Sunday, 29 April 2012

Sudafed PE Day & Night Cold


Pronunciation: a-SEET-a-MIN-oh-fen/DEX-troe-meth-OR-fan/gwye-FEN-e-sin/FEN-il-EF-rin and a-SEET-a-MIN-oh-fen/DYE-fen-HYE-dra-meen/FEN-il-EF-rin
Generic Name: Acetaminophen/Dextromethorphan/Guaifenesin/Phenylephrine
Brand Name: Sudafed PE Day & Night Cold


Sudafed PE Day & Night Cold is used for:

Relieving symptoms of fever, headache, pain, sinus congestion, runny nose, sneezing, itchy nose or throat, itchy or watery eyes, sore throat, and cough due to colds, upper respiratory infections, and allergies. It may also used for other conditions as determined by your doctor.


Sudafed PE Day & Night Cold is an analgesic, antihistamine, cough suppressant, decongestant, and expectorant combination. The analgesic works in the brain to decrease pain and reduce fever. The antihistamine works by blocking the action of histamine, which helps reduce symptoms such as watery eyes and sneezing. The cough suppressant works in the brain to reduce a dry or unproductive cough. The decongestant works by constricting blood vessels and reducing swelling in the nasal passages. The expectorant works by loosening mucus and lung secretions in the chest, making coughs more productive.


Do NOT use Sudafed PE Day & Night Cold if:


  • you are allergic to any ingredient in Sudafed PE Day & Night Cold

  • you have severe high blood pressure, severe heart blood vessel disease, rapid heartbeat, or severe heart problems

  • you are unable to urinate or are having an asthma attack

  • you are taking droxidopa, sodium oxybate (GHB), or you have taken furazolidone or a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the last 14 days

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



Before using Sudafed PE Day & Night Cold:


Some medical conditions may interact with Sudafed PE Day & Night Cold. 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 fast, slow, or irregular heartbeat

  • if you have a history of adrenal gland problems (eg, adrenal gland tumor), heart problems (eg, fast, slow, or irregular heartbeat), high blood pressure, diabetes, blood vessel problems, a stroke, glaucoma or increased pressure in the eye, or thyroid problems

  • if you have a history of asthma, chronic cough, lung or breathing problems (eg, chronic bronchitis, emphysema, sleep apnea); chronic obstructive pulmonary disease (COPD); or if your cough occurs with large amounts of mucus

  • if you have a history of stomach or bowel ulcers; a blockage of your stomach, bladder, or bowel; kidney problems; liver problems; an enlarged prostate or other prostate problems; or trouble urinating

  • if you smoke, drink more than 3 alcohol-containing drinks per day, or have a history of alcohol abuse

Some MEDICINES MAY INTERACT with Sudafed PE Day & Night Cold. Tell your health care provider if you are taking any other medicines, especially any of the following:


  • Anticoagulants (eg, warfarin), digoxin, or droxidopa because risk of bleeding, irregular heartbeat, or heart attack may be increased

  • Beta-blockers (eg, propranolol), catechol-O-methyltransferase (COMT) inhibitors (eg, tolcapone), furazolidone, indomethacin, isoniazid, MAOIs (eg, phenelzine), sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Sudafed PE Day & Night Cold's side effects

  • Bromocriptine or hydantoins (eg, phenytoin) because the risk of their side effects may be increased by Sudafed PE Day & Night Cold

  • Guanadrel, guanethidine, mecamylamine, methyldopa, or reserpine because their effectiveness may be decreased by Sudafed PE Day & Night Cold

This may not be a complete list of all interactions that may occur. Ask your health care provider if Sudafed PE Day & Night Cold 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 Sudafed PE Day & Night Cold:


Use Sudafed PE Day & Night Cold as directed by your doctor. Check the label on the medicine for exact dosing instructions.


  • Take Sudafed PE Day & Night Cold by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.

  • This product contains 2 different tablets, one for the morning and one for the evening. Be sure you understand how to take Sudafed PE Day & Night Cold. Check with your doctor or pharmacist if you are not sure which tablet to take in the morning and which to take in the evening.

  • If you miss a dose of Sudafed PE Day & Night Cold, take it as soon as possible. If it is almost time for your 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 Sudafed PE Day & Night Cold.



Important safety information:


  • Sudafed PE Day & Night Cold may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Sudafed PE Day & Night Cold with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

  • Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Sudafed PE Day & Night Cold; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.

  • Do not take diet or appetite control medicines while you use Sudafed PE Day & Night Cold unless your doctor tells you otherwise.

  • Sudafed PE Day & Night Cold contains acetaminophen, dextromethorphan, diphenhydramine, guaifenesin, and phenylephrine. Before you start any new medicine, check the label to see if it has any of these medicines in it. If it does or if you are not sure, check with your doctor or pharmacist.

  • Sudafed PE Day & Night Cold may harm your liver. Your risk may be greater if you drink alcohol while you are using Sudafed PE Day & Night Cold, if you take more than the recommended dose, or if you are taking another medicine that contains acetaminophen. Talk to your doctor before you take Sudafed PE Day & Night Cold or other fever reducers if you drink more than 3 drinks with alcohol per day.

  • Do not use Sudafed PE Day & Night Cold for a cough with a lot of mucus. Do not use it for a long-term cough (eg, caused by asthma, emphysema, smoking). However, you may use it for these conditions if your doctor tells you to.

  • Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.

  • If new symptoms occur; if cough occurs with persistent rash or headache; or if your symptoms go away and come back, do not get better within 7 days, or get worse, check with your doctor.

  • Contact your doctor if you have a sore throat that is severe; lasts more than 2 days; or occurs with a fever, rash, headache, nausea, or vomiting.

  • Contact your doctor if you have a fever that lasts for more than 3 days.

  • Sudafed PE Day & Night Cold may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Sudafed PE Day & Night Cold. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.

  • This product may contain tartrazine dye (FD&C Yellow No. 5). This may cause an allergic reaction in some patients. If you have ever had an allergic reaction to tartrazine, ask your pharmacist if your product has tartrazine in it.

  • Sudafed PE Day & Night Cold may interfere with skin allergy tests. If you are scheduled for a skin test, talk to your doctor. You may need to stop taking Sudafed PE Day & Night Cold for a few days before the tests.

  • Tell your doctor or dentist that you take Sudafed PE Day & Night Cold before you receive any medical or dental care, emergency care, or surgery.

  • Use Sudafed PE Day & Night Cold with caution in the ELDERLY; they may be more sensitive to its effects, especially confusion, dizziness, drowsiness, dry mouth, nervousness, sleeplessness, and trouble urinating.

  • Caution is advised when using Sudafed PE Day & Night Cold in CHILDREN; they may be more sensitive to its effects, especially excitability.

  • Sudafed PE Day & Night Cold should not be used in CHILDREN younger than 12 years old. Sudafed PE Day & Night Cold contains more than the recommended dose of acetaminophen for children this age and may cause liver damage.

  • Different brands of Sudafed PE Day & Night Cold may have different dosing instructions for CHILDREN. Follow the dosing instructions on the package labeling. If your doctor has given you instructions, follow those. If you are unsure of the dose to give a child, check with your doctor or pharmacist.

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


Possible side effects of Sudafed PE Day & Night Cold:


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:



Constipation; diarrhea; dizziness; drowsiness; dry mouth, nose, or throat; excitability; headache; nervousness; trouble sleeping; upset stomach.



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); confusion; fast or irregular heartbeat; fever, chills, or persistent sore throat; hallucinations; redness; seizures; severe dizziness, drowsiness, lightheadedness, or headache; severe or persistent nervousness or trouble sleeping; shortness of breath; symptoms of liver problems (eg, dark urine, loss of appetite, pale stools, stomach pain, yellowing of the skin or eyes); tremor; trouble urinating or inability to urinate; vision changes.



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.



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 blurred vision; confusion; dark urine; hallucinations; nausea, vomiting, or stomach pain; seizures; severe dizziness, lightheadedness, or headache; severe drowsiness; unusually fast, slow, or irregular heartbeat.


Proper storage of Sudafed PE Day & Night Cold:

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


General information:


  • If you have any questions about Sudafed PE Day & Night Cold, please talk with your doctor, pharmacist, or other health care provider.

  • Sudafed PE Day & Night Cold 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 Sudafed PE Day & Night Cold. 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.

Saturday, 28 April 2012

Tranxene T-Tab



clorazepate dipotassium

Dosage Form: tablet
Tranxene* T-TAB® Tablets C-IV/DEA Schedule IV

(clorazepate dipotassium tablets, USP)


Rx only

DESCRIPTION


Chemically, TRANXENE is a benzodiazepine. The empirical formula is C16H11ClK2N2O4; the molecular weight is 408.92; 1H-1, 4-Benzodiazepine-3-carboxylic acid, 7-chloro-2,3-dihydro-2-oxo-5-phenyl-, potassium salt compound with potassium hydroxide (1:1) and the structural formula may be represented as follows:



The compound occurs as a fine, light yellow, practically odorless powder. It is insoluble in the common organic solvents, but very soluble in water. Aqueous solutions are unstable, clear, light yellow, and alkaline.


Tranxene T-Tab tablets contain either 3.75 mg, 7.5 mg or 15 mg of clorazepate dipotassium for oral administration.


Inactive ingredients for Tranxene T-Tab Tablets: Colloidal silicon dioxide, FD&C Blue No. 2 (3.75 mg only), FD&C Yellow No. 6 (7.5 mg only), FD&C Red No. 3 (15 mg only), magnesium oxide, magnesium stearate, microcrystalline cellulose, potassium carbonate, potassium chloride, and talc.



CLINICAL PHARMACOLOGY


Pharmacologically, clorazepate dipotassium has the characteristics of the benzodiazepines. It has depressant effects on the central nervous system. The primary metabolite, nordiazepam, quickly appears in the blood stream. The serum half-life is about 2 days. The drug is metabolized in the liver and excreted primarily in the urine.


Studies in healthy men have shown that clorazepate dipotassium has depressant effects on the central nervous system. Prolonged administration of single daily doses as high as 120 mg was without toxic effects. Abrupt cessation of high doses was followed in some patients by nervousness, insomnia, irritability, diarrhea, muscle aches, or memory impairment.


Since orally administered clorazepate dipotassium is rapidly decarboxylated to form nordiazepam, there is essentially no circulating parent drug. Nordiazepam, the primary metabolite, quickly appears in the blood and is eliminated from the plasma with an apparent half-life of about 40 to 50 hours. Plasma levels of nordiazepam increase proportionally with TRANXENE dose and show moderate accumulation with repeated administration. The protein binding of nordiazepam in plasma is high (97-98%).


Within 10 days after oral administration of a 15 mg (50μCi) dose of 14C-TRANXENE to two volunteers, 62-67% of the radioactivity was excreted in the urine and 15-19% was eliminated in the feces. Both subjects were still excreting measurable amounts of radioactivity in the urine (about 1% of the 14C-dose) on day ten.


Nordiazepam is further metabolized by hydroxylation. The major urinary metabolite is conjugated oxazepam (3-hydroxynordiazepam), and smaller amounts of conjugated p-hydroxynordiazepam and nordiazepam are also found in the urine.



INDICATIONS AND USAGE


TRANXENE is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.


TRANXENE tablets are indicated as adjunctive therapy in the management of partial seizures.


The effectiveness of TRANXENE tablets in long-term management of anxiety, that is, more than 4 months, has not been assessed by systematic clinical studies. Long-term studies in epileptic patients, however, have shown continued therapeutic activity. The physician should reassess periodically the usefulness of the drug for the individual patient.


TRANXENE tablets are indicated for the symptomatic relief of acute alcohol withdrawal.



CONTRAINDICATIONS


TRANXENE tablets are contraindicated in patients with a known hypersensitivity to the drug and in those with acute narrow angle glaucoma.



WARNINGS



Use in Depressive Neuroses or Psychotic Reactions


TRANXENE tablets are not recommended for use in depressive neuroses or in psychotic reactions.



Use in Children


Because of the lack of sufficient clinical experience, TRANXENE tablets are not recommended for use in patients less than 9 years of age.



Interference with Psychomotor Performance


Patients taking TRANXENE tablets should be cautioned against engaging in hazardous occupations requiring mental alertness, such as operating dangerous machinery including motor vehicles.



Concomitant Use with CNS Depressants


Since TRANXENE has a central nervous system depressant effect, patients should be advised against the simultaneous use of other CNS depressant drugs, and cautioned that the effects of alcohol may be increased.



Physical and Psychological Dependence


Withdrawal symptoms (similar in character to those noted with barbiturates and alcohol) have occurred following abrupt discontinuance of clorazepate. Withdrawal symptoms associated with the abrupt discontinuation of benzodiazepines have included convulsions, delirium, tremor, abdominal and muscle cramps, vomiting, sweating, nervousness, insomnia, irritability, diarrhea, and memory impairment. The more severe withdrawal symptoms have usually been limited to those patients who had received excessive doses over an extended period of time. Generally milder withdrawal symptoms have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation of clorazepate should generally be avoided and a gradual dosage tapering schedule followed.


Caution should be observed in patients who are considered to have a psychological potential for drug dependence.


Evidence of drug dependence has been observed in dogs and rabbits which was characterized by convulsive seizures when the drug was abruptly withdrawn or the dose was reduced; the syndrome in dogs could be abolished by administration of clorazepate.



Suicidal Behavior and Ideation


Antiepileptic drugs (AEDs), including TRANXENE, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.


Pooled analyses of 199 placebo-controlled clinical trials (mono- and adjunctive therapy) of 11 different AEDs showed that patients randomized to one of the AEDs had approximately twice the risk (adjusted Relative Risk 1.8, 95% CI:1.2, 2.7) of suicidal thinking or behavior compared to patients randomized to placebo. In these trials, which had a median treatment duration of 12 weeks, the estimated incidence rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one case of suicidal thinking or behavior for every 530 patients treated. There were four suicides in drug-treated patients in the trials and none in placebo-treated patients, but the number is too small to allow any conclusion about drug effect on suicide.


The increased risk of suicidal thoughts or behavior with AEDs was observed as early as one week after starting drug treatment with AEDs and persisted for the duration of treatment assessed. Because most trials included in the analysis did not extend beyond 24 weeks, the risk of suicidal thoughts or behavior beyond 24 weeks could not be assessed.


The risk of suicidal thoughts or behavior was generally consistent among drugs in the data analyzed. The finding of increased risk with AEDs of varying mechanisms of action and across a range of indications suggests that the risk applies to all AEDs used for any indication. The risk did not vary substantially by age (5-100 years) in the clinical trials analyzed. Table 1 shows absolute and relative risk by indication for all evaluated AEDs.




























Table 1: Risk by indication for antiepileptic drugs in the pooled analysis
IndicationPlacebo Patients with Events Per 1000 PatientsDrug Patients with Events Per 1000 PatientsRelative Risk: Incidence of Events in Drug Patients/Incidence in Placebo PatientsRisk Difference: Additional Drug Patients with Events Per 1000 Patients
Epilepsy1.03.43.52.4
Psychiatric5.78.51.52.9
Other1.01.81.90.9
Total2.44.31.81.9

The relative risk for suicidal thoughts or behavior was higher in clinical trials for epilepsy than in clinical trials for psychiatric or other conditions, but the absolute risk differences were similar for the epilepsy and psychiatric indications.


Anyone considering prescribing tranxene or any other AED must balance the risk of suicidal thoughts or behavior with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Should suicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated.


Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Behaviors of concern should be reported immediately to healthcare providers.



Usage in Pregnancy


An increased risk of congenital malformations associated with the use of minor tranquilizers (chlordiazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has been suggested in several studies. Clorazepate dipotassium, a benzodiazepine derivative, has not been studied adequately to determine whether it, too, may be associated with an increased risk of fetal abnormality. Because use of these drugs is rarely a matter of urgency, their use during this period should almost always be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physician about the desirability of discontinuing the drug.


To provide information regarding the effects of in utero exposure to TRANXENE, physicians are advised to recommend that pregnant patients taking TRANXENE enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry. This can be done by calling the toll-free number 1-888-233-2334, and must be done by patients themselves. Information on the registry can also be found at the website http://www.aedpregnancyregistry.org/.



Usage during Lactation


TRANXENE tablets should not be given to nursing mothers since it has been reported that nordiazepam is excreted in human breast milk.



PRECAUTIONS


In those patients in which a degree of depression accompanies the anxiety, suicidal tendencies may be present and protective measures may be required. The least amount of drug that is feasible should be available to the patient.


Patients taking TRANXENE tablets for prolonged periods should have blood counts and liver function tests periodically. The usual precautions in treating patients with impaired renal or hepatic function should also be observed.


In elderly or debilitated patients, the initial dose should be small, and increments should be made gradually, in accordance with the response of the patient, to preclude ataxia or excessive sedation.



Information for Patients


To assure the safe and effective use of benzodiazepines, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is essential that they consult with their physician before either increasing the dose or abruptly discontinuing this drug.


Patients, their caregivers, and families should be counseled that AEDs, including TRANXENE, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Behaviors of concern should be reported immediately to healthcare providers.


Patients should be encouraged to enroll in the NAAED Pregnancy Registry if they become pregnant. This registry is collecting information about the safety of antiepileptic drugs during pregnancy. To enroll, patients can call the toll-free number 1-888-233-2334 (see Usage in Pregnancy).


Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with clorazepate dipotassium and should counsel them in its appropriate use. A patient Medication Guide is available for TRANXENE. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is available at www.lundbeckinc.com.



Pediatric Use


See WARNINGS.



Geriatric Use


Clinical studies of TRANXENE were not adequate to determine whether subjects aged 65 and over respond differently than younger subjects. Elderly or debilitated patients may be especially sensitive to the effects of all benzodiazepines, including TRANXENE. In general, elderly or debilitated patients should be started on lower doses of TRANXENE and observed closely, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant disease or other drug therapy. Dose adjustments should also be made slowly, and with more caution in this patient population (see PRECAUTIONS and DOSAGE AND ADMINISTRATION).



ADVERSE REACTIONS


The side effect most frequently reported was drowsiness. Less commonly reported (in descending order of occurrence) were: dizziness, various gastrointestinal complaints, nervousness, blurred vision, dry mouth, headache, and mental confusion. Other side effects included insomnia, transient skin rashes, fatigue, ataxia, genitourinary complaints, irritability, diplopia, depression, tremor, and slurred speech.


There have been reports of abnormal liver and kidney function tests and of decrease in hematocrit.


Decrease in systolic blood pressure has been observed.


To report SUSPECTED ADVERSE REACTIONS, contact Lundbeck Inc. at 1-800-455-1141 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.



DOSAGE AND ADMINISTRATION



For the symptomatic relief of anxiety


Tranxene T-Tab tablets are administered orally in divided doses. The usual daily dose is 30 mg. The dose should be adjusted gradually within the range of 15 to 60 mg daily in accordance with the response of the patient. In elderly or debilitated patients it is advisable to initiate treatment at a daily dose of 7.5 to 15 mg.


TRANXENE tablets may also be administered in a single dose daily at bedtime; the recommended initial dose is 15 mg. After the initial dose, the response of the patient may require adjustment of subsequent dosage. Lower doses may be indicated in the elderly patient. Drowsiness may occur at the initiation of treatment and with dosage increment.



For the symptomatic relief of acute alcohol withdrawal


The following dosage schedule is recommended:










1st 24 hours (Day 1)30 mg initially; followed by

30 to 60 mg in divided doses
2nd 24 hours (Day 2)45 to 90 mg in divided doses
3rd 24 hours (Day 3)22.5 to 45 mg in divided doses
Day 415 to 30 mg in divided doses

Thereafter, gradually reduce the daily dose to 7.5 to 15 mg. Discontinue drug therapy as soon as patient's condition is stable.


The maximum recommended total daily dose is 90 mg. Avoid excessive reductions in the total amount of drug administered on successive days.



As an Adjunct to Antiepileptic Drugs


In order to minimize drowsiness, the recommended initial dosages and dosage increments should not be exceeded.



Adults


The maximum recommended initial dose in patients over 12 years old is 7.5 mg three times a day. Dosage should be increased by no more than 7.5 mg every week and should not exceed 90 mg/day.



Children (9-12 years)


The maximum recommended initial dose is 7.5 mg two times a day. Dosage should be increased by no more than 7.5 mg every week and should not exceed 60 mg/day.



DRUG INTERACTIONS


If TRANXENE is to be combined with other drugs acting on the central nervous system, careful consideration should be given to the pharmacology of the agents to be employed. Animal experience indicates that clorazepate dipotassium prolongs the sleeping time after hexobarbital or after ethyl alcohol, increases the inhibitory effects of chlorpromazine, but does not exhibit monoamine oxidase inhibition. Clinical studies have shown increased sedation with concurrent hypnotic medications. The actions of the benzodiazepines may be potentiated by barbiturates, narcotics, phenothiazines, monoamine oxidase inhibitors or other antidepressants.


If TRANXENE tablets are used to treat anxiety associated with somatic disease states, careful attention must be paid to possible drug interaction with concomitant medication.


In bioavailability studies with normal subjects, the concurrent administration of antacids at therapeutic levels did not significantly influence the bioavailability of TRANXENE tablets.



OVERDOSAGE


Overdosage is usually manifested by varying degrees of CNS depression ranging from slight sedation to coma. As in the management of overdosage with any drug, it should be borne in mind that multiple agents may have been taken.


The treatment of overdosage should consist of the general measures employed in the management of overdosage of any CNS depressant. Gastric evacuation either by the induction of emesis, lavage, or both, should be performed immediately. General supportive care, including frequent monitoring of the vital signs and close observation of the patient, is indicated. Hypotension, though rarely reported, may occur with large overdoses. In such cases the use of agents such as norepinephrine bitartrate injection, USP or metaraminol bitartrate injection, USP should be considered.


While reports indicate that individuals have survived overdoses of clorazepate dipotassium as high as 450 to 675 mg, these doses are not necessarily an accurate indication of the amount of drug absorbed since the time interval between ingestion and the institution of treatment was not always known. Sedation in varying degrees was the most common physiological manifestation of clorazepate dipotassium overdosage. Deep coma when it occurred was usually associated with the ingestion of other drugs in addition to clorazepate dipotassium.


Flumazenil, a specific benzodiazepine receptor antagonist, is indicated for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with a benzodiazepine is known or suspected. Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation, and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Patients treated with flumazenil should be monitored for resedation, respiratory depression, and other residual benzodiazepine effects for an appropriate period after treatment. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. The complete flumazenil package insert including CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS should be consulted prior to use.



ANIMAL PHARMACOLOGY AND TOXICOLOGY


Studies in rats and monkeys have shown a substantial difference between doses producing tranquilizing, sedative and toxic effects. In rats, conditioned avoidance response was inhibited at an oral dose of 10 mg/kg; sedation was induced at 32 mg/kg; the LD50 was 1320 mg/kg. In monkeys aggressive behavior was reduced at an oral dose of 0.25 mg/kg; sedation (ataxia) was induced at 7.5 mg/kg; the LD50 could not be determined because of the emetic effect of large doses, but the LD50 exceeds 1600 mg/kg.


Twenty-four dogs were given clorazepate dipotassium orally in a 22-month toxicity study; doses up to 75 mg/kg were given. Drug-related changes occurred in the liver; weight was increased and cholestasis with minimal hepatocellular damage was found, but lobular architecture remained well preserved.


Eighteen rhesus monkeys were given oral doses of clorazepate dipotassium from 3 to 36 mg/kg daily for 52 weeks. All treated animals remained similar to control animals. Although total leucocyte count remained within normal limits it tended to fall in the female animals on the highest doses.


Examination of all organs revealed no alterations attributable to clorazepate dipotassium. There was no damage to liver function or structure.



Reproduction Studies


Standard fertility, reproduction, and teratology studies were conducted in rats and rabbits. Oral doses in rats up to 150 mg/kg and in rabbits up to 15 mg/kg produced no abnormalities in the fetuses. TRANXENE did not alter the fertility indices or reproductive capacity of adult animals. As expected, the sedative effect of high doses interfered with care of the young by their mothers (see Usage in Pregnancy).



HOW SUPPLIED


TRANXENE 3.75 mg scored T-TAB tablets are supplied as blue-colored tablets bearing the letters OV, the distinctive T shape and a two-digit designation, 31:


Bottles of 100 (NDC 67386-301-01).



7.5 mg scored T-TAB tablets are supplied as peach-colored tablets bearing the letters OV, the distinctive T shape and a two-digit designation, 32:


Bottles of 100 (NDC 67386-302-01).



15 mg scored T-TAB tablets are supplied as lavender-colored tablets bearing the letters OV, the distinctive T shape and a two-digit designation, 33:


Bottles of 100 (NDC 67386-303-01).



Recommended storage: Protect from moisture. Keep bottle tightly closed. Store at 20-25°C (68-77°F). See USP controlled room temperature. Dispense in a USP tight, light-resistant container.


T-TAB tablet appearance and shape are registered trademarks of Lundbeck Inc.


U.S. Design Pat. No. D-300,879


Manufactured by: Abbott Pharmaceuticals PR Ltd.

Barceloneta, PR 00617


For: Lundbeck Inc., Deerfield IL, 60015, U.S.A.


*Trademark of Sanofi-Aventis

®Trademark of Lundbeck Inc.


Revised: May 2010



MEDICATION GUIDE


Tranxene* (TRAN-zeen) T-TAB®

(clorazepate dipotassium)

tablets

C-IV/DEA Schedule IV


Read this Medication Guide before you start taking TRANXENE and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment.




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


Do not stop taking TRANXENE without first talking to your healthcare provider.


Stopping TRANXENE suddenly can cause serious problems.


TRANXENE can cause serious side effects, including:


1.  TRANXENE can make you sleepy or dizzy and can slow your thinking and motor skills


  • Do not drive, operate heavy machinery, or do other dangerous activities until you know how TRANXENE affects you.

  • Do not drink alcohol or take other drugs that may make you sleepy or dizzy while taking TRANXENE without first talking to your healthcare provider. When taken with alcohol or drugs that cause sleepiness or dizziness, TRANXENE may make your sleepiness or dizziness much worse.

2.  TRANXENE can cause abuse and dependence.


  • Do not stop taking TRANXENE all of a sudden. Stopping TRANXENE suddenly can cause seizures that do not stop, hearing or seeing things that are not there (hallucinations), shaking, and stomach and muscle cramps.
    • Talk to your doctor about slowly stopping TRANXENE to avoid getting sick with withdrawal symptoms.

    • Physical dependence is not the same as drug addiction. Your healthcare provider can tell you more about the differences between physical dependence and drug addiction.


TRANXENE is a federally controlled substance (C-IV) because it can be abused or lead to dependence. Keep TRANXENE in a safe place to prevent misuse and abuse. Selling or giving away TRANXENE may harm others, and is against the law. Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines or street drugs.


3.  TRANXENE may harm your unborn or developing baby.


Medicines like TRANXENE can cause birth defects. Talk with your healthcare provider if you are pregnant or plan to become pregnant. Tell your healthcare provider right away if you become pregnant while taking TRANXENE. You and your healthcare provider should decide if you will take TRANXENE while you are pregnant. Birth defects may occur even in children born to women who are not taking any medicines and do not have other risk factors.


  • If you become pregnant while taking TRANXENE, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry. You can register by calling 1-888-233-2334. The purpose of this registry is to collect information about the safety of antiepileptic drugs during pregnancy.

  • Tranxene can pass into breast milk. Talk to your healthcare provider about the best way to feed your baby if you take TRANXENE. You and your healthcare provider should decide if you will take TRANXENE or breast feed. You should not do both.

4.  Like other antiepileptic drugs, TRANXENE may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.


Call your healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:


  • thoughts about suicide or dying

  • attempts to commit suicide

  • new or worse depression

  • new or worse anxiety

  • feeling agitated or restless

  • panic attacks

  • trouble sleeping (insomnia)

  • new or worse irritability

  • acting aggressive, being angry, or violent

  • acting on dangerous impulses

  • an extreme increase in activity and talking (mania)

  • other unusual changes in behavior or mood

How can I watch for early symptoms of suicidal thoughts and actions?


  • Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings.

  • Keep all follow-up visits with your healthcare provider as scheduled.

Call your healthcare provider between visits as needed, especially if you are worried about symptoms.


Do not stop TRANXENE without first talking to a healthcare provider.


Stopping TRANXENE suddenly can cause serious problems.


Stopping a seizure medicine suddenly in a patient who has epilepsy can cause seizures that will not stop (status epilepticus).


Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.




What is TRANXENE?


TRANXENE is a prescription medicine used:


  • to treat anxiety disorders

  • with other medicines to treat partial seizures

  • to treat the symptoms of sudden alcohol withdrawal



Who should not take TRANXENE?


Do not take TRANXENE if you:


  • are allergic to clorazepate dipotassium or any of the ingredients in TRANXENE. See the end of this Medication Guide for a complete list of ingredients in TRANXENE.

  • have an eye disease called acute narrow angle glaucoma.



What should I tell my healthcare provider before taking TRANXENE?


Before you take TRANXENE, tell your healthcare provider if you:


  • have liver or kidney problems

  • have or have had depression, mood problems, or suicidal thoughts or behavior

  • have a history of abnormal thinking and behavior (psychotic reactions)

  • have any other medical conditions

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Taking TRANXENE with certain other medicines can cause side effects or affect how well they work. Do not start or stop other medicines without talking to your healthcare provider.


Know the medicines you take. Keep a list of them and show it to your healthcare provider and pharmacist when you get a new medicine.




How should I take TRANXENE?


  • Take TRANXENE exactly as prescribed. Your healthcare provider will tell you how much TRANXENE to take.

  • Your healthcare provider may change your dose. Do not change your dose of TRANXENE without talking to your healthcare provider.

  • Do not stop taking TRANXENE without first talking to your healthcare provider. Stopping TRANXENE suddenly can cause serious problems.

If you take too much TRANXENE, call your healthcare provider or local Poison Control Center right away.




What are the possible side effects of TRANXENE?


See "What is the most important information I should know about TRANXENE?"


The most common side effects of TRANXENE include:


  • drowsiness

  • dizziness

  • upset stomach

  • blurred vision

  • dry mouth

  • confusion

These are not all the possible side effects of TRANXENE. For more information ask your healthcare provider or pharmacist.


Tell your healthcare provider if you have any side effect that bothers you or that does not go away.


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




How should I store TRANXENE?


  • Store TRANXENE between 68°F to 77°F (20°C to 25°C).

  • Keep TRANXENE in a tightly closed container.

  • Keep TRANXENE out of the light.

  • Keep TRANXENE tablets dry.

Keep TRANXENE and all medicines away from children.




General Information about TRANXENE


Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use TRANXENE for a condition for which it was not prescribed. Do not give TRANXENE to other people, even if they have the same symptoms that you have. It may harm them.


This Medication Guide summarizes the most important information about TRANXENE. If you would like more information, talk with your healthcare provider. You can ask your pharmacist or healthcare provider for information about TRANXENE that is written for health professionals.


For more information about TRANXENE, go to www.lundbeckinc.com or call Lundbeck Inc. at 1-888-514-5204.




What are the ingredients in TRANXENE?


Active ingredient: clorazepate dipotassium


Inactive ingredients: colloidal silicon dioxide, magnesium oxide, magnesium stearate, microcrystalline cellulose, potassium carbonate, potassium chloride and talc.


In addition:


  • the 3.75 mg tablets contain FD&C Blue No. 2

  • the 7.5 mg tablets contain FD&C Yellow No. 6

  • the 15 mg tablets contain FD&C Red No. 3

This Medication Guide has been approved by the U.S. Food and Drug Administration.


Manufactured by: Abbott Pharmaceuticals PR Ltd.

Barceloneta, PR 00617


For: Lundbeck Inc.

Deerfield, IL 60015, U.S.A.


* Trademark of Sanofi-Aventis

® Trademark of Lundbeck Inc.


Revised: May 2010



PRINCIPAL DISPLAY PANEL


NDC 67386-301-01 (3.75 mg T-TAB tablets)


Bottle:



NDC 67386-302-01 (7.5 mg T-TAB tablets)


Bottle:



NDC 67386-303-01 (15 mg T-TAB tablets)


Bottle:



  









TRANXENE  T-TAB
clorazepate dipotassium  tablet










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)67386-301
Route of AdministrationORALDEA ScheduleCIV    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
CLORAZEPATE DIPOTASSIUM (CLORAZEPIC ACID)CLORAZEPATE DIPOTASSIUM3.75 mg




















Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE 
FD&C BLUE NO. 2 
MAGNESIUM OXIDE 
MAGNESIUM STEARATE 
CELLULOSE, MICROCRYSTALLINE 
POTASSIUM CARBONATE 
POTASSIUM CHLORIDE 
TALC 


















Product Characteristics
ColorBLUE (BLUE)Score2 pieces
ShapeFREEFORM (FREEFORM)Size9mm
FlavorImprint CodeT;OV;31
Contains      










Packaging
#NDCPackage DescriptionMultilevel Packaging
167386-301-01100 TABLET In 1 BOTTLENone










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDANDA01710506/23/1972







TRANXENE  T-TAB
clorazepate dipotassium  tablet










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)67386-302
Route of AdministrationORALDEA ScheduleCIV    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
CLORAZEPATE DIPOTASSIUM (CLORAZEPIC ACID)CLORAZEPATE DIPOTASSIUM7.5 mg




















Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE 
FD&C YELLOW NO. 6 
MAGNESIUM OXIDE 
MAGNESIUM STEARATE 
CELLULOSE, MICROCRYSTALLINE 
POTASSIUM CARBONATE 
POTASSIUM CHLORIDE 
TALC 


















Product Characteristics
ColorORANGE (ORANGE)Score2 pieces
ShapeFREEFORM (FREEFORM)Size9mm
FlavorImprint CodeT;OV;32
Contains      










Packaging
#NDCPackage DescriptionMultilevel Packaging
167386-302-01100 TABLET In 1 BOTTLENone










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDANDA01710506/23/1972







TRANXENE  T-TAB
clorazepate dipotassium  tablet










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)67386-303
Route of AdministrationORALDEA ScheduleCIV    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
CLORAZEPATE DIPOTASSIUM (CLORAZEPIC ACID)CLORAZEPATE DIPOTASSIUM15 mg




















Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE 
FD&C RED NO. 3 
MAGNESIUM OXIDE 
MAGNESIUM STEARATE 
CELLULOSE, MICROCRYSTALLINE 
POTASSIUM CARBONATE 
POTASSIUM CHLORIDE 
TALC 


















Product Characteristics
ColorPURPLE (PURPLE)Score2 pieces
ShapeFREEFORM (FREEFORM)Size9mm
FlavorImprint CodeT;OV;33
Contains      










Packaging
#NDCPackage DescriptionMultilevel Packaging
167386-303-01100 TABLET In 1 BOTTLENone





Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing E

Monday, 23 April 2012

Lupron Depot


Generic Name: leuprolide (Intradermal route, Intramuscular route, Subcutaneous route)


LOO-proe-lide AS-e-tate


Commonly used brand name(s)

In the U.S.


  • Eligard

  • Lupron

  • Lupron Depot

  • Lupron Depot-Ped

  • Viadur

Available Dosage Forms:


  • Powder for Solution

  • Powder for Suspension, 3 Month

  • Solution

  • Powder for Suspension, 1 Month

  • Powder for Suspension, 6 Month

  • Kit

  • Powder for Suspension, 4 Month

  • Powder for Suspension

Therapeutic Class: Antineoplastic Agent


Pharmacologic Class: Leuprolide


Uses For Lupron Depot


Leuprolide is a man-made version of a hormone that is similar to the one normally released from the hypothalamus gland in the brain. It is used to treat a number of medical problems. These include:


  • Anemia caused by bleeding of uterine leiomyomas (tumors in the uterus).

  • Cancer of the prostate, advanced.

  • Central precocious puberty (CPP), a condition that causes early puberty in boys (before 9 years of age) and in girls (before 8 years of age).

  • Pain due to endometriosis.

When given regularly to men and boys, leuprolide decreases testosterone levels. Reducing the amount of testosterone in the body is one way of treating cancer of the prostate.


When given regularly to women, leuprolide decreases estrogen levels. Reducing the amount of estrogen in the body is one way of treating endometriosis. By shrinking tumors in the uterus, leuprolide helps stop anemia by decreasing the vaginal bleeding from these tumors. Iron supplements should be used to help treat the anemia.


When given to boys and girls experiencing early puberty, leuprolide slows down the development of the genital areas in both sexes and breast development in girls. This medicine delays puberty in a child only as long as the child continues to receive it.


Suppressing estrogen can cause thinning of the bones or slowing of growth. This is a problem for adult women whose bones are no longer growing like the bones of children. Slowing the growth of bones is a positive effect in girls and boys whose bones grow too fast when puberty begins too early. Boys and girls may benefit by adding inches to their adult height when leuprolide helps their bones grow at the proper and expected rate for children.


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


Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, leuprolide is used in certain patients with the following medical condition:


  • Cancer of the breast.

Before Using Lupron Depot


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 performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of leuprolide pediatric injection in children. However, use is not recommended in children younger than 2 years of age. Leuprolide pediatric injection will stop having an effect on a child treated for central precocious puberty soon after the child stops using it, and puberty will advance normally. It is not known if using leuprolide around the time of puberty causes changes in boys' and girls' future abilities to have babies. Their chances of having children later are thought to be normal. It is especially important that you discuss with the child's doctor the benefit of this medicine as well as the risk of using it.


Appropriate studies have not been performed on the relationship of age to the effects of Eligard®, Lupron® injection, Lupron Depot®, Lupron Depot®-3 month, Lupron Depot®-4 month, Lupron Depot®-6 month, or Viadur® in the pediatric population. Safety and efficacy have not been established.


Geriatric


Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of Eligard®, Lupron® injection, Lupron Depot®, Lupron Depot®-3 month, Lupron Depot®-4 month, or Lupron Depot®-6 month in the elderly.


No information is available on the relationship of age to the effects of leuprolide pediatric injection and Viadur® in geriatric patients.


Pregnancy








Pregnancy CategoryExplanation
All TrimestersXStudies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit.

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. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.


Interactions with Food/Tobacco/Alcohol


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


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:


  • Benzyl alcohol allergy, history of—Using Lupron® injection (certain brand) may cause a skin reaction.

  • Brain problems (e.g., brain tumors), history of or

  • Pituitary gland problem or

  • Seizures or epilepsy, history of or

  • Stroke, history of—Use with caution. May make these conditions worse.

  • Changes in vaginal bleeding from an unknown cause (for use for endometriosis or anemia due to tumors of the uterus)—Leuprolide may delay diagnosis or worsen condition. The reason for the bleeding should be determined before leuprolide is used.

  • Conditions that increase the chances of developing thinning bones or

  • Osteoporosis (thinning of the bones), family history of—It is important that your doctor know if you already have an increased risk of osteoporosis. Some things that can increase your risk for having osteoporosis include cigarette smoking, alcohol abuse, and a family history of osteoporosis or easily broken bones. Some medicines, such as corticosteroids (cortisone-like medicines) or anticonvulsants (seizure medicine), can also cause thinning of the bones when used for a long time.

  • Congestive heart failure or

  • Diabetes or

  • Electrolyte imbalance or

  • Heart or blood vessel disease or

  • Heart rhythm problems (e.g., congenital long QT syndrome) or

  • Hyperglycemia (high sugar in the blood)—Use with caution. May make these conditions worse in patients treated for prostate cancer.

  • Nerve problems caused by bone lesions in the spine (in treatment of cancer of the prostate) or

  • Problems in passing urine (in treatment cancer of the prostate)—Conditions may get worse for a short time after leuprolide treatment is started. Your doctor will want to follow your condition carefully.

Proper Use of leuprolide

This section provides information on the proper use of a number of products that contain leuprolide. It may not be specific to Lupron Depot. Please read with care.


For leuprolide injections (Eligard®, Lupron® injection, Lupron Depot®, Lupron Depot®-Ped 1-month or 3-month, Lupron Depot®-3 month, Lupron Depot®-4 month, or Lupron Depot®-6 month):


  • A nurse or other trained health professional may give you this medicine. This medicine is given as a shot under your skin or into a muscle.

  • You may be taught how to give this medicine at home. Make sure you understand all of the instructions before giving yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.

  • You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas.

  • Use a new needle and syringe each time you inject your medicine.

  • Before each injection, look carefully at the medicine to check for any particles or a change in color. You should not use medicine that has changed color or has particles in it.

  • If you have any questions about any of this, check with your doctor.

Each package of leuprolide injection contains patient directions. Read the instructions carefully and make sure you understand:


  • How to prepare the injection.

  • Proper use of disposable syringes.

  • How to give the injection.

  • How long the injection is stable.

The long-acting form of this medicine (depot) may be given once every month or once every 3 to 12 months. Your schedule depends on the reason you are using this medicine. To stay on the right schedule with the medicine, make sure you keep all appointments.


If you are to receive the leuprolide implant (Viadur®):


  • Viadur® is an implant that is surgically placed under the skin of the upper arm. Your doctor will treat the arm with numbing medicine and then cut a small incision to insert the implant with a special tool. The incision will be closed with surgical strips. An adhesive bandage will be placed over the arm and should be left on for 24 hours.

  • After the implant is put in place, you should keep the arm clean and dry, and should not swim or bathe for 24 hours. You should avoid any heavy lifting or strenuous exercise for 48 hours after the implant is put into the arm.

  • The surgical strips can be removed after at least 3 days or as soon as the incision is healed.

  • The implant will be left in place for one year and then removed. If needed, your doctor will then insert a new implant to continue treatment for another year.

  • Viadur® comes with patient instructions. Read these instructions carefully.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.


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 cancer of the prostate:
    • The dose varies depending on the specific product used.


  • For central precocious puberty:
    • Children 2 years of age and older—Dose is based on body weight and must be determined by your doctor. The starting dose for the once daily product is 50 microgram (mcg) per kilogram (kg) of body weight injected under the skin once a day. The starting dose for the once monthly product is 0.3 milligrams (mg) per kg of body weight or 7.5 mg, 11.25 mg, or 15 mg injected into a muscle every 4 weeks. The 3-month product dose is 11.25 mg or 30 mg injected into a muscle as a single injection every 12 weeks. Your doctor may increase your dose as needed.

    • Children younger than 2 years of age—Use is not recommended.


  • For anemia caused by tumors of the uterus or endometriosis:
    • Adults—The dose given depends on the specific product used. Some examples are 3.75 milligrams (mg) injected into a muscle once a month for up to 3 months or 11.25 mg injected into a muscle as a single injection to last for 3 months. .


Missed Dose


This medicine needs to be given on a fixed schedule. If you miss a dose or forget to use your medicine, call your doctor or pharmacist for instructions.


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.


The mixed suspension should be discarded if not used right away. Eligard® must be used within 30 minutes after mixing, and Lupron Depot® must be used within 2 hours after mixing.


Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.


Precautions While Using Lupron Depot


It is very important that your doctor check the progress of you or your child at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.


For female patients: You should not receive this medicine if you are pregnant or may become pregnant. Using this medicine while you are pregnant can harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.


For patients receiving leuprolide for central precocious puberty (CPP):


  • If you are a female patient, you may have occasional bleeding or spotting. If you continue to have heavy bleeding or regular periods after 2 months of using this medicine, call your doctor.

  • If you develop a rash or irritation at the injection site, check with your doctor right away.

For patients receiving leuprolide for endometriosis or for anemia caused by tumors of the uterus:


  • For the first few days of treatment, the symptoms of your condition may get worse. This is normal. Do not stop taking this medicine. Talk with your doctor if you have concerns about this.

  • During the time you are receiving leuprolide, your menstrual period may not be regular or you may not have a menstrual period at all. This is to be expected when being treated with this medicine. If regular menstruation does not begin within 60 to 90 days after you stop receiving this medicine, check with your doctor.

  • During the time you are receiving leuprolide, you should use birth control methods that do not contain hormones. If you have any questions about this, check with your doctor.

  • If you suspect you may have become pregnant, stop using this medicine and check with your doctor. There is a chance that continued use of leuprolide during pregnancy could cause birth defects or a miscarriage.

When you first start using this medicine for prostate cancer treatment, some of your symptoms might get worse for a short time. You might also have new symptoms. You might have bone pain, back pain, a tingling or numbness in the body, blood in the urine, or trouble urinating. These symptoms should improve within a few weeks. Tell your doctor if you have any new symptoms or your symptoms get worse.


Patients receiving leuprolide for advanced prostate cancer:


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

  • This medicine may increase your risk of having a heart attack or stroke. Check with your doctor right away if you are having chest pain or discomfort; pain or discomfort in the arms, jaw, back, or neck; confusion; shortness of breath; nausea or vomiting, or sweating.

  • This medicine can cause changes in heart rhythms, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Contact your doctor right away if you have any symptoms of heart rhythm problems, such as fast, pounding, or irregular heartbeats.

This medicine can cause decreases in bone mineral density, which may lead to osteoporosis or weakened bones. Talk with your doctor about how this risk will affect you.


This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth while you are using this medicine.


Do not stop using or changing the dose of Lupron® injection without checking first with your doctor.


Before you have any medical tests, tell the medical doctor in charge that you are using this medicine. The results of some tests may be affected by this medicine.


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.


Lupron Depot 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:


For adultsLess common
  • Fast or irregular heartbeat

Rare
  • Bone, muscle, or joint pain

  • fainting

  • fast or irregular breathing

  • numbness or tingling of the hands or feet

  • puffiness or swelling of the eyelids or around the eyes

  • shortness of breath

  • skin rash, hives, or itching

  • sudden, severe decrease in blood pressure and collapse

  • tightness in the chest or wheezing

  • troubled breathing

For males only (adults)More common
  • Arm, back, or jaw pain

  • bloody or cloudy urine

  • blurred vision

  • burning while urinating

  • chest pain or discomfort

  • chest tightness or heaviness

  • difficult or labored breathing

  • difficult, burning, or painful urination

  • difficulty with moving

  • dizziness

  • frequent urge to urinate

  • headache

  • increased urge to urinate during the night

  • muscle pain or stiffness

  • nausea

  • nervousness

  • pain in the joints

  • pale skin

  • pounding in the ears

  • slow or fast heartbeat

  • sweating

  • troubled breathing with exertion

  • unusual bleeding or bruising

  • unusual tiredness or weakness

  • waking to urinate at night

Rare
  • Pain in the groin or legs (especially in the calves of the legs)

Incidence not known
  • Altered mental status

  • cardiovascular collapse

  • double vision

  • visual changes

  • vomiting

For females only (adults)Rare
  • Anxiety

  • deepening of voice

  • increased hair growth

  • mental depression

  • mood changes

For childrenRare
  • Body pain

  • burning, itching, redness, or swelling at the injection site

  • skin rash

For females only (children)—expected in first few weeksRare
  • Vaginal bleeding (continuing)

  • white vaginal discharge (continuing)

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:


For adultsMore common
  • Sudden sweating and feelings of warmth (also called hot flashes)

Less common
  • Bleeding, bruising, burning, itching, pain, redness, or swelling at the injection site

  • decreased interest in sexual intercourse

  • swelling of the feet or lower legs

  • swelling or increased tenderness of the breasts

  • trouble with sleeping

  • weight gain

For females only (adults)More common
  • Light, irregular vaginal bleeding

  • stopping of menstrual periods

Less common
  • Burning, dryness, or itching of the vagina

  • pelvic pain

For males only (adults)More common
  • Back pain

  • chills

  • constipation

  • cough

  • diarrhea

  • fever

  • general feeling of discomfort or illness

  • loss of appetite

  • pain or discomfort at the injection site

  • redness of the face, neck, arms, and occasionally, upper chest

  • runny nose

  • shivering

  • sleeplessness

  • sore throat

  • sudden sweating

  • trouble sleeping

  • unable to sleep

  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

Less common
  • Bone pain

  • decreased size of the testicles

  • inability to have or keep an erection

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: Lupron Depot side effects (in more detail)



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


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


More Lupron Depot resources


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


  • Lupron Depot Prescribing Information (FDA)

  • Lupron Depot MedFacts Consumer Leaflet (Wolters Kluwer)

  • Leuprolide Prescribing Information (FDA)

  • Leuprolide MedFacts Consumer Leaflet (Wolters Kluwer)

  • Eligard Consumer Overview

  • Eligard Prescribing Information (FDA)

  • Eligard Kit MedFacts Consumer Leaflet (Wolters Kluwer)

  • Leuprolide Acetate Monograph (AHFS DI)

  • Lupron Consumer Overview

  • Lupron Depot-PED Prescribing Information (FDA)

  • Lupron Depot-PED Kit MedFacts Consumer Leaflet (Wolters Kluwer)

  • Viadur Prescribing Information (FDA)

  • Viadur Implant MedFacts Consumer Leaflet (Wolters Kluwer)



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Functional bowel disorder agents


Functional bowel disorder agents are different classes of drugs that work by different mechanisms to relieve symptoms of irritable bowel syndrome, chronic bloating, diarrhea and constipation.

See also

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Drug List:

Sunday, 22 April 2012

Ingacillin




Ingacillin may be available in the countries listed below.


Ingredient matches for Ingacillin



Ampicillin

Ampicillin is reported as an ingredient of Ingacillin in the following countries:


  • Sri Lanka

International Drug Name Search

Alconefrin-25


Generic Name: phenylephrine nasal (FEN il EFF rin)

Brand Names: Afrin 4 Hour Extra Moisturizing, Alconefrin-12, Alconefrin-25, Neo-Synephrine Nasal, Nostril Nasal Decongestant, Rhinall, Sinex Nasal Spray, Sinex Ultra Fine Mist


What is Alconefrin-25 (phenylephrine nasal)?

Phenylephrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).


Phenylephrine nasal is used to treat nasal congestion and sinus pressure caused by allergies, the common cold, or the flu. Phenylephrine may be used to treat congestion of the tubes that drain fluid from your inner ears, called the eustachian (yoo-STAY-shun) tubes.


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


What is the most important information I should know about Alconefrin-25 (phenylephrine nasal)?


Do not give this medication to a child younger than 4 years old. Always ask a doctor before giving cough or cold medicine to a child. Death can occur from the misuse of cough or cold medicine in very young children.

You should not use this medication if you are allergic to phenylephrine.


Do not use phenylephrine nasal if you have used linezolid (Zyvox) or procarbazine (Matulane), or if you have taken a monoamine oxidase inhibitor (MAOI) such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the last 14 days. Serious, life-threatening side effects can occur if you use phenylephrine before these other drugs have cleared from your body.

Before using phenylephrine nasal, tell your doctor if you are allergic to any decongestants, or if you have heart disease, heart rhythm disorder, high blood pressure, diabetes, glaucoma, a thyroid disorder, or an enlarged prostate or urination problems.


Phenylephrine may interact with heart or blood pressure medications, antidepressants, diabetes medications, and other decongestants.


Never use more of this medicine than directed on the label or prescribed by your doctor.


Call your doctor if your symptoms do not improve after 3 days of using phenylephrine nasal, or if they get worse and you also have a fever. Using phenylephrine nasal too long can damage the lining of your nasal passages and lead to chronic nasal congestion.

What should I discuss with my healthcare provider before using Alconefrin-25 (phenylephrine nasal)?


You should not use this medication if you are allergic to phenylephrine.


Do not use phenylephrine nasal if you have used linezolid (Zyvox) or procarbazine (Matulane), or if you have taken a monoamine oxidase inhibitor (MAOI) such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the last 14 days. Serious, life-threatening side effects can occur if you use phenylephrine before these other drugs have cleared from your body.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use phenylephrine nasal:



  • heart disease, heart rhythm disorder;




  • high blood pressure;




  • diabetes;




  • glaucoma;




  • a thyroid disorder; or




  • an enlarged prostate or urination problems.




FDA pregnancy category C. Is not known whether this medication will harm an unborn baby. Before using phenylephrine nasal, tell doctor if you are pregnant. Phenylephrine nasal may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more likely to have side effects from this medication.

How should I use Alconefrin-25 (phenylephrine nasal)?


Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts, or use it for longer than recommended. Cold medicine is usually taken only for a short time until your symptoms clear up.


Do not give this medication to a child younger than 4 years old. Always ask a doctor before giving cough or cold medicine to a child. Death can occur from the misuse of cough or cold medicine in very young children.

Phenylephrine nasal is usually used every 4 hours. Follow the directions on the medicine label. Never use more of this medicine than directed on the label or prescribed by your doctor. Using phenylephrine nasal too long can damage the lining of your nasal passages and lead to chronic nasal congestion.


Gently blow your nose to clear any mucus before using this medication.


To use the nasal spray, insert the tip of the spray bottle into your nostril, past the middle of the inside of your nose (the nasal septum). Gently press your other nostril closed with your finger.


Keep your head upright, and squeeze the bottle while breathing in deeply through your nose. Sniff quickly a few times to get the medicine deep into your nasal passages.


Repeat these steps to use the medicine in your other nostril if needed.


After each use, clean the tip of the spray bottle with a clean tissue or rinse it with hot water, making sure that no water gets into the medicine bottle. Keep the cap on the bottle when not in use.


To use the nasal drops, lie on your back with your head tilted back. Insert the correct number of drops and remain lying in this position for several minutes. Gently turn your head from side to side.


Call your doctor if your symptoms do not improve after 3 days of using phenylephrine nasal, or if they get worse and you also have a fever.

If you need to have any type of surgery, tell the surgeon ahead of time if you have used phenylephrine nasal within the past few days.


Store phenylephrine nasal at room temperature away from moisture and heat. To prevent the spread of infection, do not share this medication with anyone else.

What happens if I miss a dose?


Since phenylephrine nasal is usually used only when needed, you may not be on a dosing schedule. If you are using the medication regularly, apply the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and apply the medicine at your next regularly scheduled time. Do not use extra medicine to make up the missed dose.


What happens if I overdose?


Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include severe dizziness or drowsiness, slow heart rate, and fainting.


What should I avoid while using Alconefrin-25 (phenylephrine nasal)?


Avoid getting this medication in your eyes. Do not use any other over-the-counter cold, allergy, or cough medication without first asking your doctor or pharmacist. Phenylephrine is contained in many medicines available over the counter. If you use certain products together you may accidentally get too much phenylephrine. Read the label of any other medicine you are using to see if it contains phenylephrine or another decongestant.

Alconefrin-25 (phenylephrine nasal) 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 phenylephrine and call your doctor at once if you have a serious side effect such as:

  • severe sneezing, runny or stuffy nose, redness or swelling in your nose, or other worsening nasal symptoms (may be a sign of overuse of phenylephrine nasal);




  • severe stinging, burning, or irritation inside your nose;




  • severe dizziness, restless feeling, nervousness, or insomnia;




  • mood changes, unusual thoughts or behavior;




  • feeling like you might pass out;




  • slow, fast, or pounding heartbeat;




  • tremors or shaking; or




  • urinating less than usual or not at all.



Less serious side effects may include:



  • temporary sneezing;




  • mild burning, dryness, cold feeling, or irritation inside your nose;




  • headache, dizziness, weakness;




  • sweating, nausea;




  • feeling excited or restless (especially in children); or




  • mild sleep problems.



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 Alconefrin-25 (phenylephrine nasal)?


Tell your doctor about all other medications you use, especially:



  • other decongestants;




  • medicine to treat diabetes;




  • medicines to treat high blood pressure such as reserpine, guanethidine (Ismelin), methyldopa (Aldomet), and others; or




  • an antidepressant such as amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Janimine, Tofranil), and others.



This list is not complete and there may be other drugs that can interact with phenylephrine nasal. 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 Alconefrin-25 resources


  • Alconefrin-25 Use in Pregnancy & Breastfeeding
  • Alconefrin-25 Drug Interactions
  • Alconefrin-25 Support Group
  • 0 Reviews for Alconefrin-25 - Add your own review/rating


  • Rhinall Advanced Consumer (Micromedex) - Includes Dosage Information

  • Rhinall Solution MedFacts Consumer Leaflet (Wolters Kluwer)



Compare Alconefrin-25 with other medications


  • Nasal Congestion


Where can I get more information?


  • Your pharmacist can provide more information about phenylephrine nasal.