Drug Facts

How The Drug Works

Loperamide decreases movement of the digestive tract. This allows more time for reabsorption of water and electrolytes from the stool.

Uses

For relief of nonspecific acute diarrhea, chronic diarrhea associated with inflammatory bowel disease and for Traveler’s diarrhea.

To deacrease the volume of discharge from ileostomies.

• Pregnancy: There are no adequate and well-controlled studies in pregnant women. Safety for use during pregnancy has not been established. Use only when clearly needed and when the potential benefits outweigh the potential hazards to the fetus.
• Breastfeeding: It is not known if loperamide appears in breast milk. Consult your doctor before you begin breastfeeding.
• Children: Not recommended in children under 6. Use with caution and consult your doctor.

Drug Interactions

Tell your doctor or pharmacist if you are taking of if you are planning to take any over-the-counter or prescription medications or dietary supplements with loperamide. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. Cholestyramine (Questran) interacts with loperamide.

Side Effects

Every drug is capable of producing side effects. Many loperamide users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy and individual susceptibility. Possible side effects include:

Digestive Tract: Constipation; nausea; vomiting; appetite loss; stomach ache; abdominal distention or bloating.

Other: Dry mouth; fever; rash; drowsiness; dizziness.

Guidelines for Use

• Do not take more than the prescribed dose.
• May cause drowsiness or dizziness. Use caution when driving or performing other tasks requiring alertness, coordination or physical dexterity.
• Drink plenty of clear fluids to help prevent dehydration, which may accompany diarrhea.
• May cause dry mouth. Chew sugarless gum or suck sugarless hard candies if desired.
• Notify your doctor if diarrhea does not stop after a few days or if abdominal pain, distention or fever occurs.

How the Drug Works

Pregnancy home tests detect the presence of human chorionic gonadotropin (HCG) in the urine. HCG is a hormone produced by the placenta during pregnancy. HCG will cause menstruation to stop. HCG slowly builds up in the body and appears in measurable levels in the urine 1 to 3 days after the first missed period.

Uses

To detect pregnancy.

False resufts: False positive results (test result is positive when no pregnancy actually exists) and false negative results (pregnancy is present but test result is negative) may occur: during menopause; when protein, blood or excessive thyroid hormone are present in the urine; with cold urine; in the presence of an ovarian cyst or ectopic pregnancy (out side the uterus); with certain drugs; performing the test too early; or when the test directions are not followed exactly. Specimen collection and preparation: Collect fresh urine in a clean dry cotainer or container provided. Do not use a wax cup. (Some products, however, may not require urine collection in a container.) For the best results, the sample should be the first morning urine. If testing cannot be done immediately, cover and refrigerate. Do not freeze. Let urine return to room temperature before testing. Do not mix or shake urine. Use the urine at the top of the container. Be sure to test the urine the same day.

Time: Depending on the test kit chosen, the time required for the test is often less than 5 minutes. Most test kits require 3 minutes or less to complete. Allow enough time to complete the test.

Drug Interactions

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements while testing for pregnancy. The following drugs and drug classes may interact with the test to cause questionable results.

1. Anticonvulsants (eg, carbamaze oral contraceptivespine)
2. Antiparkinson agents phenothiazines (eg, chlorpromazine)
3. Steroids (eg, prednisone)
4. Methadone (eg, Dolophine)

Guidelines for Use

• Follow the instructions exactly.
• For best results, use the first urine of the day.
• Consult your doctor or pharmacist if you are taking any medication (eg, birth control pills) which could cause questionable tests results.
• If urine is cloudy, pink or red or has a strong odor, do not do the test. Wait 1 to 2 days and try the test then.
• Read instructions before beginning the test. Have all of the materials you need on hand test kit, clean dry container, timer, and sink with cold running water.
• If test results seem questionable, check the expiration date on the test kit and repeat the test. Follow directions exactly.
• Negative results – Recount the number of days since your last period.
• Retest in 3 to 7 days. It is possible that not enough HCG has accumulated to cause a positive result. If you still do not have your period, contact your doctor. A health condition other than pregnancy may be causing your missed periods.
• Positive results-Contact your doctor to confirm the test results.
• Regardless of test results, contact your doctor if there are any signs of pregnancy (eg, delayed menstrual cycle, morning sickness).
• For some tests, color vision may be needed to properly read test results . Have someone else confirm results if in doub

Laxatives promote bowel emptying. Nonprescription laxatives are frequently misued due to lack of understanding of normal bowel function. Restrict self ­ medication to short-term therapy of constipation. Chronic use of laxatives (particularly stimulants) may lead to dependence. Prior to laxative use, consider living habits affecting bowel function including disease state and drug history. Rational therapy and prevention of constipation include: Adequate fluid intake (4 to 6 glasses of water daily), proper dietary habits including sufficient bulk or roughage, responding to the urge to defecate and daily exercise.

How The Drug Works

Stimulant laxatives act directly on the intestines, irritating the digestive tract lining and stimulating intestinal activity.

Uses

For short-term treatment of constipation.

To clean out the bowel before bowel examinations or bowel surgery.

Frequent use of laxatives and inadequate fluid can cause an imbalance in fluid and electrolyte levels. Symptoms may include muscle cramps, muscle weakness or dizziness.

Rectal bleeding o failure of the laxative to produce a bowel movement can indicate a more serious condition which requires medical attention.

Discoloration of the urine (yellow-brown, pink-red, red-violet or red-brown) may occur with phenolphthalein, cascara sagrada or senna.

Tartrazine: Some of these products may contain the dye tartrazine (FD&C Yellow No.5) which can cause allergic reactions in certain individuals. Check package label when available or consult your doctor or pharmalist.

Pregnancy: Adequate studies have not been done in pregnant women, or animal studies may have shown a risk to the fetus. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus. Improper use of these products can cause a dangerous electrolyte imbalance. Use of a bulk or stool-softening laxative is preferred.

Castor oil – Do not use during pregnancy. It can produce premature labor.

Breastfeeding: Cascara sagrada appears in breast milk. Use can result in diarrhea in the infant. Consult your doctor before you begin breast ­ feeding.

Children: Do not use bisacodyl tannex in children under 10 years of age.

Drug Interactions

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements while taking these products. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. Antacids and milk interact with bisacodyl.

Side Effects

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depends on many factors including dose, duration of therapy and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; vomiting; stomach pain; bowel cramping; diarrhea; bloating; gas.

Nervous System: Weakness; dizziness; fainting.

Other: Irritation of the rectal area; sweating; pounding of the chest (palpitations).

Guidelines for Use

• Use exactly as prescribed.
• Laxative use is only a temporary measure. Do not use longer than one week. Stop use of these products when normal bowel habits return. Prolonged, frequent or excessive use may result in dependence or electrolyte imbalance.
• Take with a full glass of water or juice.
• Bisacodyl- Swallow tablets whole (do not crush). Do not take within 1 hours of antacids or milk.
• Suspensions and emulsions – Shake well before use.
• Do not use if abdominal pain, nausea or vomiting occurs.
• Contact your doctor if unrelieved constipation, rectal bleeding, muscle cramps or pain, weakness or dizziness occurs.
• Phenolphthalein may cause a skin reaction. Stop using if this occurs.
• Biscodyl suppositories may cause proctitis and inflammation. Do not take these for long-term use.
• Pink-red, red-violet, yellow-brown or red-brown discoloration of the urine may occur, particularly with phenophthalein, senna or cascara sagrada.
• Some of these products may contain the dye tartrazine (FD&C Yellow No.5) which can cause allergic reactions in certain individuals. Check package label when available or consult your doctor or pharmacist.
• Prevention of constipation includes: Adequate fluid intake (4 to 6 glasses of water daily), proper dietary habits including sufficient bulk or rough age, responding to the urge to defecate and daily exercise.
• Effects usually occur in 6 to 10 hours with most of these products, except castor oil (2 to 4 hours) and bisacodyl suppositories (15 to 60 minutes). Plan accordingly.
• Store at room temperature.

How The Drug Works

Difenoxin and diphenoxylate, related to the narcotic pain reliever meperidine, act on intestinal tract muscles and slow intestinal motility. Atropine is present to discourage deliberate misuse of these drugs.

Uses

To relieve diarrhea.

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: Difenoxin and diphenoxylate may appear in breast milk.

Atropine appears in breast milk. Because of the potential for serious side effects in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Children: Do not use difenoxin tablets or diphenoxylate liquid in children under 2 years of age. Do not use diphenoxylate tablets in children under 13 years of age. Safety and effectiveness of difenoxin tablets have not been established in children under 12 years of age. Use with caution in children with Down syndrome due to presence of atropine.

Drug Interactions

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with antidiarrheals containing difenoxin, diphenoxylate, or atropine sulfate. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with antidiarrheals containing difenoxin, diphenoxylate, or atropine sulfate.

Side Effects

Every drug is capable of producing side effects. Many antidiarrheal users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Both: Nausea; vomiting; dizziness; drowsiness; headache.

Difenoxin Only: Constipation; lightheadedness; dry mouth; stomach pain.

Diphenoxylate Only: Stomach ache; appetite loss; toxic megacolon; paralyticileus; pancreatitis; restiessness; confusion; depression; exaggerated sense of well-being; itching; hives; swelling of gums; numbness of arms or legs; general body discomfort; allergic reaction.

Atropine Only: Dry skin; flushing; fever; fast heartbeat; urinary retention.

Guidelines for Use

• Difenoxin – Starting dose in adults is 2 mg by mouth, then 1 mg after each loose stool or 1 mg every 3 to 4 hours as needed. Total dose in any 24-hour period should not exceed 8 mg.
• Diphenoxylate – Initial dosage in adults is 2 tablets by mouth 4 times daily or 10 ml (2 tsp) of liquid 4 times daily (20 mg/day). Once control of diarrhea is achieved, reduce the dose to the lowest possible level (eg, 2 tablets daily) to maintain control.
• Do not use tablets for children under 13 years of age. Only use the plastic dropper included with the liquid to measure doses for children. Doses for children must be carefully determined. Talk to your doctor or pharmacist about the correct dose for your child.
• If clinical improvement of acute diarrhea is not observed within 48 hours, do not continue the medication. If improvement of chronic diarrhea is not seen within 10 days of using diphenoxylate (with a maximum daily dose of 20 mg), symptoms are unlikely to be controlled by further administration.
• Do not take more than the prescribed dose.
• Appropriate fluid and electrolyte therapy should be used in conjunction with diphenoxylate therapy in the treatment of diarrhea in children.
• Avoid alcohol and other sedatives that may cause drowsiness.
• May cause drowsiness or dizziness. Use caution when performing tasks requiring alertness, coordination, or physical dexterity.
• May cause dry mouth. Chew sugarless gum or suck sugarless hard candies if desired.
• Keep out of reach of children because accidental overdose may result in severe, even fatal, breathing problems.
• Notify your doctor if diarrhea persists or if fever, rapid heart rate, or stomach swelling occur.
• Store at room temperature (59^o to 86°F) in a child resistant container.
• Protect diphenoxylate from light.

How the Drug Works

Ovulation predictor kits test for the presence of luteinizing hormone (LH) in the urine. The pituitary gland increases LH production 12 to 16 days before menstruation begins. This “LH surge” causes an ovarian follicle to rupture and releases a mature egg in 1 to 1.5 days (24 to 40 hours). The onset of the LH surge (and therefore ovulation) can be estimated by using the ovulation predictor tests for several days. An egg survives for 12 to 24 hours after ovulation. If the egg and sperm are not united shortly after ovulation, conception will not occur.

It is possible the LH surge and ovulation will not occur during every menstrual cycle. Onset of menstrual bleeding does not always mean ovulation has occurred.

Uses

To aid in planning pregnancy; to determine fertile time of menstrual cycle.

Menopause: Women entering menopause may have high LH levels during their entire menstrual cycle.

Day for beginning testing is determined by the approximate length of the menstrual cycle, the first day being the onset of bleeding (even spotting), the last being the day before bleeding onset. Test kits vary regarding the date to begin testing. Follow manufacturers’ instructions carefully.

Specimen collection and handling: Collect urine in the urine cup from the kit or in a clean, dry container. If testing cannot be done in 3 to 4 hours after collecting the urine specimen, cover and refrigerate immediately. Let it return to room temperature before testing. Do not freeze specimen. For best results, do the test the same day as the urine was collected.

Time: Allow enough time to complete the test.

Drug Interactions

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements while testing for LH surge (ovulation). The following drugs and drug classes may interact with the test to cause questionable results:

1. Thyroid stimulating hormone (eg, Thyrogen)
2. HCG injection (eg, APL., Profasi HP)
3. Menopropins (eg, Pergonal)
4. Steroids (eg, prednisone)

Guidelines for Use of Ovulation Predictor Kits

• Do not use as a contraceptive aid. Results cannot guarantee that pregnancy will not occur.
• Follow the directions on the label exactly.
• Results may not be accurate during menopause, pregnancy, in the presence of ovarian cysts, or after an abortion.
• Not all women ovulate during every menstrual cycle.
• Drinking large quantities of water before the test may dilute the urine and interfere with the results.
• Have all the materials you need on hand before beginning the test: Test kit, timer (second hand and 30-minute timer), clean dry container, and pen or pencil for dating test. Be near a cold water faucet.
• Do test at the same time in the same room with the same lighting each day, if possible. It is best to test in the mid-morning (10 a.m.).
• Color vision is needed to properly read the test results. Have someone else confirm results if in doubt.
• Look for the FIRST noticeable change in color, not the darkest.

How the Drug Works

Glucose does not normally appear in the urine, but when too much glucose builds up in the blood, the excess spills over from the kidney into the urine where it can be detected by specially designed plastic test strips and reagent tablets containing chemicals which detect glucose in urine. Color changes occur according to the amount of sugar present.

Regular monitoring of glucose levels aids in the control of diabetes. It will help determine medication, exercise and dietary needs and help decrease complications (eg, kidney and eye problems) and problems during pregnancy.

Ketones appear in the urine when the body breaks down body fats to use as a source of energy or food. This can occur in fasting individuals, out­of-control diabetics and individuals on starvation diets. Proteins in the urine may be an early sign of kidney disease.

Uses

To detect glucose in urine.

To aid diabetics in monitoring medication regimens, diet and exercise programs.

To help prevent the development of complications and problems during pregnancy.

Avoid contact with skin, mucous membranes or clothing. If contact occurs, flush the affected area with large amounts of water. If test strips, tape, or tablets are eaten or rubbed in the eyes, contact your doctor or local poison control center immediately. If eaten, do not induce vomiting; instead, drink large amounts of water or milk. If contact with the eyes occurs, flush with water for 15 minutes. Get prompt medical attention.

Specimen Collection and Handling: Collect fresh urine in a clean, dry container and test as soon as possible. (An alternate method is to pass the test strips directly through the urine stream). If testing cannot be done within an hour after collection, refrigerate. Let it return to room temperature before testing. Prolonged exposure of unpreserved urine to room temperature (59° to 86°F) may result in bacterial contamination and bacterial consumption of the glucose. Urine preservatives may also affect the accuracy of test results.

Storage and Handling: For bottled strips-Store at room temperature (59° to 86 F). Do not store the bottle in direct sunlight. Protect from light, heat, and moisture.

Keep unused test strips in the original bottle with the cap tightly closed. Always replace the cap immediately and tightly. A new bottle of test strips can be used for 6 months after first being opened. Always write the date you first opened the bottle on the bottle label. Do not use the product after the expiration date. Use of strips beyond the expiration date may yield inaccurate test results. Never transfer strips to another bottle. Do not remove drying agent from the bottle. The agent absorbs moisture and keeps the strips dry. Never put cotton or other materials in the bottle. If test areas are discolored or darkened, throw the strip away and use a strip from a new bottle.

For tablets – Tablets have prolonged stability in the unopened container if stored at room temperature between 59° and 86°F. Do not refrigerate. Do not store in direct sunlight. Once the bottle is opened, protect from moisture. Excessive moisture may cause a chemical reaction and a bottle explosion may occur. Use tablets on a regular basis and do not store for extended periods of time after the bottle is opened. Recap the bottle tightly immediately after removing a tablet. Tablets in foil must be used immediately upon opening. Protect tablets from light, heat and moisture. Do not open the bottle in a steamy bathroom. Moisture causes tablets to turn a deeper shade of blue. If tablets darken or if test results seem questionable or inconsistent with expected findings:

Confirm that product is within expiration date shown on label or foil. Check performance with a positive control. If proper result is not obtained, discard and retest with a fresh tablet.

Tablets: Sugars other than glucose will cause a positive test result. These sugars include: Lactose, fructose, galactose, and pentose.

Ketones: High levels of ketones may cause false positive test results for urine containing small amounts of glucose.

How The Drug Works

These drugs reduce intestinal movement, absorb fluid, reduce the severity of intestinal inflammation and modify intestinal bacteria.

Uses

To treat diarrhea and the cramps and pain that accompany it. Adequate controlled studies demonstrating the effectiveness of these antidiarrheal combinations are lacking.

Opium (tincture, powder, or paregoric) is used to reduce the intestinal activity, to relieve the urge to have a bowel movement without success and to relieve the pain associated with diarrhea.

Belladonna alkaloids are used to control hyperactivity and increased secretion in the digestive tract.

Activated attapulgite, kaolin and pectin are used for their absorbent actions to bind up and remove digestive tract irritants.

Bismuth salts have antacid and absorbent properties.

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: It is not known if opium appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Not for use in children younger than 13 years of age.

Elderly: Use with caution in the elderly.

Drug Interactions

Tell your doctor or pharmacist if you are taking of if you are planning to take any over-the-counter or prescription medications or dietary supplements with this drug. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. CNS depressants interact with this drug.

Side Effects

Every drug is capable of producing side effects. Many ptients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include: blurred vision; constipation; dizziness; drowsiness; dry mouth; hives, rash; itching; nausea; photophobia; rapid pulse; urinary retention; vomiting.

Guidelines for Use

• Follow individual product instructions.
• Do not use if diarrhea is accompanied by a fever or if blood or mucus is present in stool.
• If severe diarrhea, stomach pain/cramps, or bloody stools occur, contact your doctor immediately. This could be, a symptom of a serious side effect requiring immediate medical attention. Do not treat diarrhea without first consulting your doctor.
• If you are taking a prescription medicine, consult your doctor before taking these products
• Inform your doctor if you are pregnant or nursing a baby.
• Drink clear fluids to prevent dehydration.
• Do not use agents that slow digestive tract motility for diarrhea associated with antibiotic caused colitis or in diarrhea caused by bacteria.
• Do not use these preparations for more than, 2 days, in the presence of high fever or in infants and children under 3, except under a doctors direction,
• Salicylate absorption may occur from bismuthsabsalicylate. Observe caution in patients with bleeding disorders or aspirin sensitivity and in children.
• Liquids – Shake well before using,
• Store at room temperature (68° to 77°F).

Type of Drug:

Antihypertensives; drugs used to lower high blood pressure.

Uses of The Combinations:

To treat high blood pressure. Used with other drugs when adequate control is not achieved by a single drug.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor.
• May cause stomach upset. Check with your doctor or pharmacist to see if your medicine can be taken with food or milk.
• Diuretics may increase urination. Take combinations containing diuretics early in the day.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless instructed by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• ACEls may cause a persistent dry cough. Recovery is rapid when the medicine is stopped .
• Dizziness, fainting, or light-headedness is most likely to occur after the first dose or in the first days of therapy. Avoid sudden changes in posture. If dizziness persists, contact your doctor.
• Do not take other prescription or OTC medications, dietary supplements, or salt substitutes unless instructed by your doctor or pharmacist.
• May cause sensitivity to sunlight. Avoid prolonged exposure to the sun and ultraviolet (UV) light (eg, tanning beds). Use sunscreens and wear protective clothing until tolerance is determined.
• Diuretics may increase blood sugar levels in diabetics.
• Many of these medications cause drowsiness or dizziness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity until tolerance is determined.
• Contact your doctor if significant, sudden joint pain occurs while taking combinations containing hydralazine
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant or if you are breastfeeding.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature in a tightly sealed container away from light.

Type of Drug:

Angiotensin converting enzyme inhibitors (ACEls); drugs used to lower blood pressure.

How the Drug Works:

Angiotensin converting enzyme (ACE) is involved in certain chemical reactions that constrict (narrow) blood vessels and cause sodium and fluid retention by the kidney. This can cause an increase in blood pressure. ACEls lower blood pressure by interfering with ACE, which causes blood vessels to relax (widen). Blow flows more freely and at a lower pressure. ACEls also increase the heart’s ability to pump blood in some types of heart failure.

Uses:

To treat high blood pressure alone or in combination with other blood pressure-lowering medications.

Captopril, Enalapril, Fosinopril, Lisinopril, Quinapril, Ramipril, Trandolapril: To treat certain types congestive of heart failure, usually in combination with other medications (eg, diuretics, digitalis).

CaptopriL: To treat diabetic nephropathy (kidney damage) in patients with Type I (insulin-dependent) diabetes mellitus and retinopathy.

Lisinopril: To improve survival in patients who have had a heart attack within 24 hours.

Unlabeled Uses: Occasionally, doctors may prescribe captopril for the management of specific types of hypertension crises or neonatal and childhood hypertension, treatment of rheumatoid arthritis, certain types of edema, Batter and Raynaud syndromes, and diagnosis of primary aldosteronism and certain kidney disorders. Enalapril has been used to treat diabetic nephropathy.

Precautions:

Low blood pressure: Dizziness and fainting due to lowered blood pressure may OCcur early in therapy. This effect is more likely to OCcur with concurrent diuretic treatment and when arising from a seated or lying position, but can OCcur at any time early in therapy. This effect can also OCcur if several doses are missed and then the medicine is restarted, if the dosage is increased rapidly, or if other blood pressure medications re added.

Potassium: Elevated serum potassium levels have occurred. Use with caulion in the presence of kidney disease, diabetes, and with potassium­ontaining products (eg, salt substitutes, potassium supplements

Cough: A persistent, dry, nonproductive cough can be caused by ACELs. The cough is more likely to OCCur in women and at low doses. Recovery is rapid and complete in 1 to 4 days when the drug has been discontinued.

Race: ACEls may not be as effective in black patients.

Pregnancy: Report pregnancy or suspected pregnancy to your doctor immediately.

First trimester: Fetal exposure to ACEls only during the first trimester usually causes no problems, but the drug should be stopped as soon as possible. Continue use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Second and third trimesters: Studies have shown a potential adverse effect on the fetus. When used during the second and third trimesters, ACEls can cause fetal harm or even death. Discontinue the drug as soon as possible.

Breastfeeding: Several ACEls appear in breast milk. It is not known if lisinopril, moexipril, perindopril, or ramipril appear in breast milk. Do not take fosinopril, ramipril, or trandolapril while breastfeeding. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness have not been established. There is limited experience with the use of captopril in children. Unpredictable decreases in blood pressure and associated complications have occurred. Use catopril in children only when other measures for control­ling blood pressure have not been effective.

Lab Tests: Lab tests will be required periodically during treatment. Tests include urine protein, liver function, kidney function, blood cell counts, and sodium and potassium levels.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements while taking these drugs. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with these drugs:

• Allopurinol (eg, Zyloprim) (captopril only)
• Antacids (eg, Maalox)
• Capsaicin (eg, Capsin)
• Diuretics (eg, furosemide)
• Lithium (eg, Eskalith)
• NSAIDs (eg, indomethacin)
• Phenothiazines (eg, promethazine)
• Potassium-containing salt substitutes (eg, Nu Salt)
• Potassium-sparing diuretics (eg, triamterene)
• Potassium supplements (eg, potassium chloride)
• Probenecid (captopril only)
• Rifampin (eg, Rifadin) (enalapril only)
• Tetracyclines (eg, oxytetracyline) (quinapril only)