Type of Drug:

Narcotic analgesics (pain relievers)

How the Drug Works:

Narcotic pain relievers relieve pain by dulling the pain perception center of the brain, They may also affect other systems in the body at higher doses, Natural narcotics include opium, codeine, and morphine, Other narcotics are synthetic (opioids) and vary in potency, addictive ability, and side effects,

Uses:

For relief of mild-to-moderate pain and for coughing induced by viral, bacterial, chemical, or mechanical irritation of the respiratory system (codeine only),

For the management of chronic pain in patients requiring continuous opioid analgesia for pain that cannot be managed by lesser means such as acetaminophen-opioid combinations, nonsteroidal analgesics, or PRN (as-needed) dosing with short-acting opioids (fentanyl only),

For the management of breakthrough cancer pain in patients with malignancies who are already receiving and are tolerant to opioid therapy for their underlying persistent cancer pain (fentanyl lozenge only),

For relief of moderate-to-severe pain (hydromorphone, meperidine, methadone, morphine, oxycodone, and oxymorphone only),

For the management of opiate dependence (levomethadyl acetate only), For the management of moderate-to-severe pain or as a preoperative medication where an opioid analgesic is appropriate (levorphanol only),

For relief of severe pain, and for detoxification and temporary maintenance treatment of narcotic addiction (methadone only),

For relief of moderate-to-severe acute and chronic pain; for the management of pain not responsive to nonnarcotic analgesics; dyspnea (short­ness of breath) associated with acute left ventricle failure and pulmonary edema; used preoperatively for patient sedation; to decrease apprehension; effective in the control of postoperative pain (morphine only),

For relief of pain in patients who require copied analgesics for more than a few days (morphine sustained-release only).

For relief of mild-to-moderate pain (propoxyphene only).

Unlabeled Uses: Occasionally doctors may prescribe inject able morphine for difficult breathing associated with acute left ventricular failure and pulmonary edema.

Precautions:

Do not use in the following situations:

Drug dependence: Narcotic pain relievers have high abuse potential.

Dependence and physical tolerance may develop upon repeated use. However, most patients who receive these agents for medical reasons and do not take more than prescribed do not develop dependence.

Tolerance: Some patients may develop tolerance to narcotic pain relievers. This may develop after days or months of continuous therapy. Consult your doctor if tolerance is suspected.

Withdrawal syndrome: Severity is related to the degree of dependence, the abruptness of withdrawal and the drug used. Generally, withdrawal symptoms begin to develop at the time the next dose would ordinarily be given. For heroin and morphine, symptoms gradually increase in intensity, reach a maximum in 36 to 72 hours and subside over 5 to 10 days. In contrast, methadone withdrawal is slower in onset and the patient may not recover for 6 to 7 weeks. Meperidine withdrawal often runs its course within 4 to 5 days. Hydrocodone withdrawal symptoms peak at 48 to 72 hours. Withdrawal precipitated by narcotic antagonists (antidotes) is manifested by onset of symptoms within minutes and maximum intensity within 30 minutes. Symptoms of withdrawal include:

Early - Yawning; tearing; runny nose; restless sleep; sweating.

Intermediate - Flushing; increased heart rate; twitching; tremor; restlessness; anxiety; irritability; goosebumps; appetite loss; dilated pupils.

Late - Muscle spasm; fever; nausea; diarrhea; vomiting; spontaneous orgasm; severe backache; stomach and leg pains; stomach and muscle cramps; hot and cold flashes; sleeplessness; intestinal spasm; repetitive sneezing; excessively runny nose; increased body temperature, blood pressure, respiratory rate and heart rate; chills; bone and muscle pain.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Regular narcotic use late in pregnancy may cause with drawl reactions in newborns. Use only if clearly needed and the potential benefits outweigh the possible risks to the fetus.

Breastfeeding: Many of these narcotics appear in breast milk, but the effect on the infant may not be significant. Consult your doctor before you begin or continue breastfeeding if narcotic if narcotic therapy is required.

Children: Safety and effectiveness of fentanyl transmucosal in children younger than 16 years of age are not established. Safety and effectiveness of codeine in children younger than 3 years of age have not been established. Do not administer fentanyl trans dermal systems to children younger than 12 years of age or patients less than 18 years of age who weigh less than 50 kg except in an authorized investigational research setting. Use of levomethadyl or levorphanol is not recommended in those less than 18 years of age. Safety and effectiveness of oxymorphone in children younger than 18 years of age have not been established. Methadone is not recommended as an analgesic in children; documented clinical experience is insufficient to establish suitable dos­age regimens. Safety of propoxyphene, morphine, opium, oxycodone, and hydromorphone are not established in children.

Elderly: Appropriately reduce the initial dose in elderly and debilitated patients. Consider the effect of the initial dose in determining supplemental doses. Use caution because opioids have the ability to depress breathing.

Sulfites: Some of these products may contain sulfite preservatives which can cause allergic reactions in certain individuals (eg, asthmatics). 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 with narcotic pain relievers. 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 narcotic pain

• Aganist/antagonist analgesics alcohol amitriptyline (eg, Elavil)
• Anticoagulants (eg, warfarin)
• Antihistamines (eg, diphenhydramine)
• Barbiturate anesthetics (eg, thiopental)
• Carbamazepine (eg, Tegretol)
• Charcoal chloral hydrate (eg, Aquachloral)
• Chlorpromazine (eg, Thorazine)
• Clomipramine (eg, Anafranil)
• Desipramine (eg, Norpramin)
• Diazepam (eg, Valium)

Side Effects:

Every drug is capable of producing side effects. Many narcotic analgesic 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:

Most Serious: Respiratory depression; skeletal muscle rigidity; difficulty breathing; slow heartbeat.

Most Frequent: Lightheadedness; dizziness; sedation; nausea; vomiting; sweating.

Digestive Tract: Nausea; vomiting; diarrhea; stomach cramps or pain; taste alterations; dry mouth; appetite loss; constipation; biliary tract spasm; ileus (obstruction of the bowels); paralytic ileus; toxic megacolon in patients with inflammatory bowel disease; gas; indigestion; difficulty swallowing.

Nervous System: Exaggerated sense of well being; restless mood; delirium; sleeplessness; agitation; anxiety; hallucinations; disorientation; drowsiness; sedation; lethargy; mental and physical impairment; uncoordinated movements; coma; mood changes; weakness; headache; mental cloudiness; blurred vision; double vision; pupil constriction; tremor; convulsions; psychic dependence; toxic psychoses; depression; increased intracranial pressure; headache; abnormal skin sensations; confusion; abnormal dreams; continual rapid eye movement; muscle twitching; amnesia; paranoid reaction; drug withdrawal; suicide attempt; decreased mobility; difficulty moving; excessive movement; speech disorder; abnormal gait; abnormal skin sensations; stupor; apathy.

Circulatory System: Flushing; faintness; peripheral circulatory collapse; change in heart rate; abnormal heart rhythm; heart pounding in the chest; chest wall rigidity; change in blood pressure; dizziness or light­headedness when rising from a seated or lying position; fainting; cardiac arrest; shock.

Urinary and Reproductive Tract: Urinary retention or hesitancy; infrequent urination; antidiuretic effect; reduced libido; difficult urination; impotence; difficult ejaculation; urinary incontinence.

Other: Depression of cough reflex; chills; asthma exacerbation; vision changes; itching; rash; hives; muscle weakness; sweating; runny nose; tearing; yawning; joint pain; general body discomfort; flu syndrome; hot flashes; hiccups; coughing up blood; sore throat; back pain; runny nose; reversible jaundice, including cholestatic jaundice (propoxyphene).

Guidelines for Use:

• Dosage is individualized.
• Do not change the dose or stop taking unless advised to do so by your doctor.
• May cause drowsiness, dizziness, or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• May cause dizziness or lightheadedness when rising from a seated or lying position.
• Avoid alcohol and drowsiness-causing drugs while taking a narcotic pain reliever.
• May cause nausea, vomiting, or constipation. Notify your doctor if these occur and become a problem.
• Long-term use may lead to addiction. Early signs include drug ineffectiveness. Dependence is not an issue in terminal illness where patient comfort is more important.
• If stomach upset occurs, take with food.
• May cause constipation (long-term use). Stool softeners or fiber laxatives may be required if use is prolonged.
• These drugs work best if taken on a routine basis. Narcotics are more effective in preventing pain than in treating pain after it occurs.
• Give the drug ample time to work before determining if more is needed (at least 30 minutes to 1 hour for oral agents).
• 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 more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Sometimes these drugs are given in combination with other non narcotic pain relievers such as aspirin or acetaminophen (eg, Tylenol). Make sure your doctor knows if you have had problems taking aspirin or acetaminophen in the past.
• Notify your doctor if shortness of breath or difficulty breathing occurs.
• Do not crush or chew controlled- or sustained-release medications.
• Fentanyl transdermal system - Keep both used and unused systems out of the reach of children. Used systems should be flushed down the toilet immediately upon removal. If the application site needs to be cleansed before application, the area should be washed with clear water and allowed to dry. Do not use soaps, alcohol, or other products to cleanse skin. Do not cut the patch. Remove the old patch before applying a new one. Avoid exposing the application site to a direct external heart source, such as an electric blanket.
• Fentanyl transmucosal system - This product is extremely toxic to children. Carefully follow the storage, administration, and disposal techniques included in the patient package insert and instructional video. Remove from the foil pouch just before use.
• The one should be sucked. Do not chew. Store in foil pouch at room temperature (59 0 to 86°F). Do not freeze.

Type of Drug:

Skeletal muscle relaxant.

How the Baclofen Product Works:

Baclofen reduces the frequency and severity of muscle spasms that occur as a result of neurological disorders such as multiple sclerosis.

Uses of The Baclofen:

Tablets: To relieve the spasticity, pain, and rigidity from muscle spasms due to multiple sclerosis. May help with spinal cord injuries and other spinal cord diseases.

Injection: To manage severe spasticity of spinal cord origin in patients who do not respond to or have side effects from the tablets.

Unlabeled Uses: Occasionally doctors may prescribe oral baclofen for trigeminal neuralgia (tic douloureux), tardive dyskinesia in combination with neuroleptics, and intractable hiccoughs; the injection form may reduce spasticity in cerebral palsy in children.

Precautions:

Abrupt withdrawal: Hallucinations and seizures have occurred when treatment with baclofen has been stopped suddenly. Except in cases of serious side effects, the dose must be reduced slowly when the drug is discontinued.

Epilepsy: Increased frequency of seizures has occurred in epileptic patients taking baclofen. Frequent physical exams and neurological tests may be required.

Ovarian cysts: Ovarian cysts are sometimes found in women who have taken baclofen for up to one year. The cysts often disappom rlosplto continued treatment.

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

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

Baclofen: Safety and effectiveness in children younger than 12 years of age (oral) and in children younger than 4 years of age (injection) 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 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.

• Alcohol
• Morphine
• Narcotic pain relievers (eg, percodan)
• Sleep aids (eg, flurazepam)
• Tricyclic antidepressants (eg, amitriptyline)

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; vomiting.

Nervous System: Drowsiness; dizziness; lightheadedness; weakness; tiredness; headache; seizures; sleeplessness; numbness; tingling; slurred speech.

Skin: Rash; itching; excessive sweating.

Other: Visual disturbances; ankle swelling (edema); weak muscles; weight gain; nasal congestion; difficulty breathing; frequent urination; low blood pressure.

Guidelines for Use:

• Use exactly as prescribed.
• 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 more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• May cause drowsiness, dizziness and tiredness. Use caution when driving or performing other tasks requiring alertness. Avoid alcohol and other drugs that cause drowsiness during use of baclofen.
• Sudden discontinuation of baclofen can result in hallucinations. Discontinue only under doctor’s supervision.
• Notify your doctor if frequent urges to urinate, painful urination, constipation, nausea, headache, insomnia, confusion, palpitations or chest pain Occurs and persists.
• Injections - Not for IV, IM, subcutaneous, or epidermal use. Visually inspect solutions for particles or discoloration.
• Store at room temperature. Do not freeze. Do not heat or sterilize solution.

Monoamine Oxidase Inhibitors Information - Drug Interactions, Uses and Benefits

Type of Drug:

Antidepressants; mood-elevating agents; MAOls.

How the Drug Works:

Monoamine oxidase inhibitors (MAOls) prevent the breakdown of the body’s own mood-elevating substances. The effect may take several weeks to be noticed.

Uses:

To treat chronic (long-term) depression in patients who have not responded satisfactorily to other antidepressants. They are rarely used as first-line antidepressant therapy.

Unlabeled Uses: Occasionally doctors may prescribe MAOls for bulimia and panic disorder associated with agoraphobia (fear of open or public places) and glob us hystericus syndrome (choking sensation associated with hysteria). Phenelzine has been investigated for use as an aid in treating cocaine addiction, night terrors, post-traumatic stress disorder, and migraines resistant to other therapies. Tranylcypromine has been used to treat Binswanger’s encephalopathy, seasonal affective disorder, and subjective symptoms of multiple sclerosis.

Drug abuse and dependence: Drug abuse and dependence have been reported in patients using excessive doses of tranylcypromine and isocarboxazid. Some of these patients had a history of substance abuse. The following withdrawal symptoms have been reported: Restless­ness; anxiety; depression; confusion; hallucinations; headaches; weakness; diarrhea.

Hypertensive Crisis: Hypertensive crisis (extreme elevations in blood pressure) can result from coadministraton of MAOls and certain drugs and foods.

Chest pain: MAOls may suppress chest pain that would otherwise serve as a warning of myocardial ischemia (inadequate circulation of blood to the heart, usually as a result of heart disease).

Liver Dysfunction: Discontinue isocarboxazid use at first sign of liver dysfunction or jaundice (yellowing of skin or eyes).

Depression: Tranylcypromine and isocarboxazid may aggravate coexisting symptoms in depression, such as anxiety and agitation.

Tyramine-containing foods: Do not eat foods with high tyramine, dopamine, or tryptophan content (see the following listing) during or for 2 weeks after the discontinuation of MAOI’s. Any high-protein food that is aged or undergoes breakdown by a putrefaction process to improve flavor is suspected of producing a significant increase in blood pressure in patients taking MAOI’s. Do not take any new prescription medication without first reviewing it with your doctor or pharmacist. Do not drink alcoholic beverages or self-medicate with dietary supplements, cold, hay fever, or weight-reducing preparations while undergoing therapy. Do not consume excessive amounts of caffeine in any form, and report headache or other unusual symptoms promptly.

Other Problem Foods: Broad beans (fava beans, overripe); chocolate; caffeine (eg, coffee, tea, colas); ginseng.

Pregnancy: Safety for use during pregnancy has not been established. Use during pregnancy or in women of childbearing age only when clearly needed and when the potential benefits outweigh the potential hazards to the fetus.

Breastfeeding: Tranylcypromine appears in breast milk. It is not known if the other MAOls appear in breast milk. Because of the potential for serious adverse effects in the nursing infant, decide whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Use in children younger than 16 years of age is not recommended.

Elderly: The most serious reactions to MAOI use involve changes in blood pressure. Older patients may suffer more problems than younger patients during and following an episode of increased blood pressure or malignant hyperthermia (extremely high fever). Older patients have less compensatory reserve to cope with any serious adverse reactions. Use with caution in the elderly.

Lab Tests: Lab tests may be required to monitor therapy. Tests may include periodic liver chemistry (isocarboxazid).

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 MAOI’s. 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 MAOls:

• anesthetic agents (eg, anesthesia, cocaine)
• anorexiants (eg, amphetamine, phentermine)
• antidiabetic agents (eg, insulin, sulfonylureas, glyburide, tolbutamide)
• beta blockers (eg, metoprolol, nadolol)
• buproprion HCI (eg, Zyban)
• meperidine (eg, Demerol)

Side Effects:

Every drug is capable of producing side effects. Many MAOI 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; constipation; diarrhea; stomach pain; appetite loss.

Nervous System: Hyperactivity; tremor; muscle twitching; unusual muscle movements; headache; dizziness; faintness; anxiety; jitteriness; memory impairment; sleep disturbances (eg, sleeplessness, excessively long sleeping periods); weakness; fatigue; drowsiness; restlessness; agitation; exaggerated reflexes; mania (eg, irritability, euphoria, distractability, excitability); abnormal skin sensations; lethargy; sedation.

Circulatory System: Changes in heart rate and rhythm; postural and orthostatic hypotension (dizziness or light headedness when rising from a seated or lying position); palpitations (pounding in the chest).

Skin: Rash; itching; sweating; jaundice (yellowing of skin or eyes).

Other: Dilated (widened) pupils; stiff neck; dry mouth; urinary frequoncy; edem (fluid retention) blurred vision; weight g8in; sexual problem; chills; impotence; abnormal blood cell counts; glucome; heavy feeling.

Guidelines for Use:

• Phenelzine - Recommended initial dosage is 15 mg 3 times daily. Increase dose to at least 60 mg/day at a fairly rapid pace consistent with patient tolerance. It may be necessary to increase dose up to 90 mg/day to obtain sufficient MAO inhibition. Many patients do not show clinical response until treatment at 60 mg has been continued for 4 weeks or more. After maximum benefit is achieved, reduce dose slowly over several weeks. Maintenance dosage may be as low as 15 mg/day or 15 mg every other day; continued for as long as required.
• Tranylcypromine - The usual effective dose is 30 mg/day in divided doses. Improvement should be seen within 48 hours to 3 weeks after starting therapy. If there is no improvement after 2 weeks, increase dose in 10 mg/day increments at 1- to 3-week intervals. Dosage range may be extended to a maximum of 60 mg/day from the usual 30 mg/day. Gradually withdraw tranylcypromine when discontinuing therapy.
• Isocarboxazid - Recommended initial dosage is 10 mg twice daily. If tolerated, increase by 10 mg every 2 to 4 days to achieve a dose of 40 mg by the end of the first week of treatment. Dose can then be increased by increments of up to 20 mg/week, if needed and tolerated, to a maximum recommended dose of 60 mg/day. Daily dose should be divided into 2 to 4 doses. After a maximum clinical response is achieved, attempt to reduce the dose slowly over a period of several weeks with­out jeopardizing therapeutic response. Beneficial effect may not be seen in some patients for 3 to 6 weeks. If no response is obtained by then, discontinue therapy. Caution is indicated in patients for whom a dose of 40 mg/day is exceeded.
• Do not discontinue this medication or adjust dosage except on the advice of your doctor. Consult your doctor before taking any other medication, including nonprescription items, while taking an MAOI.
• This medicine may take several weeks to become effective. Continue to take as directed.
• 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 more than one dose is missed, or it is necessary to establish a new dosage schedule, contact your doctor.
• Avoid tyramine-containing foods, alcohol, caffeine, and tryptophan (see Precautions).
• May cause drowsiness or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Dizziness, weakness, or fainting may occur when rising from a lying or sitting position. If this occurs, get up slowly.
• At doses over 30 mg/day, postural hypotension (dizziness or lightheadedness when rising from a seated or lying position) is a major side effect and may result in fainting. Dosage increases will be more gradual in patients showing a tendency toward low blood pressure at the beginning of therapy. Postural hypotension may be relieved by lying down until blood pressure returns to normal.
• Hypertensive crises (increase in blood pressure) as a result of concur­rent use of MAOI and certain foods or drugs (see Precautions) can occur and are potentially fatal. These crises usually occur within several hours after ingestion of the interacting food or drug. Notify your doctor immediately if you experience a headache that starts in the back of the head and moves forward, pounding in the chest, neck stiffness or soreness, nausea, vomiting, sweating (sometimes with fever or cold, clammy skin), dilated pupils, sensitivity to light, or changes in heart rate with or without chest pain or tightness.
• Notify your doctor if you experience rash or intolerable side effects.
• Use may complicate other medical treatment (eg, general anesthesia, surgery). Inform your doctors and dentist about your use of MAOls. Wear a Medic Alert bracelet or carry a card saying that you are taking an MAOI.
• A waiting period of 10 to 14 days is recommended when switching from one MAOI to another or from a dibenzapine-related agent. Other medications that interact with MAOls (eg, fluoxetine) have different waiting periods. Discuss appropriate waiting periods for changes in therapy with your doctor or pharmacist.
• Blood pressure will need to be monitored frequently.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature.

Pemoline - Guidelines for Using Pemoline - Uses and Benefits

Type of Drug:

Central nervous system stimulant.

How the Pemoline Product Works:

Pemoline stimulates the central nervous system. How it does this is not fully understood.

Uses of The Pemoline:

To aid in treatment of children with behavior problems (attention deficit disorder) characterized by hyperactivity, moderate to severe distractibility, short attention span, impulsive behavior, and extreme mood changes.

Unlabeled Uses: Occasionally doctors may prescribe pemoline for narcolepsy (irresistible periods of sleep lasting less than 15 minutes during normal waking hours) and excessive daytime sleepiness.

Precautions:

• Drug dependence: The similarity of pemoline to other brain stimulants with known dependence liability suggests that psychological and physical dependence might also occur. There have been isolated reports of temporary psychotic symptoms occurring in adults following the long-term misuse of excessive doses. Pemoline should be given with caution to emotionally unstable patients who may increase the dosage on their own initiative.

• CNS stimulants: CNS stimulants, including pemoline, have been reported to precipitate motor and phonic tics, and Tourette syndrome. Therefore, clinical evaluation for tics and Tourette syndrome in children and their families should precede use of stimulant medications.

• Potential liver toxicity: Report any unexplained appetite loss, nausea, vomiting, general body discomfort, weakness, or yellowing of the skin or eyes to your doctor.

• Total treatment program: Pemoline therapy should be part of a total treatment program that includes psychological, educational psychological, educational, and social measures.

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

• Children: Safety and effectiveness in children less than 6 years of age have not been established. Pemoline use may worsen symptoms of behavior disturbance and thought disorder in psychotic children. Aggravation of Tourette syndrome and seizure disorders have been reported after starting pemoline therapy. Chronic administration of stimulants to children may be associated with growth inhabiting. Therefore, growth must be monitored during treatment. Long-term effects in children have not been well established. Treatment is not indicated in all cases of attention deficit disorder with hyperactivity. The decision to prescribe pemoline should depend on the assessment of the severity of the child’s symptoms for his or her age, and not depend solely on the presence of one or more of the behavioral characteristics.

• Lab Tests: Lab tests will be required before and during pemoline therapy. Tests may include periodic liver function evaluation.

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 pemoline. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. Decreased seizure thresh­old has been reported in patients also taking anti epileptic medications (eg, phenytoin).

Side Effects:

Every drug is capable of producing side effects. Many pemoline 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; stomachache; loss of appetite.

• Nervous System: Sleeplessness; seizures; hallucinations; dizziness; drowsiness; increased irritability; involuntary movements of tongue, face, arms, and legs; Tourette syndrome; depression; headache; abnormal eye movements.

• Other: Rash; yellowing of skin or eyes; dark urine; abnormal liver function tests; weight loss; liver dysfunction.

Guidelines for Use:

• Do not use pemoline until you have discussed with your doctor the risks and benefits of treatment. A written informed consent is required before beginning therapy.
• Dosage is individualized. Take exactly as prescribed. Administer as a single dose each morning.
• Do not stop taking or change the dose unless directed your doctor.
• 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.
• Clinical improvement with pemoline is gradual. Significant benefit may not be evident until after 3 to 4 weeks of therapy.
• Because of its association with life-threatening liver failure, pemoline should not ordinarily be considered as first-line drug therapy for attention deficit hyperactivity disorder (ADHD).
• May cause drowsiness or dizziness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity until tolerance is determined.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Notify your doctor immediately if you experience darkening of urine, appetite loss, general body discomfort, nausea, vomiting, yellowing of the skin or eyes, or uncontrolled movement.
• Notify your doctor if sleeplessness occurs and is bothersome.
• Chronic use may suppress growth in children.
• Your doctor may interrupt treatment occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.
• Pemoline therapy should be stopped if no benefit is noted after 3 weeks of taking the maximum do.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59° to 86°F).

Anorexiants Information - Side Effects, Uses and Benefits

Type of Drug:

Anorectic or anorexigenic drugs.

How the Drug Works:

Benzphetamine, diethylpropion, phendimetrazine, and phentermine ar central stimulants similar to amphetamine. These drugs reduce app title and may have other central or metabolic effects. Sibutramine pr longs the activity of central neurotransmitters.

Uses:

For the management of exogenous obesity as a short term adjunct (a flow weeks) in a regimen of weight reduction based on caloric restriction.

Precautions:

• Psychological disturbances: Psychological disturbances have occurred in patients who received an anorexiant together with a restrictive diet.

• Tolerance: Tolerance may develop within a few weeks. If tolerance develops, do not exceed the recommended dose to increase the effect; rather, discontinue the drug.

• Pregnancy: There are no adequate and well-controlled studies in pregnant women. Anorexiant use in pregnancy is not recommended. Do not use benzphetamine in pregnant women.

• Breastfeeding: Anorexiants are excreted in breast milk. It is not known if sibutramine appears in breast milk. Anorexiants are not recommended for nursing mothers. Consult your doctor before you begin breastfeeding.

• Children: Safety and effectiveness of diethylpropion, phentermine, and sibutramine in children younger than 16 years of age have not been established. Phendimetrazine and benzphetamine are not recommended for use in children younger than 12 years of age.

• Phentermine - Safety and effectiveness of Adipex-P have not been established. lonamin is not recommended in children younger than 16 years of age.

• Elderly: Use sibutramine with caution in elderly patients.

• Lab Tests:Lab tests  or exams may be required to monitor treatment. Tests may include blood pressure, pulse rate, and heart rhythm monitoring.

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 an anorexiant. 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 anorexiants:

• drugs that may raise blood pressure or increase heart rate (eg, certain decongestants;cough, cold, and allergyrine or pseudoephedrine)
• MAOls (eg, phenelzine)
• methyldopa (Aldomet)
• serotonergic agents (eg, SSRls, medications that contains ephed-oids, lithium, tryptophan)
• igraine drugs, certain opitricyclic antidepressants (eg, amitriptyline)

Side Effects:

Every drug is capable of producing side effects. Many anorexiant 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 changes; constipation; nausea; indigestion; vomiting; intestinal inflammation; stomach pain; diarrhea; dry mouth; gas.

• Nervous System: Headache; migraine; sleeplessness; dizziness; nervousness; anxiety; depression; drowsiness; restlessness; general body discomfort; euphoria; agitation; jitteriness; emotional instability; abnormal involuntary movements; tremor; leg cramps; abnormal thinking.

• Circulatory System: Increased heart rate; flushing; increased blood pressure; palpitations (pounding in the chest); chest pain; heart rhythm disturbances.

• Respiratory System: Increased cough; shortness of breath.

• Urinary and Reproductive Tract: Irregular vaginal bleeding; difficult or pain fulmination; changes in urinary frequency; impotence; changes in sex drive; increased breast size in males.

• Skin: Rash; sweating; itching; hair loss; flushing.

• Other: Abnormal lab tests; muscle, chest, neck, or back pain; joint pain or disorder; taste sensation changes; fever; fluid retention; double vision; weakness; blurred vision; pupil dilation.

Guidelines for Use:

• If there is a patient package insert available with your prescription, read it before starting therapy and reread it each time your prescription is renewed.
• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking, unless directed by your doctor. These drugs can be addicting.
• A single daily dose of benzphetamine is preferably given in the mid­morning or mid-afternoon, according to your eating habits. In an occasional patient, it may be desirable to avoid late afternoon administration.
• Take diet hyperopic 1 hour before meals, and in mid-evening if needed to overcome night hunger. Take diet hyperopic controlled-release once daily at mid-morning.
• Take immediate-release phendimetrazine 1 hour before meals. Take sustained-release phendimetrazine once daily in the morning, 30 to 60 minutes before the morning meal.
• Take 15 or 37.5 mg phentermine as a single daily dose before break­fast or 10 to 14 hours before bedtime. Take Adipex-Pcapsules and tablets before breakfast or 1 to 2 hours after breakfast; the tablet dosage may be adjusted to the patient’s need.
• Swallow loamingcapsules and all sustained-release products whole. Do not crush or chew.
• Take sibutramine once daily with or without food.
• 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 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.
• Wait at least 2 weeks before starting treatment with an anorexiant after stopping MAOls and before starting MAOls after stopping an anorexiant.
• Notify your doctor immediately if you experience rash, hives, or other allergic reactions; shortness of breath; chest pain; palpitations (pounding in the chest); nervousness; dizziness; fainting; swelling of the legs; pronounced dry mouth or constipation; deterioration of exercise tolerance; seizures; or sleeplessness.
• Discontinue sibutramine and contact your doctor if seizures occur.
• May cause drowsiness, dizziness, or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Do not take other medications or dietary supplements without your doctor’s approval. This includes nonprescription medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
• Avoid alcohol and other mental depressants (eg, narcotics, tranquilizers, antidepressants, hypnotics, antihistamines) while you are taking this medicine unless approved by your doctor.
• Inform you doctor if you are pregnant, become pregnant, are planning to become pregnant, or if you are breastfeeding. Women of childbearing potential should use adequate contraception while taking these drugs.
• Appetite suppressants are not a substitute for proper dieting. Lifestyle changes (eg, diet, exercise) are necessary to lose and then maintain weight loss.
• Diabetic patients - Insulin requirements in diabetes mellitus may change in association with the use of anorexiants and the concomitant diet restrictions.
• Avoid taking late in the day because of the possibility of sleeplessness.
• The long-term effects of this medicine are unknown.
• Lab tests or exams may be required to monitor treatment. Be sure to keep appointments.
• Store at controlled room temperature (59° to 86°F) in a tightly closed container. Protect from heat and moisture.

Aspirin And Salicylates Drug - How does Aspirin And Salicylates Works?

Type of Drug:

Aspirin pain reliever, fever reducer and anti-inflammatory agent. ASA.

How the Drug Works:

Salicylates relieve pain by inhibiting pain perception by pain receptors and by inhibiting the formation of chemicals called prostaglandins. Prostaglandins cause pain receptors to be more sensitive to pain-producing stimuli.

They reduce fever by direct action on the heat regulating center of the brain (the body’s “thermostat”). This increases the removal of heat through increased sweating and dilation (widening) of blood skin.

Salicylates also help in preventing blood platelets from clumping together to form clots.

Uses:

To relieve mild to moderate pain.

To reduce fever.

To reduce inflammation, redness, swelling (eg, in arthritis).

• Aspirin: To reduce the risk of recurrent transient is chemic attacks (TIAs) or stroke in men.

To reduce risk of death or nonfatal heart attacks (myocardial infarction) in people with previous heart attack or unstable angina.

• Unlabeled Uses: Occasionally doctors may prescribe aspirin-like pain relievers for the possible protective effect against cataract formation and to prevent toxemia of pregnancy. It may also be of benefit in pregnant women with inadequate uteroplacental blood flow.

Precautions:

• Ears: Discontinue use if dizziness, ringing in the ears, or any hearing difficulty occurs. These symptoms are indications that salicylate blood level may be too high. Temporary hearing loss disappears gradually after the drug is stopped.

• Controlled release aspirin: Because of its relatively long onset of action, controlled-released aspirin is not recommended for fevers or short-term pain relief. It is not recommended in children younger than 12 or children with fever accompanied by dehydration.

• Aspirin intolerance: Symptoms (spasms in bronchioles, hives, swelling, inflammation of the nose) occur within 3 hours after ingestion. Aspirin intolerance is more common in patients with a history of asthma and nasal polyps.

• Foods collnlning salicylate may contribute to a reaction. Some foods with curry powder, paprika, licorice, Benedictine liqueur,

• Desensitization: Desensitizationhas been successful. It should be done in a hospital. it is generally maintained with 1 aspirin/day. Any NSA/D can maintain desensitization. However, if maintenance is interrupted, sensitivity will reappear (2 to 5 days).

• Pregnancy: Salicylates cross the placenta. Avoid use during pregnancy, especially the third trimester. Aspirin studies have shown a potential effect to the fetus. 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: Salicylates appear in breast milk. Consult your doctor before you begin breastfeeding.

• Children: Administration of aspirin to children (including teenagers) with fever-causing illnesses (eg, chickenpox, flu) has been associated with the development of Reye syndrome. Reye is a rare illness characterized by vomiting, lethargy, and belligerence that may progress to delirium and coma. Safety and effectiveness of magnesium salicylate or salsa­late in children 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 supplements with saicylates. 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 salicylates.

Drugs affecting aspirin _

• Acetazolamide (eg, Diamox)
• Antacids (eg, Tums)
• Charcoal, activated contraceptives, oral (eg, Ortho­Novum)
• Corticosteroids (eg, prednisone) dichlorphenamide (Daranide )
• Methazolamide (eg, Neptazane)
• Nizatidine (eg, Axid)
• Ticlopidine (eg, Ticlid)
• Urinary acidifiers (eg, vitamin C)
• Urinary alkalinizers (eg, sodium bicarbonate)

Side Effects:

Every drug is capable of producing side effects. Many salicylate user 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:

• Allergic Reactions: Difficulty breathing and inflammation in nose may occur in people with a history of nasal polyps or asthma.

• Digestive Tract: Stomach upset; nausea; vomiting; appetite loss; indigestion; heartburn; diarrhea; ulcers; GI bleeding.

• Nervous System: Dizziness; weakness; confusion; headache.

• Other: Ringing in the ears; difficulty hearing; thirst; sweating; liver problems; prolonged bleeding; abnormal blood counts; black or bloody stools; rapid breathing; iron deficiency anemia (chronic use); dim vision; rash; fever; hives.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose unless directed by your doctor.
• May cause stomach upset. Take with food or after meals.
• Do not crush or chew sustained-release preparations.
• Take with a full glass of water to reduce the risk of medication lodging in the throat.
• Patients allergic to tartrazine dye should avoid aspirin; use caution with asthma or nasal polyps.
• Avoid use during pregnancy.
• Avoid use in children with a fever-causing illness.
• Notify your doctor if ringing in ears or persistent stomach pain occurs.
• Do not use aspirin if it has a strong vinegar-like odor.
• Do not place or dissolve on an oral lesion (eg, canker sore, cold sore) or directly on an aching tooth. A serious local inflammatory reaction could occur.