Drugs Blog

Type of Drug:

Ovulation stimulant.

How the Clomiphene Works:

Clomiphene produces a “false signal” that estrogen levels are low. The body responds by increasing the secretion of hormones (eg, gonadotropins) from the pituitary gland. These hormones stimulate the ovaries, causing the ovarian follicle to mature, resulting in ovulation (release of the egg). Clomiphene is not a steroid.

Effectiveness is documented but unpredictable. In clinical trials, pregnancy occurred in approximately 30% of women with ovulation problems who received clomiphene.

Uses of The Clomiphene:

To treat female ovulatory dysfunction (infertility) when the patient desires pregnancy, the sexual partner is fertile and potent, and the patient has normal liver function and normal estrogen levels.

Ovulatory dysfunction due to thyroid or adrenal conditions will not respond to clomiphene.

Unlabeled Uses: Occasionally doctors may prescribe clomiphene citrate for male infertility.

Before therapy: A complete pelvic examination is mandatory prior to treatment and repeated before each course. Clomiphene is not used in the presence of an ovarian cyst; further enlargement may occur. Other lab tests may also be required.

Multiple births: The risk of a multiple pregnancy is increased approximately 6 times when clomiphene is given. In 2369 pregnancies associated with clomiphene therapy, 92.1 % were single and 6.9% wore twins. The remainder resulted in triplets or more. Of the multiple pregnoncios, 96% to 99% were live births.

Eyes: Blurring or other visual symptoms, such as spots or flashes may occur. Use caution while driving or operating machinery, especially in variable light. If visual symptoms occur, discontinue treatment and call your doctor about a complete eye evaluation.

Over stimulation of the ovary: The lowest effective dose is used to reduce the risk of abnormal ovarian enlargement. Mild to moderate ovarian enlargement, with or without bloating or stomach pain, may occur and generally goes away within 2 or 3 weeks after discontinuing this medicine. All patients who experience bloating or stomach pain should be examined for ovarian enlargement. If significant ovarian enlargement occurs after ovulation, do not engage in sexual intercourse.

Pregnancy: Do not use during pregnancy. The risk of use in a pregnant woman clearly outweighs any possible benefit. Consult your doctor if pregnancy is suspected. Clomiphene may be linked to birth defects.

Breastfeeding: It is not known if clomiphene appears in breast milk. How­ever, it may reduce lactation. Consult your doctor before you begin breastfeeding ..

Side Effects of Clomiphene:

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:

Eyes or Ocular: Blurred vision; spots or flashes of light; sensitivity to light; double vision.

Digestive Tract: Nausea; vomiting; diarrhea; stomach pain.

Nervous System: Headache; dizziness; light-headedness; nervousness; feeling of whirling motion (vertigo); sleeplessness.

Other: Multiple pregnancy; pregnancy; hot flushes; flushing; abnormal uterine bleeding; breast tenderness; ovarian enlargement; pelvic discomfort; distention or bloating; weight gain.

Guidelines for Use:

• Dosage is individualized. Use exactly as prescribed.
• Do not stop taking or change the dose, unless instructed 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 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.
• Each course of clomiphene should be started on or about the fifth day of the menstrual cycle. Wait 30 days between courses.
• Properly timed intercourse is important for good results.
• Intercourse should be prohibited in patients in whom significant ovarian enlargement occurs after ovulation.
• Notify your doctor immediately if you experience bloating, stomach or pelvic pain, blurred vision, weight gain, yellowing of skin or eyes, hot flushes, breast discomfort, headache, difficulty breathing, decreased uri­nation, nausea, or vomiting.
• May cause dizziness, light-headedness, and visual disturbances. Use caution while driving or performing tasks requiring alertness, coordination, or physical dexterity, particularly in variable lighting.
• Multiple pregnancy is possible and poses potential hazards.
• The likelihood of conception diminishes with each succeeding course of therapy. If pregnancy has not been achieved after three courses of treatment, further treatment is not recommended. Long-term cyclic therapy is not recommended.
• Do not use this medicine if you are pregnant or think you might be pregnant. A reliable pregnancy test should be administered before starting therapy to avoid taking this medicine during early pregnancy.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59 0 to 86°F) away from heat, light, and moisture.

Type of Drug:

Antiparkinson agent.

How the Drug Works:

Parkinsonism is a neurological disease characterized by tremor, rigidity, and disorders of posture and equilibrium. It has multiple causes. The onset is slow and progressive with symptoms advancing over months to years.

It is thought that the involuntary muscle movements (shaking) of Parkinson disease are due to reduced amounts of the chemical dopamine in the central nervous system (brain). Pergolide may exert its effects by directly stimulating the dopamine receptors in the brain.

Uses:

To manage the signs and symptoms of Parkinson’s disease. Used along with levodopa and carbidopa.

For complete information on levodopa and carbidopa as antiparkinson agents, see the Antiparkinson-Dopaminergic

Precautions:

Neuroleptic Malignant-like Syndrome (NMS): NMS, including muscular rigidity, elevated body temperature, mental changes, and increased serum enzymes, has been reported when anti parkinson agents were stopped suddenly. Therefore, do not reduce the dosage of pergolide abruptly or discontinue it without consulting your doctor.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use during pregnancy only if clearly needed.

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

Children: Safety and effectiveness have not been established.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take Any OVOI the-counter or prescription medications or dietary supplements with pergolide mesylate. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drug and drug classes interact with pergolide mesylate:

• Butyrophenones (eg, haloperidol)
• Metoclopramide (eg, Reglan)
• Phenothiazines (eg, chlorpromazine)
• Thioxanthines (eg, thiothixene)

Side Effects:

Every drug is capable of producing side effects. Many pergolide 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; diarrhea; indigestion; stomach pain; appetite loss; difficulty swallowing.

Nervous System: Hallucinations; difficult or abnormal movement; restlessness; twitching; confusion; dizziness; drowsiness; fainting; sleeplessness; anxiety; tremor; depression; abnormal dreams; personality changes; headache; weakness; incoordination; difficulty walking.

Circulatory System: High or low blood pressure; orthostatic hypotension (dizziness or lightheadedness when arising from a seated or lying position); palpitations (pounding in the chest); irregular heartbeat; heart attack.

Respiratory System: Runny nose; difficulty breathing.

Skin: Rash; sweating; abnormal skin sensations.

Other: Dry mouth; taste changes; general body pain; joint, muscle, or nerve pain; abnormal vision; double vision; frequent urination; urinary tract infections; blood in urine; edema (fluid retention); back, neck, and chest pain; flu-like symptoms; nosebleed; hiccups; weight gain; chills; difficulty speaking; anemia.

Guidelines for Use:

• Dosage will be individualized.
• Do not change the dose or stop taking this medicine unless advised to do so 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 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.
• Notify your doctor if you experience confusion, hallucinations, pounding in the chest, irregular heart rate, or difficulty in movement.
• Orthostatic hypotension - Dizziness or lightheadedness may occur when arising quickly from a seated or lying position. Avoid sudden changes in posture while taking pergolide.
• May cause drowsiness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or if you are breastfeeding.
• Store at controlled room temperature (59 to 86°F).

Type of Drug:Enzyme replacement therapy.

How the Imiglucerase Drug Works:

An enzyme used long-term to break down glucocerebroside into glucose and ceramide. This prevents the accumulation of glucocerebroside in disease.

Uses Imiglucerase:

For long-term enzyme replacement therapy for type I Gaucher disease that results in one or more of the following problems: anemia, low platelet counts, bone disease and deterioration, enlargement of the liver or spleen.

Precautions:

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

Use with caution in the following situations: Pulmonary hypertension.

Hypersensitivity: Approximately 15% of patients have developed antibodies reactive with imiglucerase during the first year of therapy. Approximately 46% of those patients experienced allergic reactions.

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 imiglucerase appears in breast milk.

Consult your doctor before you begin breastfeeding.

Side Effects of Imiglucerase:

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

Nervous System: Headache; fever; chills; fatigue; dizziness.

Other: Nausea; vomiting; stomach discomfort; diarrhea; back pain; chest discomfort; swelling; difficulty breathing; low blood pressure; rapid heart rate; injection site burning, itching, and swelling; rash; itching; flushing; skin discoloration

Guidelines for Use:

• This drug is prepared and administered intravenously (IV; into a vein) by your health care provider in a medical setting.
• Dosage is individualized and may be administered as frequently as 3 times per week or as infrequently as once every 2 weeks depending on disease severity.
• Contact your doctor immediately if you experience any symptoms of allergic reaction (eg, rash, difficulty breathing).

Type of Drug: Water-soluble vitamin. Vitamin not stored by the body.

How the Drug Works:

Thiamine (vitamin B 1 ) is important in carbohydrate (sugar and starch) metabolism, maintenance of normal growth, and transmission of nerve impulses.

Uses:

To treat or prevent thiamine deficiency (a severe form is called beriberi).

Beriberi may cause vomiting, rapid heart rate, abnormal skin sensations in the hands and feet, loss of muscle strength, appetite loss, difficulty breathing, pounding in the chest, fluid retention, greenish stools, voice loss, and muscle wasting or rigidity.

Unlabeled Uses: Oral thiamine has been used as a mosquito repellant; however, effectiveness has not been proven.

Precautions:

Do not use in the following situations: Allergy to thiamine.

Use with caution in the following situations: Wernicke-Korsak off syndrome.

Multiple vitamin deficiencies: It is unusual for thiamine deficiency to occur alone. Other vitamin supplements may be needed. Consult your pharmacist or doctor.

Pregnancy: This drug appears to be safe for use during pregnancy. How­ever, no drug should be used during pregnancy unless clearly needed. Use only in amounts recommended by your doctor.

Breastfeeding: It is not known whether thiamine appears in breast milk.

Consult your doctor before you begin breastfeeding.

Doses:

Side Effects:

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

Skin: Itching; rash; hives; sweating; bluish skin discoloration; tenderness or hardening of the skin at injection site (injection only).

Other: Feeling of warmth; nausea; fluid retention; tightness of throat; low blood pressure; fluid accumulation in the lungs; dizziness.

Guidelines for Use:

• Most people on balanced diets do not need vitamin supplements. People with excessive alcohol intake, long-term dialysis, mala sorption, excessive carbohydrate intake, excessive coffee or tea intake, appetite loss, chronic diarrhea, bleary disease, liver dysfunction, or hyperthyroidism are at risk for thiamine deficiency .
• Do not take enteric-coated tablets with dairy productS.
• Recommended Dietary Allowances (RDAs) - Adult males: 1.2 to 1.5 mg Adult females: 1 to 1.1 mg
• Common sources of thiamine - Pork, liver, brewer’s yeast, legumes, beef, milk, nuts, whole grains, enriched flour.
• Store at controlled room temperature (59 0 to 86°F). Protect from moisture.

Type of Drug:

Central nervous system stimulant.

How the Drug Works:

Dexmethylphenidate is thought to block reuptake of norepinephrine and dopamine in the brain, but the exact mechanism of action is not known.

Uses:

Dexmethylphenidate is indicated for the treatment of attention deficit hyperactivity disorder (ADHD).

Precautions:

Drug Dependence: Dexmethylphenidate should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic, abusive use can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior. Psychotic episodes can occur.

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

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

Children: Safety and efficacy in children younger than 6 years of age have not been established.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over- the-counter or prescription medications or dietary supplements while taking 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 drug classes interact with this drug:

• Anticonvulsants (eg, phenytoin)
• Antidepressants (eg, amitriptyline, sertraline)
• Centrally acting alpha-2 agonists (eg, clonidine)
• Coumarin anticoagulants (eg, warfarin)
• Dopamine (eg, Inotrpin)
• Epinephrine (eg, Adrenalin Chloride)
• Phenylephrine (eg, Rhinall)

Side Effects:

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

Digestive Tract: Nausea; stomach pain; appetite loss.

Nervous System: Dizziness; drowsiness; sleeplessness; headache; nervousness; Tourette syndrome; involuntary movements; abnormal thinking or hallucinations.

Circulatory System: Irregular heartbeat; pulse increased or decreased; chest pain; pounding in the chest (palpitations); changes in blood pressure.

Other: Fever; weight loss; skin rash; joint pain.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not take more frequently than prescribed. This drug can be addicting.
• 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.
• May be administered with or without food.
• Tell your doctor if you have ever abused or been dependent on alcohol or drugs, or if you are now abusing or dependent on alcohol or drugs.
• May cause sleeplessness. Avoid taking these medications late in the day.
• Notify your doctor if you experience blurred vision.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Growth (weight gain and height ) will be monitored by a doctor during therapy. Bb to keep appointments
• Store at room temperature (59 0 to 86°F).

Type of Drug:

Nonbarbiturate sedative/hypnotics. Central nervous system depressant. Short-term sleep aid.

How the Drug Works:

Nonbarbiturate sedatives and hypnotics act on the central nervous system (brain), causing drowsiness to aid in falling asleep, They are less likely to cause a slower breathing rate than barbiturate-type sedative hypnotics.

Should sleeplessness persist, a drug-free interval of 1 or more weeks should elapse before retreatment is considered. An attempt should be made to find alternative non drug therapy in chronic sleeplessness.

Uses

Chloral hydrate: To lessen anxiety and produce sleep before surgery. After surgery, chloral hydrate may be used with other medications to control pain. Also used to prevent or suppress alcohol withdrawal symptoms (suppositories).

Unlabeled Uses: Occasionally doctors may prescribe ethchlorvynol as a sedative at doses of 100 mg to 200 mg 2 or 3 times daily.

Precautions:

Dependence: Long-term use may result in dependence. Withdrawal symptoms (eg, rebound insomnia) may occur when the drug is stopped abruptly after long-term use.

Ethchlorvynol: Patients who exhibit unpredictable behavior, restlessness, or excitement in response to barbiturates or alcohol may react in this manner to ethchlorvynol. This drug should not be used for the management of insomnia in the presence of pain, unless sleep loss persists after pain is controlled with pain relievers.

Triazolam: Short-term episodes of significant memory loss have been reported with the use of triazolam. Patients, especially the elderly, may become confused or disoriented and may attempt to wander after taking the drug. Upon waking in the morning, the patient may not remember the episode.

Pregnancy: Do not use benzodiazepines during pregnancy. The risk of use in a pregnant woman clearly outweighs any possible benefit. Use of ethchlorvynol is not recommended during the first and second trirmesters of pregnancy. Use during the third trimester of pregnancy may produce. Symptoms in the newborn (eg, jitteriness, hyperactivity, restlessness, irrtability, disturbed sleep, hunger). There are no adequate and well controlled studies for other sedative/hypnotics in pregnant women. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: Benzodiazepines, chloral hydrate, zaleplon, and zolpidem appear in breast milk. It is not known if the other sedative/hypnotics appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness of estazolam, ethchlorvynol, quazepam, temazepam, triazolam, zaleplon, and zolpidem have not been established in patients younger than 18 years of age. Safety and effectiveness of flurazepam have not been established in patients younger than 15 years of age. These drugs are generally not recommended for use in children.

Elderly: Use with caution. Elderly patients may be more sensitive to these drugs. There is a risk of over sedation, “morning hangover” (grogginess in the morning), dizziness, and confusion. Smaller doses may be needed. See triazolam precaution.

Lab Tests: Lab tests may be required to monitor therapy. Tests may include blood counts, urinalysis, blood chemistry, and liver and kidney function tests.

Tartrazine: Some of these products may contain tartrazine dye (FD&C Yellow No.5), which can cause allergic reactions in certain individuals. Check package label when available or consult your doctor or pharmacist.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over the-counter or prescription medications with non barbiturate sedatives. 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 non barbiturate sedatives:

• Azole antifungal agents (eg, ketoconazole)
• Cimetidine (eg, Tagamet)
• Contraceptives, oral (eg, Ortho-Novum)

Side Effects:

Every drug is capable of producing side effects. Many nonbarbiturate sedative 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: Stomach pain or upset; vomiting; nausea; diarrhea; constipation; indigestion; appetite loss; gastric irritation; colitis.

Nervous System: Confusion; drowsiness; dizziness; hallucinations; headache; anxiety; depression; facial numbness; nervousness; vertigo (feeling of whirling motion); memory loss; drugged feeling; lethargy; sleeplessness; abnormal thinking; depersonalization; agitation; light­headedness; abnormal dreams; sleep disorder; euphoria (exaggerated sense of well being); incoordination; weakness; tremor.

Circulatory System: Abnormal blood counts; palpitations (pounding in the chest).

Skin: Jaundice (yellowing of skin or eyes); rash; hives; itching; abnormal skin sensations.

Other: Allergy; back pain; chest pain; fatigue; flu-like symptoms; blurred vision; mild “hangover”; aftertaste; dry mouth; urinary tract infection; conjunctivitis; migraine; arthritis; fever; double vision; abnormal vision; muscle, joint, ear, or eye pain; swelling of the arms or legs; general body discomfort; photosensitivity; sinus infection; sore throat; runny nose; bronchitis; distorted sense of smell; nosebleed; painful menstruation; abnormal acuteness of hearing; muscle tension; muscle pain; falling.

Benzodiazepines only

Digestive Tract: Heartburn; appetite loss; nausea; vomiting; diarrhea; constipation; stomach pain; indigestion; taste alterations; dry mouth.

Nervous System: Drowsiness; nervousness; talkativeness; apprehension; irritability; euphoria (exaggerated sense of well being); relaxed feeling; tremor; memory loss; tiredness; general body discomfort; dreaming or nightmares; depression; in coordination; confusion; hangover; abnormal thinking; anxiety; dizziness; disorientation; weakness; agitation; speech disorder; daytime drowsiness; feeling of whirling motion.

Circulatory System: Palpitations (pounding in the chest); chest pain.

Other: Abnormal skin sensations; joint or body pain; weakness; headache; genitourinary complaints;falling; staggering; rash; itching; leg or back pain stiffness.

Guidelines for Use:

• Dosage is individualized.
• Do not change the dose or stop taking unless advised by your doctor.
• Take immediately before going to bed.
• May cause dizziness, drowsiness, or blurred vision. Do not drive or per­form other tasks requiring alertness, coordination, or physical dexterity.
• Avoid alcohol and other drugs that cause drowsiness (eg, pain relievers, sedatives).
• Contact your doctor if you notice any unusual or disturbing thoughts or behaviors during treatment with any sleep medicine.
• Do not take any sleep medicine unless you are able to get a full night of sleep before you must be active again.
• May cause photosensitivity (sensitivity to light). Avoid prolonged expo­sure to the sun. Use sunscreens and wear protective clothing until tolerance is determined.
• May be habit forming. Do not discontinue drug abruptly after prolonged use, especially if you have a history of seizures, regardless of other anti seizure medications you may be taking.
• Contact your doctor if visual changes, irregular heartbeats, chest pains, yellowing of skin or eyes, rash, or unusual bleeding or bruising occurs.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Benzodiazepines - Nighttime sleep may be disturbed for 1 or 2 nights following stopping of the drug. Tell your doctor if you are pregnant, plan to become pregnant, or become pregnant while taking this medicine.
• Chloral hydrate May cause stomach upset. Take capsules with a full glass of water or other liquid. Swallow capsules whole. Do not crush or chew. Dilute syrup in a half glass of water, ginger ale, or fruit juice.
• Ethchlorvynol- Symptoms of giddiness, incoordination, and stomach upset may be reduced if medication is taken with food.
• Triazolam - Do not take when a full night’s sleep and elimination of the drug from the body are not possible before the need to be active and functional. May cause amnesia.
• Zaleplon - Do not take with or immediately following a high fat or heavy meal. May cause sleepiness during the day. Daytime drowsiness can be best avoided by taking the lowest possible dose. May cause amnesia. In most cases, memory problems can be avoided if zaleplon is taken only when you are able to get 4 hours or more of sleep before being active.
• Zolpidem - For faster sleep onset, do not take with or immediately after a meal.

Type of Drug:

Drugs used to elevate blood pressure.

How the Midodrine Product Works:

Midodrine causes blood vessels to constrict (become smaller), resulting in an increase in blood pressure

Uses of The Midodrine:

To treat symptoms of orthostatic hypotension (feeling dizzy or lightheaded when rising from a sitting or standing position, or feelings of dizziness while standing). Use only in patients whose lives are considerably impaired despite standard clinical care, such as support stockings, fluid expansion and lifestyle changes.

Unlabeled Uses: To manage urinary incontinence

Precautions:

Supine hypertension is the most potentially serious side effect of midodrine. Supine (lying) and sitting blood pressures should be monitored. Supine hypertension can often be controlled by not lying totally flat (eg, sleeping with the head of the bed elevated).

Pregnancy: Adequate studies have not been done in pregnant women, or animal studies may have shown a risk to the fetus. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

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

Children: Safety and effectiveness are not established.

Lab Tests: Lab tests will be required to monitor therapy. Lab tests may include blood pressure tests kidney and liver 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 this medicine. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs or drug classes may interact with this medicine.

• Alpha-adrenergic blockers (eg, doxazoxin)
• Cardiac glycosides (eg, digoxin)
• Phenylephrine phenylpropanolamine (eg, Contac)
• Metformin (Glucophage)
• Ranitidine (eg, Zantac)

Side Effects:

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

Nervous System: Numbness or tingling in scalp, hands or feet; pain; headache; feeling of pressure/fullness in the head; facial flushing; confusion; abnormal thinking; nervousness; anxiety.

Skin: Goosebumps; itching; rash.

Other: Painful or difficult urination; high blood pressure while lying or sitting; chills; dry mouth.

Guidelines for Use:

• Use exactly as prescribed.
• Usual dose is 10 mg, taken three times daily. Take during the daytime hours when you are upright and pursuing daily activities. A suggested dosing schedule of approximately 4 hour intervals is: Shortly before or upon arising in the morning, midday and late afternoon (not later than 6 pm). Doses may be taken in 3 hour intervals if required to control symptoms, but not more frequently. Do not take after the evening meal or less than 4 hours before bedtime.
• If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose in order to “catch up” (unless advised to do so by your doctor). If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Supine (lying down) hypertension can often be controlled by not lying totally flat (eg, sleeping with the head of the bed elevated).
• Tell your doctor or pharmacist about any over-the-counter medications you are taking (eg, cold remedies, diet aids); they can increase the side effects of this medicine.
• Contact your doctor if you experience pounding in the ears, headache, blurred vision, slow pulse, increased dizziness, fainting, cardiac awareness, goosebumps, sensation of coldness or urinary retention.
• Continue taking this medicine, even if your symptoms of low blood pressure are controlled.
• Monitor blood pressure in both the lying and sitting positions.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59 to 77°F), out of the reach of children.