Drug Facts

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

Uses

To treat constipation

For more information on laxative ingredients, see the Laxatives ­ Stimulant and Laxatives - Stool Softeners monographs in this site. Casanthranol is a stimulant laxative used in laxative combinations.

Guidelines for Use

• Use exactly as prescribed.
• Take 5 to 45 ml at bedtime with a full glass of water.
• Do not use in the presence of abdominal pain, nausea or vomiting.
• Laxative use if only a temporary measure do not use. longer than 1 week. When regularity returns, discontinue use. Prolonged, frequent or excessive use may tesult in dependence or electrolyte imbalance.
• Contact your doctor if relieved constipation rectal bleeding or symptoms of electrolyte imbalance (e.g, muscle cramps or pain, weakness, dizziness) occurs.
• Pink-red, red-violet or red-brown. discoloration of alkaline urine may occur with cascara sagrada, phenolphthalein or senna.
• Some of these products may contain the dye tartrazine (FD&C Yellow No.5) which can cause allergic reactions in certain individuals. Check package label when available or consult your doctor or pharmacist.
• Prevention of constipation includes: Adequate fluid intake (4 to 6 glasses of water daily), proper dietary habits including sufficient bulk or rough age, responding to the urge to defecate and daily exercise.
• Store at room temperature.

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

How The Drug Works

Saline laxatives cause water to accumulate in the intestine, thereby increasing pressure in the intestine and causing bowel movements.

Uses

For the short-term treatment of constipation.

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

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

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

Pregnancy: Saline laxatives can cause an electrolyte imbalance (eg, potassium). Use of a bulk or stool-softening laxative is preferred. Consult your doctor.

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. Tetracyclines interact with magnesium-containing products.

Side Effects

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

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

Nervous System: Weakness; dizziness; fainting.

Other: Irritation of the rectal area; sweating; pounding of the chest (palpitations); rectal bleeding; muscle cramps or pain; electrolyte imbalance (eg, potassium).

Guidelines for Use

• Take with a full glass of water or juice.
• Laxative use is only a temporary measure. Do not use longer than one week. Stop use of these products when normal bowel habits return. Prolonged, frequent, or excessive use may result in dependence or electrolyte imbalance.
• Do not use if you experience stomach pain, nausea, or vomiting,
• Contact your doctor if you experience unrelieved constipation, rectal bleeding, muscle cramps or pain, weakness, or dizziness.
• Prevention of constipation includes: adequate fluid intake (4 to 6 glasses of water daily), proper dietary habits, including sufficient bulk or rough age, responding to the urge to defecate, and daily exercise,
• Although the usual directions are to give the dose at bedtime, caution is advised because of lipid pneumonia
• Effects usually occur in 30 minutes to 3 hours. Plan accordingly .
• Store magnesium citrate solutions in the refrigerator to retain potency and to improve taste.

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Type of Drug:

Agent for treating acute gout attacks and preventing or delaying a recurrence of symptoms.

How the Colchicine Product Works:

Gout is a hereditary form of arthritis characterized by increased blood levels of uric acid. Colchicine decreases the inflammatory response to uric acid crystals that occurs in gout. However, it does not lower uric acid levels and thus does not treat the underlying cause of gout. Colchicine relieves pain but it is not an analgesic. Its suppressive effect helps reduce the incidence of gout attacks.

Uses of The Colchicine:

Colchicine:

To relieve pain of acute gout attacks. Works most effectively if administered early in the attack.

To prevent or delay acute attacks of gout (prophylaxis).

Probenecid and colchicine combination:

For the treatment of chronic gouty arthritis when complicated by frequent, recurrent acute attacks of gout.

Unlabeled Uses: Occasionally doctors may prescribe colchicine for treatment of certain types of cirrhosis, familial Mediterranean fever, primary amyloidosis, Behcet’s disease, pseudogout, skin manifestations of scleroderma, refractory idiopathic thrombocytopenic purpura, and chronic progressive multiple sclerosis.

Precautions:

• Pregnancy: Colchicine can cause fetal harm when administered to a pregnant woman. If this drug is used during pregnancy, or if the patient becomes pregnant while taking it, notify the woman of the potential hazared to the fetus.
• Breastfeeding: It is not known if colchicine appears in breast milk. Consult your doctor before you begin breastfeeding.
• Children: Safety and effectiveness for use in children have not been established. Do not use the probenecid and colchicine combination in children younger than 2 years of age.
• Elderly: Administer colchicine with great caution to elderly and debilitated patients, especially those with kidney, digestive tract, or heart disease. Reduce dosage if weakness, appetite loss, nausea, vomiting, or diarrhea appears.
• Lab Tests: Lab tests may be required during treatment with colchicine. Tests may include blood counts and uric acid levels.

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 colchicine or the probenecid and colchicine combination. 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 colchicine.

Side Effects:

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

Colchicine: Vomiting; nausea; diarrhea; stomach pain; muscle weakness; hair loss; sore throat; unusual bleeding or bruising; tingling in hands or feet; abnormal blood counts; bone marrow depression; rash; agranulocytosis; decreased blood platelets; red or purple spots under the skin; a plastic anemia.

Probenecid and colchicine combination: Headache; dizziness; hepatic necrosis; vomiting; nausea; appetite loss; sore gums; nephrotic syndrome; uric acid stones with or without blood in the urine; renal colic; rib and vertebra pain; frequent urination; precipitation of acute gouty arthritis; allergic reaction; fever; rash; hives; itching; aplastic anemia; decreased white blood counts; hemolytic anemia; anemia; skin inflammation; hair loss; flushing; diarrhea; stomach pain; muscle weakness; sore throat; unusual bleeding or bruising; tingling in hands or feet; agranulocytosis; red or purple spots under the skin; abnormal blood counts; bone marrow depression.

Type of Drug:

Antidepressant; mood-elevating agent.

How the Drug Works:

Citalopram blocks the uptake of a chemical found in the brain (serotonin) which increases the activity of this chemical, resulting in improved mood.

Uses:

To treat depression.

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

Breastfeeding: Citalopram appears in breast milk. A decision should be made whether to discontinue nursing or discontinue the drug, taking into account the risks to the infant of citalopram exposure (eg, excessive drowsiness, decreased feeding, weight loss) and the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

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

Elderly: Older individuals may be more sensitive to the effects of citalopram than younger individuals. The recommended dose for most elderly patients is 20 mg/day with titration to 40 mg/day only for nonresponding patients.

Drug Interactions:

Tell your doctor if you are taking or are planning to take any over-the­counter or prescription medications while taking citalopram. 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 citalopram: alcohol

• Carbamazepine (eg, Tegretol)
• Cimetidine (eg, Tagamet)
• CNS drugs (eg, antidepressants)
• Imipramine (eg, Tofranil)
• Lithium (eg, Lithobid)

Side Effects:

Every drug is capable of producing side effects. Many citalopram 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; dry mouth; vomiting; diarrhea; indigestion; stomach pain; gas; increased salivation; appetite changes.

Nervous System: Dizziness; sleeplessness; drowsiness; agitation; tremor; fatigue; weakness; anxiety; impaired concentration; amnesia; apathy; worsening of depression; suicide attempt; confusion; headache.

Circulatory System: Decreased heart rate; fast heartbeat; postural (standing) low blood pressure; low blood pressure.

Respiratory System: Upper respiratory tract infection; runny nose; sinus infection; coughing.

Urinary and Reproductive Tract: Painful menstruation; absence of menstruation; excessive urination; ejaculation disorder; decreased sex drive; impotence.

Other: Rash; itching; increased sweating; fever; abnormal skin sensations (eg, burning, prickling, tingling); joint or muscle pain; yawning; weight changes; taste pereception changes.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose unless directed by your doctor.
• Usual adult starting dose is 20 mg/day as a single dose. If necessary, dose may be increased to 40 mg/day after at least 1 week.
• Take once daily, in the morning or evening, with or without food.
• For most elderly patients and patients with liver disease, 20 mg/day is the recommended dose, with titration to 40 mg/day only for non responding patients.
• If a dose is missed, inhale 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 directed by your doctor. If more than one dose is missed or if it is necessary to establish a new dosage schedule, con­tact your doctor or pharmacist.
• Contact your doctor if you experience suicidal thoughts, sexual problems, appetite loss, nausea, vomiting, weight gain, restlessness, irritability, confusion, or excessive urination.
• Citalopram should not be used in combination with an MAOI, or within 14 days of discontinuing treatment with an MAOI. At least 14 days should be allowed after stopping citalopram before starting an MAOI.
• May cause drowsiness or dizziness. Use caution while driving or per­forming other tasks requiring alertness, coordination, or physical dexterity.
• Avoid alcohol while taking citalopram.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Improvement in depression may be noticed in 1 to 4 weeks. Continue to take citalopram as directed even though your depression has improved.
• Contact your doctor if adverse reactions persist and become bother­some.
• Store at controlled room temperature (59° to 86 F).

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How The Drug Works

The exact mechanism of action of the 5-aminosalicyclic acid (5-ASA) agents is unknown. They appear to work topically, reducing inflammation of the colon by preventing the production of substances involved in the inflammatory process.

Uses

Balsalazide Disodium: To treat mild to moderate active ulcerative colitis (inflammation of the colon or rectum).

Mesalamine: To treat mild to moderate inflammation of the colon or rectum (eg, ulcerative colitis) and to reduce chances of reoccurance (delayed-release tablets).

To treat active mild to moderate distal ulcerative colitis, proctosigmoiditis, or proctitis (rectal suppositories and suspension).

Olsalazine Sodium: To reduce the chances that ulcerative colitis will reoccur in patients who cannot take sulfasalazine.

Intolerance: Mesalamine can cause an intolerance syndrome characterized by cramping, acute stomach pain, bloody diarrhea, fever, head­ache, and rash. Prompt withdrawal is required. Consult your doctor.

Worsening of Symptoms: Worsening of symptoms of colitis (thought to have been caused by mesalamine or sulfasalazine) has occurred.

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

Breastfeeding: Oral mesalamine appears in breast milk. It is not known if rectal mesalamine, balsalazide, or olsalazine appear in breast milk. Consult your doctor before you begin breastfeeding.

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

Sulfites: Some of these products contain sulfite preservatives that 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 with 5-ASA. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. Thiopurines (eg, mercaptopurine) and anticoagulants (eg, warfarin) interact with olsalazine.

Side Effects

Every drug is capable of producing side effects. Many 5-ASA 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; constipation; frequent stools; indigestion; heart­burn; bloating; gas; stomach pain or cramps; nausea; vomiting; belching; worsening of colitis; appetitie loss; rectal bleeding; mouth inflammation.

Nervous System: Dizziness; headache; tiredness; weakness; disorientation; sleeplessness; fatigue; drowsiness; depression; vertigo (feeling of whirling motion); Lightheadedness.

Other: Sweating; chills; hair loss; fever; flu-like symptoms; cough; muscle pain, cramps, or tension; general pain; painful urination; fever; leg, back, chest, joint, or rectal pain; hemorrhoids; sore throat; edema (fluid retention); general body discomfort; dry mouth; sore throat; congestion; runny nose; sinus inflammation; upper respiratory infection; painful menstruation; eye inflammation; hives; rash; itching; acne; increased bowel swelling; urinary tract infection.

Type of Drug

Digestive enzymes.

How The Drug Works

Pancreatic enzymes (lipase, protease, and amylase) help digest and absorb the fats, proteins, and carbohydrates (starches and sugars) from food. Lipase accelerates the breakdown of fat, protease accelerates the breakdown of protein, and amylase accelerates the breakdown of starch.

Uses

To replace pancreatic enzymes in patients who do not produce normal amounts (eg, patients with cystic fibrosis, chronic pancreatitis, removal of the pancreas, obstruction of the pancreatic duct, and pancreatic insufficiency).

To treat excess fat in a bowel movement due to malabsorption syndrome or stomach bypass surgery.

To test pancreatic function.

Powder: Do not inhale or spill powder on skin because it may irritate skin or mucous membranes. Inhalation can precipitate an allergic reaction, coughing spell, bronchospasm, nasal irritation, watery eyes, or asthma attack. If it is necessary to open the capsules, wear a mask and gloves.

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

Breastfeeding: It is not known if these drugs are excreted in breast milk. Consult your doctor before you begin breastfeeding.

Lab tests may be required during treatment. Tests include stool fat content monitoring, blood albumin levels, and blood-clotting 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 these drugs. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with these drugs:

1. Calcium carbonate (eg, Tums) folic acid
2. Iron supplements (eg, Feosol)
3. Magnesium hydroxide (eg, Milk of Magnesia)

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; stomach cramps; diarrhea; constipation; vomiting; stomach pain or burning; belching; gas; intestinal obstruction; anal irritation; stool abnormalities (eg, greasy stool); bloating; loose stools; diarrhea.

Other: Skin irritation.

Guidelines for Use

• Consult your doctor and product labeling for individual dosing instructions. Do not exceed the recommended dosage.
• Do not change the dose or stop taking unless advised to do so by your doctor.
• Take with meals and snacks. Do not take on an empty stomach.
• Do not inhale or spill powder on skin. Inhaling may cause an allergic reaction, coughing spell, bronchospasm, nasal irritation, or asthma attack.
• Do not crush or chew coated tablets or capsules. If an intact capsule cannot be swallowed whole, it may be opened and the contents taken with a small amount of food that does not require Chewing and has a pH less than 5.5 (eg, applesauce, apricot, banana, and sweet potato baby foods, gelatin snacks). Do not mix with dairy products. Consume immediately after mixing. Wear a mask and gloves while handling.open capsules containing powder.
• Drink a full glass of water or juice with medicine to insure swallwing.
• Avoid using antacids or supplements containing calcium carbonate or magnesium hydroxide while taking digestive enzymes. Antacids may negate the beneficial effect of the enzymes.
• Maintain an adequate fluid intake (at least 64 oz per day) while taking this medicine.
• May interfere with the absorption of folic acid. Women who are pregnant or planning to become pregnant during treatment with this medicine should take folic acid supplements.
• Do not change brands without consulting with your pharmacist or doctor.
• Stop taking and notify your doctor if you experience allergy symptoms (eg, rash, wheezing, shortness of breath), bloody diarrhea, or stomach pain with ongoing diarrhea and poor weight gain.
• Vegetarians or patients with allergies to pork can use Hi-Vegi-Lip tablets, which are of vegetable origin.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature below 77⁰F in a cool, dry place.

Type of Drug:

Combination hormone products.

Uses of Estrogen Combination:

Estrogen and androgen combinations: To treat moderate to severe vasomotor symptoms associated with menopause (feeling of warmth in the face, neck, or chest or sudden intense episodes of heat and sweating throughout the body) in patients who have not improved with treatment of estrogens alone. To treat vulvar and vaginal atrophy associated with menopause.

Precautions:

Estrogen and progestin combinations: To treat moderate to severe vasomotor symptoms associated with menopause (feeling of warmth in the face, neck, or chest or sudden intense episodes of heat and sweating throughout the body) in patients who have not improved with treatment of estrogens alone.

To treat vulvar and vaginal atrophy associated with menopause (fuehrer excluded).

To prevent osteoporosis (Comb-Patch excluded).

To treat low estrogen conditions caused by diseases such as hypochondrias or primary ovarian failure.

Unlabeled Uses: There is no adequate evidence that estrogens are effective for nervous symptoms or depression that might occur during menopause; they should not be used to treat these conditions.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking, unless directed by your doctor.
• Carefully read the patient package insert available with your medicine.
• Fluid retention may aggravate asthma, epilepsy, migraine, heart disease or kidney disease. Use with caution in these conditions.
• 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.
• 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.
• Store as directed by package labeling.