Drugs Blog

• Read the package inserts of the insulin and understand all aspects of its use .
• Carefully follow the storage, preparation, and injection techniques taught to you by your doctor or diabetes educator.
• Participate in a thorough diabetes education program so that you under­stand diabetes and all aspects of its treatment, including diet, exercise, personal hygiene, and how to self-monitor blood glucose.
• Become familiar with the specific type of insulin that you are using and how your blood sugar levels are affected by each dose. Do not switch types, brands, strengths, doses, or the order of mixing your insulin without first con3ulting your doctor or diabetes educator. Overdosage could result in insulin shock.
• Wear an 10 tag (eg, Medic Alert) so appropriate treatment can be given if an emergency occurs away from home.
• Always keep an extra supply of insulin, as well as a spare syringe and needle, on hand.
• Visually inspect the solution/suspension before administration.
• Rotate injection sites to prevent scarring and other possible complications.
• Do not switch the model and brand of syringe or needle without first consulting your doctor or diabetes educator.
• Monitor blood glucose and urine for glucose and ketones as prescribed.
• Keep track of the results so that adjustments in your treatment can be made more easily.
• Contact your doctor if you experience symptoms of hypoglycemia or ketoacidosis (see table in Precautions for symptoms).
• Insulin requirements may change when you are ill (eg, vomiting, fever), under stress, or exercising. Stay on your regular diet, if possible. Establish a “sick day” plan with your doctor. A “sick day” plan provides directions for what to do when you are sick and cannot keep food down or are having difficulty eating. The plan should include advice on when to call your doctor or seek emergency care.
• To avoid possible transmission of disease, do not share syringes, needles, or cartridges with anyone else.
• Consult your doctor about your insulin schedule if you will be traveling across 2 or more time zones. You may need to make adjustments in your insulin schedule.
• Be sure to have regular physical and eye examinations. The frequency of these exams will be determined by your regular doctor and your eye doctor.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Regular insulin - Do not use if solution is cloudy, colored, thickened, or if particles are seen.

• Lente and NPH insulins - Gently mix well before using. Do not use if clumps are seen or if white material (the insulin) remains at the bottom of the insulin bottle.
• Store at room temperature (up to 30 days), away from light and heat.
• If you buy extra bottles of insulin, store the bottles that you are not using in the door of the refrigerator. Do not freeze insulin. Do not use the bottles after the expiration date stamped on the label or if the insulin has been frozen.

Hyoscine is a natural plant product, helpful against tremor and to a lesser extent against rigidity. It causes considerable dryness of the mouth and blurring of vision. Benadryl, an antihistamine, is frequently employed for the control of tremor. It is a safe drug to use, except that patients who experience marked drowsiness must not employ it while driving a car.

Since the tremor of Parkinson’s disease becomes greatly aggravated by embarrassment, nervousness and excitement, especially when in the presence of strangers, various tranquilizing drugsprove helpful to some patients as a temporary alleviant. They are more effective when not used too often and preferably in small doses, since they can cause mental fogginess and drowsiness. Alcohol if used in small amount helps to alleviate excitement and tremor in some patients, hence should not be prohibited where it proves useful.

For patients that suffer from insomnia, there is a wide assortment of remedies. The doctor will usually find the remedy that will best serve the needs and tolerance of the patient.

Swelling of the ankles is a frequent occurrence among the very rigid and frozen Parkinson patients, especially those who spend many hours of the day sitting, which leads water to gravitate down to the ankles. A number of very effective drugs are available for swelling or edema of the legs and ankles.

For patients who suffer from marked slowness of movement, sluggishness, fatigue, depression, inactivity and drowsiness by day, and who fail to respond to previously mentioned drugs, there is a wide assortment of stimulants available. Various amphetamine stimulants prove helpful to some patients, and yet in other patients they tend to produce cardiac excitation, palpitations, and shortness of breath and have to be discontinued or used in very small amount. Thyroid in small dosage two or three times a day provides the extra energy that some patients require, although in some it tends :0 aggravate tremor and leads to over­excitement.

Vitamins are needed for patients who are undernourished or have difficulty in swallowing, hence give on erratic diets. Sometimes injections of B-12 prove helpful, also liver injections. However, people should not be gullible about reports of “miracle injections” or “miracle cures.” Some patients, desperate for something new and different, turn to exotic drugs and treatments, not realizing that the most effective medications are well known to doctors.

The most common side reactions from the use of drugs for Parkinson’s disease are dryness of the mouth and throat, blurring of vision, nausea and indigestion, and constipation. Mild forms of dryness of the mouth can be counteracted by sips of water, or the use of hard candies or chewing gum. However, instances of dryness that are severe enough to interfere with swallowing of food and with speech should be called to the attention of the doctor for changes in medication. Blurred vision is corrected by changes in the lens of the glasses to render reading easier, since Parkinson remedies blur only close vision.

Indigestion and nausea caused by pills can often be prevented by swallowing them with milk or buttermilk instead of water. Patients who gag and have difficulty in swallowing large pills and capsules will find it easier to do so if the capsule is pressed into the bottom of a teaspoon of applesauce or Jello. Vomiting is never caused by the standard drugs for Parkinson’s disease and should it occur, all drugs are to be stopped and the doctor called. Parkinson remedies do not cause bladder retention, but they may slow the urinary stream among the male patients who have enlarged and obstructing prostate glands. Constipation can be aggravated by the above remedies, but rarely constitutes a serious problem.

Type of Drug:

Oral nonsulfoylurea antidiabetic agent used in the treatment of type 2 diabetes mellitus (previously referred to as non-insulin-dependent diabetes mellitus [NIDDM]).

How the Metformin Products Works:

Metformin reduces the amount of glucose produced by the liver and the amount of glucose absorbed by the intestines, and enhances insulin sensitivity by increasing peripheral glucose uptake and utilization.

Uses of The Metformin:

Used as monotherapy along with diet and exercise to treat type 2 diabetes mellitus. May also be prescribed for use with a sulfonylurea, meglitinide, or insulin.

Lactic acidosis: Lactic acidosis is a rare but serious side effect that can occur when taking this medication, particularly if kidney function is impaired. Stop taking this medicine and contact your doctor immediately if you experience general body discomfort, muscle pain, difficulty breathing, drowsiness, stomach pain, chills, dizziness, lightheadedne or slow heartbeat.

Diet and exercise: Diet and exercise are the primary managements type 2 diabetes. Metformin is used with, not as a substitute for, diet and exercise.

Heart problems: This medicine may increase the risk of heat problems compared to treatment with diet alone or diet plus insulin.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Pregnant women with diabetes should be treated with insulin. Metformin is not recommended for control of blood sugar levels in pregnant women.

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

Children: Safety and effectiveness for use of metformin tablets in patients under 10 years of age and metformin extended-release tablets in patients under 17 years of age have not been established.

Elderly: Elderly and debilitated patients are more likely to develop hypoglycemia (low blood sugar levels). Use with caution.

Lab Tests: Lab tests will be required to monitor therapy. Tests include blood glucose, glycosylated hemoglobin (HbA ), and kidney function tests.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements while taking metformin. 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 metformin:

Side Effects of Metformin:

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

Digestive Tract: Diarrhea; nausea; vomiting; stomach bloating or pain; gas; constipation; indigestion; abnormal stools; heartburn.

Nervous System: light-headedness; headache; weakness; dizziness.

Other: Changes in taste porception; rash; difficulty breathing; increased sweating low blood pressure pain ;upper respiratory infections ;chest discomfort chills; flu-like symptom ; flising; palpitations(pounding in the chest).

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed. May be taken with other anti diabetic medication.
• Tablets are usually taken twice daily with the morning and evening meals. Extended-release tablets are usually taken once daily with the evening meal.
• Follow the diet and exercise program exactly as prescribed by your doctor.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Contact your doctor immediately if you experience difficulty breathing, muscle pain, general body discomfort, drowsiness, dizziness, light­headedness, slow heartbeat, stomach pain, or chills.
• Nausea, vomiting, diarrhea, gas, and appetite loss generally stop with continued use. If they continue, contact your doctor immediately.
• Avoid drinking alcohol while undergoing therapy with metformin.
• The effectiveness of this medicine may decrease over time. If you feel that it is losing its effectiveness, contact your doctor.
• Patients switched from metformin tablets to extended-release tablets do not appear to require dosage adjustments, but glycemic control should be closely monitored when switches occur.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59 to 86°F).

Type of Drug:

Antidepressant; mood elevating agent.

How the Nefazodone Product Works:

The exact mechanism is unknown. Nefazodone appears to block the uptake of serotonin and norepinephrine (chemicals found in the brain). The effect may take a few weeks to be noticed.

Uses of The Nefazodone:

To treat mental depression in patients 18 years of age and older.

Unlabeled Uses: Occasionally, doctors may prescribe nefazodone for posttraumatic stress disorder (PTSD).

Precautions:

Liver abnormalities: Life-threatening liver failure has been reported in patients taking nefazodone. Notify your doctor if you experience yellowing of the skin or eyes, appetite loss, or tiredness.

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 nefazodone appears in breast milk. Consult your doctor before you begin breastfeeding.

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

Elderly: Lower initial does or recommended for patient older than 65 years of age.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications while taking this drug. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with this drug:

• buspirone (eg, BuSpar)
• carbamazepine (eg, Tegretol)
• cyclosporine (eg, Sandimmune)
• digoxin (eg, Lanoxin)
• haloperidol (eg, Haldol)

Side Effects of Nefazodone:

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

Digestive Tract: Nausea; constipation; indigestion; diarrhea; appetite changes; vomiting; stomach pain; gas; dry mouth.

Nervous System: Dizziness; sleeplessness; weakness; drowsiness; light­headedness; confusion; headache; memory loss; incoordination; tremor; anxiety; unstable emotions; depression; abnormal dreams; decreased concentration; migraine; agitation.

Circulatory System: Low blood pressure; chest pain; pounding in the chest (palpitations); slow heartbeat.

Respiratory System: Cough; runny nose; difficulty breathing; sinus infection; bronchitis; sore throat.

Skin: Itching; rash; abnormal skin sensations; flushing; sweating; increasod sensitivity to touch.

Urinary and Reproductive Tract: Prolonged or inappropriate erections; decreased sexual drive; changes in urinary frequency; breast pain; painful menstruation; impotence; painful urination.

Other: Eye pain; flu syndrome; chills; fever; stiff neck; swelling in the arms and legs; joint, muscle, back, or neck pain; ringing in the ears; abnormal taste sensations; weight gain; swelling; cramping; blurred or abnormal vision; thirst.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Take in 2 divided doses on an empty stomach, or as directed by your doctor.
• Do not stop taking or change the dose unless instructed by your doctor.
• Notify your doctor immediately if you develop a rash, hives, or other type of allergic reaction.
• 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 instructed by your doctor. If more than one dose is missed, or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Do not use in combination with MAOls (eg, phenelzine) or within 14 days of discontinuing treatment with an MAOI. After stopping this medicine, wait at least 1 week before starting an MAOI.
• May impair judgment, thinking, or motor skills. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity until tolerance is determined.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Avoid alcohol while using this medicine.
• Improvement may not be seen for several weeks. Exams may be necessary. Be sure to keep appointments.
• Store at room temperature (59° to 86°F) in a dry place.

Type of Drug:

Antidepressant (SSRI); mood-elevating agent.

How the Drug Works:

The actual antidepressant mechanism of paroxetine is not known. It is presumed that it works by blocking the uptake of serotonin, a chemical found in the brain.

Uses Paroxetine

Immediate-release: To treat obsessions and compulsions in patients with obsessive-compulsive disorder (OCD).

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

Breastfeeding: Paroxetine appears in breast milk. Consult your doctor before breastfeeding.

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

Elderly: Initial dosage in the elderly should be reduced.

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 paroxetine. 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 paroxetine:

• Alcohol procyclidine (Kemadrin)
• Antidepressants (eg, fluoxetine)
• Phenobarbital (eg, Solfoton)
• Phenytoin (eg, dilantin)
• Quinidine (eg, Quinora)

Paroextine Side Effects:

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

Circulatory System: Chest pain; palpitations (pounding in the chest); high blood pressure; rapid heart rate.

Digestive Tract: Nausea; diarrhea; vomiting; constipation; gas; indigestion; appetite changes; dry mouth.

Nervous System: Drowsiness; sleeplessness; agitation; tremor; anxiety; weakness; headache; dizziness; nervousness; confusion; twitching; amnesia; inability to concentrate; abnormal dreams; depression; unstable emotions; vertigo (feeling of whirling motion).

Skin: Flushing; sweating; rash; itching.

Other: Abnormal ejaculation and other male genital disorders; back pain; joint pain; muscle weakness or pain; tightness in throat; abnormal skin sensations; decreased sex drive; blurred vision; runny nose; taste pervorslon; urinary frequency; urinary disorder; chills; general body discomfort changes; cough; congestion; ringing in the ears;

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed. Small doses are usually used at first and then gradually increased until the desired benefit is obtained. Dosage changes are usually made at intervals more than 1 week.

• Take once daily, preferably in the morning, without regard to meals. Take with food if stomach upset occurs.

• Do not change the dose or stop taking, unless directed by your doctor.

• Avoid alcohol when using this drug.

• Do not use in combination with MAOls or within 14 days of discontinuing treatment with an MAOI. Similarly, at least 2 weeks should be allowed after stopping paroxetine before starting an MAOI.

• May cause drowsiness or dizziness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.

• Improvement may be noticed in 1 to 4 weeks; continue therapy as directed.

• Shake oral suspension well before using.

• Do not chew or crush controlled-release tablets. Swallow whole.

• Consult your doctor or pharmacist before taking any nonprescription or prescription drugs while using paroxetine.

• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.

• Significant weight loss may be an undesirable effect of paroxetine therapy.

• Store tablets at controlled room temperature (59° to 86°F).

• Store controlled-release tablets and suspension at or below 77 F.

Type of Drug:

Antidepressant; SSRI; mood-elevating agent.

How the Sertraline Works:

The actual antidepressant mechanism of sertraline is not known. It is presumed that it works by blocking the uptake of serotonin, a chemical found in the brain.

Uses of The Sertraline:

To treat major depressive disorder, obsessions and compulsions in adult patients with obsessive-compulsive disorder (OCD), panic disorder with or without agoraphobia, posttraumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).

Unlabeled Uses: Has been used to treat generalized social phobia.

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

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

Children: Safety and effectiveness have not been established for uses other than OCD in children 6 years of age and older.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take many over-the-counter or prescription medications or dietary supplement with sertraline. Doses of one or both drugs may need to be modified or different drug may need to be prescribed.

• Disulfiram (Antabuse)
• Flecainide (Tambocor)
• Hydantoins (eg, phenytoin)
• Lithium (eg, Eskalith)
• MAOls (eg, phenelzine)
• Propafenone (Rythmol)
• Sumatriptan (Imitrex)
• Tolbutamide (eg, Orinase)
• Tricyclic antidepressants (eg, doxepin)
• Warfarin (eg, Coumadin)

Side Effects of Sertraline:

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

Digestive Tract: Nausea; vomiting; diarrhea; indigestion; constipation; gas; appetite changes.

Nervous System: Headache; dizziness; tremor; fatigue; nervousness; anxiety; drowsiness; agitation; sleeplessness; decreased or abnormal skin sensations.

Circulatory System: Pounding in the chest; chest pain.

Other: Dry mouth; vision disturbances; ringing in the ears; back pain; muscle pain; decreased sexual interest or performance; excessive sweating; rash; yawning; fatigue; weakness; general body discomfort; flushing.

Guidelines for Use:

• Dosage will be individualized. Take exactly as prescribed.
• Do not change the dose or stop taking, unless directed by your doctor.
• Administer once daily, either in the morning or evening.
• Shake oral concentrate well before using.
• Do not use in combination with MAOls or within 14 days of treatment with an MAOl.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If several doses are missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Avoid alcohol when using this drug.
• May cause drowsiness, dizziness, or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Significant weight loss or gain may be an undesirable effect of sertraline therapy.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Store at room temperature (59 to 86 F).

Type of Drug:

Oral antidiabetic agents for use only as an adjunct to diet and exercise in the management of type 2 (non-insulin-dependent) diabetes mellitus.

How the Sulfonylureas Works:

The sulfonylurea hypoglycemic agents appear to decrease blood sugar by stimulating the release of insulin from the pancreas. Sulfonylureas may also decrease the amount of sugar that is dumped into the blood from the liver and may increase the sensitivity of fat and muscle tissue to the action of insulin. By increasing the amount of insulin or The effectiveness of insulin, blood sugar levels are lowered. Sulfonylureas do not work in type 1 (insulin-dependent) diabetes mellitus in which the pancreas is not capable of manufacturing or releasing insulin.

Uses of Sulfonylureas:

As an adjunct to diet and exercise to low or blood glucose In patients with type 2 diabetes mellitus whoso hyperglycemia cnn not bo controlled by diet and exercise alone. They may be used or combined with other blood sugar lowering medicine (eg. thiazolidinediones,metformin,insulin).

Precatuions:

Alcohol: A reaction may occur, including facial flushing, changes in blood sugar, and breathlessness, when alcohol is ingested. This occurs most often in patients taking.

Diet and exercise: Diet and exercise are the primary management of type 2 diabetes. Sulfonylureas are used with, not as a substitute for, diet and exercise.

Hyperglycemia (high blood sugar levels): Hyperglycemia is a major risk factor in the development of diabetes complications. Maintaining blood sugar levels as close to normal as possible is important. Symptoms of hyperglycemia include excessive thirst or urination, nausea, and stomach upset.

Hypoglycemia (low blood sugar levels): Patients with kidney or liver problems or patients taking more than blood glucose lowering medicine may be at higher risk for the development of medication-induced hypoglycemia. Symptoms include shaking, dizziness, faintness, headache, irritability, confusion, fatigue, excessive hunger, profuse sweating, numbness of arms or legs, and rapid pulse. May lead to convulsions or coma if extremely severe.

To prevent hypoglycemia:

• Understand the symptoms of low blood sugar levels.
• Maintain an adequate diet. Do not miss meals.
• Frequently monitor blood glucose levels.
• Keep a source of quick-acting sugar with you at all times.
• Know how exercise, alcohol, and other drugs affect your blood sugar level.

Hypoglycemia is more of a problem with chlorpropamide than with their medications in this class. Discuss the expected results of your sulfonyluroa therapy with your doctor, pharmacist, or diabetes educator. Know the onset of action, peak activity, and total duration of activity.

Heart disease: long term use of sulfonyureas has been associate with increased risk of development of heart problem compared with diet along or diet plus insulin.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed. In general, avoid sulfonylureas in pregnancy. They will not provide good control in patients whose blood glucose levels cannot be controlled by diet alone. Insulin is recommended to treat pregnant patients with diabetes to maintain blood glucose levels as close to normal as possible.

Breastfeeding: Chlorpropamide is excreted in breast milk. It is not known if other sulfonylureas appear in breast milk. Because of the potential for hypoglycemia in nursing infants, decide whether to discontinue nursing or discontinue the drug. Consult your doctor before you begin breast feeding.

Children: Safety and effectiveness in children have not been established. Elderly: Elderly, debilitated, or malnourished patients may be particularly sensitive to sulfonylureas. If there is a tendency toward hypoglycemia (low blood sugar levels), dosage will be reduced or therapy discontinued by your doctor. Use with caution.

Lab Tests: Lab tests will be required to monitor therapy. Tests may include blood glucose, glycosylated hemoglobin, and kidney and liver function tests.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements while taking sulfonamides. 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 sulfonylureas:

Other: Digitalis glycosides (eg, dioxin); ciprofloxacin (eg, Cipro); ethanol; barbiturates (eg, phenobarbital).

Side Effects:

Every drug is capable of producing side effects. Many sulfonylurea 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; heartburn; feeling of fullness; diarrhea; vomiting; appetite loss; taste alteration (tolbutamide only); gas; constipation; stomach pain; indigestion; hunger.

Narvous System: Weakness; dizziness; headache; abnormal skin sensations; drowsiness; nervousness; tremor; sleeplessness; anxiety; depression; decreased sensitivity to stimulation; confusion.

Skin: Yellowing of the skin or eyes; rash; hives; dry, red skin; itching; sensitivity to sunlight; sweating.

Other: Abnormal blood counts and blood tests; pain; dark urine; leg cramps; fainting;join or muscle pain ;runny nose ;blurred;vision;excessive urination ;low blood sugar.

Guidelines for Use:

• Dosage is individualized. Do not change dose or stop taking this medicine unless advised to do so by your doctor.
• Follow the diet and exercise program and personal hygiene and infection avoidance regimens exactly as prescribed by your doctor.
• May be taken with food if stomach upset Occurs. Always take immediate­release glipizide 30 minutes prior to a meal to increase effectiveness.
• Avoid alcohol. It can cause flushing, breathlessness, and changes in blood sugar.
• Avoid aspirin in large doses.
• Get specific instructions from your doctor on how to examine your feet for complications of diabetes. In addition, obtain equipment for and learn the correct process of home glucose monitoring. Monitor blood sugar levels as recommended by your doctor. Notify your doctor if you experience low blood sugar symptoms (eg, fatigue, excessive hunger, profuse sweating, numbness of arms or legs, rapid pulse, confusion) or high blood sugar symptoms (eg, bad breath, excessive thirst or urination).
• Diet and exercise are the primary managements of type 2 diabetes. these medications should be used with, not as a substitute for, diet and exercise.
• To prevent hypoglycemia - Understand the symptoms of low blood sugar levels. Maintain an adequate diet. Do not miss meals. Know how exercise, alcohol, and other drugs affect blood sugar levels. During periods of stress such as fever, trauma, infection, or surgery, modication requirements may change. Consult your doctor.
• Long-term use of sulfonylureas may be associated with increased heart when compared with diet treatment alone, or diet plus insulin. Patients with heart problems or concern bout heart problems should should their doctor.
• Glipizide, extended-release - Do not crush, chew, or divide tablets. DO not be alarmed if the tablet shell appears in the stool. This drug is loosened to slowly release the medicine and then expel the empty shell the body.
• MaY cause sensitivity to sunlight. Avoid prolonged exposure to the sun. Use sunscreens and wear protective clothing until tolerance is `
• May cause drowsiness or dizziness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store at controlled room temperature. Protect from moisture.

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Dosage is individualized. Take exactly as prescribed.
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Do not stop taking or change the dose unless directed by your doctor.
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Maprotiline - May be given as a single daily dose or in divided doses.
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Mirtazapine - Take in a single dose, preferably at bedtime. May be taken without regard to food.
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Remeron SolTabs- Open tablet blister pack with dry hands and place the tablet on the tongue. The tablet will disintegrate rapidly and can be swallowed with saliva. No water is needed. Do not chew the tablet, split the tablet, or store the tablet for later use.
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If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
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Avoid the use of alcohol, barbiturates, or other CNS depressants (eg, tranquilizers) while taking this medicine.
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Contact your doctor if you experience sore throat, fever, chills, mouth sores, or other signs of infection. Pay particular attention to any f1u­like symptoms or other symptoms that might suggest infection.
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May cause drowsiness or dizziness. Alcohol use may increase this effect. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
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Allow at least 14 days between discontinuation of an MAO inhibitor anti­depressant (eg, phenelzine) and the start of therapy with this medicine. Also, allow at least 14 days after stopping this medicine before starting an MAO inhibitor.
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Maprotiline has been associated with seizures. This risk is higher in patients with a history of seizures, in patients taking phenothiazines (eg, promethazine) or withdrawing from benzodiazepines (eg, alprazolam).
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Inform your doctor if you are pregnant, become pregnant, are plan to become pregnant, or are breastfeeding.
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Maprotiline - Beneficial effects are sometimes seen within 3 to 7 days, although 2 to 3 weeks are usually necessary.
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Mirtazapine - Beneficial effects may take 1 to 4 weeks to occur.
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Lab tests may be required to monitor therapy. Be sure to keep appointments.
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Store room temperature (59 to 86°F) in a tightly closed container, away from light and moisture.

Type of Drug:

Antidepressant; mood-elevating agent.

How the Drug Works:

The exact mechanism of action is not known. It is believed that tetracyclic antidepressants adjust or balance how the brain and nervous system produce and respond to natural chemicals (neurotransmitters) that elevate mood.

Uses:

Maprotiline: To treat depressive illness in patients with depressive neurosis (dysthymic disorder) and manic-depressive illness (major depressive episode).

Mirtazapine: To treat depression.

Unlabeled Uses: Maprotiline is also effective for the relief of anxiety associated with depression.

Precautions:

Do not use in the following situations:

Aallergy to the tetracyclic compound or any of its ingredients electroshock therapy, concurrent (maprotiline only)

Seizures: Maprotiline use has been associated with seizures. The risk is higher in patients with a history of seizures, in patients taking phenothiazines (eg, promethazine), or when benzodiazepines (eg, alprazolam) are being withdrawn.

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

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

Children: Safety and effectiveness in children (younger than 18 years of age for maprotiline) have not been established.

Elderly: The elimination of mirtazapine is reduced in elderly patients. In general, lower doses of maprotiline are recommended for patients older than 60 years of age. Use with caution in elderly patients.

Lab Tests: Lab test may be required periodically during treatment. Lab tests may include blood counts and enzyme levels.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or are planning to take any over-the-counter or prescription medications or dietary supplements while taking a tetracyclic compound. 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 tetracyclic compounds:

• Alcohol
• Barbiturates (eg, phenobarbital)
• Benzodiazepines (eg, alprazolam)
• MAOI antidepressants (eg, phenelzine)
• phenothiazines (eg, promethazine)

Side Effects:

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

Digestive Tract: Nausea; vomiting; constipation; dry mouth; thirst; increased appetite; stomach pain; indigestion.

Nervous System: Confusion; anxiety; agitation; abnormal thinking; nervous­ness; tremor; twitching; drowsiness; clumsiness; dizziness; vertigo (feeling of whirling motion); weakness; fatigue; tiredness; sleeplessness; headache; abnormal dreams; increased sensitivity; apathy; depression; memory loss; numbness or tingling in the hands or feet.

Respiratory System: Difficulty breathing; cough; sinus problems: wheezing.

Circulatory System: Rapid heart rate; irregular heartbeat; increased cholesterol and triglyceride levels; increased blood pressure; low blood pressure on arising.

Skin: Rash; itching; hives; acne; dry skin; flushing; redness; hair loss. Other: Flu syndrome; general body discomfort; swelling in the hands or feet; blurred vision; muscle, joint, or back pain; frequent urination; urinary tract infection.

Type of Drug:

Antidepressant; mood-elevating agent.

How the Trazodone Works:

It is not known how trazodone works to relieve depression. It is believed trazodone modifies the chemical balance in the brain, which changes behavior. It does not stimulate the brain.

Uses of The Trazodone:

To relieve mental depression.

Unlabeled Uses: Occasionally doctors may prescribe trazodone for cocaine withdrawal, to manage aggressive behavior when used with other medications, and to treat patients with panic disorder or agoraphobia (fear of open or public places) with panic attacks.

Precautions:

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

Priapism: If you experience prolonged or painful penile erection, discontinue use immediately and consult your doctor. Permanent damage of normal penis function and impotence have occurred.

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

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

Children: Safety and effectiveness in children younger than 18 years of age have not been established.

Lab Tests: Lab tastes may be required to monitor therapy. Tests include blood counts.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with trazodone. 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 trazodone:

• Anesthetics CNS depressants (eg, alcohol, barbiturates, narcotics)
• Digoxin (eg, Lanoxin)
• Phenytoin (eg, dilantin)
• Warfarin (eg, Coumadin)

Side Effects of Trazodone:

Every drug is capable of producing side effects. Many trazodone 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: Upset stomach; nausea; vomiting; diarrhea; constipation; decreased appetite; dry mouth.

Nervous System: Anger; hostility; sleeplessness; nightmares or vivid dreams; confusion; disorientation; decreased concentration; dizziness; drowsiness; excitement; fatigue; headache; tremor; impaired memory; nervousness; incoordination; lightheadedness.

Circulatory System: Changes in blood pressure; pounding in the chest; fast heartbeat.

Senses: Ringing in the ears; blurred vision; red, tired, itching eyes; nasal or sinus congestion.

Other: Shortness of breath; weight changes; swelling; aches and pains; fainting; bad taste in the mouth; abnormal skin sensations; general body discomfort; feeling of heaviness or fullness in the head; prolonged painful erection; decreased sex drive; clamminess; sweating; orthostatic hypotension (dizziness or lightheadedness when rising from a sitting or lying position).

Guidelines for Use:

• Dosage is individualized.
• Dosage will be initiated at a low level and increased gradually by your doctor.
• Take shortly after a meal or snack.
• If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed, or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• May cause drowsiness, dizziness, or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Avoid alcohol or other drowsiness-causing medications (eg, antihistamines, barbiturates, narcotic pain relievers) while taking trazodone.
• Notify your doctor if you experience drowsiness, sore throat, fever, or any signs of infection.
• Male patients with prolonged and painful erections (priapism) should immediately discontinue the drug and consult their doctor.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at controlled room temperature (59 0 to 86°F).