Coagulation modifiers


Coagulation modifiers are drugs that act on the blood coagulation pathway in different places to prevent or promote blood clot formation.

Coagulation modifiers that prevent blood clot formation are anticoagulants, antiplatelet drugs and thrombolytic drugs. Those that promote clot formation are fibrinolytics. Heparin antagonists and platelet-stimulating agents are used to reduce the risk of bleeding.

See also anticoagulants coumarins and indandiones factor Xa inhibitors heparins thrombin inhibitors antiplatelet agents glycoprotein platelet inhibitors platelet aggregation inhibitors heparin antagonists miscellaneous coagulation modifiers platelet-stimulating agents thrombolytics Drug List:
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Aplastic Anemia Medications


Definition of Aplastic Anemia: Aplastic anemia occurs when the bone marrow produces too few of all three types of blood cells: red blood cells, white blood cells, and platelets. A reduced number of red blood cells causes hemoglobin to drop. A reduced number of white blood cells makes the patient susceptible to infection. And, a reduced number of platelets causes the blood not to clot as easily.

Drugs associated with Aplastic Anemia

The following drugs and medications are in some way related to, or used in the treatment of Aplastic Anemia. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

Learn more about Aplastic Anemia

Micromedex Care Notes:

Aplastic Anemia Bone Marrow Failure In Children

Medical Encyclopedia:

Anemia

Harvard Health Guide:

Symptoms and treatment for Aplastic Anemia
Drug List: Atgam Leukine Neupogen
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Promacta


Pronunciation: el-TROM-boe-pag
Generic Name: Eltrombopag
Brand Name: Promacta

Promacta may cause serious and sometimes fatal liver problems. Your doctor will perform blood tests to check your liver before you start Promacta and for as along as you take it. Contact your doctor right away if you experience yellowing of the skin or eyes, dark urine, stomach pain, or unusual tiredness or weakness.


Promacta is used for:

Treating low blood platelets in certain patients with chronic immune (idiopathic) thrombocytopenic purpura (ITP).

Promacta is a thrombopoietin (TPO) receptor agonist. It works by causing the bone marrow to produce more clot-forming cells (platelets).

Do NOT use Promacta if: you are allergic to any ingredient in Promacta you have low blood platelets caused by chemotherapy or by a condition other than chronic ITP (eg, certain bone marrow problems, such as myelodysplastic syndrome or blood cancer; chronic liver disease)

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

Before using Promacta:

Some medical conditions may interact with Promacta. 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 a history of liver or kidney problems, cataracts, other bleeding problems, or bone marrow problems, or if you have had surgery to remove your spleen if you have a blood clot, a history of blood clots, a high number of clot-forming cells (platelets) in the blood, or a condition that may increase your risk of getting a blood clot (eg, antithrombin III deficiency, antiphospholipid syndrome) if you use tobacco products if you take a blood thinner (eg, warfarin) or an antiplatelet medicine (eg, clopidogrel)

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

Ciprofloxacin, fluvoxamine, gemfibrozil, omeprazole, rifampin, or trimethoprim because they may increase the risk of Promacta's side effects Acetaminophen, benzylpenicillin, doxorubicin, HMG-CoA reductase inhibitors (eg, atorvastatin, rosuvastatin), meglitinides (eg, nateglinide), methotrexate, narcotic pain medications (eg, codeine), or nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen) because the risk of their side effects may be increased by Promacta

This may not be a complete list of all interactions that may occur. Ask your health care provider if Promacta 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 Promacta:

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

Promacta comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Promacta refilled. Take Promacta by mouth on an empty stomach at least 1 hour before or 2 hours after a meal. Take Promacta at least 4 hours before or 4 hours after you take certain other medicines (eg, antacids), calcium-rich foods (eg, dairy products, calcium-fortified juices), or supplements that contain iron, calcium, aluminum, magnesium, selenium, or zinc. Do not suddenly stop taking Promacta. You may have an increased risk of severe low platelets and bleeding. If you need to stop Promacta, your doctor will need to monitor your condition. If you miss a dose of Promacta, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Do not take more than 1 dose in 1 day.

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

Important safety information: If you stop taking Promacta, the number of clot-forming cells (platelets) in your blood may return to a similar low platelet count as before you started taking Promacta. Low blood platelets may increase your risk of bleeding, especially if you are also taking certain other medicines (eg, anticoagulants such as warfarin, antiplatelet medicines such as clopidogrel). These effects are most likely to occur within 4 weeks after you stop taking Promacta. Your doctor will check your blood platelet counts for at least 4 weeks after you stop taking Promacta. Tell your doctor if you have unusual bruising or bleeding after you stop taking Promacta. Avoid activities that may cause bruising or injury. Discuss any questions or concerns with your doctor. Tell your doctor or dentist that you take Promacta before you receive any medical or dental care, emergency care, or surgery. Serious blood clots have occurred in patients taking Promacta. Some serious blood clots may be fatal. The risk of developing a blood clot may be greater if you have a high number of clot-forming cells (platelets) in the blood. However, blood clots have occurred in patients with normal or low blood platelet levels. Tell your doctor immediately if you notice any signs of a blood clot (eg, pain, redness, tenderness, or swelling in the legs; chest pain; shortness of breath; coughing up blood). Lab tests, including liver function, complete blood cell counts, peripheral blood smears, and eye exams, may be performed while you use Promacta and for at least 4 weeks after you stop Promacta. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Use Promacta with caution in East Asian patients (eg, Chinese, Japanese, Taiwanese, Korean) and in patients who have moderate to severe liver problems. They may be more sensitive to the medicine and may require a lower dose than other patients. Discuss any questions or concerns with your doctor. Use Promacta with caution in the ELDERLY; they may be more sensitive to its effects. Promacta should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. PREGNANCY and BREAST-FEEDING: It is not known if Promacta can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Promacta while you are pregnant. It is not known if Promacta is found in breast milk. Do not breast-feed while taking Promacta. Possible side effects of Promacta:

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:

Back pain; diarrhea; indigestion; menstrual changes; mild flu-like symptoms (eg, fever, headache, tiredness, sore throat, body aches); minor muscle aches or pain; nausea; runny or stuff nose; sneezing; vomiting.

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); bleeding of the eye or eyelid; chest pain; coughing; coughing up blood; dark urine; frequent, painful, or urgent urination; new or worsening vision problems (eg, cloudy vision); pain, redness, tenderness, or swelling in the legs; severe or persistent nausea, vomiting, or stomach pain; symptoms of heart attack (eg, pain in the chest or jaw; numbness or an arm or leg; sudden, severe vomiting or headache; fainting); symptoms of stroke (eg, confusion, slurred speech, sudden vision changes, one-sided weakness); trouble breathing; unusual bruising or bleeding; unusual burning, itching, numbness, or tingling of the skin; unusual tiredness or weakness; yellowing of the skin or eyes.

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: Promacta 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 bleeding; chest pain; confusion; coughing; dark urine; one-sided weakness; pain, redness, tenderness, or warmth in the legs; slurred speech; trouble breathing; unusual tiredness or weakness; vision problems; yellowing of the skin or eyes.

Proper storage of Promacta:

Store Promacta at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Promacta out of the reach of children and away from pets.

General information: If you have any questions about Promacta, please talk with your doctor, pharmacist, or other health care provider. Promacta 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 Promacta. 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 Copyright © 2012 Wolters Kluwer Health, Inc. More Promacta resources Promacta Side Effects (in more detail) Promacta Use in Pregnancy & Breastfeeding Promacta Drug Interactions Promacta Support Group 1 Review for Promacta - Add your own review/rating Promacta Prescribing Information (FDA) Promacta Consumer Overview Promacta Monograph (AHFS DI) Promacta Advanced Consumer (Micromedex) - Includes Dosage Information Eltrombopag Professional Patient Advice (Wolters Kluwer) Compare Promacta with other medications Idiopathic Thrombocytopenic Purpura Thrombocytopenia Idiopathic
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Lysteda


Generic Name: tranexamic acid (Oral route)

tran-ex-AM-ik AS-id

Commonly used brand name(s)

In the U.S.

Lysteda

Available Dosage Forms:

Tablet Syrup

Therapeutic Class: Hemostatic

Uses For Lysteda

Tranexamic acid is used to treat heavy menstrual bleeding in women. This medicine may be used by teenage females, but is not recommended before the start of menstruation.

Tranexamic acid is an antifibrinolytic agent. It works by blocking the breakdown of blood clots, which prevents bleeding.

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

Before Using Lysteda

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

Appropriate studies have not been performed on the relationship of age to the effects of tranexamic acid in children or teenage females below 18 years of age. Safety and efficacy have not been established.

Geriatric

Appropriate studies on the relationship of age to the effects of tranexamic acid have not been performed in the geriatric population. This medicine is not recommended for use in women who are no longer having menstrual bleeding (postmenopausal).

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

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.

Anti-Inhibitor Coagulant Complex Chlorpromazine Desogestrel Dienogest Drospirenone Estradiol Cypionate Estradiol Valerate Ethinyl Estradiol Ethynodiol Diacetate Etonogestrel Levonorgestrel Medroxyprogesterone Acetate Mestranol Norelgestromin Norethindrone Norgestimate Norgestrel Tretinoin 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.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

Blood clots, active or history of or Deep vein thrombosis (blood clot in the leg) or Pulmonary embolism (blood clot in the lung) or Retinal artery or vein occlusion (blood clot in the eye) or Stroke (blood clot in the brain)—Should not be used in patients with these conditions. Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body. Proper Use of Lysteda

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

Do not take this medicine when you do not have your period. You should wait until your monthly period has started before taking this medicine.

This medicine comes with a patient information insert. Read and follow the instructions in the insert carefully. Ask your doctor if you have any questions.

You may take this medicine with or without food.

Swallow the tablet whole. Do not break, crush, or chew it.

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.

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 oral dosage form (tablets): To treat heavy menstrual bleeding: Adults—Two tablets (650 milligrams per tablet) three times a day in the morning, afternoon, and evening. The tablets should not be taken more than 5 days in a row for each monthly period. 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.

If you take a dose that is late, wait at least six hours before you take your next 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.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using Lysteda

It is very important that your doctor check your progress while you are using this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

Tell your doctor if you are using birth control pills or other types of birth control (e.g., patch, vaginal ring, or intrauterine device). Using these medicines together may increase your chance of having a blood clot, heart attack, or stroke.

This medicine may cause serious allergic reactions including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have shortness of breath; trouble breathing; chest tightness; flushing of the face; trouble swallowing; or any swelling of your hands, face, or mouth while you are using this medicine.

Stop taking this medicine and call your doctor right away if you have any eye problems, such as a change in your vision. Your doctor will want you to have your eyes checked by an ophthalmologist (eye doctor).

If this medicine does not reduce your bleeding after two menstrual cycles or if it seems to stop working, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Lysteda 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 Pale skin troubled breathing with exertion unusual bleeding or bruising unusual tiredness or weakness Incidence not known Anxiety blurred or loss of vision chest pain confusion cough difficulty with swallowing disturbed color perception dizziness or lightheadedness double vision fainting fast heartbeat hives itching night blindness numbness of the hands overbright appearance of lights pain, redness, or swelling in the arm or leg puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue seeing halos around lights seeing shades of colors differently than before shortness of breath skin rash sudden shortness of breath or troubled breathing tightness in the chest tunnel vision wheezing

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:

More common Abdominal or stomach pain, discomfort, or tenderness back pain chills difficulty with moving fever flushing headache headache, severe and throbbing increased sensitivity to sunlight itching, pain, redness, or swelling of the eye or eyelid joint pain muscle aching or cramping muscle pains or stiffness pain or tenderness around the eyes and cheekbones severe skin rash or hives stuffy or runny nose swollen glands swollen joints watering of the eyes Incidence not known Diarrhea nausea vomiting

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: Lysteda 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.

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More Lysteda resources Lysteda Side Effects (in more detail) Lysteda Use in Pregnancy & Breastfeeding Lysteda Drug Interactions Lysteda Support Group 13 Reviews for Lysteda - Add your own review/rating Lysteda Prescribing Information (FDA) Lysteda Consumer Overview Lysteda MedFacts Consumer Leaflet (Wolters Kluwer) Tranexamic Acid Professional Patient Advice (Wolters Kluwer) Cyklokapron MedFacts Consumer Leaflet (Wolters Kluwer) Cyklokapron Prescribing Information (FDA) Compare Lysteda with other medications Menorrhagia Menstrual Disorders
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Alteplase


Pronunciation: AL-teh-PLACE
Generic Name: Alteplase
Brand Name: Cathflo Activase
Alteplase is used for:

Restoring function to central venous access devices that have become clogged with clotted blood. It may also be used for other conditions as determined by your doctor.

Alteplase is a tissue plasminogen activator (tPA). It works by helping to break down unwanted blood clots.

Do NOT use Alteplase if: you are allergic to any ingredient in Alteplase

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

Before using Alteplase:

Tell your health care provider 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 active internal bleeding if you have had any type of surgery or medical procedure or have undergone childbirth within the past 48 hours if you have blood problems (eg, thrombocytopenia, blood clotting problems) or severe liver or kidney disease if you have an increased risk for complications due to clotting (eg, blood clot near the catheter) if you have a known or suspected infection at the catheter site

Some MEDICINES MAY INTERACT with Alteplase. Tell your health care provider if you are taking any of the following medicines.

Abciximab, anticoagulants (eg, warfarin, heparin), aspirin, or dipyridamole because the risk of serious side effects, such as bleeding, may be increased Nitrates (eg, nitroglycerin, isosorbide dinitrate) because the effectiveness of Alteplase may be decreased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Alteplase 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 Alteplase:

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

Alteplase is usually administered at your doctor's office, hospital, or clinic. If you are using Alteplase at home, carefully follow the procedures taught to you by your health care provider. If Alteplase contains particles or is discolored, or if the vial is cracked or damaged in any way, do not use it. Mix Alteplase by swirling gently. Do not shake. Throw away any unused medicine left in the vial. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for selecting an appropriate container and properly disposing of the container when full. If you miss a dose of Alteplase, contact your doctor right away.

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

Important safety information: Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Alteplase. Using Alteplase alone, with certain other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Be sure you know why the catheter is not functioning before using Alteplase. If the catheter is not functioning due to a reason other than clotted blood, contact your doctor before using Alteplase. Contact your doctor if the catheter remains blocked after using this product as directed. If redness, swelling, or pain develops at the catheter site, contact your doctor immediately. Alteplase may reduce the number of cells in your blood that help your blood clot (platelets). To prevent bleeding, avoid situations in which bruising or injury may occur. Report any unusual bleeding, bruising, blood in stools, or dark, tarry stools to your doctor. If serious bleeding occurs while you are using Alteplase, contact your doctor immediately. Additional monitoring of your dose or condition may be needed if you are taking warfarin or aspirin. Use Alteplase with caution in the ELDERLY because they may be more sensitive to its effects. PREGNANCY AND BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using this product during pregnancy. It is unknown if Alteplase is excreted in breast milk. If you are or will be breast-feeding while you are using Alteplase, check with your doctor or pharmacist to discuss the risks to your baby. Possible side effects of Alteplase:

All medicines may cause side effects, but many people have no, or minor, side effects. When used in small doses, no COMMON side effects have been reported with this product. Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; bloody vomit; calf pain or tenderness; changes in vision; chest pain; chills; coughing up blood; difficulty breathing or sudden shortness of breath; fast, slow, or irregular heartbeat; fever; one-sided weakness; redness, swelling, or pain at the catheter site; severe bleeding; severe stomach pain; speech problems or changes; unusual or easy bleeding or bruising.

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: Alteplase 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 unusual bleeding.

Proper storage of Alteplase:

Store Alteplase in the refrigerator between 36 and 46 degrees F (2 and 8 degrees C). Store away from heat, moisture, and light. Keep Alteplase, as well as syringes and needles, out of the reach of children and away from pets.

General information: If you have any questions about Alteplase, please talk with your doctor, pharmacist, or other health care provider. Alteplase 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 Alteplase. 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 Copyright © 2012 Wolters Kluwer Health, Inc. More Alteplase resources Alteplase Side Effects (in more detail) Alteplase Use in Pregnancy & Breastfeeding Alteplase Drug Interactions Alteplase Support Group 0 Reviews for Alteplase - Add your own review/rating Compare Alteplase with other medications Heart Attack Ischemic Stroke IV Catheter Clot Pulmonary Embolism Thrombotic/Thromboembolic Disorder
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Heparins


A drug may be classified by the chemical type of the active ingredient or by the way it is used to treat a particular condition. Each drug can be classified into one or more drug classes.

Heparin is an injectable anticoagulant that activates antithrombin III, which inhibits thrombin and factor Xa, factors necessary in the final stages of blood clotting cascade.

There are two types of heparins: high molecular weight heparins and low molecular weight heparins.

High molecular weight heparins require daily blood monitoring to check the aPTT. Low molecular weight heparins give a better anticoagulant response and do not need daily blood monitoring.

Heparin is used to treat or prevent clots in conditions where there is a high risk of clot formation and thromboembolism, such as in atrial fibrillation, myocardial infarction, deep vein thrombosis, knee and hip surgery and so on.

See also

Medical conditions associated with heparins:

Acute Coronary Syndrome Angina Anticoagulation During Pregnancy Antiphospholipid Syndrome Deep Vein Thrombosis Deep Vein Thrombosis Prophylaxis after Abdominal Surgery Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery Deep Vein Thrombosis Prophylaxis after Orthopedic Surgery Deep Vein Thrombosis, Prophylaxis Heart Attack Patency Maintenance of Indwelling Intravenous Devices Pulmonary Embolism Thrombotic/Thromboembolic Disorder Venous Thromboembolism Drug List: Fragmin Innohep Lovenox Normiflo Heparin-Lock-Flush Heparin-Sodium Orgaran
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Indivina


Indivina 1 mg/2.5 mg tablets

Indivina 1 mg/5 mg tablets

Indivina 2 mg/5 mg tablets

estradiol /medroxyprogesterone

Read all of this leaflet carefully before you start taking this medicine Keep this leaflet. You may need to read it again. If you have any further questions, ask your doctor or pharmacist. This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist. In this leaflet:

1. What Indivina is and what it is used for
2. Before you take Indivina
3. How to take Indivina
4. Possible side effects of Indivina
5. How to store Indivina
6. Further information

What Indivina Is And What It Is Used For

The name of your medicine is Indivina. It is a hormone replacement therapy (HRT) used to treat some of the symptoms which occur when the oestrogen levels decline and the periods stop (menopause) by replacing the oestrogen that your body is no longer producing. The tablets contain oestrogen and progestogen. Indivina is only recommended for women whose periods stopped more than three years ago and who still have their womb.

Indivina can also be used to help to prevent osteoporosis (thinning of the bones) if you are at an increased risk of fractures due to osteoporosis but are unable to take other treatments or if other therapies prove to be ineffective. Your doctor should discuss all the available options with you.

There is only limited experience of treating women older than 65 years with Indivina.

Before You Take Indivina Medical check-ups

Before you start taking Indivina, your doctor will inform you about the risks and benefits of the treatment (see also section 4, “Other side effects of combined HRT”). Before you start treatment and regularly during treatment, your doctor will evaluate whether Indivina is the right treatment for you. Your doctor will tell you how often you should go for periodic check-ups, taking into account your general state of health. If you have any close relative (mother, sister, maternal or paternal grandmother), who has suffered from serious illness, e.g. blood clot or breast cancer, you might be at increased risk. You should therefore always tell your doctor about any close relative suffering from serious illness, and you should also tell your doctor about any changes, you might find in your breasts.

As well as regular check-ups with your doctor, be sure to:

Regularly check your breasts for any changes, such as dimpling or sinking of the skin, changes in the nipple, or any lumps you can see or feel. Go for regular breast screening (mammography) and cervical smear tests. While you are receiving this medication, you should see your doctor regularly, at least every six to twelve months If you have unusual symptoms such as unexplained pains in the chest, abdomen or legs you must consult your doctor immediately. If you have a family history of breast cancer you should use this medication with great caution. Do not take Indivina, if: you are allergic (hypersensitive) to estradiol valerate or medroxyprogesterone acetate or any of the other ingredients of Indivina (see section 6: Further information) you have or have had breast cancer in the past you have or have had an oestrogen-dependent tumour such as endometrial cancer (cancer of the lining of the womb) you have unusual vaginal bleeding that has not been checked by a doctor you have endometrial hyperplasia (abnormal growth of the lining of the womb) that is not being treated you have had a recent blood clot of an artery (leading to chest pain or heart attack) you have had liver disease and have been told by your doctor that your liver function has not yet returned to normal you have or have had a blood clot in a vein in your leg or anywhere else (a “deep vein thrombosis or pulmonary embolism”) you have porphyria (a genetic disorder). Take special care with Indivina

As well as benefits, HRT has some risks which you need to consider when you are deciding whether to take it, or whether to carry on taking it. Tell your doctor if you have any of the following as you may need more frequent check ups’ if:

you think you might be at risk of oestrogen dependent tumors such as breast cancer or endometrial cancer (see the section below on effects on your risk of developing cancer) you have had endometrial hyperplasia (thickening of the lining of the womb) you have uterine fibroids or endometriosis you feel you might be at risk of developing blood clots (see section below on blood clots) you have liver, kidney or heart problems you have gallstones you have asthma, epilepsy or diabetes you have high blood pressure you have otosclerosis (hearing problems due to bone overgrowth in the ear) you have been told that you have an intolerance to some sugars you have systemic lupus erythematosus (SLE) you have migraine or severe headaches you have been told you have high cholesterol or fat levels in your blood you are going to have surgery, make sure your doctor knows about it. You may need to stop taking HRT about 4 to 6 weeks before the operation, to reduce the risk of a blood clot. Your doctor will tell you when you can start taking HRT again.

HRT may change the results of some laboratory tests. If you are going to have any laboratory tests, tell your doctor/nurse that you are taking Indivina.

Taking other medicines

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

In particular tell your doctor if you are taking any of the following:

antibiotics such as rifampicin, rifabutin anti-epileptic medicines such as phenytoin, phenobarbital and carbamazepine HIV medicines such as nelfinavir, ritonavir, nevirapine and efavirenz the herbal preparation St. Johns Wort.

If you are in any doubt about taking other medicines with Indivina, talk to your doctor or your pharmacist.

Taking Indivina with food and drink

Indivina can be swallowed with a glass of water at the same time each day.

Pregnancy and breast-feeding Pregnancy – Do not take Indivina if you are pregnant, think you are pregnant or planning to become pregnant Breast feeding – Do not take Indivina if you are breast feeding.

Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

Indivina should not affect your ability to drive or operate machinery.

Important information about some ingredients of Indivina

This medicine contains lactose. If you have been told by your doctor that you have intolerance to some sugars, contact your doctor before taking this medicinal product.

How To Take Indivina

Always take Indivina as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

Take one Indivina tablet every day, preferably at about the same time each day. Calendar days are printed on the blister sheet to help you follow your daily tablet intake. Swallow the tablet whole with a drink if necessary. You will normally start on the lowest dose of Indivina and this will be increased, if necessary. Your doctor should aim to prescribe the lowest dose for the shortest time that gives you relief from your symptoms. Talk to your doctor if your symptoms are not better after three months. If you feel that the effect of Indivina is too strong or too weak, do not change the dose or stop taking the tablets yourself, but ask your doctor for advice.

If you are not having periods and you have not previously taken HRT or you are changing from another continuous combined HRT product, treatment with Indivina may be started on any day.

If you switch from a cyclic HRT regimen, start Indivina treatment one week after taking the last tablet of the cyclic HRT. Talk to your doctor or pharmacist if you are unsure.

Whilst taking this medicine

When you first start taking Indivina you may get some bleeding at odd times for a few months (Please also refer to the section above on Endometrial cancer). However, if this is still happening after a few months or if you experience heavy bleeding tell your doctor.

If you take more Indivina than you should:

If you or somebody else has taken too many Indivina tablets, talk to your doctor or pharmacist. An overdose of Indivina could make you feel sick or make you get a headache or uterine bleeding.

If you forget to take Indivina:

It is best to take the tablet at the same time each day. If you forget to take a tablet leave the forgotten tablet. You should then continue by taking the next tablet at your usual time. Missing a tablet or irregular use of Indivina tablets may cause breakthrough bleeding or spotting.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

If you stop taking Indivina

If you want to stop taking Indivina, talk to your doctor first. He/she will explain the effects of stopping treatment and discuss other possibilities with you.

Indivina Side Effects

Like all medicines, Indivina may cause side effects although not everybody gets them, particularly early on (in the first few months of treatment), for example irregular bleeding may occur. These often disappear with continued treatment.

There are a number of situations in which you may have to stop taking Indivina. Tell your doctor immediately if you develop any of the following conditions:

Common (affecting more than 1 person in 100):

feeling sick, stomach pain headache breast tenderness, breast enlargement, breakthrough bleeding weight increase or decrease changes in mood including anxiety and depressive mood, changes in libido increase in size of uterine muscle lumps (fibroids) swelling caused by fluid retention

Uncommon (affecting more than 1 in 1,000 but less than 1 in 100)

dizziness, migraine leg cramps increased blood pressure vaginal thrush (candidiasis) indigestion/heartburn wind, vomiting gall bladder disease and/or gallstones

Rare (affecting more than 1 in 10,000 but less than 1 in 1,000)

skin rash, itching blood clots hair loss, excessive hair growth (hirsutism) Other side effects of combined HRT

The following side effects have been reported after taking other oestrogen/progestagen products:

Oestrogen dependent tumours, heart attack, stroke, disorders of skin and underlying tissues.

Endometrial hyperplasia and endometrial cancer

In women with an intact uterus, the risk of excessive growth of the womb lining (endometrial hyperplasia) is increased. Treatment with unopposed oestrogens for long periods of time increases the risk of cancer of the lining of the womb (endometrial cancer). Adding a progestagen, which Indivina contains, greatly reduces this increased risk.

Compare

Looking at women who still have a uterus and who are not taking HRT, on average, 5 in 1000 will be diagnosed with endometrial cancer between the ages of 50 and 65. For women who take oestrogen-only HRT the number will be 2 to 12 times higher, depending on the dose and how long you take it. The addition of progestogen to oestrogen-only HRT substantially reduces the risk of endometrial cancer.

Breast cancer

Every woman is at risk of getting breast cancer whether or not she takes HRT. There is a small increase in this risk for women who have been using HRT compared with women of the same age who have never used HRT. This risk increases with the duration of intake of HRT, but returns to normal within a few (at most five) years of having stopped HRT. The risk seems to be higher for women who use oestrogen in combination with progestagen as compared to oestrogen alone.

Compare:

Looking at women aged 50 who are not taking HRT – on average, 32 in 1000 will be diagnosed with breast cancer by the time they reach the age of 65.

For women who start taking oestrogen-only HRT at age 50 and take it for 5 years, the figure will be between 33 and 34 in 1000 (i.e. an extra 1-2 cases).

If they take oestrogen-only HRT for 10 years, the figure will be, 37 in 1000 (i.e. an extra 5 cases). For women who start taking oestrogen plus progestogen HRT at age 50 and take it for 5 years, the figure will be 38 in 1000 (i.e. an extra 6 cases).

If they take oestrogen plus progestogen HRT for 10 years, the figure will be 51 in 1000 (i.e. an extra 19 cases).

To be able to detect a breast tumour as early as possible, it’s important to regularly check your breasts for any changes and to discuss any changes with your doctor. Also go for regular health check, including mammography. If you are anxious about the risk of developing breast cancer, you should talk to your doctor about the risks and benefits of hormone replacement therapy.

Blood clots in the deep veins

Every woman is at risk of getting a blood clot whether or not she takes HRT.

HRT may increase the risk of blood clots in the veins up to3 times, especially in the first year of taking it.

If you suspect you are suffering from a blood clot, seek immediate medical attention.

You are also more likely to get a blood clot:

If you are very overweight If you have had a blood clot before, or have had any blood clotting problem that needs treatment with a medicine such as Warfarin If any of your close family has had blood clots If you have had a miscarriage If you are off your feet for a long time through surgery, injury or illness If you have Systemic Lupus Erythematosus ((SLE) – an autoimmune disease)

Compare

Looking at women in their 50’s who are not taking HRT – on average, over a 5 year period, 3 in 1000 would be expected to get a blood clot.

For women in their 50s who are taking HRT, the figure would be 7 in 1000.

Looking at women in their 60s who are not taking HRT – on average, over a 5 year period, 8 in 1000 would be expected to get a blood clot.

For women in their 60’s who are taking HRT, the figure would be 17 in 1000.

Symptoms that may be indicative of blood clots:

Pain and swelling in your leg Sudden chest pain Difficulty breathing.

Seek immediate medical help. Stop taking HRT until your doctor says you can.

Heart disease

If you ever have had angina or heart attack, you should talk to your doctor about the risks and benefits of hormone replacement therapy.

There is no evidence from clinical trials of beneficial effects on the risks of cardiovascular disease with hormone replacement therapy in the menopause. Results from two large clinical studies showed that women, who used another type of oestrogen/progestagen combination, had a slightly increased risk of heart disease in the first year of use.

For other HRT products there are only very limited data from trials examining the effects on the risk of cardiovascular disease.

Stroke

There may be a slightly higher chance of having a stroke if you are taking HRT.

Other things that also increase the risk of stroke are:

Getting older High blood pressure Smoking Drinking too much alcohol An irregular heartbeat.

Compare

Looking at women in their 50’s who are not taking HRT - on average, over a 5 year period, 3 in 1000 would be expected to have a stroke.

For women in their 50s who are taking HRT, the figure would be 4 in 1000.

Looking at women in their 60s who are not taking HRT - on average, over a 5 year period, 11 in 1000 would be expected to have a stroke.

For women in their 60’s who are taking HRT, the figure would be 15 in 1000.

If you get:

Unexplained migraine-type headaches, with or without disturbed vision.

See a doctor as soon as possible. Stop taking HRT until your doctor says you can.

Ovarian cancer

Long-term (at least 5 or 10 years) use of oestrogen-only HRTs and oestrogen plus progestogen HRTs has been associated with an increased risk of ovarian cancer in some epidemiological studies.

Dementia

HRT will not prevent memory loss. In one study of women who started using combined HRT after the age of 65, a small increase in the risk of dementia was observed.

Effects on the skin

Brown patches in the face (chloasma), skin rashes including red inflammation on the hands or the legs (erythema multiforme), formation of tender, red nodules on the front of the legs/knees (erythema nodosum) or a bruise-like rash (vascular purpura).

If you notice any side effects not listed in this leaflet or if any of the side effects mentioned gets serious please tell your doctor or pharmacist.

How To Store Indivina

Keep out of the reach and sight of children. Do not use Indivina after the expiry date which is stated on the pack. Do not store above 30 ?C. Store in the original package in order to protect from moisture. Medicines should not be disposed via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

Further Information What Indivina contains:

The active ingredients of Indivina tablets are estradiol valerate and medroxyprogesterone acetate. Three different strengths of tablets are available.

Indivina 1 mg/2.5 mg tablets contain 1 mg of estradiol valerate and 2.5 mg medroxyprogesterone acetate.

Indivina 1 mg/5 mg tablets contain 1 mg of estradiol valerate and 5 mg medroxyprogesterone acetate.

Indivina 2 mg/5 mg tablets contain 2 mg of estradiol valerate and 5 mg medroxyprogesterone acetate.

The other ingredients of all Indivina tablets are lactose monohydrate, maize starch, gelatin, and magnesium stearate

What Indivina looks like and contents of the pack:

Indivina 1 mg/2.5 mg tablets are white, round, bevelled-edge, diameter 7 mm, flat tablets with a code ‘1 + 2.5’on one side.

Indivina 1 mg/5 mg tablets are white, round, bevelled-edge, diameter 7 mm, flat tablets with a code ‘1 + 5’on one side.

Indivina 2 mg/5 mg tablets are white, round, bevelled-edge, diameter 7 mm, flat tablets with a code ‘2 + 5’on one side.

The tablets are packed in a PVC/PVDC-aluminium blister of 28 tablets. The pack sizes available are 1 x 28 tablets and 3 x 28 tablets for all three strengths. All pack sizes may not be available in your country.

Marketing Authorisation Holder: Orion Corporation Orionintie 1 FIN-02200 Espoo FINLAND Manufactured by: Orion Corporation Tengstr?minkatu 8 FIN-20360 Turku FINLAND

This medicinal product is authorised in the Member States of the EEA under the following names:

Indivina, Duova

This leaflet was last revised: June 2010


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nitroprusside


Generic Name: nitroprusside (nye troe PRUS ide)
Brand Names: Nitropress

What is nitroprusside?

Nitroprusside is a vasodilator that works by relaxing the muscles in your blood vessels to help them dilate (widen). This lowers blood pressure and allows blood to flow more easily through your veins and arteries.

Nitroprusside is used to treat congestive heart failure and life-threatening high blood pressure (hypertension). Nitroprusside is also used to keep blood pressure low during a surgery.

Nitroprusside may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about nitroprusside? You should not receive this medication if you are allergic to nitroprusside, or if you have hereditary vision loss (Leber's disease), vision problems caused by smoking, or a history of blood clot in your brain.

Before receiving nitroprusside, tell your doctor if you have high blood pressure, kidney or liver disease, anemia (a lack of red blood cells), a seizure disorder, or a history of head injury or brain tumor.

In an emergency situation it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast-feeding. Make sure any doctor caring for you afterward knows that you have received this medication.

Tell your caregivers right away if you have a serious side effect such as breathing problems, tremors or twitching, numbness or cold feeling in your arms and legs, confusion, ringing in your ears, or feeling like you might pass out. What should I discuss with my health care provider before receiving nitroprusside? You should not receive this medication if you are allergic to nitroprusside, or if you have:

hereditary vision loss (Leber's disease);

vision problems caused by smoking; or

a history of blood clot in your brain.

If possible before you receive nitroprusside, tell your doctor if you have:

high blood pressure (hypertension);

kidney disease; liver disease;

anemia (a lack of red blood cells);

epilepsy or other seizure disorder; or

a history of head injury or brain tumor.

FDA pregnancy category C. It is not known whether nitroprusside will harm an unborn baby. Tell your doctor if you are pregnant. It is not known whether nitroprusside passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

In an emergency situation, it may not be possible before you are treated with nitroprusside to tell your caregivers if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.

How is nitroprusside given?

Nitroprusside is injected into a vein through an infusion pump. You will receive this injection in a clinic or hospital setting.

Nitroprusside is usually given for as long as needed until your body responds to the medication. Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving nitroprusside. Your blood and urine may also need to be tested during treatment. What happens if I miss a dose?

Since nitroprusside is given as needed by a healthcare professional, you are not likely to miss a dose.

What happens if I overdose? Tell your caregivers at once if you think you have received too much of this medicine. Overdose symptoms may include extreme dizziness, nausea and vomiting, muscle twitching, rapid breathing, fast or pounding heartbeat, and feeling like you might pass out. What should I avoid after receiving nitroprusside?

Follow your doctor's instructions about any restrictions on food, beverages, activity, or other medications.

Nitroprusside side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have a serious side effect such as:

feeling like you might pass out, even while lying down;

gasping, struggling to breathe, or shallow breathing;

confusion, ringing in your ears;

dizziness with nausea and vomiting, rapid breathing, seizure (convulsions);

fast, slow, or uneven heart rate;

numb or cold feeling in your arms and legs; or

chills, sweating, tremors, twitching, overactive reflexes.

Less serious side effects may include:

mild skin rash;

mild stomach pain or nausea;

warmth, redness, or tingly feeling under your skin;

darkening or deeper color of veins through your skin; or

irritation around the IV needle.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Nitroprusside Dosing Information

Usual Adult Dose for Hypertensive Emergency:

Initial dose: 0.3 mcg/kg/min IBW administered by continuous IV infusion.
Maintenance dose: The dose may be titrated upward to a maximum of 10 mcg/kg/min IBW.

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 10 to 15 mcg/min administered by continuous IV infusion.
Maintenance dose: The dose may be titrated to 10 to 200 mcg/min.
Maximum dose: 280 mcg/min (4 mcg/kg/min).

What other drugs will affect nitroprusside?

Tell your doctor if you take any type of blood pressure medication.

There may be other drugs that can interact with nitroprusside. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More nitroprusside resources Nitroprusside Side Effects (in more detail) Nitroprusside Dosage Nitroprusside Use in Pregnancy & Breastfeeding Nitroprusside Drug Interactions Nitroprusside Support Group 0 Reviews for Nitroprusside - Add your own review/rating Nitropress Prescribing Information (FDA) Nitropress Monograph (AHFS DI) Compare nitroprusside with other medications Heart Failure Hypertensive Emergency Where can I get more information? Your doctor or pharmacist can provide more information about nitroprusside.

See also: nitroprusside side effects (in more detail)


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Soltamox


Generic Name: tamoxifen (ta MOX i fen)
Brand Names: Soltamox

What is Soltamox (tamoxifen)?

Tamoxifen blocks the actions of estrogen, a female hormone. Certain types of breast cancer require estrogen to grow.

Tamoxifen is used to treat some types of breast cancer in men and women. Tamoxifen is also used to lower a woman's chance of developing breast cancer if she has a high risk (such as a family history of breast cancer).

Tamoxifen may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Soltamox (tamoxifen)? Do not use tamoxifen if you are pregnant. It could harm the unborn baby. Use a barrier form of birth control (such as a condom or diaphragm with spermicide) while you are using this medication and for at least 2 months after your treatment ends. You should not use tamoxifen if you are allergic to it, or if you have a history of blood clots in your veins or your lungs, or if you are also taking a blood thinner such as warfarin (Coumadin).

Before using tamoxifen, tell your doctor if you have liver disease, high triglycerides (a type of fat in the blood), a history of cataract, or a history of stroke or blood clot. Also tell your doctor if you if you are receiving chemotherapy or radiation treatment.

If you are taking tamoxifen to reduce your risk of breast cancer, you may need to take your first dose while you are having a menstrual period. You may also need to have a pregnancy test before you start taking tamoxifen, to make sure you are not pregnant. Follow your doctor's instructions.

Taking tamoxifen may increase your risk of uterine cancer, stroke, or a blood clot in the lung, which can be fatal. Talk with your doctor about your specific risks in taking this medication.

To make sure this medication is not causing harmful effects, your doctor may want you to have mammograms and to perform routine breast self exams on a regular basis. Your liver function may also need to be tested. Visit your doctor regularly.

What should I discuss with my healthcare provider before taking Soltamox (tamoxifen)? You should not use tamoxifen if you are allergic to it, or if you have:

a history of blood clots in your veins or your lungs; or

if you are also taking a blood thinner such as warfarin (Coumadin).

To make sure you can safely take tamoxifen, tell your doctor if you have any of these other conditions:

liver disease;

high cholesterol or triglycerides (a type of fat in the blood);

a history of stroke or blood clot;

a history of cataract; or

if you are receiving chemotherapy or radiation.

Taking tamoxifen may increase your risk of uterine cancer, stroke, or a blood clot in the lung, which can be fatal. Talk with your doctor about your specific risks in taking this medication. FDA pregnancy category D. Do not use tamoxifen if you are pregnant. It could harm the unborn baby. Use a barrier form of birth control (such as a condom or diaphragm with spermicide) while you are using this medication and for at least 2 months after your treatment ends.

Hormonal contraception (such as birth control pills, injections, implants, skin patches, and vaginal rings) may not be effective enough to prevent pregnancy during your treatment.

It is not known whether tamoxifen passes into breast milk or if it could harm a nursing baby. However, this medication may slow breast milk production. You should not breast-feed while taking tamoxifen. How should I take Soltamox (tamoxifen)?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take this medication with a full glass (8 ounces) of water.

Tamoxifen can be taken with or without food.

If you are taking tamoxifen to reduce your risk of breast cancer, you may need to take your first dose while you are having a menstrual period. You may also need to have a pregnancy test before you start taking tamoxifen, to make sure you are not pregnant. Follow your doctor's instructions.

Use tamoxifen regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. You may need to keep using this medication for up to 5 years.

To make sure this medication is not causing harmful effects, your doctor may want you to have mammograms and to perform routine breast self exams on a regular basis. Your liver function may also need to be tested. Visit your doctor regularly.

Store at room temperature away from moisture, heat, or cold. Do not freeze. What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking Soltamox (tamoxifen)?

Avoid eating soy or soy products without first asking your doctor.

Soltamox (tamoxifen) side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using tamoxifen and call your doctor at once if you have a serious side effect such as:

sudden numbness or weakness, especially on one side of the body;

sudden severe headache, confusion, problems with vision, speech, or balance;

chest pain, sudden cough, wheezing, rapid breathing, fast heart rate;

pain, swelling, warmth, or redness in one or both legs;

nausea, loss of appetite, increased thirst, muscle weakness, confusion, and feeling tired or restless;

unusual vaginal bleeding or discharge;

irregular menstrual periods;

pain or pressure in your pelvic area;

blurred vision, eye pain, or seeing halos around lights;

easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

fever, chills, body aches, flu symptoms;

new breast lump; or

upper stomach pain, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

hot flashes;

bone pain, joint pain, or tumor pain;

swelling in your hands or feet;

vaginal itching or dryness;

decreased sex drive, impotence, or difficulty having an orgasm;

headache, dizziness, depression; or

thinning hair.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Soltamox (tamoxifen)?

Many drugs can interact with tamoxifen. Below is just partial list. Tell your doctor if you are using any of these medications:

bromocriptine (Parlodel);

cimetidine (Tagamet);

clozapine (Clozaril, FazaClo);

cyclophosphamide (Cytoxan, Neosar);

isoniazid (for treating tuberculosis);

letrozole (Femara);

methimazole (Tapazole);

nicardipine (Cardene);

pioglitazone (Actos);

rifampin (Rifadin, Rifater, Rifamate, Rimactane);

ropinirole (Requip);

ticlopidine (Ticlid);

tranylcypromine (Parnate);

anti-malaria medication such as chloroquine (Arelan) or pyrimethamine (Daraprim), or quinine (Qualaquin);

an antibiotic such as terbinafine (Lamisil);

an antidepressant such as bupropion (Wellbutrin, Zyban), clomipramine (Anafranil), desipramine (Norpramin), duloxetine (Cymbalta), fluoxetine (Prozac), imipramine (Tofranil), paroxetine (Paxil), sertraline (Zoloft), or tranylcypromine (Parnate);

a heart rhythm medication such as amiodarone (Cordarone, Pacerone) or quinidine (Quin-G);

HIV or AIDS medicine such as delavirdine (Rescriptor) or ritonavir (Norvir); or

medicine to treat psychiatric disorders, such as aripiprazole (Abilify), chlorpromazine (Thorazine), fluphenazine (Permitil, Prolixin), haloperidol (Haldol), perphenazine (Trilafon), or thioridazine (Mellaril).

This list is not complete and other drugs may interact with tamoxifen. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Soltamox resources Soltamox Side Effects (in more detail) Soltamox Use in Pregnancy & Breastfeeding Soltamox Drug Interactions Soltamox Support Group 0 Reviews for Soltamox - Add your own review/rating Soltamox Advanced Consumer (Micromedex) - Includes Dosage Information Soltamox Solution MedFacts Consumer Leaflet (Wolters Kluwer) Soltamox Prescribing Information (FDA) Tamoxifen Prescribing Information (FDA) Nolvadex Monograph (AHFS DI) Nolvadex MedFacts Consumer Leaflet (Wolters Kluwer) Nolvadex Prescribing Information (FDA) Compare Soltamox with other medications Breast Cancer Breast Cancer, Adjuvant Breast Cancer, Male Breast Cancer, Metastatic Breast Cancer, Palliative McCune-Albright Syndrome Precocious Puberty Where can I get more information? Your pharmacist can provide more information about tamoxifen.

See also: Soltamox side effects (in more detail)


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meprobamate


Generic Name: meprobamate (meh pro BA mate)
Brand names: Equanil, Miltown, MB-TAB

What is meprobamate?

Meprobamate affects chemicals in your brain that may become unbalanced and cause anxiety.

Meprobamate is used to relieve anxiety, nervousness, and tension associated with anxiety disorders.

Meprobamate may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about meprobamate? Use caution when driving, operating machinery, or performing other hazardous activities. Meprobamate may cause drowsiness, dizziness, and blurred vision. If you experience drowsiness, dizziness, or blurred vision, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking meprobamate. Do not stop taking meprobamate suddenly if you have been taking it for several weeks. Stopping suddenly may cause withdrawal symptoms and make you uncomfortable. Talk to your doctor if you need to stop treatment with meprobamate. Notify your doctor if you develop a fever, a skin rash, or a sore throat. What should I discuss with my healthcare provider before taking meprobamate?

Before taking this medication, tell your doctor if you have

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porphyria,

kidney disease, liver disease,

epilepsy or another seizure disorder, or

a history of drug or alcohol abuse.

You may not be able to take meprobamate, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.

Meprobamate may harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. Meprobamate passes into breast milk. Do not take meprobamate without first talking to your doctor if you are breast-feeding a baby. If you are over 60 years of age, you may be more likely to experience side effects from meprobamate. You may require a lower dose of this medication or special monitoring during treatment. Meprobamate is not approved for use by children younger than 6 years of age. How should I take meprobamate?

Take meprobamate exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Do not crush, chew, or open any of the tablets or capsules. Swallow them whole.

Do not take more of this medication than is prescribed for you.

Do not stop taking meprobamate suddenly if you have been taking it for several weeks. Stopping suddenly may cause withdrawal symptoms and make you uncomfortable. Talk to your doctor if you need to stop treatment with meprobamate. Store meprobamate at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication. A double dose could be very dangerous.

What happens if I overdose? Seek emergency medical attention.

Symptoms of a meprobamate overdose include sleepiness, dizziness, confusion, a slow heartbeat, difficulty breathing, difficulty walking and talking, an appearance of being drunk, and unconsciousness.

What should I avoid while taking meprobamate? Use caution when driving, operating machinery, or performing other hazardous activities. Meprobamate may cause drowsiness, dizziness, and blurred vision. If you experience drowsiness, dizziness, or blurred vision, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking meprobamate.

Avoid other sedatives, sleeping pills, and tranquilizers. They should not be used while you are taking meprobamate unless your doctor approves.

Meprobamate side effects If you experience any of the following serious side effects, stop taking meprobamate and seek emergency medical attention:

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, face, or tongue; or hives);

fast or irregular heartbeats;

abnormal behavior;

fever;

a skin rash; or

a sore throat.

Other, less serious side effects may be more likely to occur. Continue to take meprobamate and talk to your doctor if you experience

drowsiness or dizziness,

headache,

weakness,

vomiting or diarrhea, or

numbness or tingling.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect meprobamate?

Meprobamate may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, other anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.

Drugs other than those listed here may also interact with meprobamate. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More meprobamate resources Meprobamate Side Effects (in more detail) Meprobamate Use in Pregnancy & Breastfeeding Drug Images Meprobamate Drug Interactions Meprobamate Support Group 2 Reviews for Meprobamate - Add your own review/rating meprobamate Advanced Consumer (Micromedex) - Includes Dosage Information Meprobamate Prescribing Information (FDA) Meprobamate Professional Patient Advice (Wolters Kluwer) Meprobamate Monograph (AHFS DI) Meprobamate MedFacts Consumer Leaflet (Wolters Kluwer) Compare meprobamate with other medications Anxiety Where can I get more information? Your pharmacist has additional information about meprobamate written for health professionals that you may read.

See also: meprobamate side effects (in more detail)


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tinzaparin


Generic Name: tinzaparin (tin ZA pa rin)
Brand Names: Innohep

What is tinzaparin?

Tinzaparin is an anticoagulant (blood thinner) that prevents the formation of blood clots.

Tinzaparin is used together with warfarin (Coumadin) to treat a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism).

Tinzaparin may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about tinzaparin? You should not use this medication if you are allergic to tinzaparin, heparin, sulfites, benzyl alcohol, or pork products, or if you have active bleeding or a history of low platelet counts after receiving heparin.

Tinzaparin may cause you to bleed more easily, especially if you have: a bleeding disorder, hemorrhagic stroke, an infection in the lining of your heart, uncontrolled high blood pressure, stomach or intestinal bleeding or ulcer, kidney disease, liver failure, amyloidosis (a build-up of certain proteins in tissues and organs of the body), or if you have had recent brain, spine, or eye surgery.

Tinzaparin can cause a very serious blood clot around your brain or spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural), especially if you have a genetic spinal defect, a history of spinal surgery or repeated spinal taps, or if you are using other medications to treat or prevent blood clots. Symptoms of this type of blood clot include numbness, tingling, muscle weakness, or loss of movement. Tell any doctor who treats you that you are using tinzaparin. Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding or life-threatening blood clots, and it is very important to tell your doctor about all medicines you have recently used.

Blood clots around the brain or spinal cord may occur if you use tinzaparin with other drugs that can affect blood clotting, including aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin, and any other medications to treat or prevent blood clots.

Tell your caregivers at once if you have signs of bleeding such as black or bloody stools, coughing up blood, confusion, feeling like you might pass out, or any bleeding that will not stop. What should I discuss with my healthcare provider before using tinzaparin? You should not use this medication if you are allergic to tinzaparin, heparin, sulfites, benzyl alcohol, or pork products, or if you have:

active or uncontrolled bleeding; or

if you have ever had low platelet counts after receiving heparin.

Tinzaparin may cause you to bleed more easily, especially if you have:

a bleeding disorder that is inherited or caused by disease;

hemorrhagic stroke;

an infection of the lining of your heart (also called bacterial endocarditis);

uncontrolled high blood pressure;

stomach or intestinal bleeding or ulcer;

liver failure; kidney disease (especially if you are an older adult);

recent brain, spine, or eye surgery; or

amyloidosis (a build-up of certain proteins in tissues and organs of the body).

Tinzaparin can cause a very serious blood clot around your brain or spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term paralysis, and may be more likely to occur if you have:

a genetic spinal defect;

a history of spinal surgery or repeated spinal taps; or

if you are using other medications to treat or prevent blood clots.

If you have any of these other conditions, you may need a tinzaparin dose adjustment or special tests:

recent stomach ulcer; or

eye problems caused by diabetes.

FDA pregnancy category B. Tinzaparin is not expected to harm an unborn baby. However, some forms of this medication contain a preservative that may be harmful to a newborn. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether tinzaparin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. How should I use tinzaparin? Tinzaparin must not be used as a substitute for heparin. These two drugs are manufactured differently and have different dosages.

Tinzaparin is injected under the skin. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

You should be sitting or lying down during the injection. Do not inject tinzaparin into a muscle or a vein.

Use a different place on your stomach each time you give the injection. Your care provider will show you the best places on your body to inject the medication. Do not inject into the same place two times in a row.

Prepare your dose in a syringe only when you are ready to give yourself an injection. Do not use the medication if it has changed colors or has particles in it. Call your doctor for a new prescription.

Use a disposable needle only once. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Tinzaparin is usually given every day until your bleeding condition improves. Follow your doctor's instructions.

To be sure this medication is not causing harmful effects, your blood and your stool (bowel movement) may need to be tested often. Your nerve and muscle function may also need to be tested. Visit your doctor regularly.

Tell any doctor who treats you that you are using tinzaparin. If you need surgery or dental work, tell the surgeon or dentist ahead of time that you are using this medication. Store at room temperature away from moisture and heat. What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose can cause excessive bleeding.

What should I avoid while using tinzaparin? Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth. Tinzaparin side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using tinzaparin and call your doctor at once if you have a serious side effect such as:

unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop;

easy bruising, purple or red pinpoint spots under your skin;

pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;

black or bloody stools, coughing up blood or vomit that looks like coffee grounds;

numbness, tingling, or muscle weakness (especially in your legs and feet);

loss of movement in any part of your body;

sudden weakness, severe headache, confusion, or problems with speech, vision, or balance;

chest pain; or

pain or burning when you urinate.

Less serious side effects may include:

mild headache, dizziness;

back pain;

fever;

pain, irritation, swelling, or bruising of the skin where the medicine was injected;

nausea, vomiting, stomach pain, gas;

diarrhea, constipation;

mild skin rash; or

sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Tinzaparin Dosing Information

Usual Adult Dose for Deep Vein Thrombosis:

175 anti-Xa intl units/kg subcutaneously once daily for at least 6 days and until the patient is adequately anticoagulated with warfarin.

What other drugs will affect tinzaparin? Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding, and it is very important to tell your doctor about all medicines you have recently used. Bleeding or blood clots around the brain or spinal cord may occur if you use tinzaparin with other drugs that can affect blood clotting, such as:

dextran (Gentran, Hyskon);

heparin;

abciximab (ReoPro), eptifibatide (Integrelin), tirofiban (Aggrastat);

cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine, Aggrenox), prasugrel (Effient), ticlopidine (Ticlid);

dalteparin (Fragmin), enoxaparin (Lovenox), fondaparinux (Arixtra);

argatroban (Acova), bivalirudin (Angiomax), lepirudin (Refludan);

alteplase (Activase), tenecteplase (TNKase), urokinase (Abbokinase);

an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others; or

salicylates such as aspirin, Backache Relief Extra Strength, Novasal, Nuprin Backache Caplet, Doan's Pills Extra Strength, Pepto-Bismol, Tricosal, and others.

This list is not complete and other drugs may interact with tinzaparin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More tinzaparin resources Tinzaparin Side Effects (in more detail) Tinzaparin Use in Pregnancy & Breastfeeding Tinzaparin Drug Interactions Tinzaparin Support Group 1 Review for Tinzaparin - Add your own review/rating tinzaparin Subcutaneous Advanced Consumer (Micromedex) - Includes Dosage Information Tinzaparin MedFacts Consumer Leaflet (Wolters Kluwer) Innohep Prescribing Information (FDA) Innohep Monograph (AHFS DI) Compare tinzaparin with other medications Deep Vein Thrombosis Where can I get more information? Your doctor or pharmacist can provide more information about tinzaparin.

See also: tinzaparin side effects (in more detail)


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Equanil


Generic Name: meprobamate (meh pro BA mate)
Brand Names: Equanil, Miltown

What is Equanil (meprobamate)?

Meprobamate affects chemicals in your brain that may become unbalanced and cause anxiety.

Meprobamate is used to relieve anxiety, nervousness, and tension associated with anxiety disorders.

Meprobamate may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Equanil (meprobamate)? Use caution when driving, operating machinery, or performing other hazardous activities. Meprobamate may cause drowsiness, dizziness, and blurred vision. If you experience drowsiness, dizziness, or blurred vision, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking meprobamate. Do not stop taking meprobamate suddenly if you have been taking it for several weeks. Stopping suddenly may cause withdrawal symptoms and make you uncomfortable. Talk to your doctor if you need to stop treatment with meprobamate. Notify your doctor if you develop a fever, a skin rash, or a sore throat. What should I discuss with my healthcare provider before taking Equanil (meprobamate)?

Before taking this medication, tell your doctor if you have

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porphyria,

kidney disease, liver disease,

epilepsy or another seizure disorder, or

a history of drug or alcohol abuse.

You may not be able to take meprobamate, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.

Meprobamate may harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. Meprobamate passes into breast milk. Do not take meprobamate without first talking to your doctor if you are breast-feeding a baby. If you are over 60 years of age, you may be more likely to experience side effects from meprobamate. You may require a lower dose of this medication or special monitoring during treatment. Meprobamate is not approved for use by children younger than 6 years of age. How should I take Equanil (meprobamate)?

Take meprobamate exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Do not crush, chew, or open any of the tablets or capsules. Swallow them whole.

Do not take more of this medication than is prescribed for you.

Do not stop taking meprobamate suddenly if you have been taking it for several weeks. Stopping suddenly may cause withdrawal symptoms and make you uncomfortable. Talk to your doctor if you need to stop treatment with meprobamate. Store meprobamate at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication. A double dose could be very dangerous.

What happens if I overdose? Seek emergency medical attention.

Symptoms of a meprobamate overdose include sleepiness, dizziness, confusion, a slow heartbeat, difficulty breathing, difficulty walking and talking, an appearance of being drunk, and unconsciousness.

What should I avoid while taking Equanil (meprobamate)? Use caution when driving, operating machinery, or performing other hazardous activities. Meprobamate may cause drowsiness, dizziness, and blurred vision. If you experience drowsiness, dizziness, or blurred vision, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking meprobamate.

Avoid other sedatives, sleeping pills, and tranquilizers. They should not be used while you are taking meprobamate unless your doctor approves.

Equanil (meprobamate) side effects If you experience any of the following serious side effects, stop taking meprobamate and seek emergency medical attention:

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, face, or tongue; or hives);

fast or irregular heartbeats;

abnormal behavior;

fever;

a skin rash; or

a sore throat.

Other, less serious side effects may be more likely to occur. Continue to take meprobamate and talk to your doctor if you experience

drowsiness or dizziness,

headache,

weakness,

vomiting or diarrhea, or

numbness or tingling.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Equanil (meprobamate)?

Meprobamate may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, other anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.

Drugs other than those listed here may also interact with meprobamate. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More Equanil resources Equanil Use in Pregnancy & Breastfeeding Drug Images Equanil Drug Interactions Equanil Support Group 0 Reviews for Equanil - Add your own review/rating Meprobamate Prescribing Information (FDA) Meprobamate Professional Patient Advice (Wolters Kluwer) Meprobamate Monograph (AHFS DI) Meprobamate MedFacts Consumer Leaflet (Wolters Kluwer) Mb-Tab Advanced Consumer (Micromedex) - Includes Dosage Information Compare Equanil with other medications Anxiety Where can I get more information? Your pharmacist has additional information about meprobamate written for health professionals that you may read.
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Cyclo-Progynova 2mg


Cyclo-Progynova 2 mg

Please read this leaflet carefully before you start to take your medicine. This leaflet provides a summary of the information known about your medicine. If you have any questions or are not sure about anything, ask your doctor or pharmacist.

Remember this medicine is for you. Only a doctor can prescribe this medicine and it may harm someone else, even if their symptoms are the same as yours.

About your medicine What is your medicine?

The name of your medicine is Cyclo-Progynova 2 mg.

Each strip of Cyclo-Progynova 2 mg has 11 white tablets containing 2 mg estradiol valerate and 10 pale brown tablets each containing 2 mg estradiol valerate and 500 micrograms of norgestrel.

The active ingredient in this medicine is estradiol. This is the new name for oestradiol. The ingredient itself has not changed.

Cyclo-Progynova 2 mg also contains the following inactive ingredients: lactose, maize starch, povidone, magnesium stearate (E 572), sucrose, polyethylene glycol 6000, calcium carbonate (E 170), glycerin (E 422), talc, montan glycol wax, titanium dioxide (E 171), yellow and red/brown ferric oxide pigments (E 172).

Each pack of Cyclo-Progynova 2 mg contains 1 or 3 memo-packs (strips) of 21 tablets.

Who produces your medicine The product licence is held by: MEDA Pharmaceuticals Ltd Skyway House Parsonage Road Takeley Bishop’s Stortford CM22 6PU This product is manufactured by: Bayer Schering Pharma AG D-13342 Berlin GERMANY What your medicine does and what it is used for

Cyclo-Progynova 2 mg is a hormone replacement therapy that contains the female sex hormones oestrogen and progestogen.

These hormones are lost in women during the "change of life" (also known as "the climacteric"). This is a gradual process which usually takes place between the ages of about 45 and 55. Periods usually become irregular, both in timing and amount of blood loss, before they stop altogether, but the time at which the periods finally stop - "the menopause" – is not the end of the change of life, which always continues for some time afterwards.

Although the change of life is natural, it often causes distressing symptoms such as hot flushes. These symptoms are due to the gradual loss of the female sex hormones produced by the ovaries.

Cyclo-Progynova 2 mg is used to treat symptoms associated with "the change of life".

In addition, the loss of these hormones may, in some women, lead to thinning of the bones (osteoporosis) in later life. If you are likely to develop osteoporosis, and are unable to take other medicines which can prevent osteoporosis, you may be prescribed Cyclo-Progynova 2 mg to prevent osteoporosis. Your doctor will be able to advise you further.

Cyclo-Progynova 2 mg will not make you able to have children, but on the other hand Cyclo-Progynova 2 mg will not prevent you becoming pregnant if you are still fertile.

Before taking your medicine You must not take Cyclo-Progynova 2 mg If you have, or have had, cancer of the breast If you have, or have had, cancer of the or womb If you currently have any problems with your liver If you have vaginal bleeding and the cause is not known If you have a condition called endometrial hyperplasia (where the lining of the womb grows more than normal) and if you are not having treatment for it If you have a blood clot in a vein in your leg or anywhere else (a "deep vein thrombosis") or if you have had one of these in the past If you have a blood clot that has travelled to your lung or another part of the body (an "embolus") or if you have had one of these in the past If you have, or have had, a disease related to blood clots such as angina, or a heart attack If you are allergic to any of the ingredients in Cyclo-Progynova If you have the condition known as porphyria. If you are pregnant, suspect that you are pregnant or if you are breast feeding What you should know before using Cyclo-Progynova

As well as benefits, HRT has some risks which you need to consider when you’re deciding whether to take it, or whether to carry on taking it.

Medical Check-ups

Before starting to take hormone replacement therapy you should discuss your personal and family medical history with your doctor.

Your doctor may decide to perform a physical examination of the breasts and/or a pelvic examination before starting this medication - but only if these examinations are necessary for you, or if you have any special concerns.

Once you’ve started on HRT, you should see your doctor for regular check-ups (at least once a year). At these check-ups, your doctor may discuss with you the benefits and risks of continuing to take HRT.

Before starting to take your medicine you must tell your doctor if you have, or have had any of the following as he may decide to alter your treatment or he may ask to see you more often:-

fibroids in your uterus endometriosis (when the lining of the womb grows outside the womb) a family history of cancer of the breast or womb liver disease diabetes gall stones migraine or severe headaches a condition known as systemic lupus erythematosus a condition called endometrial hyperplasia (where the lining of the womb grows more than normal) epilepsy asthma deafness (otosclerosis) hypertension risk factors that indicate you may experience blood clots. These include being seriously overweight, having blood clotting problems or having a blood clot previously. The full list of these risk factors is provided in the section on Blood clotting below.

Be sure to:

go for regular breast screening and cervical smear tests regularly check your breasts for any changes such as dimpling of the skin, changes in the nipple, or any lumps you can see or feel.

Effects On Your Heart or Circulation

Heart Disease

HRT is not recommended for women who have heart disease, or have had heart disease recently. If you have ever had heart disease, talk to your doctor to see if you should be taking HRT.

HRT will not help to prevent heart disease.

Studies with one type of HRT (containing conjugated oestrogen plus the progestogen MPA) have shown that women may be slightly more likely to get heart disease during the first year of taking the medication.

For other types of HRT, the risk is likely to be similar, although this is not yet certain.

If you get: a pain in your chest that spreads to your arm or neck you must see a doctor as soon as possible. Do not take any more HRT until your doctor says you can. This pain could be a sign of heart disease.

Stroke

Recent research suggests that HRT slightly increases the risk of having a stroke. Other things that can increase the risk of stroke include:

getting older high blood pressure smoking drinking too much alcohol an irregular heartbeat

If you are worried about any of these things, or if you have had a stroke in the past, talk to your doctor to see if you should take HRT.

Consider the following:

Looking at women in their 50s who are not taking HRT — on average, over a 5-year period, 3 in 1000 would be expected to have a stroke.

For women in their 50s who are taking HRT, the figure would be 4 in 1000.

Looking at women in their 60s who are not taking HRT — on average, over a 5-year period, 11 in 1000 would be expected to have a stroke.

For women in their 60s who are taking HRT, the figure would be 15 in 1000.

If you get unexplained migraine-type headaches (with or without disturbed vision) you must see a doctor as soon as possible. Do not take any more HRT until your doctor says you can. These headaches may be an early warning sign of a stroke.

Blood Clots

HRT may increase the risk of blood clots in the veins (also called deep vein thrombosis, or DVT), especially during the first year of taking it.

These blood clots are not always serious, but if one travels to the lungs, it can cause chest pain, breathlessness, collapse or even death. This condition is called pulmonary embolism, or PE.

DVT and PE are examples of a condition called venous thromboembolism, or VTE.

You are more likely to get a blood clot:

if you are seriously overweight if you have had a blood clot before if any of your close family have had blood clots if you have had one or more miscarriages if you have any blood clotting problem that needs treatment with a medicine such as warfarin if you’re off your feet for a long time because of major surgery, injury or illness if you have a rare condition called SLE

If any of these things apply to you, talk to your doctor to see if you should take HRT.

Consider the following:

Looking at women in their 50s who are not taking HRT — on average, over a 5-year period, 3 in 1000 would be expected to get a blood clot.

For women in their 50s who are taking HRT, the figure would be 7 in 1000.

Looking at women in their 60s who are not taking HRT — on average, over a 5-year period, 8 in 1000 would be expected to get a blood clot.

For women in their 60s who are taking HRT, the figure would be 17 in 1000.

If you get any of the following:

painful swelling in your leg sudden chest pain difficulty breathing

you must see a doctor as soon as possible. Do not take any more HRT until your doctor says you can. These may be signs of a blood clot.

If you’re going to have surgery, make sure your doctor knows about it. You may need to stop taking HRT about 4 to 6 weeks before the operation, to reduce the risk of a blood clot. Your doctor will tell you when you can start taking HRT again.

Effects on Your Risk of Developing Cancer

Breast Cancer

Women who have breast cancer, or have had breast cancer in the past, should not take HRT

Taking HRT slightly increases the risk of breast cancer; so does having a later menopause. The risk for a post-menopausal woman taking oestrogen-only HRT for 5 years is about the same as for a woman of the same age who’s still having periods over that time and not taking HRT. The risk for a woman who is taking oestrogen plus progestogen HRT is higher than for oestrogen-only HRT (but oestrogen plus progestogen HRT is beneficial for the endometrium, see ‘Endometrial cancer’ below).

For all kinds of HRT, the extra risk of breast cancer goes up the longer you take it, but returns to normal within about 5 years after stopping HRT. Your risk of breast cancer is also higher:

if you have a close relative (mother, sister or grandmother) who has had breast cancer if you are seriously overweight

Consider the following:

Looking at women aged 50 who are not taking HRT – on average 32 in 1000 will have breast cancer diagnosed by the age of 65.

For women who start taking oestrogen-only HRT at age 50 and take it for 5 years, the figure will be between 33 and 34 in 1000 (ie an extra 1-2 cases). If they take oestrogen-only HRT for 10 years, the figure will be 37 in 1000 (i.e. an extra 5 cases).

For women who start taking oestrogen plus progestogen HRT at age 50 and take it for 5 years, the figure will be 38 in 1000 (ie an extra 6 cases). If they take oestrogen plus progestogen HRT for 10 years, the figure will be 51 in 1000 (i.e. an extra 19 cases).

If you notice any changes in your breast, such as:

dimpling of the skin changes in the nipple any lumps you can see or feel

you must make an appointment to see your doctor as soon as possible.

Endometrial cancer (cancer of the lining of the womb)

Taking oestrogen-only HRT for a long time can increase the risk of cancer of the lining of the womb (the endometrium). Taking a progestogen as well as the oestrogen helps to lower the extra risk.

If you still have your womb, your doctor may prescribe a progestogen as well as oestrogen. If so, these may be prescribed separately, or as a combined HRT product.

If you have had your womb removed (a hysterectomy), your doctor will discuss with you whether you can safely take oestrogen without a progestogen.

If you’ve had your womb removed because of endometriosis, any endometrium left in your body may be at risk. If so, your doctor may prescribe HRT that includes a progestogen as well as an oestrogen.

Your product, Cyclo-Progynova 2 mg contains a progestogen.

Consider the following:

Looking at women who still have a uterus and who are not taking HRT – on average 5 in 1000 will be diagnosed with endometrial cancer between the ages of 50 and 65.

For women who take oestrogen-only HRT, the number will be 2 to 12 times higher, depending on the dose and how long you take it.

The addition of a progestogen to oestrogen-only HRT substantially reduces the risk of endometrial cancer.

If you get breakthrough bleeding or spotting, it’s usually nothing to worry about, especially during the first few months of taking HRT.

But if the bleeding or spotting:

carries on for more than the first few months starts after you’ve been on HRT for a while carries on even after you’ve stopped taking HRT

you must make an appointment to see your doctor. It could be a sign that your endometrium has become thicker.

Ovarian cancer

Ovarian cancer (cancer of the ovaries) is very rare, but it is serious.

It can be difficult to diagnose, because there are often no obvious signs of the disease.

Some studies have indicated that taking oestrogen-only HRT for more than 5 years may increase the risk of ovarian cancer. It is not yet known whether other kinds of HRT increase the risk in the same way.

What about other medicines that you may be taking?

Some medicines affect the way that drugs are handled by the liver and may reduce the effectiveness of Cyclo-Progynova 2 mg. These include some epilepsy medicines (for example phenytoin, phenobarbital and carbamazepine), and some antibiotics/anti-infectives (for example rifampicin, rifabutin, nevirapine, efavirenz, ritonavir, nelfinavir) and the herbal preparation, St John’s Wort.

If you are taking oral contraceptives, these should be stopped and other, non-hormonal methods of contraception should be used.

If you are a diabetic on insulin or tablets, your daily dose might need to be changed, your doctor will advise you.

What about food and drink?

Cyclo-Progynova 2 mg is not known to react with any types of food and drink.

What to do if you see a different doctor or have to go to hospital for treatment.

If you see any other doctor or go to hospital for treatment, tell your doctor about all your medicines, including Cyclo-Progynova 2 mg.

Special warnings

Lactose

This product contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

You should stop taking your tablets and tell your doctor if you:

develop any of the conditions listed in this leaflet under "You must not take Cyclo-Progynova". start developing headaches or migraines develop jaundice or problems with your liver become pregnant experience pain, tingling or numbness in any part of the body experience sudden chest pain

Cyclo-Progynova 2 mg must also be stopped at once if your doctor finds your blood pressure to be significantly raised.

Taking your medicine How to take your Cyclo-Progynova 2 mg

It is usually recommended that Cyclo-Progynova is taken at the lowest dose which is effective and for the shortest time possible.

About the pack:

The pack of Cyclo-Progynova 2 mg is designed to help you take your tablets. To use it you must first know the day of the week on which you will take the first tablet. If you are still having your periods, take the first tablet on the fifth day of your period, whether the period has finished or not. If your periods have become infrequent or have stopped altogether, your doctor may have advised you to start Cyclo-Progynova 2 mg immediately. If you have been taking a continuous HRT product (i.e. you take the same dose each day) you may change to Cyclo-Progynova 2 mg on any day. If you have been taking an HRT product which is followed by a withdrawal bleed, you should complete the cycle of treatment before changing to Cyclo-Progynova 2 mg.

In addition to the memo-pack (which contains the tablets), the outer carton contains a self adhesive blue sticker showing the days of the week. Peel the circular sticker off its backing and stick it in the centre of the memo-pack so that the day on which you start taking the tablets is directly underneath the red segment marked 'Start'.

For instance, if you are to start the tablets on a Wednesday, then stick a 'Wed' directly underneath the red segment marked 'Start'. You can now see on which day you have to take each tablet. Simply take one tablet each day, following the direction of the arrows on the foil, until the pack is empty. This means that you will be taking one white tablet for the first 11 days and then one pale brown tablet daily for the following 10 days. If, at any time, you are in doubt whether you have taken your tablet, a glance at the appropriate day on the memo-pack will tell you.

When you have finished taking your pack, you must leave a tablet free interval of seven days (unless your doctor decides otherwise). During this week, bleeding similar to a period may occur. This is normal.

Start your next pack of Cyclo-Progynova 2 mg immediately after this seven day break, whether the bleeding has stopped or not. You will in fact start on the same day of the week that you started your previous pack and the same will be true for each successive pack.

It is best to take your tablet at the same time each day, preferably after a meal. The tablet should not be chewed or sucked, but swallowed whole with a glass of water.

What to do if you forget to take a tablet

Take it as soon as possible, and take the next one at your normal time. If you are more than twelve hours late, leave the forgotten tablet in the pack. Continue to take the remaining tablets at the usual time on the right days.

You may experience some vaginal bleeding (breakthrough bleeding) if you have missed a tablet. This is normal.

What to do if you take too many tablets at once

There have been no reports of ill effects from taking too many tablets.

You should consult your doctor who will be able to advise you what action, if any, is necessary.

What bleeding to expect (what to do if your bleeding pattern seems different)

Just as with normal periods, the amount of bleeding with Cyclo-Progynova 2 mg varies from woman to woman. Usually the blood loss is not unduly heavy and it may even be rather scanty, but this is not important as far as the treatment is concerned. If you have recently had very light, short periods, you may have rather heavier blood loss with Cyclo-Progynova 2 mg.

If you are still menstruating, you will probably have regular blood loss 2 – 3 days after finishing each pack of Cyclo-Progynova 2 mg. If you miss a period, the possibility of pregnancy should be investigated.

Ask your doctor for advice.

If you have stopped having periods, Cyclo-Progynova 2 mg will probably cause you to experience blood loss again after the end of each pack, but may not always do so.

If blood loss occurs during the three weeks in which you are taking the tablets, let your doctor know. This may be a sign that your endometrium is getting thicker (see section on Endometrial Cancer in this leaflet). It is not necessary to stop taking your tablets unless your doctor tells you to.

After taking your medicine

During the first few months of treatment you may experience some vaginal bleeding at unexpected times (breakthrough bleeding and spotting) and some breast tenderness or enlargement. These symptoms are usually temporary and normally disappear with continued treatment. If they don't, contact your doctor.

All women have a small chance of having a blood clot in the veins of the leg, in the lung or other parts of the body whether or not they take HRT. If you think you have developed a blood clot while you are taking Cyclo-Progynova 2 mg you should stop taking it immediately and contact your doctor. The warning signs to look out for are listed in this leaflet in the section on Blood Clots under What you should know before taking Cyclo-Progynova.

The following symptoms have been reported: indigestion, nausea, vomiting, bloated stomach, increased appetite, increased or reduced weight, leg pains, fluid retention, palpitations, dizziness, anxiety, headaches, depressive moods, rashes, altered sexual interest. Tell your doctor if you have any of these symptoms, or, indeed, any other symptoms while you are taking Cyclo-Progynova 2 mg.

If you have any of the symptoms of heart disease, stroke or blood clots, breast, endometrial or ovarian cancer, as described earlier in this leaflet, tell your doctor.

Dementia: HRT will not prevent memory loss. In one study of women who started using combined HRT after the age of 65, a small increase in the risk of dementia was observed.

How to store your medicine

Keep your medicine in a safe place where children cannot see or reach it. Your medicine could harm them.

Do not use your medicines after the expiry date on the box, even if there is some medicine left after this date. Ask your doctor for a replacement prescription.

This leaflet was amended in November 2007

Cyclo-Progynova is a registered trademark of Schering AG.

© MEDA

United Kingdom 80620633_1107


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Lithostat


Generic Name: acetohydroxamic acid (a SEET oh HYE drox AM ik AS id)
Brand Names: Lithostat

What is Lithostat (acetohydroxamic acid)?

Acetohydroxamic acid works by preventing bacteria from increasing ammonia levels in urine. Increased ammonia in urine can lead to a certain type of kidney stone.

Acetohydroxamic acid is used together with antibiotics to treat bladder infections caused by bacteria that can increase ammonia levels in the urine.

Acetohydroxamic acid may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Lithostat (acetohydroxamic acid)? This medication can cause birth defects. Do not use if you are pregnant. Use effective birth control, and tell your doctor if you become pregnant during treatment.

Before using acetohydroxamic acid, tell your doctor if you have kidney disease, a history of blood clot or stroke, hemolytic anemia (a lack of red blood cells), or a weak immune system.

Take acetohydroxamic acid on an empty stomach, at least 1 hour before or 2 hours after a meal. Acetohydroxamic acid is usually taken 3 or 4 times daily. Follow your doctor's instructions. Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Acetohydroxamic acid is not an antibiotic and will not treat a bacterial infection alone. Take your antibiotic medication as directed. Avoid drinking alcohol. Drinking alcohol while taking this medication can cause you to have warmth, redness, or tingling under your skin. This may be an unpleasant side effect. Call your doctor at once if you have a serious side effect such as chest pain, fast or pounding heartbeats, pale or yellowed skin, dark colored urine, fever, confusion or weakness, mood changes, confusion, anxiety, tremors or shaking, easy bruising or bleeding, flu symptoms, or pain or swelling in one or both legs. What should I discuss with my health care provider before taking Lithostat (acetohydroxamic acid)?

Before using acetohydroxamic acid, tell your doctor if you are allergic to any drugs, or if you have:

kidney disease;

a history of blood clot or stroke;

hemolytic anemia (a lack of red blood cells); or

a weak immune system.

If you have any of these conditions, you may need a dose adjustment or special tests to safely use acetohydroxamic acid.

FDA pregnancy category X. This medication can cause birth defects. Do not use acetohydroxamic acid if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are using this medication. Acetohydroxamic acid may pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. How should I take Lithostat (acetohydroxamic acid)?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Take acetohydroxamic acid on an empty stomach, at least 1 hour before or 2 hours after a meal.

Acetohydroxamic acid is usually taken 3 or 4 times daily. Follow your doctor's instructions.

Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Acetohydroxamic acid is not an antibiotic and will not treat a bacterial infection alone. Take your antibiotic medication as directed.

To be sure this medication is not causing harmful effects, your blood may need to be tested on a regular basis. Do not miss any scheduled appointments.

Store acetohydroxamic acid at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

Remember to acetohydroxamic acid on an empty stomach. What happens if I overdose? Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include weakness, loss of appetite, nausea, vomiting, or tremors.

What should I avoid while taking Lithostat (acetohydroxamic acid)? Avoid drinking alcohol. Drinking alcohol while taking this medication can cause you to have warmth, redness, or tingling under your skin. This may be an unpleasant side effect.

Avoid taking vitamin or mineral supplements that contain iron, unless your doctor has told you to.

Lithostat (acetohydroxamic acid) side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

chest pain, fast or pounding heartbeats;

pale or yellowed skin, dark colored urine, fever, confusion or weakness;

mood changes, confusion, anxiety;

tremors or shaking;

easy bruising or bleeding;

sore throat, body aches, flu symptoms; or

pain or swelling in one or both legs.

Less serious side effects may include:

mild nausea, vomiting, upset stomach;

loss of appetite;

headache; or

hair loss.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Lithostat (acetohydroxamic acid)?

There may be other drugs that can interact with acetohydroxamic acid. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

More Lithostat resources Lithostat Side Effects (in more detail) Lithostat Use in Pregnancy & Breastfeeding Lithostat Drug Interactions Lithostat Support Group 1 Review for Lithostat - Add your own review/rating Lithostat MedFacts Consumer Leaflet (Wolters Kluwer) Compare Lithostat with other medications Bladder Infection Urinary Tract Infection Where can I get more information? Your pharmacist can provide more information about acetohydroxamic acid.

See also: Lithostat side effects (in more detail)


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tirofiban


Generic Name: tirofiban (tye roe FYE ban)
Brand Names: Aggrastat

What is tirofiban?

Tirofiban keeps the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions.

Tirofiban is used to prevent blood clots or heart attack in people with severe chest pain or other conditions, and in those who are undergoing a procedure called angioplasty (to open blocked arteries).

Tirofiban may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about tirofiban? Do not receive this medication if you are allergic to tirofiban, or to similar drugs such as abciximab (ReoPro) or eptifibatide (Integrilin).

Do not receive this medication if you have a stomach ulcer or ulcerative colitis, severe liver disease, severe high blood pressure, a bleeding or blood clotting disorder, a history of head injury, brain tumor, or blood clot in the brain (aneurysm), a stroke or any type of bleeding within the past 30 days, or any type of surgery, injury, or medical emergency within the past 6 weeks.

Tirofiban is not expected to be harmful to an unborn baby. However, aspirin is sometimes given with tirofiban, and aspirin can cause bleeding when it is taken during the last 3 months of pregnancy. Aspirin can also cause side effects in a newborn baby.

Tell your doctor if you are pregnant or plan to become pregnant during treatment with tirofiban and aspirin.

Because tirofiban keeps your blood from coagulating (clotting) to prevent unwanted blood clots, it can also make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop.

What should I discuss with my health care provider before receiving tirofiban? Do not receive this medication if you are allergic to tirofiban, or to similar drugs such as abciximab (ReoPro) or eptifibatide (Integrilin), or if you have:

a stomach ulcer or ulcerative colitis;

severe liver disease;

a severe form of hypertension (high blood pressure);

a bleeding or blood clotting disorder, such as hemophilia or thrombocytopenia;

a history of head injury, brain tumor, or blood clot in the brain (aneurysm);

if you have had a stroke or any type of bleeding within the past 30 days; or

if you have had any type of surgery, injury, or medical emergency within the past 6 weeks.

Before using tirofiban, tell your doctor if you are allergic to any drugs, or if you have:

kidney disease (or if you are on dialysis);

stomach ulcer;

high blood pressure;

congestive heart failure; or

a vision disorder involving the blood vessels in your eyes.

If you have any of these conditions, you may not be able to receive tirofiban, or you may need a dosage adjustment or special tests during treatment.

Tirofiban is not expected to be harmful to an unborn baby. However, aspirin is sometimes given with tirofiban, and aspirin can cause bleeding when it is taken during the last 3 months of pregnancy. Aspirin can also cause side effects in a newborn baby.

Tell your doctor if you are pregnant or plan to become pregnant during treatment with tirofiban and aspirin.

It is not known whether tirofiban passes into breast milk or if it could harm a nursing baby. Do not receive this medication without telling your doctor if you are breast-feeding a baby. How is tirofiban given?

Tirofiban is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting.

Tirofiban is usually given continuously for at least 2 days.

Tirofiban is sometimes given together with aspirin.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.

Because tirofiban keeps your blood from coagulating (clotting) to prevent unwanted blood clots, it can also make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop.

What happens if I miss a dose?

Since tirofiban is usually given in a hospital or clinic setting as needed, it is not likely that you will miss a dose.

What happens if I overdose? Seek emergency medical attention if you think you have received too much of this medicine.

Symptoms of a tirofiban overdose may include vomiting, feeling exhausted or short of breath, and severe bleeding.

What should I avoid while receiving tirofiban? While you are receiving tirofiban, do not take aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) without your doctor's advice. NSAIDs include ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), piroxicam (Feldene), and others.

Tirofiban lowers blood cells that help your blood clot. This can make it easier for you to bruise or bleed from an injury or minor cut. Avoid activities that increase your risk of a bruising or bleeding injury. Use extra caution to avoid cuts when brushing your teeth or shaving.

Avoid drinking alcohol while receiving tirofiban. Alcohol may increase your risk of bleeding in your stomach or intestines. Tirofiban side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

nosebleed or other bleeding that will not stop;

black, bloody, or tarry stools;

coughing up blood or vomit that looks like coffee grounds;

chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

fever, chills, body aches, flu symptoms; or

pale skin, easy bruising or bleeding, weakness, fever, and urinating more or less than usual.

Less serious side effects may also occur, such as:

nausea, stomach pain;

runny or stuffy nose, cough, sore throat; or

mild headache or dizziness.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

Tirofiban Dosing Information

Usual Adult Dose for Acute Coronary Syndrome:

Initial (IV): 0.4 mcg/kg/min for the first 30 minutes.
Maintenance (IV): 0.1 mcg/kg/min constant infusion to continue for 12 to 24 hours following angioplasty or atherectomy.

What other drugs will affect tirofiban?

Before receiving tirofiban, tell your doctor if you are using any of the following drugs:

phenytoin (Dilantin);

tamoxifen (Nolvadex);

tolbutamide (Orinase);

torsemide (Demadex);

fluvastatin (Lescol);

a blood thinner such as warfarin (Coumadin), heparin, ardeparin (Normiflo), dalteparin (Fragmin), danaparoid (Orgaran), enoxaparin (Lovenox), or tinzaparin (Innohep); or

any other medications used to prevent blood clots, such as alteplase (Activase), anistreplase (Eminase), clopidogrel (Plavix), dipyridamole (Persantine), streptokinase (Kabikinase, Streptase), ticlopidine (Ticlid), or urokinase (Abbokinase).

If you are using any of these drugs, you may not be able to receive tirofiban, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect tirofiban. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

More tirofiban resources Tirofiban Side Effects (in more detail) Tirofiban Dosage Tirofiban Use in Pregnancy & Breastfeeding Tirofiban Drug Interactions Tirofiban Support Group 0 Reviews for Tirofiban - Add your own review/rating Tirofiban MedFacts Consumer Leaflet (Wolters Kluwer) Tirofiban Monograph (AHFS DI) Aggrastat Prescribing Information (FDA) Compare tirofiban with other medications Acute Coronary Syndrome Where can I get more information? Your pharmacist has information about tirofiban written for health professionals that you may read.

See also: tirofiban side effects (in more detail)


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Vagifem 25 ?g film-coated tablets


Vagifem 25 micrograms film-coated vaginal tablets

Estradiol hemihydrate

Read all of this leaflet carefully, before you start using this medicine. Keep this leaflet. You may need to read it again. If you have any questions, ask your doctor or pharmacist. This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. If any of the side effects get serious, or if you notice any side effects not listed in this leaflet please tell your doctor or pharmacist. In this leaflet: 1. What Vagifem is and what it is used for 2. Before you use Vagifem 3. How to use Vagifem 4. Possible side effects 5. How to store Vagifem 6. Further information What Vagifem Is And What It Is Used For

Vagifem contains estradiol

Estradiol is a female sex hormone It belongs to a group of hormones called oestrogens It is exactly the same as the estradiol produced by the ovaries of women.

Vagifem belongs to a group of medicines called Hormone Replacement Therapy (HRT).

It is intended for post-menopausal women and is used to relieve menopausal symptoms in the vagina such as dryness or irritation. In medical terms this is known as ‘vaginal atrophy’. It is caused by a drop in the levels of oestrogen in your body. This happens naturally around the menopause.

Vagifem works by replacing the oestrogen which is normally produced in the ovaries of women.

It is inserted into your vagina, so the hormone is released where it is needed.

The experience of treating women older than 65 years is limited.

Before You Use Vagifem Medical check-ups

Before you start using Vagifem, your doctor will tell you about the risks and benefits of the treatment (see also Section 4). Before you start using Vagifem and regularly during treatment, your doctor will check whether Vagifem is the right treatment for you. Once you’ve started on HRT, your doctor will tell you how often to go for regular check-ups. At these check-ups, your doctor may discuss with you the benefits and risks of continuing to take HRT.

If you have a close relative (e.g. mother, sister, maternal or paternal grandmother), who has suffered from any serious illness such as blood clots or breast cancer, you might be at a higher risk for serious illness. Always tell your doctor about any close relative(s) suffering from serious illness.

As well as regular check-ups with your doctor, you should:

Regularly examine your breasts for any changes, such as dimpling or sinking of the skin, changes in the nipple, or any lumps you can see or feel. Tell your doctor if you notice any changes. Go for regular breast screening (mammography) and cervical smear tests. Do not use Vagifem if: You are allergic (hypersensitive) to estradiol or any of the other ingredients of Vagifem (listed in Section 6 below) You have or have ever had, or think you might have breast cancer You have or have had a hormone dependent tumour (e.g. cancer of the lining of the womb) You have unusual vaginal bleeding which you have not told your doctor about You have thickening of the lining of the womb (endometrial hyperplasia) and you are not being treated for it You have or previously have had a blood clot inside the blood vessels of the legs or lungs (deep vein thrombosis or pulmonary embolism) You have porphyria. This is a rare disease which affects the production of some of your blood pigments. You have active or recent arterial thromboembolic disease (e.g. angina, myocardial infarction) You have acute liver disease or history of liver disease as long as liver function tests have failed to return to normal

Do not use Vagifem if any of the above applies to you. If you are not sure, talk to your doctor or pharmacist before using this medicine.

Take special care with Vagifem

Check with your doctor before using Vagifem if you have or have ever had any of the illnesses in the list below. He or she may want to follow you more closely.

Asthma Epilepsy Diabetes Gallstones High blood pressure Migraines or severe headaches Liver problems such as ‘liver adenoma’ (a benign tumour) Endometrial hyperplasia (thickening of the lining of your womb) Otosclerosis. This is when you lose your hearing over a period of time Systemic lupus erythematosus (a disease affecting the skin, joints and kidneys) Blood clots or risk factors for blood clots (see Section 4 ‘Other side effects of systemic HRT’) Leiomyoma (benign tumours of the womb) or endometriosis (growth of the womb lining outside the womb)

If any of the above applies to you, or if you are not sure, talk to your doctor or pharmacist before using Vagifem.

Using other medicines

Please tell your doctor or pharmacist if you are using or have recently used any other medicines, including medicines obtained without a prescription.

Pregnancy and breast-feeding Do not use Vagifem if you think you might be pregnant, or if you are breast-feeding If you get pregnant while you are using Vagifem, stop using it and see a doctor straight away. Driving and using machines

No known effect.

How To Use Vagifem

Always use Vagifem exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

Using this medicine You can start using Vagifem on any day which is best for you Insert the vaginal tablet into your vagina with the applicator.

The ’USER INSTRUCTIONS’ at the end of the leaflet tell you how to do this. Read the instructions carefully before using Vagifem.

How much to use Use one vaginal tablet each day for the first 2 weeks Then use one vaginal tablet twice a week. Leave 3 or 4 days between each dose. If you use more Vagifem than you should If you have used more Vagifem than you should, talk to a doctor or pharmacist. An overdose of oestrogen could make you feel sick or vomit. If you forget to use Vagifem If you forget a dose, use the medicine as soon as you remember. Do not use a double dose to make up for a forgotten dose.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

General information about treating symptoms of the menopause When using medicines for any menopausal symptoms, use the lowest dose that works. Also, use the medicine for as short a time as you need to.

Only continue treatment if the benefit is more than the risk.

Talk to your doctor about this.

Possible Side Effects

Like all medicines, Vagifem can cause side effects, although not everybody gets them.

Stop using Vagifem and see a doctor straight away if you notice any of the following side effects: A migraine-type headache you have not had before Yellow colouring of your skin or eyes (jaundice) or other liver problems A big increase in blood pressure Blood clots called ‘deep vein thrombosis’ (see also ‘Other side effects of systemic HRT’) If you develop any of the illnesses listed in Section 2, ’Do not use Vagifem’ You become pregnant Tell your doctor or pharmacist if any of the following side effects get serious or last longer than a few days:

Common (may affect more than 1 in 100 women)

Headache Passing wind (flatulence) Feeling sick (nausea) or being sick (vomiting) Indigestion Stomach pain, discomfort or distension Swelling of arms or legs (oedema) Vaginal bleeding, discharge or discomfort An infection of the genitals caused by a fungus or inflamed vagina Breast oedema or breast enlargement, breast pain or breast tenderness.

Very rare (may affect less than 1 in 10000 women)

Breast cancer Cancer of the lining of the womb (endometrial cancer) Thickening of the lining of your womb (endometrial hyperplasia) Blood clots called ‘deep vein thrombosis’ Other side effects of systemic HRT are: Allergic reaction (hypersensitivity) Diarrhoea Weight increase Fluid retention Being unable to sleep (insomnia) Feeling depressed Worsening of existing migraine Rash, including itchy, lumpy rash called ‘hives or urticaria’ Itching of the genitals Vaginal pain, irritation of the vagina, painful spasm of the vagina (vaginismus) or vaginal ulcers Increase in blood oestrogen (shown in blood test) Drug ineffective. Important information on the side effects of HRT

Vagifem is used for local treatment in the vagina and contains only a small amount of estradiol. This means that the chances of getting the diseases described below are less likely than with HRT products used for systemic treatment (treatment that affects the body as a whole).

As well as benefits, HRT has some risks which you need to consider when you’re deciding whether to take it, or whether to carry on taking it.

Effects on your heart or circulation

Heart disease

HRT is not recommended for women who have heart disease, or have had heart disease recently. If you have ever had heart disease, talk to your doctor to see if you should be taking HRT. HRT will not help to prevent heart disease.

Studies with one type of HRT (containing conjugated oestrogen plus the progestogen MPA) have shown that women may be slightly more likely to get heart disease during the first year of taking the medication. For other types of HRT, the risk is likely to be similar, although this is not yet certain.

If you get:

a pain in your chest that spreads to your arm or neck See a doctor as soon as possible and do not take any more HRT until your doctor says you can. This pain could be a sign of heart disease.

Stroke

Recent research suggests that systemic HRT slightly increases the risk of having a stroke. Other things that can increase the risk of stroke include:

getting older high blood pressure smoking drinking too much alcohol an irregular heartbeat

If you are worried about any of these things, or if you have had a stroke in the past, talk to your doctor to see if you should take HRT.

Compare

Looking at women in their 50s who are not taking HRT - on average, over a 5-year period, 3 in 1000 would be expected to have a stroke.

For women in their 50s who are taking HRT, the figure would be 4 in 1000.

Looking at women in their 60s who are not taking HRT - on average, over a 5-year period, 11 in 1000 would be expected to have a stroke.

For women in their 60s who are taking HRT, the figure would be 15 in 1000.

If you get:

unexplained migraine-type headaches, with or without disturbed vision See a doctor as soon as possible and do not take any more HRT until your doctor says you can. These headaches may be an early warning sign of a stroke.

Blood clots

Systemic HRT may increase the risk of blood clots in the veins (also called deep vein thrombosis, or DVT), especially during the first year of taking it.

These blood clots are not always serious, but if one travels to the lungs, it can cause chest pain, breathlessness, collapse or even death. This condition is called pulmonary embolism, or PE. DVT and PE are examples of a condition called venous thromboembolism, or VTE.

You are more likely to get a blood clot:

if you are seriously overweight if you have had a blood clot before if any of your close family have had blood clots if you have had one or more miscarriages if you have any blood clotting problem that needs treatment with a medicine such as warfarin if you’re off your feet for a long time because of major surgery, injury or illness if you have a rare condition called SLE

If any of these things apply to you, talk to your doctor to see if you should take HRT.

Compare

Looking at women in their 50s who are not taking HRT - on average, over a 5-year period, 3 in 1000 would be expected to get a blood clot.

For women in their 50s who are taking HRT, the figure would be 7 in 1000.

Looking at women in their 60s who are not taking HRT - on average, over a 5-year period, 8 in 1000 would be expected to get a blood clot.

For women in their 60s who are taking HRT, the figure would be 17 in 1000.

If you get:

painful swelling in your leg sudden chest pain difficulty breathing See a doctor as soon as possible and do not take any more HRT until your doctor says you can. These may be signs of a blood clot.

If you’re going to have surgery, make sure your doctor knows about it. You may need to stop taking HRT about 4 to 6 weeks before the operation, to reduce the risk of a blood clot. Your doctor will tell you when you can start taking HRT again.

Effects on your risk of developing cancer

Breast cancer

Women who have breast cancer, or have had breast cancer in the past, should not take HRT

Taking HRT slightly increases the risk of breast cancer; so does having a later menopause. The risk for a post-menopausal woman taking oestrogen-only HRT for 5 years is about the same as for a woman of the same age who’s still having periods over that time and not taking HRT.

The extra risk of breast cancer goes up the longer you take it, but returns to normal within about 5 years after stopping HRT.

Your risk of breast cancer is also higher:

if you have a close relative (mother, sister or grandmother) who has had breast cancer if you are seriously overweight

Compare

Looking at women aged 50 who are not taking HRT - on average, 32 in 1000 will be diagnosed with breast cancer by the time they reach the age of 65.

For women who start taking oestrogen-only HRT at age 50 and take it for 5 years, the figure will be between 33 and 34 in 1000 (i.e. an extra 1-2 cases).

If they take oestrogen-only HRT for 10 years, the figure will be 37 in 1000 (i.e. an extra 5 cases).

If you notice

any changes in your breast, such as:

dimpling of the skin changes in the nipple any lumps you can see or feel Make an appointment to see your doctor as soon as possible.

Endometrial cancer (cancer of the lining of the womb)

Taking oestrogen-only HRT tablets orally for a long time can increase the risk of developing cancer of the lining of the womb (the endometrium). It is possible there may be a similar risk with oestrogen cream/rings/tablets used directly in the vagina for repeated treatments or over a long time.

If you get breakthrough bleeding or spotting, it’s usually nothing to worry about, but you should

Make an appointment to see your doctor. It could be a sign that your endometrium has become thicker.

Ovarian cancer

Ovarian cancer (cancer of the ovaries) is very rare, but it is serious. It can be difficult to diagnose, because there are often no obvious signs of the disease.

Some studies have indicated that taking oestrogen-only HRT for more than 5 years may increase the risk of ovarian cancer. It is not yet known whether other kinds of HRT increase the risk in the same way.

HOW TO STORE Vagifem

Keep out of the reach and sight of children.

Do not store above 25°C. Do not refrigerate. Keep the blisters in the outer carton in order to protect from light.

Do not use Vagifem after the expiry date which is stated on the carton. The expiry date refers to the last day of that month.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

Further Information What Vagifem contains The active substance is estradiol 25 micrograms (as estradiol hemihydrate) Other ingredients are: hypromellose, lactose monohydrate, maize starch and magnesium stearate The film-coating contains: hypromellose and Macrogol 6000. What Vagifem looks like and content of the pack

Each Vagifem comes in an applicator which is used once only.

There are 15 applicators with vaginal tablets in each box.

Vagifem is engraved with NOVO 279.

Marketing Authorisation Holder Novo Nordisk A/S Novo Alle DK-2880 Bagsvaerd Denmark The registered office in the UK is: Novo Nordisk Limited Broadfield Park Crawley West Sussex RH11 9RT Tel:(01293) 613555

This leaflet was last approved in: 04/2010

Detailed information on this medicine is available on the web site of www.emc.medicines.org.uk

User Instructions How to use Vagifem 1. Tear off one single blister pack. Open the end as shown in the picture. 2. Insert the applicator carefully into the vagina.

Stop when you can feel some resistance.

3. To release the tablet, gently press the push button until you feel a click.

The tablet will stick to the wall of the vagina straight away.

It will not fall out if you stand up or walk.

4. Take out the applicator and throw it away

Vagifem is a trademark owned by Novo Nordisk Femcare AG, Switzerland.

© 2010

Novo Nordisk A/S

8-2790-01-033-1


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chlorotrianisene


Generic Name: chlorotrianisene (klor oh trye AN i seen)
Brand Names: Tace

What is chlorotrianisene?

Chlorotrianisene is a form of estrogen. Estrogen is a female sex hormone necessary for many processes in the body.

Chlorotrianisene is used to treat symptoms of menopause, deficiencies in ovary function (including underdevelopment of female sexual characteristics and some types of infertility), and prostate cancer.

Chlorotrianisene may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about chlorotrianisene?

Have yearly physical exams and examine your breasts for lumps on a monthly basis while taking chlorotrianisene.

Take chlorotrianisene with food or milk to lessen stomach upset. Do not take chlorotrianisene if you are pregnant. Who should not take chlorotrianisene? Do not take chlorotrianisene if you

have breast cancer. Tell your doctor if you have (or have ever had) breast cancer.

have vaginal bleeding that has not been diagnosed. It will be necessary to determine if any abnormal bleeding has a hormonal cause.

have a bleeding or blood-clotting disorder. Chlorotrianisene may increase the risk that a blood clot will form.

Before taking this medication, tell your doctor if you

have any type of liver or gallbladder disease,

are diabetic,

suffer from migraines,

have epilepsy or seizures,

have heart disease, or

have kidney disease.

You may need a lower dose or special monitoring during treatment if you have any of the conditions listed above.

Chlorotrianisene is in the FDA pregnancy category X. This means that chlortrianisene will cause birth defects in an unborn baby. Do not take this medication if you are pregnant or are planning a pregnancy. Chlorotrianisene may decrease milk flow and have other effects on milk composition. Do not use this medication without first talking to your doctor if you are breast-feeding a baby. How should I take chlorotrianisene?

Take this medication exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Take chlorotrianisene with food or milk to lessen stomach upset.

Try to take each dose at the same time each day, preferably in the morning. You may be taking it every day, or you may be taking it every day for 3 weeks with 1 week off each month to mimic your body's natural cycle. Follow the directions on your prescription label.

If you are taking chlorotrianisene to treat cancer, you may be taking it several times a day in very large doses.

Store chlorotrianisene at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. Do not take a double dose of this medication unless otherwise directed by your doctor.

What happens if I overdose? An overdose of this medication is unlikely to threaten life. Consult an emergency room or poison control center for advice.

Symptoms of an estrogen overdose include nausea and vomiting.

What should I avoid while taking chlorotrianisene? Avoid prolonged exposure to sunlight. Chlorotrianisene may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. Chlorotrianisene side effects If you experience any of the following serious side effects, stop taking chlorotrianisene and seek emergency medical attention:

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

a blood clot (pain, redness, and swelling in an arm or leg, shortness of breath, chest pain, headache, blurred vision, or confusion);

a lump in a breast; or

liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue).

Other, less serious side effects may be more likely to occur. Continue to take chlorotrianisene and talk to your doctor if you experience

decreased appetite, nausea, or vomiting;

swollen breasts;

acn? or skin color changes;

decreased sex drive;

migraine headaches or dizziness;

water retention (swollen hands, feet, or ankles);

depression; or

changes in your menstrual cycle or breakthrough bleeding.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect chlorotrianisene?

Chlorotrianisene may decrease the effects of the following drugs:

anticoagulants (blood thinners) such as warfarin (Coumadin). This could lead to blood clots. Your doctor will want to monitor your anticoagulant therapy.

thyroid medications. A larger dose of thyroid medication may be needed.

insulin. Monitor your blood sugar levels and discuss any unusual changes with your doctor.

tamoxifen. Chlorotrianisene should not be taken during therapy with tamoxifen.

Chlorotrianisene may also increase the effects of some medications. The following drugs may have increased or dangerous side effects if taken with chlorotrianisene:

tricyclic antidepressants such as amitriptyline (Elavil) and doxepin (Sinequan); other commonly used tricyclic antidepressants, including amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil); and

didanosine (Videx).

Before taking this medication, tell your doctor if you are taking any of the medicines listed above.

Other drugs may also affect chlorotrianisene. The effects of chlorotrianisene are decreased by

phenytoin (Dilantin) and ethotoin (Peganone),

carbamazepine (Tegretol),

phenobarbital (Solfoton, Luminal),

primidone (Mysoline), and

rifampin (Rifadin).

You may need larger doses of chlorotrianisene if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with chlorotrianisene. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More chlorotrianisene resources Chlorotrianisene Drug Interactions Chlorotrianisene Support Group 0 Reviews for Chlorotrianisene - Add your own review/rating Compare chlorotrianisene with other medications Menopausal Disorders Primary Ovarian Failure Prostate Cancer Where can I get more information? Your pharmacist has additional information about chlorotrianisene written for health professionals that you may read. What does my medication look like?

Chlorotrianisene is available with a prescription under the brand name Tace. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Tace 12 mg--green, hard-gelatin capsules


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NPlate


Pronunciation: roe-mi-PLOE-stim
Generic Name: Romiplostim
Brand Name: NPlate
NPlate is used for:

Treating low platelets (thrombocytopenia) in certain patients with chronic immune thrombocytopenia purpura (ITP).

NPlate is a thrombopoietin (TPO) mimetic protein. It works by helping the bone marrow to increase the number of clot-forming cells (platelets) in the blood. This helps the blood to clot more normally and reduce your risk for excessive or severe bleeding.

Do NOT use NPlate if: you are allergic to any ingredient in NPlate

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

Before using NPlate:

Some medical conditions may interact with NPlate. 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 had your spleen removed (splenectomy) if you have blood clotting problems, bleeding problems, or a history of heart attack, stroke, or blood clots in your veins (eg, pulmonary embolism) if you have kidney problems, liver problems, bone marrow problems, a precancerous condition of the blood (eg, myelodysplastic syndrome [MDS]) or blood cancer (eg, leukemia) if you are also taking an anticoagulant or antiplatelet medicine

Some MEDICINES MAY INTERACT with NPlate. However, no specific interactions with NPlate are known at this time.

Ask your health care provider if NPlate 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 NPlate:

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

NPlate comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again before each time you use NPlate. NPlate is given as an injection at your doctor's office, hospital, or clinic. You should receive NPlate only under direct medical supervision by a doctor experienced in the use of NPlate. If you miss a dose of NPlate, contact your doctor right away.

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

Important safety information: NPlate may worsen precancerous conditions of the blood (eg, MDS) and may increase the risk of developing blood cancer. Tell your doctor if you have any of these conditions before you use NPlate. NPlate may increase the risk of high platelet counts and blood clots. Your doctor will perform tests to check for these conditions. Discuss any questions or concerns with your doctor. You may be at greater risk for low platelet counts and bleeding after you stop NPlate, especially if you also take anticoagulants or antiplatelet medicines. Check with your doctor right away if you notice any unusual bleeding or bruising. Lab tests, including complete blood cell counts and bone marrow tests, may be performed while you use NPlate and for at least 2 weeks after you stop using it. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools. Use NPlate with caution in the ELDERLY; they may be more sensitive to its effects. NPlate should be used with extreme caution in CHILDREN; safety and effectiveness in these children have not been confirmed. PREGNANCY AND BREAST-FEEDING: It is not known if NPlate can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using NPlate while you are pregnant. It is not known if NPlate is found in breast milk. Do not breast-feed while taking NPlate. Possible side effects of NPlate:

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; headache; indigestion; joint pain; muscle tenderness or weakness; shoulder pain; stomach pain or upset; trouble sleeping.

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); black, tarry stools; blurred vision; chest pain; leg or arm pain; numbness or tingling of the hands and feet; one-sided weakness; severe or persistent dizziness or headache; unusual bruising or bleeding; unusual weakness or tiredness; vomit that looks like coffee grounds.

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: NPlate 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.

Proper storage of NPlate:

NPlate is handled and stored by a health care provider.

General information: If you have any questions about NPlate, please talk with your doctor, pharmacist, or other health care provider. NPlate 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 NPlate. 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 Copyright © 2012 Wolters Kluwer Health, Inc. More NPlate resources NPlate Side Effects (in more detail) NPlate Use in Pregnancy & Breastfeeding NPlate Support Group 0 Reviews for NPlate - Add your own review/rating Nplate Prescribing Information (FDA) Nplate Consumer Overview Nplate Monograph (AHFS DI) Nplate Advanced Consumer (Micromedex) - Includes Dosage Information Romiplostim Professional Patient Advice (Wolters Kluwer) Compare NPlate with other medications Idiopathic Thrombocytopenic Purpura
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Hydroxyzine Suspension


Pronunciation: hye-DROX-i-zeen
Generic Name: Hydroxyzine
Brand Name: Vistaril
Hydroxyzine Suspension is used for:

Treating anxiety, causing sedation before and after general anesthesia, and treating itching due to certain allergic conditions, including hives and contact dermatitis (eg, poison ivy). It also may be used for other conditions as determined by your doctor.

Hydroxyzine Suspension is an antihistamine. It works by affecting the brain to reduce anxiety. It also has other activities, including opening breathing tubes, relieving pain or allergy symptoms, and preventing or treating nausea and vomiting caused by motion sickness.

Do NOT use Hydroxyzine Suspension if: you are allergic to any ingredient in Hydroxyzine Suspension you are taking sodium oxybate (GHB) you are in your first 3 months of pregnancy

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

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Before using Hydroxyzine Suspension:

Some medical conditions may interact with Hydroxyzine Suspension. 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 asthma, glaucoma, difficulty urinating, a urinary or intestinal blockage, a prostate disease, or a blood disease if you drink alcoholic beverages

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

Sodium oxybate (GHB) because side effects, such as an increase in sleep duration and slowed breathing, may occur

This may not be a complete list of all interactions that may occur. Ask your health care provider if Hydroxyzine Suspension 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 Hydroxyzine Suspension:

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

Take Hydroxyzine Suspension by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Shake well before each use. Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose. If you miss a dose of Hydroxyzine Suspension and you are using it regularly, take it as soon as possible. If it is almost time for you next 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 Hydroxyzine Suspension.

Important safety information: Hydroxyzine Suspension may cause drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Hydroxyzine Suspension with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Avoid drinking alcohol or using medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Hydroxyzine Suspension; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. The effectiveness of Hydroxyzine Suspension as anxiety treatment for longer than 4 months is not known. Use Hydroxyzine Suspension with caution in the ELDERLY; they may be more sensitive to its effects. Hydroxyzine Suspension should not be used in NEWBORNS; safety and effectiveness in newborns have not been confirmed. PREGNANCY and BREAST-FEEDING: Do not use Hydroxyzine Suspension if you are in your first 3 months of pregnancy. If you think you may be pregnant, contact your doctor right away. It is not known if Hydroxyzine Suspension is found in breast milk. Do not breast-feed while taking Hydroxyzine Suspension. Possible side effects of Hydroxyzine Suspension:

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:

Drowsiness; dry mouth.

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); involuntary movements.

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: Hydroxyzine 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 unusual drowsiness or dizziness.

Proper storage of Hydroxyzine Suspension:

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

General information: If you have any questions about Hydroxyzine Suspension, please talk with your doctor, pharmacist, or other health care provider. Hydroxyzine Suspension 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 Hydroxyzine Suspension. 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 Copyright © 2012 Wolters Kluwer Health, Inc. More Hydroxyzine resources Hydroxyzine Side Effects (in more detail) Hydroxyzine Use in Pregnancy & Breastfeeding Drug Images Hydroxyzine Drug Interactions Hydroxyzine Support Group 99 Reviews for Hydroxyzine - Add your own review/rating Compare Hydroxyzine with other medications Allergic Urticaria Allergies Anxiety Interstitial Cystitis Nausea/Vomiting Pain Pruritus Sedation
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Metalyse 8,000 units


Metalyse

8,000 units powder and solvent for solution for injection

Tenecteplase

Read all of this leaflet carefully before you start receiving this medicine. Keep this leaflet. You may need to read it again. If you have any further questions, ask your doctor or pharmacist. If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist. In this leaflet:

1. What METALYSE is and what it is used for
2. Before you receive METALYSE
3. How is METALYSE administered
4. Possible side effects
5. How to store METALYSE
6. Further information

What Metalyse Is And What It Is Used For

METALYSE is a powder and solvent for solution for injection. This means that each pack contains:

one vial of 8,000 units METALYSE powder and one pre-filled syringe containing 8 ml water for injections.

Before use, the solvent (water for injections) is added to the powder to form a solution that is given by injection.

METALYSE belongs to a group of medicines called thrombolytic agents. These medicines help to dissolve blood clots. Tenecteplase is a recombinant fibrin-specific plasminogen activator.

METALYSE is used to treat myocardial infarctions (heart attacks) within 6 hours after the onset of symptoms and helps to dissolve the blood clots that have formed in the blood vessels of the heart. This helps to prevent the damage caused by heart attacks and has been shown to save lives.

Before You Receive Metalyse

METALYSE will not be prescribed and given by your doctor

if you have previously had a sudden life-threatening allergic reaction (severe hypersensitivity) to the active ingredient tenecteplase, to gentamicin (a trace residue from the manufacturing process) or any of the other ingredients of METALYSE. If treatment with Metalyse is nevertheless considered to be necessary, facilities for reanimation should be immediately available in case of need; if you have, or have recently had, an illness that increases your risk of bleeding (haemorrhage), including: a bleeding disorder or tendency to bleed (haemorrhage) stroke (cerebrovascular event) very high, uncontrolled blood pressure a head injury severe liver disease a stomach ulcer (peptic ulcer) varicose veins in the gullet (oesophageal varices) abnormality of the blood vessels (e.g. an aneurysm) certain tumours inflammation of the lining around the heart (pericarditis); inflammation or infection of the heart valves (endocarditis); if you are taking tablets/capsules used to “thin” the blood, such as warfarin or coumarin (anti-coagulants); if you have an inflamed pancreas (pancreatitis); if you have recently had major surgery including surgery to your brain or spine; if you have been given cardiopulmonary resuscitation (chest compressions) for more than 2 minutes duration, in the last two weeks. Your doctor will take special care with METALYSE if you have had any allergic reaction other than a sudden life-threatening allergic reaction (severe hypersensitive) to the active substance tenecteplase, to gentamicin (a trace residue from the manufacturing process), or to any of the other ingredients of Metalyse (see section 6: “Further information”); if you have high blood pressure; if you have problems with circulation of blood in the brain (cerebrovascular disease); if you have had gastrointestinal (gut) or genitourinary bleeding within the last ten days (this may cause blood in stools or urine); if you have a heart valve abnormality (e.g. mitral stenosis) with an abnormal heart rhythm (e.g. atrial fibrillation); if you have had an intramuscular injection in the last two days; if you are aged over 75 years; if you weigh less than 60 kg. Taking other medicines

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Pregnancy and breast-feeding

Ask your doctor for advice before you are given METALYSE.

How Is Metalyse Administered

The doctor calculates your dose of METALYSE according to your bodyweight, based on the following scheme:

Bodyweight less than 60kg 6,000 units

Bodyweight 60 to 70kg 7,000 units

Bodyweight 70 to 80kg 8,000 units

Bodyweight 80 to 90kg 9,000 units

Bodyweight above 90kg 10,000 units

Your doctor will give you medication to prevent blood clotting in addition to METALYSE, as soon as possible after your chest pain starts.

METALYSE is given by a single injection into a vein by a doctor who is experienced in the use of this type of drug.

Your doctor will give METALYSE as soon as possible after your chest pain starts as a single dose.

Repetition is not recommended.

Possible Side Effects

Like all medicines, METALYSE can cause side effects, although not everybody gets them.

Evaluation of side effects is based on the following frequencies:

very common: affects more than 1 user in 10

common: affects 1 to 10 users in 100

uncommon: affects 1 to 10 users in 1,000

rare: affects 1 to 10 users in 10,000

very rare: affects less than 1 user in 10,000

not known: frequency cannot be estimated from the available data

The side effects described below have been experienced by people given METALYSE:

Very Common:

bleeding

Common:

bleeding at the injection or puncture site nosebleeds genitourinary bleeding (you may notice blood in your urine) bruising gastro-intestinal bleeding (e.g. bleeding from the stomach or bowel)

Uncommon:

irregular heart beat (reperfusion arrhythmias), sometimes leading to cardiac arrest internal bleeding in the abdomen (retroperitoneal bleeding) bleeding in the brain (cerebral haemorrhage). Death or permanent disability may occur following bleeding in the brain or other serious bleeding events bleeding in the eyes (eye haemorrhage)

Rare:

low blood pressure (hypotension) bleeding in the lungs (pulmonary haemorrhage) hypersensitivity (anaphylactoid reactions) e.g. rash, hives (urticaria), swelling of the throat bleeding into the area surrounding the heart (haemopericardium) blood clot in the lung (pulmonary embolism) and in the vessels of other organ systems (thrombotic embolisation)

Not known :

fat embolism (clots consisting of fat) nausea vomiting body temperature increased (fever) blood transfusions as consequence of bleedings

As with other thrombolytic agents, the following events have been reported as sequelae of myocardial infarction and/or thrombolytic administration:

Very common:

Low blood pressure (hypotension) Irregular heart beat Chest pain (angina pectoris)

Common:

Further heart attack (recurrent ischaemia) Heart failure Shock due to heart failure Inflammation of the lining around the heart Fluid in the lungs (pulmonary oedema)

Uncommon:

Heart arrest Problem with the heart valve or heart lining (mitral valve incompetence, pericardial effusion) Blood clot in the veins (venous thrombosis) Fluid between the heart lining and the heart (cardiac tamponade) Rupture of the heart muscle (myocardial rupture)

Rare:

Blood clot in the lung (pulmonary embolism)

These cardiovascular events can be life-threatening and may lead to death.

In case of bleeding in the brain events related to the nervous system have been reported e.g. drowsiness (somnolence), speech disorders, palsy of parts of the body (hemiparesis) and fits (convulsions).

Tell your doctor immediately if you think you are experiencing any of these side effects.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

How To Store Metalyse

Keep out of the reach and sight of children.

Do not store above 30°C.

Keep the container in the outer carton in order to protect from light.

Once METALYSE has been reconstituted it may be stored for 24 hours at 2-8°C and 8 hours at 30°C. However, for microbiological reasons your doctor will normally use the reconstituted solution for injection immediately.

Do not use METALYSE after the expiry date which is stated on the label/carton.

Further Information What METALYSE contains The active substance is tenecteplase. One vial contains 8,000 units of tenecteplase. One pre-filled syringe contains 8 ml of water for injections. The other ingredients are L-arginine, phosphoric acid and polysorbate 20. The METALYSE solvent is water for injections. Gentamicin is contained as trace residue from the manufacturing process. What METALYSE looks like and contents of the pack

The folding box contains one vial with a lyophilised powder, one ready for use syringe with a solvent, one vial adapter and one needle.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder

Boehringer Ingelheim International GmbH Binger Strasse 173 D-55216 Ingelheim am Rhein Germany

Manufacturer

Boehringer Ingelheim Pharma GmbH & Co. KG Birkendorfer Strasse 65 D-88397 Biberach/Riss Germany

For any information about this medicinal product, please contact the local representative of the Marketing Authorisation Holder:

United Kingdom Boehringer Ingelheim Ltd. Tel:+44 1344 424 600

This leaflet was last approved in 06/2010

Detailed information on this medicine is available on the European Medicines Agency (EMA) web site: http://www.ema.europa.eu

74366-01


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