Jul
26
Bicalutamide
July 26, 2009 | Leave a Comment
Generic Name
Bicalutamide (bye-kal-UTE-uh-mide)
Brand tjSMb Casodex
The information in this profile also applies to the following drug:
Generic Ingredient: Nilutamide Nilandron
Type of Drug Antiandrogen.
Prescribed For Prostate cancer.
General Information
Antiandrogens are prescribed together with another hormone product for prostate cancer. Bicalutamide competes with testosterone and other natural androgens (male hormones) by binding to the same places in body tissue where androgens normally bind. Prostate cancer is androgen sensitive and responds to treatments that counteract the effects of androgen or remove the sources of androgen.
Cautions and Warnings
Do not take this drug if you are allergic or sensitive to it or any of its ingredients.
People taking this medication may develop severe liver injury. People with liver disease may be at greater risk for serious side effects.
Almost 40% of men taking bicalutamide as single therapy for prostate cancer develop breast pain and enlargement. Bicalutamide may also reduce sperm count.
Two of every 100 people taking nilutamide develop interstitial pneumonitis (symptoms include cough, chest pain, fever, and breathing difficulties). People with lung disease and Asians may be at greater risk. Report any breathing difficulty or worsening of pre-existing breathing difficulty to your doctor immediately.
Isolated cases of aplastic anemia (a potentially fatal blood disorder) have been reported in people taking nilutamide, but the relationship between the drug and the disease is not established.
Possible Side Effects
♦ Most common’. hot dashes, hot flushes, general pain, headache, weakness, back pain, nausea, constipation, sleeplessness, breathing difficulties, and swollen breasts. Nilutamide–difficulty seeing in the dark and loss of testicle function.
V Common: diarrhea and pelvic pain.
Possible Side Effects (continued)
♦ Less common: vomiting, abdominal pains, chest pain, flu-like symptoms, high blood pressure, swelling in the ankles or lower legs, high blood sugar, weight loss, dizziness, tingling in the hands or feet, sweating, rash, nighttime urination, blood in the urine, urinary or other infection, loss of libido, impotence, breast pain, painful urination, anemia, and bone pain.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Bicalutamide and nilutamide increase the effect of oral anticoagulant (blood-thinning) drugs such as warfarin. Dosage adjustment may be necessary.
• Nilutamide may increase the risk of the potentially serious side effects of phenytoin, theophylline, or vitamin K antagonists.
Food Interactions
None known. Usual Dose
Bicalutamide
Adult: 50 mg once a day, morning or night.
Nilutamide
Adult: 300 mg a day, reduced to 150 mg a day after 30 days.
Overdosage
Symptoms of overdose may include nausea, vomiting, tiredness, headache and dizziness. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the presc6pktm bottle or container,
Special Information
Report anything unusual to your doctor, especially pain or tenderness in the upper right abdomen, yellowing of skin or whites of eyes, severe itching, dark urine, persistent appetite loss, and unexplained flu-like symptoms. These may be signs of severe liver toxicity. Also report any breathing difficulties, cough, chest pain,
orfever.
Up to half of people taking nilutamide can take from a few sec-
onds to a few minutes to adapt to darkness. This can be a problem especially when driving at night or through tunnels. Wearing tinted glasses will minimize this effect.
Up to 5% of people taking nilutamide may experience intolerance to alcohol. Symptoms include flushing, tiredness, and lightheadedness. If you experience this reaction, you should avoid alcohol.
Bicalutamide should be taken at the same time each day for best results. If you forget a dose of bicalutamide, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Call your doctor if you forget to take more than 1 dose.
Special Populations
PregnancylBreast-feeding: Antiandrogens are not intended for use by women.
Seniors: Seniors may take this drug without special precaution.
Jul
26
Betaxolol
July 26, 2009 | Leave a Comment
Generic Name
Betaxolol (bay-TAX-0-101) IN
Brand Names
Betoptic Kerlone Betoptic S
The information in this profile also applies to the following drugs:
Generic Ingredient: Carteolol Ocupress
Generic Ingredient: Levobunolol 92
AK Beta Betagan
Generic Ingredient: Metipranolol Optipranolol
Type of Drug
Beta-adrenergic blocking agent. Prescribed For
High blood pressure and glaucoma.
General Information
betaxololhydrochloride is one of many beta-adrenergic blocking drugs, or beta blockers, which interfere with the action of a specific part of the nervous system. Beta receptors are found all over the body and affect many body functions. Each beta blocker has particular characteristics that make it more suitable for certain conditions or people. Beta-blocker eyedrops reduce ocular pressure (pressure inside the eye) by slowing the production of eye fluids and by slightly increasing the rate at which these fluids flow through and leave the eye. Small amounts of these drugs are absorbed into the general blood circulation after they are instilled in the eye and may affect areas of the body other than the eye.
Cautions and Warnings
Q(3 M *e betaxolol if you are allergic or sensitive to any of its ingredients. You should be cautious about taking betaxolol if you have asthma, chronic bronchitis, emphysema, severe heart failure, a very slow heart rate, or heart block (disruption of the electrical impulses that control heart rate) because the drug may aggravate these conditions.
People with angina risk aggravating their angina if they suddenly stop taking the drug. These people should have their betablocker eyedrops dosage reduced gradually over 1-2 weeks.
Liver or kidney problems may reduce your ability to eliminate beta-blocker eyedrops from your body.
Beta-blocker eyedrops may mask the physical signs of hypoglycemia (low blood sugar). People with diabetes who must take insulin or oral medications to lower blood sugar and those subject to hypoglycemia should use beta-blocker eyedrops with caution.
Beta-blocker eyedrops may reduce the amount of blood your heart pumps with each beat. This reduction in blood flow may aggravate the condition of people with poor circulation or circulatory disease.
If you are undergoing major surgery, your doctor may want you to stop using beta-blocker eyedrops at least 2 days before surgery.
Betaxolol eyedrops should be avoided by people who cannot take oral beta-blocking drugs such as propranolol.
People with a history of severe anaphylactic reaction to allergens may be unresponsive to usual doses of epinephrine while taking beta blockers.
Possible Side Effects
Side effects are relatively uncommon and usually mild.
✓ Common: discomfort in the eye.
✓ Less common: blurred vision, inflammation of the cornea, sensation of having something in the eye, sensitivity to light, tearing, itching, dry eye, redness, inflammation, discharge, eye pain, cloudy vision, and crusting of the lashes.
✓ Rare: unusual tiredness or weakness, slow heartbeat, heart failure, dizziness, breathing difficulties, bronchospasm, depression, rash, and hair loss. Contact your doctor if you experience any side effect not listed above.
I
OMg ITAGractions
Beta-blocker eyedrops may interact with surgical anesthetics to increase the risk of heart problems during surgery. Some anesthesiologists recommend gradually stopping the drug Combining beta-blocker eyedrops and oral beta blockers will increase the effects of each drug. These drugs should be combined cautiously.
• Cocaine may reduce the effectiveness of all beta-blocker eyedrops.
• Betaxolol will counteract thyroid hormone replacements.
• Calcium channel blockers, reserpine, phenothiazine compounds, and quinidine may increase the amount of betablocker eyedrops in the bloodstream and lead to low blood pressure and heart rate disturbances.
• Betaxolol should not be taken within 2 weeks of taking a monoamine oxidase inhibitor (MAOI) antidepressant.
• Combining betaxolol with digitalis drugs can result in ex-
cessive slowing of the heart, possibly causing heart block.
• If you use other glaucoma eye medications, separate your doses to avoid physically combining them.
• Small amounts of beta-blocker eyedrops are absorbed into the bloodstream and may interact with other drugs in the same way as oral beta blockers, although this is unlikely.
• Beta blockers may block the effects of epinephrine.
• If you stop smoking while taking betaxolol, your dose may have to be reduced because your liver will break down the drug more slowly afterward.
Food Interactions
None known. Usual Dose
Adult
Glaucoma: 1-2 drops in the affected eye twice a day.
Hypertension: 10 mg tablet a day. May increase to 20 mg a day after 7-14 days. For seniors or people with severe kidney impairment, starting dose is 5 mg.
Child: not recommended. Overdosage
If Q\4tCqOSZ Occurs in the eye, flush it with water or saline. If accidentally ingested, symptoms of overdose of beta-blockers taken orally may occur. These include changes in heartbeat—unusually slow, unusually fast, or irregular—severe dizziness or fainting, breathing difficulties, bluish-colored fingernails or palms, low blood pressure, heart failure, shock, and seizures. If these symptoms occur, the victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container with you.
Special Information
Call your doctor at once if you develop back or joint pain, breathing difficulties, cold hands or feet, depression, rash, or changes in heartbeat. Beta-blocker eyedrops may produce an undesirable lowering of blood pressure, leading to dizziness or fainting; call your doctor if this happens to you. Also call your doctor if you experience persistent or bothersome anxiety, diarrhea, constipation, impotence, headache, itching, nausea or vomiting, nightmares or vivid dreams, upset stomach, trouble sleeping, stuffy nose, frequent urination, unusual tiredness, or weakness.
Do not use with your contact lenses in your eye. Do not touch the dropper to any surface.
If you forget a dose of beta-blocker eyedrops, administer it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: In animal studies, betaxolol given orally at doses much higher than is absorbed through administration in the eye was associated with miscarriage. There is little information about the effects of betaxolol in pregnant women. Betaxolol should be used during pregnancy only if the benefit outweighs the risk.
Some beta blockers pass into breast milk. Nursing mothers taking beta-blocker eyedrops should use infant formula.
Seniors: Seniors may take betaxolol without special precautions.
Jul
26
Betaine
July 26, 2009 | Leave a Comment
Generic Name
Betaine (BEE-lane)
Brand Name Cystadane
Type of Drug Homocysteine antagonist.
Prescribed For Homocysteinuria.
General Information
Homocysteinuria is a group of 3 disorders of the metabolism characterized by too much homocysteine in the blood and urine. People with this problem tend to have skeletal problems, problems with the lens of the eye, and blood-clotting problems that can cause chest pain or heart attack. Virtually all people treated with betaine experience a decrease of homocysteine in their blood. When used together with other homocysteinuria treatments, including folate and vitamins Bl;, and B., betaine’s effect has been additive to those treatments. Betaine starts working in several days and has been used for several years with no loss of effect. Most patients treated with betaine have been children. The effects of homocysteinuria can be devastating in children and include developmental problems, lethargy, seizures, and eye problems.
Cautions and Warnings None known.
Possible Side Effects
Side effects, which are uncommon, include nausea, upset stomach, diarrhea, choking if the powder is inhaled, and bad odors. Reported psychological changes from betaine are questionable.
Drug Interactions
None known. Betaine has been used successfully together with to-late and vitamins 1312 and B6.
Food Interactions
Betaine should be taken with food.
Usual Dose
Adult and Child: 3 g twice a day. Dosage for children under age 3 may be started at about 45 mg per 1b. a day and then increased in weekly 45-mg steps. Dosage should be increased in all patients until homocysteine is either undetectable in the blood or present in small amounts; doses up to 20 g a day have been required. Carefully measure all doses with the scoop provided. Each level scoopful is equal to 1 g of betaine.
Overdosage
Little is known about the effects of betaine overdose. People have been safely and successfully treated at doses up to 20 g a day. Call your poison control center or a hospital emergency room for more information. If you go to a hospital emergency room, ALWAYS bring the prescription bottle or container.
Special Information
Shake the bottle lightly before removing the cap to loosen the powder. Protect the powder from moisture.
Mix each dose with 4-6 oz. of water until it dissolves completely, then drink it at once.
Do not use the product if the final solution is either not clear or colored, or if the powder does not completely dissolve.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Tell your doctor about any missed doses.
Special Populations
PreSRdiAr-Yf8TeaSWeeding: The safety of using betaine during pregnancy is unknown. This drug should only be used during pregnancy if it is absolutely necessary.
It is not known if betaine passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may use this drug without special precaution.
Jul
26
Benazepril
July 26, 2009 | Leave a Comment
Generic Name
Benazepril (ben-AY-zuh-pril) [’Qj
Brand Name Lotensin
Combination Product
Generic Ingredients: Benazepril + Hydrochlorothiazide Lotensin HCT
Type of Drug
Angiotensin- convert i ng enzyme (ACE) inhibitor.
Prescribed For
High blood pressure. Also prescribed for renal failure, kidney hypertension, heart failure, post-heart attack management, the management of people with a high risk of heart disease, diabetes, chronic kidney disease, prevention of a second stroke, and non-diabetic neuropathy.
General Information
1616wepril hydrochloride and other ACE inhibitors prevent the conversion of a hormone called angiotensin I to another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, thus reducing blood pressure and relieving symptoms of heart failure. Benazepril also affects the production of other hormones and enzymes that participate in the regulation of blood-vessel dilation. Benazepril starts working in 1 hour and continues to work for about 24 hours.
Cautions and Warnings
Do not take benazepril if you are allergic or sensitive to any of its ingredients.
Swelling of the face, extremities, or throat has been known to occur with benazepril, which can be dangerous (see “Special Information”).
Benazepril occasionally causes very low blood pressure.
Benazepril may affect kidney function. Your doctor should check your urine for protein content during the first few months of treatment. Dosage adjustment is necessary if you have reduced kidney function.
Benazepril can affect white-blood-cell counts, possibly increasing your susceptibility to infection. Your doctor should monitor your blood counts periodically.
Benazepril can cause serious injury or death to the fetus if taken during pregnancy. Pregnant women should not take benazepril.
ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.
Possible Side Effects
✓ Most common: dizziness, tiredness, headache, nausea, and chronic cough. The cough usually goes away a few days after you stop taking the medication.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you develop any side effect not listed above.
Drug Interactions
• Combining 325 mg a day or more of aspirin with benazepril carries a higher risk of death than taking lower doses (less than 160 mg a day). People taking aspirin to prevent a heart attack should use the lower dose.
• Mixing any ACE inhibitor with an NSAID pain reliever can increase the chance of kidney failure.
• Benazepril may increase the effect of lithium; this combination should be used with caution.
• Severe sensitivity reactions with an ACE inhibitor can occur in hemodialysis patients, in patients undergoing venom immunization, or in those taking allopurinol.
• The blood-pressure-lowering effect of benazepril is additive
with diuretics and beta Mockers. Any other drug that causes
a rapid drop in blood pressure should be used with caution
if you are taking benazepril.
• Benazepril may increase blood-potassium levels, especially ff taken with dyazide or other potassium-sparing diuretics. Left untreated, this can be fatal.
• Antacids and benazepril should be taken at least 2 hours apart.
• Capsaicin may trigger or aggravate the cough associated with benazepril therapy.
• Indomethacin may reduce the blood-pressure-lowering effects of benazepril.
• Phenothiazine sedatives and antivomiting drugs may increase the effects of benazepril.
• Combining allopurinol and benazepril increases the risk of side effects.
• Benazepril increases blood levels of digoxin, which may increase the chance of digoxin-related side effects.
Food Interactions
You may take benazepril with food if it upsets your stomach.
Usual Dose
Adult: maintenance dose-20-40 mg a day as a single dose or in 2 equally divided doses. People with poor kidney function may need less medication.
Child (age 6 and over): 0.045-0.27 mg per lb. of body weight once a day.
Child (under age 6): not recommended.
Overdosage
The principal effect of benazepril overdose is a rapid drop in blood pressure, as evidenced by dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Benazepril can cause swelling of the face, lips, hands, and feet. This swelling can also affect the larynx (throat) and tongue and interfere with breathing. If this happens, go to a hospital at once. Call your doctor if you develop a sore throat, mouth sores, abnormal heartbeat, sudden difficulty breathing, chest pain, persistent rash, or loss of taste perception.
Some people who start taking benazepril after they are already on a diuretic (agent that increases urination) experience a rapid drop in blood pressure after their first dose or when their dosage is increased. To prevent this from happening, your doctor may tell you to stop taking your diuretic 2 or 3 days before starting benazepril or to increase your salt intake during that time. The diuretic may then be restarted gradually.
You may get dizzy if you rise to your feet too quickly from a sitting or lying position when taking benazepril.
Avoid strenuous exercise or very hot weather because heavy sweating or dehydration can cause a rapid drop in blood pressure.
While taking benazepril, avoid over-the-counter diet pills, decongestants, and other stimulants that can raise blood pressure. Also, do not use potassium supplements or salt substitutes containing potassium without consulting your doctor.
If you take benazepril once a day and forget a dose, take it as soon as you remember. If it is within 8 hours of your next dose, skip the dose you forgot and continue with your regular schedule. If you take benazepril twice a day and miss a dose, take the missed dose right away. If it is within 4 hours of your next dose, take 1 dose immediately and another in 5 or 6 hours, and then go back to your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: ACE inhibitors can cause fetal injury or death. Women who are or might become pregnant should not take ACE inhibitors. If you become pregnant, stop taking the medication and call your doctor immediately.
Small amounts Qt tei)wzepfil pass into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors may be more sensitive to the effects of this drug due to age-related losses in kidney or liver function.
Jul
26
Becaplermin
July 26, 2009 | Leave a Comment
If you forget a dose, apply it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding
The safety of using becaplermin during pregnancy is not known. The drug should only be used during pregnancy if it is absolutely necessary.
It is not known if becaplermin passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors
Seniors may take this drug without special precaution.Generic Name
Becaplermin (beh-CAP-ler-min)
Brand Name Regranex
Type of Drug Human growth factor.
Prescribed For
Diabetic foot and leg wounds.
General Information
Becaplermin is a type of human growth factor produced in a laboratory. While it is not a substitute for good wound care, becaplermin can stimulate wound tissue to heal taster. Studies of the drug have produced mixed results. In some studies, people using becaplermin were 111.–2 times more likely to have complete healing of their wounds. In another study, the results with becaplermin were the same as those with good wound care alone.
Cautions and Warnings
Do not use becaplermin if you are allergic or sensitive to any of its ingredients.
Becaplermin should not be used to speed the healing of wounds that are healing by themselves.
Becaplermin should not be applied to skin cancer or tumors or exposed bones, joints, tendons, or ligaments because its effect on these body structures is not known.
Becaplermin should not be used for wounds that do not extend to subcutaneous tissue or are caused by poor circulation.
Drug and Food Interactions None known.
Usual•Dose
Adult and Child (age 16 and over): Apply a thin layer to the wound and leave in place for 12 hours. Then, remove the becaplermin bandage, rinse the wound, and cover it with a plain saline-soaked bandage for the rest of the day. Continue this process until the wound has healed completely.
Child (under age 16): not recommended.
Overdosage
Little is known about the effects of accidental ingestion. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
Call your doctor if your wound worsens or is irritated by becaplermin.
Wash your hands bet43ve -applying becaplermin.
Do not allow the tip of the becaplermin tube to touch any surface, including the wound being treated.
Your doctor should reassess your treatment if the wound is not 30% smaller in 10 weeks and completely healed in 20 weeks.
Applying more becaplermin than recommended will not make your wound heal better or faster.
alone. plus wound care had a eveloping a rash than those who re-
e.
Possible Side Effects
People treated with becaplermin larger risk of developing wound care.
Jul
26
Baclofen
July 26, 2009 | Leave a Comment
Generic Name
Baclofen (BAK-loe-fen)
Brand Name Kemstro
Type of Drug
Skeletal muscle relaxant.
Prescribed For
Muscle spasms associated with multiple sclerosis (MS), spinal cord injury or disease, or other nervous system conditions; may also be used to treat trigeminal neuralgia (tic douloureux), hiccups, acid reflux, and as migraine prevention.
QeCttt!b% %iftTimation
Baclofen may work by interfering with nervous system reflexes at the spinal cord, although it may also have some effect outside the spinal cord. Baclofen is chemically similar to a natural nerve transmitter known as GABA; baclofen’s effect on muscle spasm may be related to its effect on GABA nerve receptors.
cautions and Warnings
Do not take baclofen if you are allergic or sensitive to any of its ingredients. It should not be taken for muscle spasm resulting from rheumatic disease, stroke, cerebral palsy, or Parkinson’s disease because its benefit in these situations has not been proven. The condition of people with epilepsy or psychotic disorders may worsen while taking baclofen.
About 4% of women with MS who take baclofen for less than 1 year develop ovarian cysts that usually disappear on their own. This is within the normal range for all women-1-5%—for developing ovarian cysts.
Baclofen is excreted primarily through the kidneys, so patients with kidney disease or impaired kidney function should use baclofen with caution.
Abruptly stopping baclofen can lead to hallucinations and seizure. Dosage should always be gradually reduced, except in cases of severe side effects.
Possible Side Effects
Baclofen may affect lab tests for liver function and can raise blood sugar levels.
♦ Most common: drowsiness, low blood pressure, weakness, dizziness, lightheadedness, nausea and vomiting, headache, and sleeplessness.
♦ Less common: frequent urination, fatigue or lethargy, confusion, euphoria, excitement, depression, hallucinations, tingling in the hands or feet, muscle pain, ringing or buzzing in the ears, coordination difficulties, tremors, rigidity, weakness, loss of muscle tone, unusual eye movement and other muscle-control problems, double vision, pinpoint or wide-open pupils, breathing difficulties, heart palpitations, dry mouth, appetite loss, changes in sense of taste, abdominal pain, diarrhea, bedwetting, difficulty u6- nating, painful urination, impotence, gash, Itching, swelling of the ankle, excessive sweating, weight gain, and stuffy
MSe.
• Rare: slurred speech, blurred vision, seizure, fainting, chest pain, blood in the urine, and testing positive for blood in the stool. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Avoid alcoholic beverages and other nervous system depressants such as antihistamines, sedatives, or narcotic pain relievers while taking baclofen.
• Combining a monoamine oxidase inhibitor (MA01) antidepressant with baclofen may cause drowsiness, nervous system depression, and low blood pressure.
• Combining a tricyclic antidepressant with baclofen may lead to severe muscle weakness.
• Baclofen may increase blood sugar. Diabetics may need to increase their dosage of antidiabetic drugs to account for this effect.
• Combining blood-pressure-lowering drugs with baclofen may lead to dizziness or fainting due to severe lowering of blood pressure.
Food Interactions
This drug may be taken without regard to food or meals.
Usual Dose
Adult and Child: 5 mg 3 times a day for 3 days, gradually increased every 3 days until the desired effect is achieved, usually at 40-80 mg a day. People with kidney disease require lower doses.
Overdosage
Symptoms of baclofen overdose include vomiting, loss of muscle tone, twitching, convulsions, pinpoint or wide-open pupils, drowsiness, blurred or double vision, breathing difficulties, seizure, and coma. Overdose victims should be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Baclofen is a nervous system depressant. Take care when driving or doing anything that requires concentration and physical coordination.
Call your doctor if you develop persistent symptoms such as a frequent u((;e, t0 %,miwale, painful urination, constipation, nausea, headache, sleeplessness, or confusion.
Do not stop taking baclofen on your own. Abruptly stopping this drug may lead to hallucinations or seizure.
Your pharmacist may prepare a baclofen liquid. This mixture should be kept in the refrigerator and must be thrown away after I month.
If you forget a dose of baclofen and remember within 1 hour of your scheduled time, take it immediately. If you do not remember until more than 1 hour later or it 1()u JoTgetft completely. skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Baclofen increases the chances of certain birth defects in lab animals. Pregnant women should only take baclofen after carefully weighing its possible benefits against its risks.
Baclofen taken by mouth passes into breast milk. Nursing mothers who must take this drug should use infant formula or receive the drug by injection directly into the spinal cord, because baclofen administered by injection does not pass into breast milk.
Seniors: Seniors may be more sensitive to nervous system side effects including hallucinations, depression, drowsiness, and confusion.
Jul
26
Azole Antifungals
July 26, 2009 | Leave a Comment
Type of Drug
Azole Antifungals
Brand Names
Generic Ingredient: Fluconazole 91 Diflucan
Generic Ingredient: Itraconazole Sporanox
Generic Ingredient: Ketoconazole 0
Extina Nizoral
Ketozole Xolegel
Generic Ingredient: Posaconazole Noxafil
Generic Ingredient: Voriconazole Wend
PlIM-fibed For
Fungal infections of the blood, mouth, throat, vagina, or central nervous system.
Fluconazole, posaconazole, and itraconazole can be used to treat opportunistic fungal infections that inflict many people with HIV or cancer whose immune systems have been compromised.
General Information
Azole antifungals are used to treat a variety of fungal organisms, including Candida, aspergillus, cryptococcus, blastomycosis, fusarium, histoplasmosis, and Scedosporium. They work by inhibiting important enzyme systems in the organisms they attack. These drugs are broken down in the liver.
Cautions and Warnings
Do not take azole antifungals if you are allergic or sensitive to any of their ingredients. People who are allergic to similar antifungals may also be allergic to these drugs, but cross-reactions are not common and serious allergic reaction is rare.
Azole antifungals can affect heart rhythm and should be used with caution if you have a history of abnormal heart rhythms.
Rarely, azole antifungals can cause liver damage. The drugs should be used with caution in people with liver disease. At least one in every 10,000 people who take ketOGonazole develop liver inflammation. The inflammation generally subsides when the drug is discontinued.
Voriconazole tablets contain lactose. They should not be taken by patients with rare hereditary problems of galactose intolerance, Lapp-lactase deficiency, or glucose-galactose malabsorption.
Rash may be an important sign of drug toxicity, especially in people with HIV or others with compromised immune function. Report any rashes, especially ones that do not heal readily, to your doctor.
These drugs can have very serious effects if combined with other medicines. See “Drug Interactions” for specific information.
Possible Side Effects
Side effects are generally more common among people with HIV.
Fluconazole
V Most common *wa)jsea, headache, rash, vomiting, ab- dominal pain, and diarrhea.
V Less common: liver toxicity, as measured by increases in specific lab tests. These changes in lab values are more common in people with HIV or cancer, who are more likely to be taking several drugs.
Possible Side Effects (continued)
V Rare: seizures and exfoliative skin disorders. People with
HIV or cancer who take fluconazole for fungal infections
may develop severe liver or skin problems. Contact your
doctor if you experience any side effect not listed above.
Itraconazole
• Most common: nausea, vomiting, and rash.
♦ Less common: diarrhea, abdominal pain, appetite loss, swelling in the legs or feet, fatigue, fever, feeling unwell, itching, headache, dizziness, reduced sex drive, tiredness, high blood pressure, liver or kidney function abnormalities, low blood potassium, and impotence.
♦ Rare: gas, sleeplessness, depression, ringing or buzzing in the ears, bronchitis, chest pain, coughing, and swollen or painful breasts in men or women. Contact your doctor if you experience any side effect not listed above.
Ketoconazole
✓ Common: nausea, vomiting, upset stomach, abdominal pain or discomfort, itching, and swollen breasts in men. Most of these side effects are mild and only a small number of people-1.5%—have to stop taking the drug because of severe side effects.
Posaconazole
✓ Most common: fever, headache, chills, swelling in the legs, appetite loss, dizziness, fluid accumulation, weakness, blood pressure changes, anemia, low white-blood-cell counts with or without fever, vaginal bleeding, diarrhea, nausea, vomiting, abdominal pain, constipation, upset stomach, mucous membrane irritation, rapid heart beat, bacteria in the blood, herpes infection, CMV infection, infection, sore throat, low blood potassium, low blood magnesium, high blood sugar, muscle and joint pain, back pain, low blood-platelet levels, ‘,-A-&ZVanO -blue marks, sleep%’Mess, cough, difficulty breathing, nosebleeds, and rash and itching.
♦ Common: upper respiratory infection, low blood calcium, and anxiety.
✓ Less common: tiredness, weakness, blurred vision, taste changes, and heart rhythm changes.
Drug Interactions
• Do not mix astemizole, cisapride, halofantrine, pimozide. quinidine, or terfenadine with itraconazole, ketoconazole, or posaconazole. Severe cardiac side effects may occur. Similarly, combining fluconazole with cisapride may cause cardiac events. Do not mix these medicines.
• Antacids interfere with the absorption of ketoconazole and itraconazole. Take antacids more than 2 hours after taking these drugs.
• Fluconazole and ketoconazole may increase the amount of the sulfonylurea-type antidiabetes drugs (eg. tolbutamide, glyburide, and glipizide) in the blood, causing low blood sugar. Cyclosporine, phenytoin, theophyiline, warfarin, and zidovudine (an HIV drug—also known as AZT) are similarly affected. Dosage adjustments of these drugs and monitoring may be required.
• Ketoconazole may also increase blood levels of HIV drugs including protease inhibitors and didanosine (ddl).
• Use caution when combining fluconazole with rifabutin, rifampin, tacromilus, and terfenadine. Dose adjustments may be necessary.
• Fluconazole and ketoconazole may interfere with contraceptive drugs. Consider using an alternative form of birth control.
• Hydrochlorothiazide may increase blood levels of fluconazole up to 40%.
• Do not mix ketoconazole with triazolam.
• Ketoconazole increases the effects of benzodiazepk”-_ se0atives, buspirone, carbamaze, ime. corticosteroids, digoxin, do(I8ptl15, Wodipine, nisoldipine, tacrolimus, tricyclic antidepressants, vinca-type alkaloids, and zolpidem. Dosage adjustments may be required.
• Do not mix itraconazole with dofetilide, ergot alkaloids, midazolam, or triazolam.
• Use caution when combining itraconazole with alfentanil, aripiprazole, buspirone, calcium channel blockers,
Possible Side Effects (continued) Voriconazole
✓ Most common: visual disturbances.
♦ Common: fever, rash, nausea, in blood infections, swelling the arms or legs, and
respiratory disorder.
carbamazepine, cilostazol, clarithromycin, corticosteroids, digoxin, erythromycin, halofantrine, haloperidol, sirolimus, tacrolimus, verapamil, vinca-type alkaloids, warfarin, and zolpidem. Dose adjustments may be necessary.
• Rarely, people who combine itraconazole or posaconazole with a statin-type blood-fat lowering drug experience muscle pain and destruction. The statin drug dose should be reduced. Some people who have experienced this interaction were also taking cyclosporine. cyclosporine dosages should be lowered when combined with itraconazole and a statin drug. Do not combine itraconazole with lovastatin or simvastin.
• Cimetidine, didanosine, famotidine, isoniazid, nizatidine, phenytoin, protease inhibitors, ranitidine, rifabutin, rifampin, and rifapentine may interfere with the effectiveness of itraconazole and posaconazole.
• Voriconazole should not be combined with astemizole, barbiturates, carbamazepine, cisapride, efavirenz, ergot drugs for migraines, pirnozide, quinidine, rifabutin, rifampin, sirolimus, and terfenadine.
• Serious increases in levels of cyclosporine and tacrolimus have been reported when mixed with posaconazole. Dosage adjustments are required.
• Posaconazole and an ergot drug should not be mixed.
• Voriconazole and posaconazole should be used with caution with benzodiazepine sedatives, calcium channel blockers, cyclosporine, methadone, statin-type drugs, sulfonylureatype antidiabetes drugs, tacrolimus, vinca-type anti-cancer drugs, and warfarin. Dosage adjustments of these drugs may be needed to avoid side effects.
• Combining voriconazole and contraceptive drugs, omeprazole, phenytoin, or a protease inhibitor (excluding indinavir) may require dose adjustments and frequent monitoring for drug toxicity.
• Combining voriconazole with an NNRTI for HIV can either increase or decrease blood levels of voriconazole and increase blood levels Qt the NNM~.Drug side effects may occur.
Food Interactions
Take voriconazole at least 1 hour before or 2 hours after a meal. Take ketoconazole and itraconazole with food or meals. Posaconazole must be taken with food or a nutritional supplement. Another treatment should be considered if this requirement cannot be met.
Usual Dose
6uconazole
Adult and Child (age 14 and over): 100-400 mg once a day. Child: 1.3-5.5 mg per lb. of body weight once a day; no more
than 400 mg a day.
Itraconazole
Adult: 200-600 mg once a day.
Child (age 3-16): 100 mg a day has been prescribed, but the long-term effects of itraconazole in children are not known.
Ketoconazole
Oral
Adult: 200-400 mg once a day. Treatment may continue for several months, depending on the type of infection being treated.
Child (age 2 and over): 1.5-3 mg per lb. of body weight once a day.
Child (under age 2): not recommended.
Topical: Apply to affected and immediately surrounding areas 12 times a day for 2-6 weeks, depending on the type of infection being treated.
Posaconazole
Adult and Child (age 13 and over): 200 mg (5 ml) 3 times a day. This product includes a measuring spoon. Child (under age 13): not recommended.
Voriconazole
Adult: 100-300 mg every 12 hours. Child: not recommended.
Overdosage
Overdose is likely to result in exaggerated drug side effects. Doses of posaconazole up to 1600 mg a day have been taken without any adverse reactions. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special WIMMation
When taking fluconazole, regular doctor visits are necessary to monitor liver function and general progress. Call your doctor if you develop severe diarrhea; vomiting; reddening, loosening, blistering, or peeling of the skin; darkening of the urine; jaundice (yellowing of the skin or whites of the eyes); loss of appetite; or abdominal pain, especially on the right side. Report other symptoms that are bothersome or persistent.
Itraconazole must be taken for at least 3 months to determine its effectiveness; otherwise, the infection may return.
If you forget a dose of one of these medicines, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies with these medicines show effects on the fetus that have not been seen in humans. Pregnant women should not use azole antifungals unless the possible benefits outweigh the risks.
These drugs pass into breast milk. Nursing mothers who must these drugs should use infant formula.
Seniors: Seniors may require a reduced dosage of fluconazole due to age-related loss of kidney function. No dosage adjustments are necessary with other azole antifungals.
Jul
26
Azithromycin
July 26, 2009 | Leave a Comment
Generic Name
Azithromycin (uh-ZIH-throe-MYE-sin) [9
Brand Names
Zithromax Zmax
Type of Drug Macrolide antibiotic.
Prescribed For
Upper and lower respiratory tract infections, skin infections, sexually transmitted diseases (STDs), middle eat Intections, tonsillitis, pharyngitis, 3R6 bacterial sinusitis.
General Information
Azithromycin is an azalide antibiotic, a subgroup of the macrolides. Macrolide drugs are either bactericidal (bacteria-killing) or bacteriostatic (inhibiting bacterial growth) depending on the organism in question and amount of antibiotic present.
Cautions and Warnings
Do not take azithromycin if you are allergic or sensitive to any of its ingredients or any macrolide antibiotic.
Azithromycin is excreted primarily through the liver. People with liver disease or damage should consult their doctors. Those on long-term therapy with this drug should have periodic blood tests.
Colitis (bowel inflammation), ranging from mild to life-threatening, has been associated with all antibiotics (see “Possible Side Effects”).
Azithromycin is considered appropriate only for the treatment of more mild forms of pneumonia in non-hospitalized patients. People with other underlying conditions, those who are immune-compromised, and those who contract pneumonia in a hospital or other institutional setting probably should be treated with other antibiotics.
Possible Side Effects
Most side effects are mild and go away once you stop taking azithromycin.
✓ Most common: nausea, vomiting, abdominal pain, and diarrhea. Colitis (symptoms include severe abdominal cramps and severe, persistent, and possibly bloody diarrhea) may develop.
✓ Less common: heart palpitations; chest pain; vaginal irritation; stomach upset; gas; dizziness; headache; tiredness; unusual sun sensitivity; rash; itching; swelling; fungal infection of the mouth or vagina; dark, tarry stools; kidney inflammation; and vertigo.
Drug Interactions
• Pimozide should not be taken by anyone also taking a macrolide antibiotic. Two people died while taking this combination.
• Antacid products containing aluminum magnesium may delay the;a13z0jptjrjR rij azithromycin into the blood. Separate your antacid dose from azithromycin by at least 1 hour.
• All macrolide antibiotics increase blood levels of cyclosporine and may cause kidney damage.
• Combining azithromycin and a statin cholesterol-lowering drug increases the risk of developing a painful and potentially fatal condition involving severe muscle degeneration.
e Combining azithromycin and nelfinavir may increase azithromycin side effects.
Food Interactions
It is important to take azithromycin liquid on an empty stomach, 1 hour before or 2 hours after meals. Tablets may be taken with or without food.
Usual Dose
Respiratory Tract Infections, Skin Infections, STDs,
and Bacterial Sinusitis
Adult (age 16 and over): 500 mg as a single dose for 3 days, or 500 mg as a single dose on day 1, then 250 mg once a day on days 2-5 of treatment. STDs are treated with a single dose of 10002000 mg.
Middle Ear Infections and Bacterial Sinusitis* (Child)
1 -Day Regimen: 13.6 mg per lb. of body weight a day for 1 day. 3-Day Regimen: 4.5 mg per lb. of body weight a day for 3 days. 5-Day Regimen: 4.5 mg per 1b. of body weight a day for day 1,
and 2.25 mg per lb. a day for days 2-5.
‘3-day regimen for bacterial sinusitis preferred.
Tonsillitis and Sore Throat
Child (age 2 and over): 5.5 mg per lb. of body weight a day for 5 days.
Overdosage
Overdose may cause severe side effects, especially nausea, vomiting, stomach cramps, and diarrhea. Call your local poison control center or hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop nausea, vomiting, diarrhea, stomach cramps, or severe abdominal pain. Stop taking this drug and immediately call your doctor it you experience breathing difficulties, chest pain, hives, rash, itching, mouth sores, or unusual sensitivity to light.
It is crucial that you follow your doctor’s directions on how to take the drug and how many days to take it—even if you feel well sooner. This drug’s effectiveness may be severely reduced otherwise. Taking azithromycin at the same time each day may help you remember your medication.
If you forget a dose of azithromycin, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and go back to your regular schedule.
Special Populations
Pregnancy/Breast-feeding: It is not known if azithromycin taken during pregnancy will harm a fetus. This medication should be taken by pregnant women only if it is clearly needed.
It is not known if azithromycin passes into breast milk, but other macrolide antibiotics do. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors with liver disease should use caution. Seniors who have pneumonia or are especially sickly or debilitated probably should be treated with other medications.
Jul
26
Atovaquone
July 26, 2009 | Leave a Comment
Generic Name
Atovaquone (ah-TOE-vuh-quone)
Brand Name Mepron *
Type of Drug Anti-infective.
Prescribed For
Prevention and treatment of mild to moderate Pneumocystis carinii pneumonia (PCP).
General Information
Atovaquone is an anti-infective with specific activity against PCP, an infection commonly associated with HIV. It is used in people who cannot take the combination of trimethoprim and sulfamethoxazole. In studies comparing atovaquone with trimethoprimsulfamethoxazole (TMP-SMX), approximately 60% of people with PCP improved on each drug. However, more people died of PCP and other infections white being treated with atovaquone. Of those who died, most had less atovaquone in their bloodstream than those who lived. In studies comparing oral atovaquone with intravenous pentamidine for treating PCP in people with HIV, both drugs were equally effective, at 14%. Again, there was a direct correlation between the amount of atovaquone in the blood and survival.
The drug stays in the body for several days and is eliminated through the liver.
Cautions and Warnings
Do not take atovaquone if you are allergic or sensitive to any of its ingredients.
This drug has not been studied for severe PCP or in those who are failing on TMP-SMZ.
Atovaquone only works against PCP People with PCP who have bacterial, viral, fungal, or other infections of the lung may continue to worsen despite atovaquone therapy. If this happens, it may be a sign that another kind of infecting organism is the cause. Additional medicine will be necessary.
Atovaquone absorption is strongly influenced by food. People with gastrointestinal disorders or those who are unable to take atovaquone with food may not be able to absorb enough medicine for it to be effective. Intravenous treatments of other PCP antiinfectives may be necessary.
Possible Side Effects
Because atovaquone was evaluated in people with advanced HIV, it is difficult to discern side effects of the drug use from those caused by the disease. Overall, only 4-7% of people studied stopped taking the drug because of side effects, a much smaller percentage than occurs with other PCP treatments.
✓ Most common: rash, nausea, diarrhea, headache, vomiting, fever, sleeplessness, weakness, itching, oral fungal infections, abdominal pain, upset stomach, appetite loss, constipation, cough, dizziness, pain, increased sweating, anxiety, sinus inflammation, and runny nose.
✓ Less common: changes in sense of taste, low blood sugar, and low blood pressure.
Drug Interactions
b Atovaquone may increase blood levels of warfarin, oral anti-diabetes drugs, digoxin, and other drugs that bind strongly to blood proteins.
• Rifampin and rifabutin may reduce blood levels of atovaquone, possibly diminishing its effectiveness.
• Taking atovaquone with TMP-SMZ has resulted in reduced blood levels of TMP-SMZ. This should not reduce TMPSMZ’s effectiveness.
• Taking atovaquone with zidovudine (AZT) drastically reduces the rate at which zidovudine is eliminated from the body. For most people, this is not a problem.
Food Interactions
Take atovaquone with food or meals to improve drug absorption. A high-fat meal can increase the amount absorbed by 300%.
Usual Dose
Prevention: 1500 mg daily with food.
Treatment: 750 mg twice a day for 3 weeks, taken with food.
Overdosage
Little is known about the effects of atovaquone overdose; symptoms are likely to be exaggerated drug side effects. Call your local poison control center or hospital emergency room for more information. If you go to the hospital, ALWAYS bring the prescription bottle or container.
Special Information
Taking atovaquone regularly and with food is essential to the drug’s effectiveness. If you cannot eat 2 meals a day, your doctor may have to prescribe another PCP treatment.
Call your doctor if you develop any persistent or bothersome side effects.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, space your remaining doses equally throughout the rest of the day so that you can still take a total daily dose of 1500 mg, or 2 tsp.
Special Populations
Pregnancy/Breast-feeding: In animal studies. atovaquone has affected fetal development. This drug should only be used during pregnancy after carefully weighing its potentia(beneiAs against its ri*kS,
Atovaquone is likely to pass into breast milk because of its affinity for body fat. Nursing mothers should use infant formula.
Seniors: This drug has not been tested systematically in people over age 65. Seniors, especially those with kidney, heart, or liver disease, may be more sensitive to atovaquone side effects.
• Taking atovaquone with TMP-SMZ has resulted in reduced blood levels of TMP-SMZ. This should not reduce TMPSMZ’s effectiveness.
• Taking atovaquone with zidovudine (AZT) drastically reduces the rate at which zidovudine is eliminated from the body. For most people, this is not a problem.
Food Interactions
Take atovaquone with food or meals to improve drug absorption. A high-fat meal can increase the amount absorbed by 300%.
Usual Dose
Prevention: 1500 mg daily with food.
Treatment: 750 mg twice a day for 3 weeks, taken with food.
Overdosage
Little is known about the effects of atovaquone overdose; symptoms are likely to be exaggerated drug side effects. Call your local poison control center or hospital emergency room for more information. If you go to the hospital, ALWAYS bring the prescription bottle or container.
Special Information
Taking atovaquone regularly and with food is essential to the drug’s effectiveness. If you cannot eat 2 meals a day, your doctor may have to prescribe another PCP treatment.
Call your doctor if you develop any persistent or bothersome side effects.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, space your remaining doses equally throughout the rest of the day so that you can still take a total daily dose of 1500 mg, or 2 tsp.
Special Populations
Pregnancy/Breast-feeding: In animal studies. atovaquone has affected fetal development. This drug should only be used during pregnancy after carefully weighing its potentia(beneiAs against its ri*kS,
Atovaquone is likely to pass into breast milk because of its affinity for body fat. Nursing mothers should use infant formula.
Seniors: This drug has not been tested systematically in people over age 65. Seniors, especially those with kidney, heart, or liver disease, may be more sensitive to atovaquone side effects.
Jul
24
Amiodarone
July 24, 2009 | Leave a Comment
Amiodarone
Prescribed For Abnormal heart rhythms.
General Information
Amiodarone should be prescribed only in situations where the abnormal rhythm is so severe as to be life-threatening and does not respond to other drug treatments. Amiodarone works by decreasing the sensitivity of heart tissue to nervous impulses within the heart. It has not been proven that people taking this drug will live longer than those with similar conditions who do not take it. Amiodarone may exert its effects 2-5 days after you start taking it, but often takes 1-3 weeks to affect your heart. Amiodarone’s antiarrhythmic effects can last for weeks or months after you stop taking it.
Cautions and Warnings
Do not take amiodarone if you are allergic or sensitive to any of its ingredients or if you have heart block or a very slow heart rate. Amiodarone can also cause heart block, a drastic slowing of electrical impulse movement between major areas of the heart, or extreme slowing of the heart rate. Amiodarone heart block occurs about as often as heart block caused by some other antiarrhythmic drugs, but its effects may last longer than those of the other drugs. Amiodarone can also worsen existing abnormal heart rhythms in 2-5% of people who take the drug. These effects can be fatal.
Amiodarone can cause potentially fatal drug side effects. At high doses, 10% or more of people taking this drug can develop potentially fatal lung and respiratory effects, beginning with cough and progressive breathing difficulties. Liver damage caused by amiodarone is usually mild. In rare cases, amiodarone has been associated with liver failure that resulted in death.
People taking amiodarone may develop optic nerve irritation, leading to partial or complete loss of vision. Most adults who take amiodarone for 6 months or more develop tiny deposits in the corneas of their eyes. These deposits may cause blurred vision or t1dil’O'S 111 Up to 10% of people taking amiodarone. Some people develop dry eyes and sensitivity to bright light.
One in ten people taking amiodarone can experience unusual sensitivity to the effects of the sun. Use an appropriate sunscreen product and reapply it frequently.
Amiodarone can cause thyroid abnormalities. It may worsen an already sluggish thyroid gland in 2-10% of people taking the drug,and increase thyroid activity in 2% of people taking it. Amiodarone has also been associated with an increase in risk of thyroid tumors.
Antiarrhythmic drugs are less effective and cause abnormal rhythms if blood potassium is low.
Possible Side Effects
About 75% of people taking 400 mg or more of amiodarone a day develop some drug side effects. As many as 18% have to stop taking the drug because of a side effect.
♦ Common: fatigue, not feeling well, tremors, unusual involuntary movements, loss of coordination, an unusual walk, muscle weakness, low blood pressure, dizziness, tingling in the hands or feet, reduced sex drive, sleeplessness, headache, nervous-system problems, nausea, vomiting, constipation, appetite loss, abdominal pain, dry eyes, unusual sensitivity to bright light, and seeing halos around bright lights. Unusual sun sensitivity is the most common skin reaction to amiodarone, but people taking this drug can develop a blue skin discoloration that may not go away completely when the drug is stopped. Other skin reactions are sun rashes, hair loss, and black-and-blue spots.
V Rare: inflammation of the lung or fibrous deposits in the lungs, changes in thyroid function, changes in taste or smell, bloating, unusual salivation, and changes in blood clotting. Amiodarone can cause heart failure, reduced heart rate, and abnormal rhythms. Up to 9% of people taking amiodarone develop abnormalities in liver function. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Amiodarone increases the effects of metopvoko% and other beta blockem Calcium channel blockers such as verapamil and diltiazem, cyclosporine, dextromethorphan, digoxin, disopyramide, flecainide, fentanyl, lidocaine, methotrexate, procainamide, quinidine, theophylline, and warfarin and other anticoagulants. These interactions can take from 2 or 3 days to several weeks to develop. Some can be life threatening, and for others, drug dosage adjustments may be enough to avoid a serious problem.
• Fluoroquinolones, azole antifungals, and macrolide antibiotics increase the effects of amiodarone, which can cause life-threatening abnormal heart rhythms.
• When amiodarone and phenytoin are taken together, both drugs can be affected. Amiodarone can be antagonized by phenytoin and other hydantoin anticonvulsants, and the effect of phenytoin can be increased by amiodarone.
• Cholestyramine interferes with the absorption of amiodarone into the bloodstream.
• Cimetidine and ritonavir interfere with the breakdown of amiodarone, leading to high drug blood levels and the increased possibility of side effects.
• Azithromycin can interfere with the effectiveness of amiodarone. This interaction may lead to dizziness and cardiac instability.
Food Interactions
Amiodarone should be taken on an empty stomach, as food delays its absorption into your bloodstream. If amiodarone upsets your stomach, however, you may take it with food but then always take it with food to be consistent. Do not drink grapefruit juice during treatment with amiodarone because grapefruit juice affects how amiodarone is absorbed in the stomach.
Usual Dose
Starting dose-800-1600 mg a day, taken in 1 or 2 doses, usually for 1-3 weeks. Then, 600-800 mg a day for approximately a month. Maintenance dose-400 mg a day. You should take the lowest effective dose in order to minimize side effects.
Overdosage
The effects of amiodarone overdose include low blood pressure, shock, slow heartbeat, and liver toxicity. Overdose victims should be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Side effects are very common with amiodarone; 75% of people taking the drug will experience some drug-related problem. Amiodarone stays in the body for months, so side effects may remain even after the drug is stopped.
Call your doctor if you develop chest pain, breathing difficulties, spitting up blood, nausea, vomiting, abnormal heartbeat,bloating in your feet or legs, tremors, fever, chills, sore throat, unusual bleeding or bruising, changes in skin color, unusual sunburn, or any other unusual side effect. See your doctor for an eye exam if your vision changes at all while taking amiodarone.
Amiodarone can make you dizzy or lightheaded. Take care while driving a car or performing complex tasks.
If you take amiodarone once a day and forget to take a dose, but remember within 12 hours, take it as soon as possible. If you do not remember until later, skip the dose you forgot and continue with your regular schedule. If you take amiodarone twice a day and remember within 6 hours of your regular dose, take it as soon as you remember. Call your doctor if you forget to take 2 or more doses in a row. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: In high doses, amiodarone has been found to be toxic to animal fetuses. Women of childbearing age should use an effective contraceptive while taking amiodarone. If you are or might be pregnant and this drug is considered crucial by your doctor, its potential benefits must be weighed against its risks.
Amiodarone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Dosage reduction may be needed in seniors with poor liver function.