Drug Facts

Type of Drug:

Diuretics (water pills); antiglaucoma agents.

How the Drug Works:

Carbonic anhydrase inhibitors block the activity of the enzyme carbonic anhydrase. This reduces the rate of fluid formation in the inner eye, resulting in reduced pressure within the eye. These drugs also cause Increased amounts of electrolytes (sodium, potassium, bicarbonate) and water to be excreted by the kidneys (diuretic effect) and slows abnormal nerve conduction in the brain (anticonvulsant effect).

Uses:

To treat chronic simple (open-angle) glaucoma and secondary glaucoma, and to lower intraocular pressure preoperatively for acute closed-angle glaucoma.

Acetazola.mide - To prevent mountain sickness in climbers who are attempting to climb rapidly and in climbers who climb gradually, but, who are prone to developing mountain sickness. Also used to treat flUid accumulation and swelling due to congestive heart failure or drugs and to treat some forms of epilepsy (eg, petit mal seizures).

Precautions:

Large doses: Taking larger than recommended doses does not increase the diuretic (water pill) activity of the drug. However, it will increase the risk of side effects.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if potential benefits to the mother out weight potential risks to the fetus.

Breastfeeding: Acetazolamide may appear in breast milk. It is not known if all carbonic anhydrase inhibitors appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children have not been established.

Lab Tests: Lab tests may be required during treatment. Tests may include electrolyte levels (eg, potassium) and blood counts.

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 doetary supplements with carbonic anhydrase inhibitors. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs interact with carbonic anhydrase inhibitors.

• Cyclosporine (eg, Sandimmune)
• Salicylates (eg. Aspirin, Arthropan, Doan’s Tusal)
• Salsalate (eg, Disalcid)
• Steroid therapy (eg, prednisone)

Side Effects:

Every drug is capable of producing side effects. Many carbonic anhydrase inhibitor 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: Appetite loss; nausea; vomiting; diarrhea; sore throat; taste changes.

Nervous System: Drowsiness; confusion; ringing in the ears; impaired coordination; headache; tingling in the hands or feet.

Skin: Rash; itching; unusual bleeding or bruising; sensitivity to light; red or purple spots under the skin.

Urinary and Reproductive Tract: Flank or loin pain; excessive urination; crystals in urine; kidney stones.

Other: Fever; weight loss; nearsightedness when decreasing or discontinuing the drug; abnormal blood counts; hearing dysfunction; severe allergic reaction.

Guidelines for Use:

• If stomach upset occurs, take with food .
• Drink plenty of water and other fluids.
• May cause drowsiness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Notify your doctor if sore throat, fever, unusual bleeding or bruising, tingling or tremors in the hands or feet, flank or loin pain, or skin rash occurs.
• May cause sensitivity to sunlight. Avoid prolonged exposure to the sun or ultraviolet (UV) light (eg, tanning beds).
• Store tablets, capsules, and injection at room temperature (59 0 to 86°F).

 

Acetazolamide:

• Tablets can be crushed and mixed with sweet foods to mask bitter taste.
• Do not crush or chew sustained release capsules. Capsules can be opened and contents sprinkled on food, if necessary.
• Acute Mountain Sickness - Dosage is 500 to 1000 mg daily, in divided doses, using tablets or sustained release capsules as appropiate. The higher dose level of 1000 mg is recommended with rapid ascent (eg, rescue or military operations). Dose should be initiated 24 to 48 hours before ascent and continued for 48 hours while at high altitude, or as long as necessary, to control symptoms. Gradual ascent is desirable to avoid acute moutain sickness. If rapid ascent is undertaken and acetazolamide used, prompt descent is still necessary if severe forms of altitude sickness (eg, lung edema or cerebral swelling) occur.
• Congestive Heart Failure - Starting dose is usually 250 to 375 mg once daily (5 mg/kg) in the morning. If the initial response fails, do not increase the dose, but allow the kidney to recover by skipping the medicine for a day.
• Acetazolamide yields the best diuretic results when given on alternate days or given for 2 days alternating with a day of rest.
• Drug-Induced Edema - Recommended dosage is 250 to 375 mg once a day for 1 to 2 days, alternating with a day of rest.
• Epilepsy - Suggested total daily dose is 8 to 30 mg/kg in divided doses. Optimum range appears to be from 375 to 1000 mg daily. When given in combination with other anticonvulsants, starting dose should be 250 mg once daily in addition to existing medicines.
• Glaucoma - Acetazolamide is used as an adjunct to the usual therapy. When using capsules, dosage is 500 mg (1 capsule) 2 times a day, usually given as 1 capsule in the morning and 1 capsule in the evening. Dosage for chronic simple (open-angle) glaucoma ranges from 250 to 1000 mg per 24 hours. Daily doses over 250 mg are usually taken in divided doses. For secondary glaucoma and in preoperative treatment of acute congestive (closed-angle) glaucoma, the preferred dosage is 250 mg every 4 hours.
• Doses larger than 1000 mg per 24 hours do not increase the effect and may increase drowsiness and other side effects.

Methazolamide:

• Effective therapeutic dose varies from 50 to 100 mg 2 to 3 times daily.
• May be used with miotic (eg, Pilocarpine) and osmotic (eg, mannitol) agents.

Dichlorphenamide:

• Usually given in conjunction with topical ocular antiglaucoma agents.
• In acute angle-closure glaucoma, it may be used together with miotic and osmotic agents in an attempt to reduce internal pressure rapidly. If this is not relieved quickly, surgery may be mandatory.
• Dose must be adjusted carefully to each individual.
• A usual initial dose is 100 to 200 mg (2 to 4 tablets), followed by 100 mg (2 tablets) every 12 hours until the desired response has been obtained.
• Recommended maintenance dosage for adults is 25 to 50 mg (V2 to 1 tablet) 1 to 3 times daily.

Type of Drug:

Female hormones; estrogens.

How the Drug Works:

Estrogens represent a group of several female hormones. The ovary produces and releases several natural estrogens until menopaUse occurs. All estrogens produce similar effects. They playa key role in the development and normal function of the reproductive system (inCluding the vagina, uterus, fallopian tubes, and breasts) and secondary sex characteristics (eg, pubic hair) of women. Estrogens also assist in development and maintenance of strong bones.

Uses:

To treat hot flashes associated with menopause. To treat vulval, vaginal, and lower urinary tract tissue breakdoWn drying and thinning following menopause. Estrogen supplements maY prevent or decrease complications. To treat kraurosis vulvae, a condition involving the breakdown a.nd drying of the external female genitalia (vulval area).

For estrogen replacement therapy after a failure of the ovaries due to menopause, disease, or surgical removal.

To treat advanced androgen-dependent cancer of the prostate gland in men.

To relieve the symptoms of breast cancer in selected men and Women with metastatic disease.

Conjugated estrogens, injection: To treat abnormal uterine bleeding caused by hormone imbalance.

Estradiol tablets and transdermal system (patch): To prevent osteoporosis (brittle bones) related to a lack of estrogen after menopause. Therapy should be accompanied by a balanced diet, adequate daily calCium either through the diet or calcium supplements, adequate vitamin D, and weight-bearing exercises.

Unlabeled Uses: Ethinyl estradiol has been used for treating Turner syndrome.

Precautions:

Blood Clots.’ There is an increased risk of blood clots in men receiving estrogens for prostate cancer, in women using estrogens for postpartum breast engorgement, and in those taking oral contraceptives in general.

Cancer Risk: Estrogens may increase the risk of endometrial (lining of the uterus) cancer in postmenopausal women. Have regular physical examinations and contact your doctor if you experience persistent or recur­rent abnormal vaginal bleeding.

Concurrent progestin therapy: A progestin agent is frequently added to long-term estrogen regimens in women who have a uterus. The addition of a progestin reduces the risk of estrogen-induced cancer of the uterus.

History/physical exam: Before beginning estrogen therapy, a complete medical and family history should be performed. Examinations every 12 months should include blood pressure tests, abdomen and pelvic organ examinations, and a Pap test (once a year). Patients should examine their breasts for lumps on a monthly basis. Women older than 40 years of age who take estrogens should have regular mammogram’s.

Pregnancy: Do not use during pregnancy. The risk of use in a pregnant woman clearly outweighs any possible benefit. Urinary system problems and testicular cancer have occurred in sons of women given diethyl­stilbestrol (DES) (not available in the US) during pregnancy. Daughters of women given DES during their pregnancy have shown an increased risk of developing vaginal or cervical cancer.

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

Children: Safety and effectiveness in children have not been established.

Use with extreme caution in young patients who are still growing. Estrogens may interfere with normal bone development.

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 pharmacist.

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 this medicine. 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 this medicine:

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 depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Urinary and Reproductive Tract: Change in menstrual flow; abnormal vaginal bleeding; vaginal discomfort or pain; vaginal infection; unusual vaginal secretions; painful menstruation; absence of menstruation during or after treatment; premenstrual-like syndrome; increased size of uterine fibroids; urinary tract infection symptoms.

Digestive Tract: Nausea; vomiting; stomach pain or cramps; bloating; pancreatitis; diarrhea; gas; enlarged stomach; constipation; indigestion.

Nervous System: Headache; migraine; dizziness; depression; weakness; unusual, jerky body movements; sleeplessness; emotional instability; anxiety; nervousness.

Skin: Rash; hives; itching; skin discoloration, particularly on the face; scalp hair loss; excessive growth of body or facial hair.

Local: Pain at the injection site; redness; irritation or itching at patch application site.

Other: Intolerance to contact lenses; weight changes; breast tenderness or enlargement; breast milk secretion; sudden vision problems; abnormal blood glucose levels; swelling; high blood pressure; changes in sex drive; yellowing of skin or eyes; swelling of the arms or legs; vertigo (feeling of whirling motion); cough; abnormal lab tests; gallbladder disease; blood clots; steepening of corneal curvature; reduced carbohydrate tolerance; liver tumor development; runny nose; back, joint, muscle, or bone pain; sore throat; flu-like symptoms; hot flushes; palpitations (pounding in the chest); leg cramps; abnormal skin sensations

• Guidelines for Use:
• Dosage is individualized.
• Carefully read the patient package insert available with your medicines.
• The lowest dose that will control symptoms should be chosen and medication should be discontinued as soon as possible.
• Notify your doctor immediately if you experience pain in the groin, calves, or chest; sudden shortness of breath; abnormal vaginal bleeding; missed menstrual period or suspected pregnancy; lumps in the breast; severe headache; dizziness; fainting; changes in vision or speech; weakness or numbness in an arm or leg; stomach pain, swelling, or tenderness; yellowing of the skin or eyes; severe depression; severe vomiting; or coughing up blood.
• Fluid retention caused by estrogens may aggravate asthma, epilepsy, migraine, heart disease, or kidney disease. Use with caution if you have any of these conditions.
• If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose in order to catch up, unless advised to do so by your doctor. If several doses are missed, or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• While taking estrogens, it is important to visit your doctor at least once a year for a check-up. If members of your family have had breast cancer or if you have ever had breast lumps, you may need to have more frequent breast exams.
• Approximately every 6 months, you and your doctor should reevaluate whether or not you need to continue estrogen therapy.
• Diabetic patients - Glucose tolerance may be decreased. Monitor blood sugar closely and report changes to your doctor.
• When using estrogens to treat hot flashes and other symptoms of menopause, the dose may need to be changed occasionally. Discuss your symptoms with your doctor.
• Inform your doctor if you are pregnant, become pregnant, or are planning to become pregnant or if you are breastfeeding.
• Do not share your medicine with anyone else.
• Brand interchange - Do not change from one brand of these drugs to another without consulting your pharmacist or doctor. Products manufactured by different companies may not be equally effective and will require different doses .
• Injections - Visually inspect solutions for particles or discoloration. If you are self-administering, carefully follow the storage, preparation, and administration instructions provided by your health care provider.
• Transdermal system (patch) - Apply immediately after opening the pouch and removing the protective liner. Press firmly in place with the palm of the hand for approximately 10 seconds. Make sure there is good contact, especially around the edges. Avoid touching the sticky side of the patch with your fingers. Place adhesive side of the system on a clean, dry area of the skin on the trunk of the body that is not exposed to sunlight, preferably the buttocks or the abdomen. Do not apply to the. breasts.

• Transdermal system (patch) (cont.) When it is time to change the patch, remove the old patch and discard. Apply a new patch on a different skin site. Rotate the application site with an interval of at least 1 week between applications to a particular site. The area selected should not be oily, damaged, or irritated. Avoid the waistline since tight clothing may rub the system off. Application to areas where sitting would dislodge the system should also be avoided. In the unlikely event that a system should fall off, the same system may be reapplied. If necessary, apply a new system. In either case, continue the original treatment schedule. If a rash or irritation develops at an application site, remove the patch and reapply at a different site. Contact your doctor if rash or irritation continues with each patch application. Contact with water while bathing, swimming, or showering will not affect the patch.
• Vaginal creams - Fill the applicator provided with the prescribed amount of cream. Insert the applicator high into the vagina. After use, clean applicator by removing the plunger from the barrel. Wash with mild soap and warm water. Do not boil or use hot water. Cream exposure has been reported to weaken latex condoms. The potential for creams to weaken and contribute to the failure of condoms, diaphragms, or cervical caps made of latex or rubber should be considered.
• Vaginal ring — Press the ring into an oval shape and insert as deeply as possible into the upper one-third of the vaginal vault. The ring will remain in place continuously for 3 months, after which it is removed and, if appropriate, replaced by a new ring. The exact position of the ring is not critical, although if you feel discomfort, it is probably not far enough inside the vagina. You should not feel the ring when it is in place and it should not interfere with sexual inter­course. Some women have experienced moving or gliding of the ring in the vagina. Instances of the ring being expelled from the vagina in connection with moving the bowels, strain, or constipation have been reported. If this occurs, the ring can be rinsed in lukewarm water and reinserted into the vagina. The ring should be removed if another intra vaginally administered medication is being used. The ring may be removed by hooking a finger through the ring and pulling it out. Contact your doctor if signs of vaginal irritation develop.
• Calcium - If you are taking calcium supplements as part of the treatment to prevent osteoporosis, check with your doctor about the amounts recommended.
• Storage - Before reconstitution, store the conjugated estrogens injection in the refrigerator (36° to 46°F). Use the reconstituted solution within a few hours. Reconstituted solution is stable for 60 days in the refrigerator. All other dose forms can be stored at controlled room temperature (59° to 86°F).

Type of Drug:

Water-soluble vitamin. Vitamin not stored by the body.

How the Drug Works:

Riboflavin (vitamin B 2 ) acts in a variety of important metabolic processes in the body and promotes healthy skin and vision.

Uses:

To treat and prevent riboflavin deficiency. Symptoms of riboflavin deficiency include itching and burning eyes, lips, mouth, or tongue; sensitivity to light; sore throat; mouth or tongue inflammation; scrotal or vulva skin changes; skin inflammation; red eyes; cataract formation; dry lips and corners of the mouth; or scaly skin inflammation on the face and scalp.

Precautions:

Multiple vitamin deficiencies: It is unusual for riboflavin deficiency to Occur alone. Other vitamins and protein may also be needed. Consult your pharmacist or doctor.

Pregnancy: Adequate, well-controlled studies have failed to demonstrate risk to the fetus. In doses that exceed RDA, risk cannot be ruled out. However, potential benefits to the mother may justify the potential risks to the fetus. Consult your doctor.

Breastfeeding: Riboflavin is excreted in breast milk. Consult your doctor before you begin breastfeeding.

Doses:

Guidelines for Use:

• Most people on balanced diets do not need vitamin supplements. People with excessive alcohol intake, mal absorption, or poor diets are at risk for riboflavin deficiency.
• Dosage for treatment of deficiency states is 5 to 10 mg/day
• May cause a yellow discoloration of the urine when taken in large doses.
• Recommended Dietary Allowances (RDAs) _ Males: 1.4 to 1.8 mg Females: 1.2 to 1.3 mg
• Common sources of riboflavin - Meats, poultry, fish, dairy products, broccoli, turnips, asparagus, spinach, enriched and fortified grains, cereals, and bakery products.
• Store at controlled room temperature (59° to 86°F). Protect from moisture.

Type of Drug:

Water-soluble vitamin. Vitamin not stored by the body. Nicotinamide (niacin amide) is chemically related to niacin.

How the Drug Works:

Niacin (nicotinic acid) is a biochemical entity involved in fat metabolism, tissue respiration, and energy production. Vitamins do not give people energy, even though they are involved in the energy production process in the body.

Niacin and nicotinamide both act as vitamins in the body. However, only niacin dilates blood vessels in the face, neck, and chest and lowers cholesterol and tryingly levels in the blood.

Uses:

The following information pertains primarily to uses of niacin in doses rotor than the incommoded Dilatory Allowanco (RDA).

To prevent or to treat niacin deficiency. Niacin requirements may be increased during periods of increased calorie use (recovery from illness or injury).

To prevent and to treat pellagra. Pellagra is rare. It Occurs most frequently in alcoholics, the poorly-nourished elderly, and people on unusual diets. It also occurs in areas where much corn is eaten, because the niacin in corn is bound to indigestible constituents, making it unavailable for use by the body.

Precautions:

Do not use in the following situations: allergy to niacin or any of its liver disease ingredients peptic ulcer, active bleeding, arterial

Use with caution in the following situations: alcoholics heart disease angina, unstable jaundice, history of bleeding, arterial, history of liver disease, history of diabetes MI, acute phase gallbladder disease peptic ulcer, history gout

Diabetes mellitus: Niacin may decrease glucose tolerance. Diet or blood sugar lowering drugs may have to be adjusted. Consult your doctor before taking niacin supplements.

Gout: Niacin may cause an increase in uric acid levels, possibly causing a gout attack.

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

Breastfeeding: Niacin appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and efficacy in children have not been established in doses that exceed the RDA.

Lab tests may be required to monitor therapy. Tests may include lipids (cholesterol and triglycerides), blood glucose, and liver function tests.

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 niacin. 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 niacin:

• Beta blockers (eg, propranolol)
• HMG-CoA reductase inhibitors (eg, lovastatin)
• Sulfinpyrazone (eg, Anturane)

Doses:

Side Effects:

Every drug is capable of producing side effects. Many niacin 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: Stomach distress or pain; nausea; vomiting; diarrhea; indigestion; activation of peptic ulcer.

Skin: Rash; hives; itching; dry skin; flushing; tingling of skin; sensation of warmth; thickening and brownish discoloration of the skin in bony folds.

Other: Headache; low blood pressure; dimming of vision; abnormal heart rhythms; liver dysfunction; lab test abnormalities; elevated blood sugar; yellowing of the skin or eyes; gout; vision changes.

Guidelines for Use:

• Most people on balanced diets do no need vitamin supplements.
• Recommended Dietary Allowances (RDAs) ­ Adult males: 15 to 20 mg Adult females: 13 to 15 mg
• For hyperlipidemia - Usual target dosage is 1 to 2 g 2 or 3 times daily. Do not exceed 6 g/day. For pellagra - Take up to 500 mg/day.
• Niacinamide - Usual dosage is 100 to 500 mg/day.
• Sustained-, extended-, or timed-release products - Take whole. Do not break, crush, or chew before swallowing.
• Do not substitute sustained-, extended-, or timed-release preparations for immediate-release (crystalline) nicotinic acid.
• May cause stomach upset. Take with meals.
• If dizziness occurs, avoid sudden changes in posture.
• Flushing appears frequently with oral therapy and generally begins 20 minutes after ingestion and lasts 30 to 60 minutes. Flushing is transient and will usually subside after 3 to 6 weeks of continued therapy. The flush response can be reduced by slowly increasing the dose (100 mg 3 times daily each week), administering with food or milk, or by administering either a ministerial anti-inflammatory drug (eg, ibuprofen) or aspirin 60 minutes prior to niacin administration.
• Discontinue use and contact a doctor if any of the following symptoms occur: Persistent flu-like symptoms (nausea, vomiting, general unwell feeling); hives; loss of appetite; decreased urine output associated with dark-colored urine; muscle discomfort such as tender, swollen muscles or muscle weakness; irregular heartbeat; or dimming of vision.
• Common sources of niacin - Liver, meat, fish, chicken, nuts, legumes, green vegetables, yeast, potatoes, and whole-grain enriched cereals and breads.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at controlled room temperature (59° to 86°F).

Type of Drug:

Antihypertensive; blood pressure-lowering agent.

How the Drug Works:

Angiotensin II is a chemical transmitter that combines with chemical receptors in blood vessels and other tissues and causes blood vessels to constrict (narrow) and the kidneys to retain sodium and fluids. Angiotensin II receptor antagonists inhibit the action of angiotensin II and allow the blood vessels to dilate (widen) and the kidneys to eliminate extra sodium and fluids. These actions combine to help lower elevated blood pressure.

Uses:

To lower blood pressure. May be used alone or in combination with other antihypertensive agents.

Precautions:

Irbesartan, losartan: To treat diabetic nephropathy (kidney damage) in patients with type 2 diabetes and hypertension.

Valsartan: To treat heart failure in patients who cannot tolerate angiotensin­converting enzyme (ACE) inhibitors.

Race: Angiotensin II receptor antagonists may not be as effective in black patients.

Pregnancy:

First Trimester When pregnancy is detected, the patient should discontinue use as soon as possible. Use only if clearly needed and the potential benefits outweigh the possible risks to the fetus.

Second and Third Trimesters - Studies have shown a potential adverse effect on the fetus.

Breastfeeding: It is not known if angiotensin II receptor antagonists are excreted in breast milk. Because of the potential for adverse effects, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness of irbesartan in children younger than 6 years of age have not been established. Safety and effectiveness of other agents in children younger than 18 years of age have not been established.

Elderly: Older patients may be more sensitive to the blood pressure-lowering effects of these agents.

Lab Tests: Lab tests may be required to monitor therapy. Tests include blood pressure readings, kidney function tests, liver function tests, and blood tests for electrolytes (eg, potassium).

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over- the-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:

• Digoxin (eg, Lanoxin) (telmisartan only)
• Indomethacin (eg, Indocin) (Iosnrtnn only)
• Potassium-containing salt substitutes
• Potassium-sparing diuretics (eg, spironolactone)
• Potassium supplements (eg, K-Our)

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 depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Indigestion; diarrhea; nausea; heartburn; stomach pain; vomiting.

Nervous System: Headache; dizziness; fatigue; nervousness; anxiety; sleeplessness; depression.

Respiratory System: Upper respiratory tract infection; cough; nasal congestion; sinus irritation; runny nose; sore throat; bronchitis.

Other: Rapid heartbeat; changes in blood pressure; chest, muscle, back, leg, or joint pain; muscle cramps; viral infection; swelling (fluid retention); trauma; weakness; flu; urinary tract infection; rash; protein in the urine; dizziness when rising from a sitting or lying position (orthostatic hypotension).

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instucted by your doctor.
• May be taken without regard to food. Take with food if stomach upset occurs.
• Telmisartan - Do not remove tablets from blister pack until just before taking.
• May be taken with other blood pressure-lowering agents prescribed by your doctor.
• Maximum blood pressure-lowering effect is generally attained after 2 to 4 weeks.
• 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.
• May cause dizziness or drowsiness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity until tolerance is determined.
• Dehydration (eg, excess sweating, vomiting, diarrhea) may increase the blood pressure-lowering effect, causing dizziness or fainting. Notify your doctor if dizziness develops.
• A low dose of a diuretic may be added by your doctor if blood pressure is not controlled.
• Inform your doctor immediately if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Lifestyle changes (eg, stop smoking, lose weight, exercise, limit salt in diet) also help to reduce blood pressure.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (68° to 77° F for eprosartan and olmesartan; 59° to 86°F for other agents) in a tightly closed container. Protect from light and moisture.

Type of Drug:

Antinauseants; antiemetics; drugs used to prevent nausea and vomiting.

How the Drug Works:

Dolasetron, granisetron, and ondansetron are selective serotonin 5-HT 3 receptor antagonists that block serotonin stimulation to prevent nausea and vomiting.

Uses:

Oral doseforms - To prevent nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemstherapy.

Oral dolasetron and ondansetron - To prevent postoperative nausea and vomiting.

Oral granisetron and ondansetron - To prevent nausea and vomiting associated with radiotherapy in patients receiving either total body irradiation, single high-dose fraction, or daily fractions the abdomen.

Intravenous (IV; into a vein) dolasetron - To prevent and treat postoperative nausea or vomiting.

Unlabeled Uses: Dolasetron has been used to treat radiotherapy-induced nausea and vomiting. Granisetron has been used for acute nausea and vomiting following surgery. Ondansetron has been used in the treatment of nausea and vomiting associated with acetaminophen poisoning, acute levodopa-induced psychosis, and prostacyclin therapy; to reduce bulimic episodes in patients with bulimia nervosa; to treat patients with social anxiety disorder; and as treatment of spinal or epidural morphine-induced pruritis.

Precautions:

Benzyl alcohol: Some of these products contain benzyl alcohol, which has been associated with a fatal “gasping syndrome” in premature infants. Consult your doctor or pharmacist.

Phenylketonuria: Ondansetron orally-disintegrating tablets contain phenylalanine. Consult your doctor or pharmacist.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Ondansetron appears in breast milk. It is not known if other 5-HT 3 receptor antagonists appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness for use of dolasetron and the injection form of granisetron in children younger than 2 years of age have not been established. Safety and effectiveness for use of the oral form of granisetron in children of any age have not been established. Safety and effectiveness for use of ondansetron in children 3 years of age and younger have not been established.

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 supplolnol1ls while taking a 5-HT 3 receptor antagonist. Doses of one or both drugs may need to be modified or a different drug may need to be prescribrd. Rifamycins (eg, rifampin) interact with ondansetron

Side Effects:

Every drug is capable of producing side effects. Many 5-HT 3 receptor antagonist 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: Diarrhea; nausea; constipation; stomach pain; appetite loss; taste disorder; indigestion; dry mouth.

Nervous System: Headache; drowsiness; weakness; agitation; fatigue; anxiety; stimulation; sleeplessness; dizziness; flushing; shivers; chills; vertigo (feeling of whirling motion); agitation.

Other: Changes in blood pressure; fever; heart rhythm changes; hair loss; abnormal blood counts; muscle, joint, chest, or bone pain; general body discomfort; injection site reaction; cold sensation; rash; tremor; itching; urinary retention; tingling or prickling sensation; deficient oxygenation of the blood.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking, unless advised by your doctor.
• Ondansetron orally-disintegrating tablets - Remove the tablets from the package just before taking. Peel backing off blister and remove tab­let gently. Place tablet on the tongue and swallow with saliva. Tablets disintegrate rapidly on the tongue and do not require water for dissolution or swallowing.
• Contact your doctor immediately if you experience rash, itching, short­ness of breath, abnormal heart rhythm, dizziness, fainting, low blood pressure, hives, facial swelling, or difficulty breathing.
• Dolasetron injection can be mixed in apple or apple-grape juice and given orally. The mixed product may be kept up to 2 hours at room temperature (59 to 86°F).
• Store at controlled room temperature (68 to 77°F). Protect from light. Do not freeze injection vials.

Type of Drug:

A drug used for specific types of severe irregular heartbeats.

How the Amiodarone Works:

Amiodarone corrects and prevents the occurrence of various types of irregular heart rhythms that may lead to life-threatening situations.

Uses of The Amiodarone:

To treat certain life-threatening heart rhythm disturbances (eg, recurrent ventricular fibrillation, recurrent hemodynamically unstable ventricular tachycardia) that are not affected by other antiarrhythmics or when other drugs are not tolerated.

Unlabeled Uses: Sometimes used to treat refractory sustained or paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia, and symptomatic atrial flutter. May improve left ventricular ejection fraction, exercise tolerance, and ventricular arrhythmias in patients with congestive heart failure.

Precautions:

Potentially fatal toxicities: Amiodarone has caused pulmonary toxicity (eg, hypersehsitivity pneumonitis or interstitial/alveolar pneumonitis). Overt liver disease has been reported, resulting in a few deaths. Significant heart block or sinus bradycardia has also been reported.

Heart effects: A worsening of heart rhythm irregularities is unusual while under treatment but can occur. Amiodarone can also cause slow heart rates or occasional pauses in the heart rhythm.

Sensitivity to sunlight: Amiodarone has caused sensitivity of the skin to sun­light and to ultraviolet light. During long-term treatment, exposed skin may appear blue-gray. Risk is increased in patients with a bit with a fail complexion and in those with excessive exposure to the sun and wear protective clothing.

Pregnancy: Amiodarone can cause fetal harm when administered to a pregnant woman. There have been some reports of congenital goiter/ hypothyroidism and hyperthyroidism. Use only if clearly needed and potential benefits to the mother outweigh the possible hazards to the fetus.

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 amiodarone. 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 amiodarone:

• Antiarrhythmics, other (eg, procainamide)
• Anticoagulants (eg, warfarin)
• Calcium channel blockers (eg, verapamil)
• Cimetidine (eg, Tagamet)
• Cyclosporine (eg, Neoral)
• Digoxin (eg, Lanoxin)
• Disopyramide (eg, Norpace)
• Fentanyl (eg, Sublimaze)
• Flecainide (Tambocor)
• Methotrexate (eg, Rheumatrex)
• Hydantoins (eg, phenytoin)
• Quinidine (eg, Quinora)
• Quinolones (eg, sparfloxacin)
• Ritonavir (Norvir)

Side Effects:

Every drug is capable of producing side effects, Many amiodaro ne 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:

Eyes or Ocular: Appearance of halos around lights; sensitivity to light; blurred or spotty vision; dry eyes’, sensitivity to light; permanent blindness; eye discomfort; fluid accumulation at the optic disc; other vision disturbances; eye degeneration; optic nerve disease.

Digestive Tract: Nausea; vomiting; constipation; diarrhea; loss of appetite; stomach pain.

Nervous System: Tremors; twitches; fatigue; loss of coordination; unsteady walking; dizziness; numbness and tingling in hands and feet; difficulty sleeping; headache; general discomfort·, abnormal gait.

Circulatory System: Slowing of heartbeat (rhythm); worsening of irregular heart rhythm; decrease in blood pressure; decrease in blood platelets; coagulation abnormalifies; heart failure; heart block.

Respiratory System: Difficulty breathing (shortness of breath); coughing; abnormal x-ray or biopsy; fibrosis.

Skin: Sensitivity to sunlight; blue-gray skin color; rash; dermatitis; unexplained bruising; hair loss; flushing; abnormal skin sensations (eg, burning, prickling, tingling).

Other: Disturbances in thyroid, respiratory, kidney and liver function (cirrhosis, hepatitis); abnormal taste and smell; edema (fluid retention); abnormal salivation; loss of sex drive; abnormal blood tests.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking unless advised by your doctor.
• High doses of amiodarone are usually required for the first 1 to 3 weeks of treatment.
• Take with meals, especially if stomach upset Occurs.
• 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 advised 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.
• Inform your doctor if you are pregnant, become pregnant, planning to become pregnant, or are breastfeeding before beginning therapy.
• May cause photosensitivity (sensitivity to sunlight). Use sunscreen and wear protective clothing until tolerance is determined.
• Shortness of breath, coughing and abnormal diagnostic tests (eg, chest x-ray, lung biopsy) can occur. Report changes in breathing or vision, or any coughing to your doctor and have a routine chest x-ray.
• Loss of vision can occur. Inform your doctor if your vision changes or your peripheral vision decreases.
• Store at room temperature (59 0 to 86°F). Keep in a tight container away from light.

Type of Drug:

Antithyroid drugs.

How the Antithyroid Agents Works:

The oral antithyroid drugs inhibit the formation of thyroid hormones.

Uses of The Antithyroid Agents:

To treat hyperthyroidism (overactive thyroid gland). To treat or prepare the overactive thyroid for surgery or radioactive iodine therapy. Sodium iodide I 131 preparations may be used to treat certain forms of thyroid cancer.

Unlabeled Uses: Occasionally doctors may prescribe propylthiouracil to treat liver disease due to alcoholism.

Precatuions:

Pregnancy: Studies have shown a potential adverse effect to the fetus. Us only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus. These agents, if used carefully, are effective in treating hyperthyroidism complicated by pregnancy. Dose must be adequate but not excessive. These drugs cross the placenta and could induce goiter or even cretinism (congenital lack of thyroid secretion which can stop physical and mental development) in the fetus. Propylthiouracil is less likely than methimazole to cross the placenta.

Breastfeeding: Patients receiving antithyroid preparations should not breastfeed.

Children: Safety and effectiveness of sodium iodide I 131 in children have not been established. Sodium iodide I 131 is not usually used for treatment of hyperthyroidism in patients under 30 years of age unless circumstances preclude other methods of treatment.

Lab Tests: Lab tests will be required to monitor therapy. Tests include blood count , bone marrow function, and thyroid function.

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 an antithyroid agent. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs or drug classes interact with antithyroid agents:

Side Effects of Antithyroid Agents:

Every drug is capable of producing side effects. Many antithyroid agent 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: Nausea; vomiting; stomach upset or pain; loss of taste sensation; swelling of salivary glands.

Nervous System: Abnormal skin sensations; headache; drowsiness; depression; feeling of whirling motion; hyperactivity.

Skin: Unusual bleeding or bruising; rash; itching; hives; excessive skin pigmentation; yellowing of skin or eyes; abnormal hair loss.

Other: Joint or muscle pain; fever; fluid retention (edema); swollen lymph glands; abnormal blood counts; kidney disease; lung disease; liver disease; low blood sugar.

Other: Sodium iodide I 131 only: Radiation sickness (eg, nausea, vomiting); anemia; chromosomal abnormalities; tenderness and swelling of the neck; pain on swallowing; sore throat; cough; temporary thinning of hair.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking this medicine unless advised to do so by your doctor.
• Take methimazole or propylthiouracil at regular intervals around the clock (usually every 8 hours), unless directed otherwise by your doctor.
• Notify your doctor if fever, sore throat, hay fever, unusual bleeding or bruising, headache, general body discomfort, rash, yellowing of the skin, vomiting, itching, appetite loss, skin surface changes, or pain in the upper right side of your body occurs.
• If a dose of methimazole or propylthiouracil 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 advised to do so 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.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store methimazole or propylthiouracil at room temperature (59° to 86°F). Store sodium iodide I 131 at room temperature controlled in compliance with government regulations.