 500, or 1000 mL of 5% dextrose injection to provide solutions containing 200, 100, or 50 mcg/mL, respectively.^b ^HID ²⁰⁷

Protect from light by promptly wrapping the container in aluminum foil or other opaque material;²⁰⁷ it is not necessary to cover the infusion drip chamber or tubing.^b

Rate of Administration

Adjust rate to maintain the desired hypotensive effect, determined by continuous monitoring of blood pressure, using a continually reinflated sphygmomanometer or, preferably, an intra-arterial pressure sensor.^b

When sodium nitroprusside is used in CHF, titrate rate based on results of invasive hemodynamic monitoring and urine output.^b

Dosage

Pediatric Patients

Hypertensive Crises, Heart Failure and Low-output Syndromes, Controlled Hypotension

IV

Initially, 0.3 mcg/kg per minute; gradually titrated upward every few minutes until adequate blood pressure control is achieved or the maximum infusion rate of 10 mcg/kg per minute is reached.^b Usual dosage is 3 mcg/kg (range of 0.1–10 mcg/kg) per minute.^a ²⁰⁵ ²⁰⁷

Discontinue immediately if adequate reduction in blood pressure is not achieved within 10 minutes in patients receiving the maximum infusion rate of 10 mcg/kg per minute.^b

Adults

Hypertensive Crises, Heart Failure and Low-output Syndromes, Controlled Hypotension

IV

Initially, 0.3 mcg/kg per minute; gradually titrated upward every few minutes until adequate blood pressure control is achieved or the maximum rate of infusion of 10 mcg/kg per minute is reached.^b Usual dosage is 3 mcg/kg (range of 0.1–10 mcg/kg) per minute.^a ²⁰⁷

Management of a hypertensive emergency: Goal is to reduce mean arterial blood pressure by no more than 25% within minutes to 1 hour, followed by further reduction if stable toward 160/100 to 110 mm Hg within the next 2–6 hours; avoid excessive declines in pressure.²⁰¹ If this blood pressure is well tolerated and the patient is clinically stable, further gradual reductions toward normal can be implemented in the next 24–48 hours.²⁰⁴

Patients with aortic dissection: Goal is to reduce systolic pressure to <100 mm Hg if tolerated.²⁰⁴

Management of acute severe hypertension in preeclampsia: Goal is to reduce diastolic blood pressure to 95–105 mm Hg.²⁰⁴

Discontinue immediately if adequate reduction in blood pressure is not achieved within 10 minutes in patients receiving the maximum infusion rate of 10 mcg/kg per minute.^b

Prescribing Limits

Pediatric Patients

Hypertensive Crises, Heart Failure and Low-output Syndromes, Controlled Hypotension

IV

Maximum 10 mcg/kg per minute.^b ²⁰⁵ ²⁰⁷

Prolonged infusions should not exceed 3 mcg/kg per minute; monitor thiocyanate concentrations if this rate is exceeded for prolonged periods.^b

Adults

Hypertensive Crises, Heart Failure and Low-output Syndromes, Controlled Hypotension

IV

Maximum 10 mcg/kg per minute.^b ²⁰⁷

Prolonged infusions should not exceed 3 mcg/kg per minute; monitor thiocyanate concentrations if this rate is exceeded for prolonged periods.^b

Special Populations

Renal Impairment

Anuric patients: Prolonged infusions should not exceed 1 mcg/kg per minute (to maintain thiocyanate concentrations <60 mcg/mL).^b

Cautions for Nitropress

Contraindications

Treatment of compensatory hypertension (e.g., arteriovenous shunt or coarctation of the aorta).^b

Controlled hypotension during surgery in patients with inadequate cerebral circulation.^b

Use during emergency surgery in patients near death.^b

Congenital (Leber’s) optic atrophy or tobacco amblyopia (associated with absent or deficient thiosulfate sulfurtransferase; patients have unusually high cyanide to thiocyanate ratios).^b (See Cyanide Toxicity under Cautions.)

Treatment of acute CHF associated with reduced peripheral vascular resistance (e.g., high-output heart failure as seem in endotoxic sepsis).^b

Warnings/Precautions

Warnings

Excessive Hypotension

Slightly excessive infusion rates can result in profound hypotension; subsequent hemodynamic changes can result in various associated symptoms or blood pressure may decrease to the point where perfusion of vital organs may be compromised.^b

This reaction is self-limiting within 1–10 minutes following discontinuance of the infusion; place patient in Trendelenburg’s position during this time to maximize venous return.^b

If BP does not normalize within a few minutes, sodium nitroprusside may not be the cause of the hypotension and another cause should be sought.^b

May cause hypotension with reflex tachycardia in the presence of hypovolemia. ²⁰⁷

Invasive hemodynamic monitoring may be useful during therapy.²⁰⁷

Cyanide Toxicity

Infusion at rates >2 mcg/kg per minute generate cyanide ion (CN^-) in amounts greater than can be effectively buffered by the methemoglobin normally present in the body.^b

The capacity of the buffering system is exhausted by the CN^- produced by 500 mcg/kg of sodium nitroprusside; this amount is administered in <1 hour when the drug is administered at 10 mcg/kg per minute.^b

The actual frequency of clinically important cyanide toxicity has not been established.^b

The only patients whose deaths have been unequivocally attributed to cyanide toxicity received the drug at rates (e.g., 30–120 mcg/kg per minute) exceeding the recommended maximum rate.^b Elevated cyanide levels, metabolic acidosis, and marked clinical deterioration have been reported in patients receiving sodium nitroprusside at the recommended rates of infusion for only a few hours, and in 1 case, for only 35 minutes.^b

Toxic effects of cyanide may be rapid, serious, and fatal; toxicity may manifest as venous hyperoxemia (secondary to the inability of tissues to extract oxygen from erythrocytes, with resultant bright red venous blood), lactic acidosis, air hunger, confusion, and death.^b

Cyanide may accumulate in patients with hepatic or renal disease or those receiving infusions at rates >3 mcg/kg per minute for >72 hours; monitor for cyanide toxicity (e.g., metabolic acidosis).²⁰⁷

Monitor acid-base balance and venous oxygen concentrations; these tests may indicate cyanide toxicity.^b (See Boxed Warning.)

Hypertensive patients and those receiving other antihypertensive agents may be more sensitive to the effects of sodium nitroprusside than healthy individuals.^b

Sodium thiosulfate has been administered with sodium nitroprusside at infusion rates 5–10 times that of the sodium nitroprusside to accelerate the metabolism of cyanide; coadministration of these agents has not been extensively researched and further study is needed.^b

Caution advised; avoid prolonged or excessive dosages of sodium nitroprusside with sodium thiosulfate, since thiocyanate toxicity and/or hypovolemia may result.^b The same precautions and contraindications apply to this method of administration as to the administration of sodium nitroprusside alone.^b

Major Toxicities

Methemoglobinemia

Administration of sodium nitroprusside can result in the sequestration of hemoglobulin as methemoglobin.^b The conversion of methemoglobin back to hemoglobin is normally rapid; clinically important methemoglobinemia (>10%) occurs rarely.^b

Suspect methemoglobinemia in patients who have received >10 mg/kg and who exhibit signs of impaired oxygen delivery despite adequate cardiac output and arterial PaO₂.^b

Methylene blue 1–2 mg/kg administered IV over several minutes may be used to treat methemoglobinemia; use with extreme caution in patients who are likely to have substantial amounts of cyanide bound to methemoglobin.^b

Thiocyanate Accumulation

Thiocyanate may accumulate in the blood, especially in patients with impaired hepatic or renal function or hyponatremia^b ²⁰⁷ or in patients receiving sodium nitroprusside infusions at rates >3 mcg/kg per minute for >72 hours or receiving sodium thiosulfate.^a ²⁰⁷ These patients should be monitored for thiocyanate intoxication (e.g., metabolic acidosis).²⁰⁷

Thiocyanate is mildly neurotoxic at serum concentrations of 60 mcg/mL and may be life-threatening at concentrations of 200 mcg/mL.^b Toxicity is manifested as confusion, hyperreflexia, and seizures.²⁰⁷

General Precautions

Effects on Intracranial Pressure

Sodium nitroprusside can increase intracranial pressure.^b

Use with caution in patients with increased intracranial pressure.^b

Use in Pulmonary Disease

May reverse hypoxic pulmonary vasoconstriction in patients with pulmonary disease (e.g., pneumonia, adult respiratory distress syndrome), which may exacerbate intrapulmonary shunting resulting in worsened hypoxemia.²⁰⁷

Use in Anesthesia

Tolerance to loss of blood, anemia, and hypovolemia may be decreased when used for controlled hypotension during anesthesia.^b

If possible, correct preexisting anemia and hypovolemia prior to use.^b

Use with extreme caution in patients who are especially poor surgical risks.^b

Specific Populations

Pregnancy

Category C.^b ^d

Lactation

Not known whether sodium nitroprusside or its metabolites are distributed into milk; discontinue nursing or the drug.^b

Hepatic Impairment

Caution in patients with hepatic impairment.^b

Cyanide and thiocyanate may accumulate in patients with hepatic disease; monitor for cyanide and thiocyanate toxicity.^b ²⁰⁷ (See Cyanide Toxicity and also Thiocyanate Accumulation under Cautions.)

Renal Impairment

Caution in patients with severe renal impairment.^a (See Renal Impairment under Dosage and Administration and Thiocyanate Accumulation under Cautions.)

Cyanide and thiocyanate may accumulate in patients with renal disease; monitor for cyanide and thiocyanate toxicity.^b ²⁰⁷ (See Cyanide Toxicity and also Thiocyanate Accumulation under Cautions.)

Common Adverse Effects

Excessive hypotension, cyanide toxicity.^b

Interactions for Nitropress

The hypotensive effects are additive when used with ganglionic blocking agents, negative inotropic agents, general anesthetics (e.g., halothane, enflurane), and most other circulatory depressants.^a

Nitropress Pharmacokinetics

Absorption

Onset

Immediate reduction in blood pressure.^b

Duration

Blood pressure begins to rise immediately when infusion is slowed or stopped; blood pressure returns to pretreatment levels within 1–10 minutes.^b

Distribution

Extent

Rapidly distributed.^b

Elimination

Metabolism

Sodium nitroprusside is metabolized by combination with hemoglobin to form cyanmethemoglobin and cyanide.^b

Essentially all cyanide in the blood is bound to methemoglobin until intraerythrocytic methemoglobin is saturated.^b

Cyanide is enzymatically converted to thiocyanate by thiosulfate sulfurtransferase (a mitochondrial enzyme).^b ²⁰⁷ This enzyme normally is present in excess quantities; the rate-limiting step in the conversion to thiocyanate is the availability of sulfur donors (e.g., thiosulfate, cystine, cysteine).^b

Cyanide not otherwise removed binds to cytochromes.^b

Elimination Route

Eliminated principally in urine as thiocyanate.^b Some cyanide is expired as hydrogen cyanide.^b

Half-life

Sodium nitroprusside: Circulation half-life: 2 minutes.^b

Thiocyanate: 3 days.^b

Special Populations

Half-life of thiocyanate is increased in patients with renal failure.^b

Stability

Storage

Parenteral

Injection

15–30°C; protect from light by storing in the carton.^b

If properly protected from light, reconstituted solutions and solutions for infusion are stable for 24 hours.^b

Sodium nitroprusside solution can be inactivated by reactions with trace contaminants; products of these reactions are often blue, green, or red and are much brighter than the very faint brownish tint of freshly prepared unreacted sodium nitroprusside solutions.^b Discard discolored solutions or solutions with visible particulate matter.^b

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

The manufacturer states that no other drug should be admixed in the sodium nitroprusside solution.^b

Parenteral

Solution Compatibility^HID

Compatible
Ringer’s injection, lactated (when protected from light)
Variable
Dextrose 4% in sodium chloride 0.18% (compatible when protected from light)
Dextrose 5% in water (compatible when protected from light)
Sodium chloride 0.9% (compatible when protected from light)

Drug Compatibility

Y-Site CompatibilityHID
Compatible
Alcohol 10% in dextrose 5%
Alprostadil
Atracurium besylate
Bivalirudin
Calcium chloride
Dexmedetomidine HCl
Diltiazem HCl
Dopamine HCl
Dopamine HCl with dobutamine HCl
Dopamine HCl with lidocaine HCl
Dopamine HCl with nitroglycerin
Enalaprilat
Epinephrine HCl
Esmolol HCl
Famotidine
Furosemide
Heparin sodium
Hetastarch in lactated electrolyte injection (Hextend)
Inamrinone lactate
Indomethacin sodium trihydrate
Isoproterenol HCl
Labetalol HCl
Lidocaine HCl
Lidocaine HCl with dobutamine HCl
Lidocaine HCl with dopamine HCl
Lidocaine HCl with nitroglycerin
Magnesium sulfate
Midazolam HCl
Milrinone lactate
Morphine sulfate
Nicardipine HCl
Nitroglycerin
Nitroglycerin with dobutamine HCl
Nitroglycerin with dopamine HCl
Nitroglycerin with lidocaine HCl
Norepinephrine bitrate
Pancuronium bromide
Potassium chloride
Potassium phosphates
Procainamide HCl
Propofol
Tacrolimus
Theophylline
Vecuronium bromide
Incompatible
Drotrecogin alfa (activated)
Levofloxacin
Variable
Amiodarone HCl
Dobutamine HCl
Haloperidol lactate
Propafenone

ActionsActions

The hypotensive action results from peripheral vasodilation caused by a direct action on vascular smooth muscle.^b

Direct vasodilation causes decreases in right and left ventricular filling (preload) resulting in relief of pulmonary congestion and reduced left ventricular volume and pressure.^b ²⁰⁷ Arteriolar relaxation causes decreases in peripheral arterial resistance (afterload) resulting in enhanced systolic emptying with reduced left ventricular volume and wall stress and reduced myocardial oxygen consumption.^b ²⁰⁷

No direct effect on the myocardium,^a but may exert a direct coronary vasodilator effect.^b

Induces renal vasodilation generally proportional to decreases in systemic blood pressure with no appreciable changes in renal blood flow or glomerular filtration rate.^b

Advice to Patients

Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^b

Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs and herbal supplements, as well as any concomitant illnesses.^b

Importance of informing patients of other important precautionary information.^b (See Cautions).

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Sodium Nitroprusside
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	For injection, concentrate, for IV infusion only	25 mg/mL*	Nitropress	Hospira
			Sodium Nitroprusside Injection
	For injection, for IV infusion only	50 mg	Nitropress ADD-Vantage	Hospira

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions April 2010. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

200. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med. 1993; 153:154-83. [IDIS 309043] [PubMed 8422206]

201. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Bethesda, MD: National Institutes of Health; 1997 Nov. (NIH publication No. 98-4080.)

202. Ryan TJ, Antman EM, Brooks NH et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: 1999 update: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). From and .

203. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) Express. Bethesda, MD: May 14 2003. From NIH website. (). (Also published in JAMA. 2003; 289.

204. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) Complete Version. Bethesda, MD: 2003 Nov 5. Hypertension. 2003; 42:1206-52. [PubMed 14656957]

205. National high blood pressure education program working group on hypertension control in children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114(Suppl 2):555-76.

206. The American Heart Association in Collaboration with the International Liaison Committee on Resuscitation. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2000; 102(Suppl I): I-133.

207. The American Heart Association. Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005; 112(Suppl I): IV1-211.

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1493-1501.

a. AHFS drug information 2007. McEvoy GK, ed. Sodium Nitroprusside. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1743-6.

b. Abbott Laboratories. Nitropress (Sodium Nitroprusside) injection prescribing information. North Chicago, Il; 2000 Jan.

d. Nitroprusside. In: Briggs GG, Freeman RK, Yaffe SJ. Drug in pregnancy and lactation: a reference guide to fetal and neonatal risk. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2002:1008.

More Nitropress resources

Nitropress Side Effects (in more detail)
Nitropress Use in Pregnancy & Breastfeeding
Nitropress Drug Interactions
Nitropress Support Group
0 Reviews for Nitropress - Add your own review/rating

Nitropress Prescribing Information (FDA)

Nitropress Concise Consumer Information (Cerner Multum)

Compare Nitropress with other medications

Heart Failure
Hypertensive Emergency

Saturday, April 14, 2012

Amlodipine

Pronunciation: am-LOE-di-peen
Generic Name: Amlodipine
Brand Name: Norvasc

Amlodipine is used for:

Treating high blood pressure and angina (chest pain). It may be used alone or with other medicines. It may also be used for other conditions as determined by your doctor.

Amlodipine is a calcium channel blocker. It works by widening blood vessels to reduce chest pain and high blood pressure. It also widens arteries in the heart, which increases blood flow to the heart.

Do NOT use Amlodipine if:

you are allergic to any ingredient in Amlodipine

Contact your doctor or health care provider right away if any of these apply to you.

Before using Amlodipine:

Some medical conditions may interact with Amlodipine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

if you have allergies to medicines, foods, or other substances

if you have low blood pressure

if you have a history of heart problems (eg, heart failure, aortic stenosis, coronary artery disease), or liver problems

Some MEDICINES MAY INTERACT with Amlodipine. Tell your health care provider if you are taking any other medicines, especially any of the following:

Sildenafil because the risk of low blood pressure may be increased

Azole antifungals (eg, itraconazole, ketoconazole), diltiazem, HIV protease inhibitors (eg, ritonavir), or vasopressin receptor antagonists (eg, conivaptan) because they may increase the risk of Amlodipine's side effects

Simvastatin because the risk of it's side effects may be increased by Amlodipine

This may not be a complete list of all interactions that may occur. Ask your health care provider if Amlodipine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Amlodipine:

Use Amlodipine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

An extra patient leaflet is available with Amlodipine. Talk to your pharmacist if you have questions about this information.

Take Amlodipine by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.

Taking Amlodipine at the same time each day will help you remember to take it.

Continue to take Amlodipine even if you feel well. Do not miss any doses.

If you miss a dose of Amlodipine, take it as soon as possible. If it has been more than 12 hours since you missed your last dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Amlodipine.

Important safety information:

Amlodipine may cause drowsiness or dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Amlodipine with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

Amlodipine may cause dizziness, light-headedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.

Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal." Tell your doctor if you develop any new symptoms.

If you are taking Amlodipine for angina, it will not relieve the pain of an acute attack if it is taken at the time of an acute attack. It prevents or reduces the number of angina attacks only if you take it on regular schedule.

When you begin taking Amlodipine, it may cause a headache, which usually lasts for a short time.

While you are using Amlodipine, it is important to brush and floss your teeth carefully to reduce swelling and tenderness of your gums.

Although rare, Amlodipine has been known to increase chest pain and increase the risk of a heart attack, especially in patients with severe heart disease.

Lab tests, including blood pressure checks, may be performed while you use Amlodipine. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Use Amlodipine with caution in the ELDERLY; they may be more sensitive to its effects.

Amlodipine should be used with extreme caution in CHILDREN younger than 6 years; safety and effectiveness in these children have not been confirmed.

PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Amlodipine while you are pregnant. It is not known if Amlodipine is found in breast milk. Do not breast-feed while taking Amlodipine.

Possible side effects of Amlodipine:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Dizziness; drowsiness; fatigue; flushing; headache; muscle cramps; nausea; stomach pain; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); dark urine; fainting; fast, slow, or irregular heartbeat; pounding in the chest; severe or persistent dizziness; shortness of breath; swelling of the feet or legs; symptoms of heart attack (eg, chest, jaw, or left arm pain; numbness of an arm or leg; sudden, severe headache or vomiting); tender, bleeding, or swollen gums; worsening angina pain (eg, longer, more often, more severe); yellowing of the eyes or skin.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Amlodipine side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include dizziness; fainting or light-headedness, especially when standing; very fast heart rate.

Proper storage of Amlodipine:

Store Amlodipine at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Amlodipine out of the reach of children and away from pets.

General information:

If you have any questions about Amlodipine, please talk with your doctor, pharmacist, or other health care provider.

Amlodipine is to be used only by the patient for whom it is prescribed. Do not share it with other people.

If your symptoms do not improve or if they become worse, check with your doctor.

Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Amlodipine. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

More Amlodipine resources

Amlodipine Side Effects (in more detail)
Amlodipine Use in Pregnancy & Breastfeeding
Drug Images
Amlodipine Drug Interactions
Amlodipine Support Group
66 Reviews for Amlodipine - Add your own review/rating

Amlodipine Prescribing Information (FDA)

Amlodipine Professional Patient Advice (Wolters Kluwer)

Amlodipine Besylate Monograph (AHFS DI)

Norvasc Consumer Overview

Norvasc Prescribing Information (FDA)

amlodipine Advanced Consumer (Micromedex) - Includes Dosage Information

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Angina
Coronary Artery Disease
Heart Failure
High Blood Pressure
Migraine Prevention
Raynaud's Syndrome

Friday, April 13, 2012

Novolin N InnoLets

Pronunciation: IN-su-lin EYE-soe-fane
Generic Name: Insulin Isophane
Brand Name: Novolin

Novolin N InnoLets are used for:

Treating diabetes mellitus.

Novolin N InnoLets are an intermediate-acting form of the hormone insulin. It works by helping your body to use sugar properly. This lowers the amount of glucose in the blood, which helps to treat diabetes.

Do NOT use Novolin N InnoLets if:

you are allergic to any ingredient in Novolin N InnoLets

you are having an episode of low blood sugar

Contact your doctor or health care provider right away if any of these apply to you.

Before using Novolin N InnoLets:

Some medical conditions may interact with Novolin N InnoLets. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

if you have allergies to medicines, foods, or other substances

if you drink alcoholic beverages or smoke

if you have kidney or liver problems; nerve problems; adrenal, pituitary, or thyroid problems; or diabetic ketoacidosis

if you use 3 or more insulin injections per day

if you are fasting, have high blood sodium levels, or are on a low-salt diet

Some MEDICINES MAY INTERACT with Novolin N InnoLets. Tell your health care provider if you are taking any other medicines, especially any of the following:

Beta-blockers (eg, propranolol), clonidine, guanethidine, lithium, or reserpine because they may increase the risk of high or low blood sugar, or may hide the signs and symptoms of low blood sugar, if it occurs

Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), disopyramide, fenfluramine, fibrates (eg, clofibrate, gemfibrozil), fluoxetine, monoamine oxidase inhibitors (MAOIs) (eg, phenelzine), oral medicines for diabetes (eg, glipizide, metformin, nateglinide), pentamidine, propoxyphene, salicylates (eg, aspirin), somastatin analogs (eg, octreotide), or sulfonamide antibiotics (eg, sulfamethoxazole) because the risk of low blood sugar may be increased

Corticosteroids (eg, prednisone), danazol, diuretics (eg, furosemide, hydrochlorothiazide), estrogen, hormonal contraceptives (eg, birth control pills), isoniazid, niacin, phenothiazines (eg, chlorpromazine), progesterones (eg, medroxyprogesterone), somatropin, sympathomimetics (eg, albuterol, epinephrine, terbutaline), or thyroid hormones (eg, levothyroxine) because they may decrease Novolin N InnoLets's effectiveness, resulting in high blood sugar

This may not be a complete list of all interactions that may occur. Ask your health care provider if Novolin N InnoLets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Novolin N InnoLets:

Use Novolin N InnoLets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

An extra patient leaflet is available with Novolin N InnoLets. Talk to your pharmacist if you have questions about this information.

Check with your doctor about how you should use Novolin N InnoLets with regard to meals.

If you will be using Novolin N InnoLets at home, a health care provider will teach you how to use it. Be sure you understand how to use Novolin N InnoLets. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.

Carefully rotate the container as directed before each injection. This will ensure that the contents are evenly mixed. This insulin should look uniformly cloudy or milky.

Do not use Novolin N InnoLets if it contains particles or clumps, is discolored, or if the vial or container is cracked or damaged.

Do NOT use Novolin N InnoLets in an insulin pump.

Use the proper technique taught to you by your doctor. Inject deep under the skin, NOT into a vein or muscle.

Injection sites within an injection area (abdomen, thigh, upper arm) must be rotated from one injection to the next.

Be sure you have purchased the correct insulin. Insulin comes in a variety of containers, including vials, cartridges, and pens. Make sure that you understand how to properly measure and prepare your dose. If you have any questions about measuring and preparing your dose, contact your doctor or pharmacist for information.

Novolin N InnoLets begins lowering blood sugar within 30 to 90 minutes after an injection. The peak effect occurs within 4 to 12 hours after a dose. The effect may last for up to 24 hours.

Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.

It is very important to follow your insulin regimen exactly. Do NOT miss any doses. Ask your doctor for specific instructions to follow in case you ever miss a dose of insulin.

Ask your health care provider any questions you may have about how to use Novolin N InnoLets.

Important safety information:

Drowsiness, dizziness, lightheadedness, or blurred vision may occur while you use Novolin N InnoLets. These effects may be worse if you take it with alcohol or certain medicines. Use Novolin N InnoLets with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

Do not drink alcohol without discussing it with your doctor. Drinking alcohol may increase the risk of developing high or low blood sugar.

Do NOT take more than the recommended dose, use Novolin N InnoLets more often than prescribed, or change the type or dose of insulin you are using without checking with your doctor.

Any change of insulin should be made cautiously and only under medical supervision. Changes in purity, strength, brand (manufacturer), type (regular, NPH, lente), species (beef, pork, beef-pork, human), and/or method of manufacture may require a change in dose.

Illness, especially with nausea and vomiting, may cause your insulin requirements to change. Even if you are not eating, you still require insulin. You and your doctor should establish a sick day plan to use in case of illness. When you are sick, test your blood/urine frequently and call your doctor as instructed.

Tell your doctor or dentist that you take Novolin N InnoLets before you receive any medical or dental care, emergency care, or surgery.

If you will be traveling across time zones, consult your doctor concerning adjustments in your insulin schedule.

Carry an ID card at all times that says you have diabetes.

An insulin reaction resulting from low blood sugar levels (hypoglycemia) may occur if you take too much insulin, skip a meal, or exercise too much. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your heart beat faster; make your vision change; give you a headache, chills, or tremors; or make you more hungry. It is a good idea to carry a reliable source of glucose (eg, tablets or gel) to treat low blood sugar. If this is not available, you should eat or drink a quick source of sugar like table sugar, honey, candy, orange juice, or non-diet soda. This will raise your blood sugar level quickly. Tell your doctor right away if this happens. To prevent low blood sugar, eat meals at the same time each day and do not skip meals.

Developing a fever or infection, eating significantly more than prescribed, or missing your dose of insulin may cause high blood sugar (hyperglycemia). High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell you doctor right away.

Check with your doctor if you notice a depression in the skin or skin thickening at the injection site. You may need to change your injection technique.

Proper diet, regular exercise, and regular testing of blood sugar are important for best results when using Novolin N InnoLets.

Lab tests, including fasting blood glucose levels and hemoglobin A_1c, may be performed while you use Novolin N InnoLets. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Use Novolin N InnoLets with caution in the ELDERLY; if low blood sugar occurs, it may be more difficult to recognize in these patients.

PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Novolin N InnoLets while you are pregnant. It is not known if Novolin N InnoLets are found in breast milk. If you are or will be breast-feeding while you use Novolin N InnoLets, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Novolin N InnoLets:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Redness, swelling, itching, or mild pain at the injection site.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; wheezing; muscle pain); changes in vision; chills; confusion; dizziness; drowsiness; fainting; fast or irregular heartbeat; headache; loss of consciousness; mood changes; seizures; slurred speech; swelling; tremor; trouble breathing; trouble concentrating; unusual hunger; unusual sweating; weakness.

See also: Novolin N side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center or emergency room immediately. Symptoms may include chills; dizziness; drowsiness; fainting; fast or irregular heartbeat; headache; loss of consciousness; nervousness; seizures; shakiness; sweating; tremor; vision changes; weakness.

Proper storage of Novolin N InnoLets:

Store new (unopened) InnoLets, Pens, or PenFill cartridges in the refrigerator, between 36 and 46 degrees F (2 and 8 degrees C). Do not freeze. Store used (open) InnoLets, Pens, or PenFill cartridges at room temperature, below 86 degrees F (30 degrees C). Do NOT store used (open) InnoLets, Pens, or PenFill cartridges in the refrigerator. Store away from heat and light. If Novolin N InnoLets has been frozen or overheated, throw it away. Throw away unrefrigerated or used InnoLets, Pens, or PenFill cartridges after 14 days, even if they still contain medicine.

Do not leave Novolin N InnoLets in a car on a warm or sunny day. Do not use Novolin N InnoLets after the expiration date stamped on the label. Keep Novolin N InnoLets, as well as syringes and needles, out of the reach of children and away from pets. Ask your doctor, pharmacist, or other health care provider how to store Novolin N InnoLets.

General information:

If you have any questions about Novolin N InnoLets, please talk with your doctor, pharmacist, or other health care provider.

Novolin N InnoLets are to be used only by the patient for whom it is prescribed. Do not share it with other people.

If your symptoms do not improve or if they become worse, check with your doctor.

Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Novolin N InnoLets. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

More Novolin N resources

Novolin N Side Effects (in more detail)
Novolin N Use in Pregnancy & Breastfeeding
Novolin N Drug Interactions
Novolin N Support Group
1 Review for Novolin N - Add your own review/rating

Compare Novolin N with other medications

Diabetes, Type 1
Diabetes, Type 2
Gestational Diabetes

Friday, April 6, 2012

Nasalcrom

Generic Name: cromolyn (Nasal route)

KROE-mo-lin

Commonly used brand name(s)

In the U.S.

Nasalcrom

Available Dosage Forms:

Spray

Therapeutic Class: Nasal Agent

Pharmacologic Class: Mast Cell Stabilizer

Uses For Nasalcrom

Cromolyn nasal solution is used to help prevent or treat the symptoms (sneezing, wheezing, runny nose, itching) of seasonal (short-term) or chronic (long-term) allergic rhinitis. Cromolyn powder for nasal inhalation is used to help prevent seasonal (short-term) allergic rhinitis.

This medicine works by acting on certain cells in the body, called mast cells, to prevent them from releasing substances that cause the allergic reaction.

When cromolyn is used to treat chronic (long-term) allergic rhinitis, an antihistamine and/or a nasal decongestant may be used with this medicine, especially during the first few weeks of treatment.

Nasal cromolyn is available without a prescription.

Before Using Nasalcrom

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of nasal cromolyn in children up to 6 years of age (in Canada, up to 5 years of age) with use in other age groups. In older children, this medicine is not expected to cause different side effects or problems than it does in adults.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of nasal cromolyn in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	B	Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Interactions with Food/Tobacco/Alcohol

Proper Use of Nasalcrom

This medicine usually comes with patient directions. Read them carefully before using the medicine.

Before using this medicine, clear the nasal passages by blowing your nose.

To use:

Cromolyn solution is used with a special spray device.

To keep clean, wipe the nosepiece with a clean tissue and replace the dust cap after use.

To avoid spreading an infection, do not use the container for more than one person.

Use this medicine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of side effects.

In order for this medicine to work properly, it must be used every day in regularly spaced doses as ordered by your doctor:

For patients using cromolyn for seasonal (short-term) allergic rhinitis, up to 1 week may pass before you begin to feel better.

For patients using cromolyn for chronic (long-term) allergic rhinitis, up to 2 to 4 weeks may pass before you feel the full effects of this medicine, although you may begin to feel better after 1 week.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

For nasal solution dosage form:
- For allergic rhinitis:
  - Adults and children 6 years of age (in Canada, 5 years of age) and older—One spray into each nostril three to six times a day until condition is better; then, one spray in each nostril every eight to twelve hours.
  - Children up to 6 years of age (in Canada, up to 5 years of age)—Use and dose must be determined by your doctor.

Missed Dose

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using Nasalcrom

If your symptoms do not improve or if your condition becomes worse, check with your doctor.

Nasalcrom Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Rare

Allergic reaction (coughing

difficulty in swallowing

hives or itching

swelling of face, lips, or eyelids

wheezing or difficulty in breathing)

nosebleeds

skin rash

More common

Burning, stinging, or irritation inside of nose

flushing

increase in sneezing

Less common

Cough

headache

postnasal drip

unpleasant taste

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Nasalcrom side effects (in more detail)

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

More Nasalcrom resources

Nasalcrom Side Effects (in more detail)
Nasalcrom Use in Pregnancy & Breastfeeding
Nasalcrom Support Group
0 Reviews for Nasalcrom - Add your own review/rating

Nasalcrom nasal Concise Consumer Information (Cerner Multum)

NasalCrom Solution MedFacts Consumer Leaflet (Wolters Kluwer)

Compare Nasalcrom with other medications

Hay Fever

Thursday, April 5, 2012

Novolog FlexPen

Generic Name: insulin aspart, recombinant (Subcutaneous route)

IN-su-lin AS-part, ree-KOM-bi-nant

Commonly used brand name(s)

In the U.S.

Novolog

Novolog FlexPen

Available Dosage Forms:

Solution

Therapeutic Class: Antidiabetic

Pharmacologic Class: Insulin, Ultra Rapid Acting

Uses For Novolog FlexPen

Insulin aspart is a fast-acting type of human insulin. Insulin is used by people with diabetes to help keep blood sugar levels under control. If you have diabetes, your body cannot make enough or does not use insulin properly. So, you must take additional insulin to regulate your blood sugar and keep your body healthy. This is very important as too much sugar in your blood can be harmful to your health. Since insulin aspart acts faster than regular human insulin, you normally should use insulin aspart with a longer-acting insulin.

This medicine is available only with your doctor's prescription.

Before Using Novolog FlexPen

Allergies

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of insulin aspart in children. However, safety and efficacy of insulin aspart mix 50/50 and 70/30 in the pediatric population have not been established.

Geriatric

Although appropriate studies on the relationship of age to the effects of insulin aspart have not been performed in the geriatric population, geriatric-specific problems are not expected to limit the usefulness of insulin aspart in the elderly. However, elderly patients are more likely to have age-related heart, liver, or kidney problems which may require an adjustment of dosage in patients receiving insulin aspart.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	B	Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Alatrofloxacin

Balofloxacin

Ciprofloxacin

Clinafloxacin

Enoxacin

Fleroxacin

Flumequine

Gatifloxacin

Gemifloxacin

Grepafloxacin

Levofloxacin

Lomefloxacin

Moxifloxacin

Norfloxacin

Ofloxacin

Pefloxacin

Prulifloxacin

Rufloxacin

Sparfloxacin

Temafloxacin

Tosufloxacin

Trovafloxacin Mesylate

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acebutolol

Alprenolol

Atenolol

Betaxolol

Bevantolol

Bisoprolol

Bitter Melon

Bucindolol

Carteolol

Carvedilol

Celiprolol

Clorgyline

Dilevalol

Esmolol

Fenugreek

Glucomannan

Guar Gum

Iproniazid

Isocarboxazid

Labetalol

Levobunolol

Mepindolol

Metipranolol

Metoprolol

Moclobemide

Nadolol

Nebivolol

Nialamide

Oxprenolol

Pargyline

Penbutolol

Phenelzine

Pindolol

Procarbazine

Propranolol

Psyllium

Selegiline

Sotalol

Talinolol

Tertatolol

Timolol

Toloxatone

Tranylcypromine

Interactions with Food/Tobacco/Alcohol

Proper Use of insulin aspart, recombinant

This section provides information on the proper use of a number of products that contain insulin aspart, recombinant. It may not be specific to Novolog FlexPen. Please read with care.

Each package of insulin aspart contains a patient information sheet. Read this sheet carefully before beginning treatment and each time you refill for any new information, and make sure you understand:

How to prepare the medicine.

How to inject the medicine.

How to use disposable insulin delivery device.

How to dispose of syringes, needles, and injection devices.

It is best to use a different place on the body for each injection (e.g., abdomen, thigh, or upper arm). If you have questions about this, contact a member of your health care team.

When used as a mealtime insulin, insulin aspart should be taken within 5-10 minutes before the meal or immediately before the meal.

Follow carefully the special meal plan your doctor gave you. This is the most important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed.

When used in an insulin pump: Carefully read and follow the external insulin pump instructions. This insulin should not be mixed with any other insulin or diluted when used in an insulin pump. If you do not understand how you are to use the insulin pump, contact your health care professional.

You should never mix insulin aspart with other insulin injections without checking with your doctor first. These injections are usually done separately. If you have questions about this, ask your doctor or pharmacist.

This medicine can also be given as an intravenous (IV) infusion only by a healthcare professional in a clinic or hospital.

Dosing

For injection dosage form:
- For diabetes mellitus:
  - Adults—The dose is based on your blood sugar and must be determined by your doctor.
  - Children—Use and dose must be determined by your doctor.

Storage

Store in the refrigerator. Do not freeze.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

After a cartridge has been inserted into a pen, store the cartridge and pen at room temperature, not in the refrigerator.

Precautions While Using Novolog FlexPen

Never share insulin pens or cartridges with others under any circumstances. It is not safe for one pen to be used for more than one person. Sharing needles or pens can result in transmission of hepatitis viruses, HIV, or other blood-borne illnesses.

Your doctor will want to check your progress at regular visits, especially during the first few weeks you take this medicine. Blood tests may be needed to check for unwanted effects.

It is very important to follow carefully any instructions from your health care team about:

Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.

Other medicines—Do not take other medicines during the time you are taking insulin aspart unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.

Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in patients with diabetes during pregnancy.

Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.

In case of emergency—There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to:

Wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and a list of all of your medicines.

Insulin aspart may cause a serious allergic reaction, which can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a rash; itching; swelling of the face, tongue, and throat; trouble breathing; or chest pain after you get the injection.

Too much insulin aspart can cause hypoglycemia (low blood sugar). Symptoms of low blood sugar include anxiety; behavior change similar to being drunk; blurred vision; cold sweats; confusion; depression; difficulty in thinking; dizziness or lightheadedness; drowsiness; excessive hunger; fast heartbeat; headache; irritability or abnormal behavior; nervousness; nightmares; restless sleep; shakiness; slurred speech; and tingling in the hands, feet, lips, or tongue.

Low blood sugar also can occur if you use insulin aspart with another antidiabetic medicine, delay or miss a meal or snack, exercise more than usual, drink alcohol, or cannot eat because of nausea or vomiting or have diarrhea.

If symptoms of low blood sugar occur, eat glucose tablets or gel to relieve the symptoms. Also, check your blood for low blood sugar. Get to a doctor or a hospital right away if the symptoms do not improve. Someone should call for emergency help immediately if severe symptoms such as convulsions (seizures) or unconsciousness occur. Have a glucagon kit available, along with a syringe and needle, and know how to use it. Members of your household also should know how to use it.

Symptoms of high blood sugar include blurred vision; drowsiness; dry mouth; flushed, dry skin; fruit-like breath odor; increased urination; ketones in urine; loss of appetite; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); unconsciousness; and unusual thirst.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your antidiabetic medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual.

If symptoms of high blood sugar occur, check your blood sugar level and then call your doctor for instructions.

Novolog FlexPen Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Anxious feeling

behavior change similar to being drunk

blurred vision

cold sweats

confusion

convulsions (seizures)

depression

difficulty in thinking

dizziness or lightheadedness

drowsiness

excessive hunger

fast heartbeat

headache

irritability or abnormal behavior

low blood sugar

nervousness

nightmares

restless sleep

shakiness

slurred speech

tingling in the hands, feet, lips, or tongue

unconsciousness

Less common or rare

Depression of the skin at the place of injection

dryness of the mouth

fast or weak pulse

feeling of pressure, itching, redness, soreness, stinging, swelling, or tingling at the place of injection

increased thirst

irregular heartbeat

loss of appetite

mood or mental changes

muscle cramps or pain

nausea or vomiting

shortness of breath

skin rash or itching over the whole body

sweating

thickening of the skin at the place of injection

unusual tiredness or weakness

wheezing

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Novolog FlexPen side effects (in more detail)

More Novolog FlexPen resources

Novolog FlexPen Side Effects (in more detail)
Novolog FlexPen Use in Pregnancy & Breastfeeding
Novolog FlexPen Drug Interactions
Novolog FlexPen Support Group
2 Reviews for Novolog FlexPen - Add your own review/rating

Insulin Aspart Monograph (AHFS DI)

Insulin Aspart Cartridges MedFacts Consumer Leaflet (Wolters Kluwer)

NovoLog Consumer Overview

Novolog Cartridges MedFacts Consumer Leaflet (Wolters Kluwer)

Compare Novolog FlexPen with other medications

Diabetes, Type 1
Diabetes, Type 2

Friday, April 20, 2012

corticosteroid Rectal

Commonly used brand name(s)

Uses For This Medicine

Before Using This Medicine

Allergies

Pediatric

Geriatric

Pregnancy

Breast Feeding

Interactions with Medicines

Interactions with Food/Tobacco/Alcohol

Other Medical Problems

Proper Use of This Medicine

Dosing

Missed Dose

Storage

Precautions While Using This Medicine

Side Effects of This Medicine

Thursday, April 19, 2012

Nitropress

Introduction

Uses for Nitropress

Hypertensive Crises

Heart Failure and Low-Output Syndromes

Controlled Hypotension

Nitropress Dosage and Administration

Administration

IV Administration

Reconstitution

Dilution

Rate of Administration

Dosage

Pediatric Patients

Hypertensive Crises, Heart Failure and Low-output Syndromes, Controlled Hypotension

IV

Adults

Hypertensive Crises, Heart Failure and Low-output Syndromes, Controlled Hypotension

IV

Prescribing Limits

Pediatric Patients

Hypertensive Crises, Heart Failure and Low-output Syndromes, Controlled Hypotension

IV

Adults

Hypertensive Crises, Heart Failure and Low-output Syndromes, Controlled Hypotension

IV

Special Populations

Renal Impairment

Cautions for Nitropress

Contraindications

Warnings/Precautions

Warnings

Excessive Hypotension

Cyanide Toxicity

Major Toxicities

Methemoglobinemia

Thiocyanate Accumulation

General Precautions

Effects on Intracranial Pressure

Use in Pulmonary Disease

Use in Anesthesia

Specific Populations

Pregnancy

Lactation

Hepatic Impairment

Renal Impairment

Common Adverse Effects

Interactions for Nitropress

Nitropress Pharmacokinetics

Absorption

Onset

Duration

Distribution

Extent

Elimination

Metabolism

Elimination Route

Half-life

Special Populations

Stability

Solution Compatibility^HID