Drug Facts

Type of Drug:

Amino acid derivative.

How the Drug Works:

Occurring naturally in the body, Localities is needed by the body for energy metabolism and to properly use fats.

Uses:

To supplement the diet of people born with primary carnation deficiency. Symptoms of primary carnitine deficiency include low blood sugar, lethargy, liver problems, heart problems, muscle weakness, neurologic disturbances, and impaired growth and development in infants.

Carnitor is used for the acute and chronic treatment of patients with internal metabolism errors that cause a secondary carnitine deficiency. It is also used for the prevention and treatment of carnitine deficiency in patients with end-stage kidney disease who are also undergoing dialysis.

Unlabeled Uses: Occasionally doctors may prescribe L-carnitine for modifying abnormal plasma lipoprotein patterns.

Precautions:

Do not use in the following situations: Allergy to L-carnitine or any of its ingredients.

Kidney disease: Patients with kidney disease taking D, L-carnitine (not L-carnitine) have, on rare occasions, noted mild muscle weakness.

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 risks to the fetus.

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

Lab tests may be required to monitor therapy. Tests include blood chemistries, vital signs, plasma L-carnitine concentrations, and overall clinical condition

Dosage

Side Effects:

Every drug is capable of producing side effects. Many L-carnitine 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 cramps; diarrhea.

Other: Body odor.

Guidelines for Use:

• Dosage will be individualized.
• Capsules and tablets - Take on an empty stomach.
• Oral solution - Take alone or dissolve in drinks or liquid food. Consume slowly. Space doses evenly (eg, every 3 or 4 hours), prefer- ably with or after meals.
• D, L-carnitine, sold in health food stores as vitamin BT’ inhibits L-carnitine and can cause a deficiency.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at controlled room temperature (59° to B6°F).

Type of Drug:

Anticonvulsant; antiepileptic.

How the Lamotrigine Product Works:

It is not known exactly how lamotrigine works. It is believed that lamotrigine prevents or reduces the number of seizures by acting on stabilizing the brain to control the activity of nerve impulses.

Uses of The Lamotrigine:

As an additional therapy in the treatment of partial seizures in patients older than 16 years of age with epilepsy.

Unlabeled Uses: Occasionally, doctors may prescribe lamotrigine to adults with generalized clonic-tonic seizures.

Precautions:

Rash may occur during treatment with this medicine and may be a symptom of a serious allergic reaction. If a rash should develop, discontinue lamotrigine if the drug is suspected and contact your doctor immediately. The incidence of severe, potentially life-threatening rash in pediatric patients is very much higher than that reported in adults using lamotrigine. Specifically, reports from clinical trials suggest that as many as 1 in 50 to 1 in 100 pediatric patients develop a potentially life-threatening rash. Thus, lamotrigine is not approved for use in patients below the age of 16.

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.

Breastfeeding: Lamotrigine appears in breast milk. Breastfeeding while taking lamotrigine is not recommended. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children younger than 16 years of age have not been established.

Lab Tests: Lab tests to monitor the amount of lamotrigine and other seizure drugs in the blood may be needed. Since it is possible that lamotrigine may collect in the tissues of the eyes, testing may be necessary if visual impairment occurs.

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 lamotrigine. 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 lamotrigine:

• Carbamazepine (eg, Tegretol)
• Phenobarbital (eg, solfoton)
• Phenytoin (eg, dilantin)
• Valroic acid (eg, depakene)

Side Effects:

Every drug is capable of producing side effects. Many lamotrigine 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:

Circulatory System: Hot flashes; pounding in the chest (palpitations); chest pain.

Digestive Tract: Stomachache; nausea; vomiting; diarrhea; indigestion; constipation; dry mouth; loss of appetite; tooth disorder.

Nervous System: Dizziness; incoordination; drowsiness; sleeplessness; tremor; depression; anxiety; nervousness; hostility; convulsions; worsened seizures; irritability; speech disorder; memory loss; confusion; thinking abnormality; unstable emotions; mind racing; rapid eye movement; concentration disturbance; feeling of whirling motion.

Respiratory System: Sore throat; increased cough; difficulty breathing; congestion.

Urinary and Reproductive Tract: Painful menstruation; inflammation of the vagina; absence of menstrual bleeding;

Skin: Rash; itching; hair loss; acne. Senses: Double vision; blurred vision.

Other: Headache; flu syndrome; fever; neck, joint or back pain; general body discomfort; chills; weakness; abnormal vision; ear pain; ringing in the ears; muscle spasm; accidental injury; infection; weight gain.

Guidelines for Use:

• Use exactly as prescribed.
• May be taken without regard to food.
• For long-term therapy, take in two equally divided doses.
• If a rash should develop, it could be a sign of a serious medical condition. Contact your doctor immediately. Also report any fever or gland swelling.
• Notify your doctor if seizures become worse.
• If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearly 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.
• May cause dizziness and drowsiness. Avoid driving or performing other tasks requiring alertness or coordination until effects are known, then use caution.
• Do not discontinue medication or change the dose without first consulting with your doctor. Seizures could increase. Unless safety concerns require a faster withdrawal, the dose of lamotrigine should be tapered over 2 weeks.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant during therapy, or if you are breastfeeding or intend to breastfeed an infant.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store in a dry place at room temperature; protect from light.

Type of Drug:

Anticonvulsant; sulfonamide used to treat a certain type of seizure disorder.

How the Zonisamide Product Works:

Zonisamide works in the brain to prevent seizures. Its mechanism of action is not fully understood.

Uses of The Zonisamide:

For adjunctive therapy in the treatment of partial seizures in adults with epilepsy.

Precautions:

Do not use in the following situations:

• Allergy to the drug or any of its ingredients
• Allergy to sulfonamides

Use with caution in the following situations:

• Kidney disease
• Liver disease

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

Breastfeeding: It is not known whether zonisamide is excreted in breast milk. Because of the potential for serious adverse reactions in nursing infants from zonisamide, decide whether to discontinue breastfeeding or the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Safety and efficacy in patients younger than 16 years of age have not been established. Zonisamide is not approved for pediatric use.

Elderly: Older patients may be more sensitive to the effects of zonisamide. Lower starting doses should be considered.

Lab Tests: Lab tests may be required during treatment. Tests include blood counts and kidney and liver function tests.

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 with this drug. Drug may need may need to be modified or a different drug prescribe.

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: Stomach pain; appetite loss; constipation; diarrhea; indigestion; nausea; vomiting.

Nervous System: Agitation or irritability; anxiety; incoordination; confusion; depression; difficulty concentrating; difficulty with memory; dizziness; fatigue; headache; sleeplessness; mental slowing; nervousness; continual rapid eye movement; tremor; convulsion; abnormal walking; weakness; unusual thoughts (schizophrenic behavior); drowsiness; tiredness; speech problems.

Respiratory System: Sore throat; cough; runny nose.

Skin: Itching; rash; abnormal skin sensations (eg, burning, prickling, tingling).

Other: Dry mouth; unusual bruising; flu symptoms; weight loss; vision problems; ringing in ear; kidney stones; taste sensation changes.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor. Abrupt stopping of zonisamide in patients with epilepsy may increase seizure frequency.
• May be taken with or without food.
• Capsules should be swallowed whole.
• Contact your doctor immediately if you experience decreased sweating with or without fever, sore throat, oral ulcers, easy bruising, rash, or worsening seizures.
• Contact your doctor if you experience sudden back pain, stomach pain, or blood in the urine. These could be signs of a kidney stone.
• If dose is missed, take 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.
• Drink at least 6 to 8 glasses of fluid per day while taking this drug to decrease the risk of kidney stones.
• Inform your doctor if you are pregnant, become pregnant, plan on becoming pregnant, or are breastfeeding.
• Women of child-bearing potential taking zonisamide should use effective contraception.
• May cause drowsiness, dizziness, or blurred vision. Use caution when driving or performing other tasks requiring alertness, coordination, or physical dexterity until tolerance is determined.
• Store at room temperature (59° to 86°F). Protect from moisture And light.

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Type of Drug:

Benzodiazepine. Anticonvulsant; drug used to treat epilepsy (seizures) and panic disorder.

How the Drug Works:

The actual mechanism of clonazepam’s action is unknown. However, it is believed that clonazepam prevents or reduces the number of seizures and controls panic attacks by acting on the central nervous system to control the activity of nerve impulses.

Uses:

To control Lennox-Gastaut syndrome (petit mal variant), akinetic, and myoclonic seizures either alone or in combination with other anticonvulsant drugs.

To treat absence (petit mal) seizures when succinimides have failed.

To treat panic disorder with or without agoraphobia (fear of crowds, public places, open areas).

Precatuions:

Multiple seizure type: When used in patients in whom several different types of seizure disorders coexist, c10nazepam may increase the frequency or precipitate the onset of generalized tonic-clonic (grand mal) seizures. This may require the addition of other anticonvulsant’s or an increase in dosage.

Chronic respiratory disease: Clonazepam may produce respiratory depression and an increase in salivation. In some patients, increased salivation can cause difficulty breathing. Because of these possibilities, use c10nazepam with caution in patients with chronic respiratory disease.

Withdrawal syndrome: Withdrawal symptoms (eg, convulsions, psychosis, hallucinations, behavioral disorder, tremor, abdominal and muscle cramps) have occurred following abrupt discontinuation of c1onazepam. Severity is related to the degree of dependence and length of time used. The more severe withdrawal symptoms occurred in patients who received excessive doses over an extended period of time. After extended therapy, avoid abrupt discontinuation and follow a gradual dos­age tapering schedule.

Drug dependence: Addiction prone individuals (eg, alcoholics, drug addicts) must be closely supervised during clonazepam therapy. Dependence has occurred in such patients.

Pregnancy: Reports suggest an association between use of anticonvulsant drugs by women with epilepsy and an increased number of birth defects in children born to these women. Other factors (eg, genetics or the epileptic condition) may also contribute to the higher incidence of birth defects. Most mothers receiving anticonvulsant medication deliver normal infants. Do not discontinue anticonvulsant drugs used to prevent major seizures. This could result in the occurrence of seizures, oxygen deficiency in body tissues, and an increased risk to both the mother and the unborn child. In cases where seizures do not pose a serious threat, your doctor may recommend discontinuation of anticonvulsants prior to and during pregnancy. It is not known whether even minor seizures constitute some risk to the developing embryo or fetus. In addition, children born to mothers taking benzodiazepines late in pregnancy may exhibit side effects (eg, flaccid muscles, breathing or feeding difficulties) or withdrawal symptoms. Use this medicine during pregnancy only when benefits to the mother outweigh risks to the fetus.

Breastfeeding: Do not breastfeed while receiving clonazepam.

Children: Children being treated for seizure disorder may be more sensitive to the effects of this drug. Consult your doctor. Safety and effectiveness for use in children younger than 18 years of age with panic disorder have not been established.

Lab tests: Lab Testmay be required during treatment with c1onazepam. Tests may include blood counts 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 clonazepam. 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 c1onazepam:

• Alcohol antidepressants (eg, fluvoxamine)
• Cimetidine (eg, tagamet)
• Contraceptives, oral (eg, orthonovum)
• Rifamycins (eg, rifampin)
• Valproic acid (eg, depakene)

Consider all drug interactions reported for benzodiazepines, in the Antianxiety Agents-Benzodiazepines monograph in this chapter when using this drug.

Side Effects:

Every drug is capable .of producing side effects. Many clonazepam 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; diarrhea; nausea; appetite changes.

Nervous System: Drowsiness; incoordination; behavior problems; headache; confusion; depression; memory loss; hysteria; bizarre behavior; mood changes; behavior changes; sleeplessness; tremor; dizziness; vertigo (feeling of whirling motion); partial paralysis; reduced intellectual ability; suicidal thoughts; nightmares; abnormal involuntary body movements; coma; hallUCinations.

Respiratory System: Difficult breathing; chest congestion; “runny” nose; coughing; sore throat.

Skin: Rash; excessive growth or loss of hair.

Eyes or Ocular: Blurred vision; double vision; “glassy-eyed” appearance; unusual eye movements.

Other: Fever; fatigue; loss of voice; increased salivation or dry mouth; coated tongue; changes in urination; fluid retention; difficulty speaking; sore gums; swollen lymph nodes; weight changes; increased or decreased sex drive; incontinence of urine or feces; muscle pain or weakness; dehydration; menstruation problems; sexual problems; general deterioration; pounding in the chest; slurred speech.

Guidelines for Use:

• Dosage will be individualized.
• Do not discontinue use or change the dose without first checking with your doctor. If you stop taking this drug suddenly, the frequency of your seizures could increase or you could experience withdrawal symptoms.
• Take with food if stomach upset occurs.
• 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 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. Use exactly as prescribed.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or if you are breastfeeding.
• May cause drowsiness, dizziness, or blurred vision. Use caution when driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Using this drug with alcohol or other central nervous system depressants (eg, pain relievers, sedatives) may cause added drowsiness.
• If the drug does not seem to be working as well after taking it for a few weeks, check with your doctor. A dosage adjustment may be needed.
• Carry Medic Alert identification indicating that you are using this drug and have epilepsy.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59° to 86°F).

Type of Drug:

Atypical antipsychotic.

How the Drug Works:

The exact mechanism of action, like other drugs used to treat schizophrenia, is not known. Benzisoxazole drugs may work by antagonizing dopamine type 2 and Sheraton type 2 receptors in the brain.

Uses:

For treatment of schizophrenia.

Precautions:

Tardive dyskinesia: Involuntary and uncontrollable movements may develop in patients treated with antipsychotic drugs. Occurrence is highest in the elderly, especially women. However, it is impossible to predict which patients are likely to develop the syndrome. The risk of developing these involuntary movements and the likelihood they will become permanent are increased with long-term use and with high doses. However, it is possible to develop these symptoms after short­term treatment at low doses. The syndrome is characterized by rhythmical, involuntary movements of tongue, face, mouth, or jaw (eg, protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements), sometimes accompanied by involuntary movements of the arms and legs. Fine worm-like movement of the tongue may be an early sign of the

syndrome . If the medication is stopped at this time, the may not develop further. There is no known treatment for established case of tardive dyskinesia, although the syndrome may stop, partially or cell politely, if the drug is withdrawn. Antipsychotic treatment, however, my suppress or partially suppress the signs and symptoms of the syndrome and thereby may possibly mask the underlying disease process; The effect that symptomatic suppression has upon the long-term scour of the syndrome is unknown.

Neuroleptic Malignant Syndrome (NMS) Is a potentially fatal syndrome associated with antipsychotic drugs. Symptoms include fever, muscle rigidity, altered mental abilities, irregular pulse and blood pressure, Increased heart rate, sweating, and irregular heart rhythm.

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

Breastfeeding: It is not known if benisoxazole derivatives appear in brest milk. It is recommended that women not breastfeed while receiving these drug.

Children: The safety and effectiveness in patients younger than 18 years of age have not been established.

Elderly: Dose modifications (eg, lower starting dose) of dispersion may be necessary. Ziprasidone injection has not been evaluated in patients 65 years of age and older.

Lab Tests: Lab tests may be required to monitor ziprasidone therapy. Tests include serum potassium and magnesium 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 with these drugs. 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 these drugs:

• Antihypertensive agents (eg, hydrochlorothiazide)
• Carbamazepine (eg, Tegretol)
• Centrally acting drugs (eg, guanfacine, tramadol)
• Clozapine (eg, Clozaril)
• Dopamine agonists (eg, pramipexole)
• Drugs that prolong the OT interval (eg, chlorpromazine, quinidine, sparfloxacin)
• Fluoxetine (eg, Prozac)
• Ketoconazole (eg, Nizoral)

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: Nausea; constipation; indigestion; diarrhea; dry mouth; vomiting; stomach pain; increased or decreased saliva; toothache; appetite loss.

Respiratory System: Upper respiratory infection; cough; rhinitis; sinus infection; sore throat; difficulty breathing; runny nose.

Nervous System: Sleepiness; dizziness; inability to sit still; muscle tension; headache; anxiety; agitation; increased dream activity; abnormal tongue, face, jaw, or mouth movements; involuntary arm and leg movements; tremor; shuffling; rigidity.

Circulatory System: Increased or decreased heart rate; postural hypotension (light-headedness when rising quickly from sitting or lying position); increased blood pressure.

Skin: Rash; skin irritation; dry skin; sensitivity to light.

Other: Weakness; muscle pain; joint pain; fainting; dizziness; erectile dysfunction; weight gain; decreased sexual desire; abnormal vision.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose unless instructed by your doctor.
• Swallow the ziprasidone capsules whole; take with food.
• It is best to take ziprasidone at the same time each day.
• It may take a few weeks for this medicine to start working. Continue taking the medication, even when you feel better.
• Avoid alcohol while taking this medicine.
• Use caution in hot weather; be careful not to become dehydrated.
• Notify your doctor immediately if you experience fever, perspiration, muscle rigidity, involuntary movements, abnormal heart rate or rhythm, or fainting.
• May cause drowsiness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• This medicine may cause dizziness, light-headedness, or fainting, especially when rising or standing. If these symptoms occur, sit or lie down. Contact your doctor if they continue.
• 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 controlled room temperature (59° to 86°F). Protect from light and moisture.

Type of Drug:

Reversible cholinesterase inhibitor used in managing mild to moderate Alzheimer disease-associated dementia.

How the Drug Works:

The exact mechanism is unknown. Cholinesterase inhibitors act by enhancing cholinergic function. Deterioration or loss of cholinergic neurons may be a primary cause of cognitive dysfunction associated with Alzheimer disease. Cholinesterase inhibitors may enhance cholinergic transmission in this setting. If this mechanism of action is correct, the effect of cholinesterase inhibitors may lessen as the disease advances and fewer cholinergic neurons remain functionally intact. There is no evidence that cholinesterase inhibitors alter the course of the underlying dementing process.

Uses:

To treat mild to moderate dementia of the Alzheimer type.

Precautions:

Do not use in the following situations:

• Allergy to acridine derivatives (tacrine only)
• Allergy to carbamate derivatives (rivastigmine only)
• Allergy to a cholinesterase inhibitor or any of its ingredients
• Allergy to piperidine derivatives (donepezil only)
• Treatment-associated jaundice from previous treatments (tacrine only)

Nicotine: Nicotine use increases the elimination of tacrine from the body.

Gender: Tacrine and galantamine are eliminated from the body more slowly in women.

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 possible hazards to the fetus.

Breastfeeding: It is not known if cholinesterase inhibitors are excreted in breast milk. Contact your doctor before you begin breastfeeding.

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

Elderly: Rivastigmine and galantamine are eliminated from the body more slowly in the elderly.

Lab Tests: Lab tests will be required to monitor therapy with tacrine. Tests include liver function tests every other week from at least week 4 to week 16, after which monitoring may be decreased to every 3 months, 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 dietary supplements with a cholinesterase inhibitor. Doses of one or both drug may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with cholinesterase inhibitors:

• Anticholinergics (eg, atropine, scopolamine)
• Cholinergic agonists (eg, bethanechol)
• Cholinesterase inhibitors (eg, neostigmine)
• Cimetidine (eg, Tagamet)
• Food (rivastigmine only)
• Ketoconazole (eg, Nizoral)
• NSAIDs (eg, ibuprofen)

Side Effects:

Every drug is capable of producing side effects. Many cholinesterase 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: Nausea; vomiting; diarrhea; appetite loss; stomach bleeding; black tarry stools; loss of bowel control; bloating; gas; belching; indigestion; stomach pain; weight loss; constipation.

Nervous System: Sleeplessness; fatigue; drowsiness; headache; pain; difficulty moving; dizziness; fainting; depression; abnormal dreams; abnormal thinking; hallucinations; tremors; irritability; numbness or tingling in hands or feet; abnormal skin sensations (eg, burning, prickling, tingling); aggression; feeling of whirling motion; clumsiness; twitching; restless­ness; nervousness; anxiety; paranoia; convulsions; weakness; confusion; hostility; difficulty speaking.

Circulatory System: Chest pain; abnormal heartbeat; heart pounding; blood pressure changes; flushing; hot flashes.

Skin: Itching; hives; rash; excessive sweating; unusual bruising or bleeding.

Respiratory System: Difficulty breathing; sore throat; nasal congestion; sinus problems; runny nose; coughing; upper respiratory infection; pulmonary congestion.

Urinary and Reproductive Tract: Loss of bladder control; frequent urination; excessive urination at night; urinary tract infection; blood in the urine.

Other: Flu-like syndrome; chills; fever; general body discomfort; muscle cramps; muscle or joint pain; muscle tension; back pain; swelling in hands or feet; anemia; dehydration; eye irritation; blurred vision; elevated transaminase; accidental trauma; abnormal gait; ringing in the ears; nosebleed.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Oonepezil- Take in the evening just before bedtime with or without food.
• Galantamine - Take during morning and evening meal if possible. Fellow recommended dosage and administration. If therapy is interrupted for several days or longer, restart treatment at the lowest dose. Nausea may be reduced by administering with food, antiemetic medication, or ensuring adequate fluid intake.
• Tacrine - Take between meals if possible; however, it may be taken with meals to avoid stomach upset. The effect of tacrine is thought to depend upon its administration at regular intervals.
• Rivastigmine capsules- Take with food in divided doses in the morning or evening.
• Rivastigmine solution - Remove the oral dosing syringe provided in its protective case and, using the provided syringe, withdraw the pre­scribed amount of rivastigmine. Each dose may be swallowed from the syringe or first mixed with a small glass of water, cold fruit juice, or soda. Stir the mixture before drinking.
• 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 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.
• Tacrine - Do not stop taking this medicine suddenly or change the dos­age unless instructed to do so by your doctor. Abrupt discontinuation or large reduction in the total daily dose of tacrine may cause a decline in mental function and behavioral disturbances. Unsupervised increases in the dose of tacrine may also have serious consequences.
• Inform your doctor if you are pregnant, become pregnant, planning to become pregnant, or are breastfeeding before beginning therapy.
• Report any new or worsening side effects to your doctor.
• May cause dizziness or blurred vision. Use caution while driving or per­forming other tasks requiring alertness, coordination, or physical dexterity.
• Rivastigmine - There is a high incidence of nausea and vomiting associated with the use of the drug, along with the possibility of anorexia and weight loss. Monitor for these adverse events and inform your doctor if they occur.
• Tacrine - Contact you doctor if you experience side effects that occur soon after taking a dose (eg, nausea, vomiting, loose stools) or develop side effects that are delayed (eg, rash, yellowing of the skin, changes in stool color).
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store capsules and tablets at controlled room temperature (59 to 86 F) away from moisture. Store rivastigmine solution below 77 F in an upright position. Protect from freezing.