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
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.