Drugs Blog

Mipramine HCI:

• Usual initial adult dose for outpatients is 75 mg/day increased to 150 mg/day. Doses over 200 mg/day are not recommended. Maintenance dose is 50 to 150 mg/day.
• For hospitalized patients, usual initial adult dosage is 100 mg/day in divided doses gradually increased to 200 mg/day as required. If no response occurs after 2 weeks, increase dose to 250 to 300 mg/day.
• For adolescents and elderly patients, usual initial dose is 30 to 40 mg/day, not to exceed 100 mg/day.
• Childhood bed wetting - An oral dosage of 25 mg/day given 1 hour before bedtime should be tried in children 6 years of age and older.
• If satisfactory response does not occur within 1 week, increase the dose to 50 mg nightly in children younger than 12 years of age; children older than 12 may receive up to 75 mg nightly.
• Doses larger than 75 mg do not work better and tend to incense the side effects.

Imipramine HCI (cant.):

• Consider instituting a drug-free period following an adequate therapeutic trial with a favorable response.
• To reduce the tendency to relapse, taper dosage gradually rather than discontinue abruptly.

Imipramine pamaate:

• Initiate adult dose for outpatients at 75 mg/day and increase to 150 mg/day, which is the dose level at which optimum response is usually obtained. If necessary, dose may be increased to 200 mg/day. Doses higher than 75 mg/day may also be administered on a once-a­day basis at bedtime after the optimum dosage and tolerance have been determined.
• Maintenance dosage is usually 75 to 150 mg/day administered on a once-a-day basis, preferably at bedtime.

Nortriptyline:

• Usual adult dosage is 25 mg 3 to 4 times daily. As an alternative regimen, the total daily dose may be given once a day.
• Doses above 150 mg/day per day are not recommended.
• Usual dosage in elderly patients is 30 to 50 mg/day in divided doses.

Protriptyline:

• Usual adult dosage is 15 to 40 mg/day divided into 3 or 4 doses. If necessary, dose may be increased to 60 mg/day. Make dose increases with the morning dose.
• Doses above 60 mg/day are not recommended.
• For elderly patients, the usual dosage is 5 mg 3 times a day initially and is increased gradually. The cardiovascular system must be monitored closely if the daily dose exceeds 20 mg.

Trimipramine:

• Usual initial adult dosage for outpatients is 75 mg/day in divided doses. May be increased to 150 mg/day if needed.
• Doses over 200 mg/day are not recommended.
• Hospitalized patients may be given 100 mg/day initially in divided doses, increased gradually in a few days to 200 mg/day. If improvement does not occur in 2 to 3 weeks, the dose may be increased to the maxi­mum recommended dose of 250 to 300 mg/day.
• Usual initial dose for adolescents and elderly patients is 50 mg/day, increasing in gradual increments up to 100 mg/day.

Type of drug:

Antidepressants; mood-elevating agents.

How the Drug Works:

Tricyclic antidepressants (TCAs) appear to adjust or rebalance the brain’s own natural chemicals (neurotransmitters), which control mood, feelings, and behaviors. The effect may take a few weeks (1 to 4) to be noticed.

Uses:

For the relief of symptoms of depression (except clomipramine).

Clomipramine: Only for the treatment of obsessive-compulsive disorder.

Doxepin: To treat anxiety.

Imipramine: For the treatment of bedwetting in children 6 years of age and older after possible organic causes have been excluded by appropriate tests.

Unlabeled Uses: Occasionally doctors may prescribe doxepin, clomipramine, imipramine, or amitriptyline to control chronic pain and to treat bulimia. Imipramine, clomipramine, nortriptyline, and other tricyclic anti­depressants have also been used to treat panic disorder. Amitriptyline has been used to prevent the onset of cluster and migraine headaches and to treat pathologic weeping and laughing secondary to forebrain disease. Protriptyline has been used in the treatment of obstructive sleep apnea. Trimipramine and doxepin have been studied in the treatment of peptic ulcer disease and to treat skin disorders. Desipramine has been used to facilitate cocaine withdrawal and to treat bulimia. Clomipramine and nortriptyline have been used to treat panic disorder. Nortriptyline has also been used to treat skin disorders and premenstrual depression.

Precautions:

Tardive Dyskinesia: Involuntary and uncontrollable movements may develop in patients treated with these drugs. Occurrence is highest among the elderly, especially women. The risk of developing these involuntary movements and the likelihood that they will become permanent are increased as the length of treatment and the total amount of drug given increases. However, it is possible to develop these symptoms after short-term treatment at low doses.

Neuroleptic Malignant Syndrome (NMS) Is a potentially fatal syndrome associated with use of tricyclic antidepressants. Symptoms include increased body heat, muscle rigidity, altered mental abilities including catatonia, irregular pulse or irregular blood pressure, increased heart rate, sweating, and irregular heart rhythm.

Withdrawal Symptoms: Stopping abruptly after prolonged therapy may pro­duce nausea, headache, dizziness, nightmares, and malaise. Clomipramine may also cause vomiting, sleep disturbances, hyperthermia (abnormally high temperature), and irritability. Gradual dose reduction may produce, within 2 weeks, transient symptoms including irritability, restlessness, dreams, and sleep disturbances.

Sensitivity to sunlight: May occur. Avoid prolonged exposure to the sun. Use sunscreens and wear protective clothing until tolerance is determined. These drugs may reduce tolerance to hot weather.

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus. There have been a few reports of birth defects associated with use of imipramine and amitriptyline. Withdrawal symptoms have been seen in newborns of mothers who have taken clomipramine, desipramine, or imipramine until delivery.

Breastfeeding: Tricyclic antidepressants appear in breast milk. Because of the potential for adverse reactions, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Amitriptyline and doxepin are not recommended for patients younger than 12 years of age. Safety and effectiveness have not been established for amoxapine in children younger than 16 years of age. Imipramine HCI use in bed wetting should be limited to children 6 years of age or older. The safety and effectiveness of imipramine HCI in children with conditions other than bed wetting have not been established. Safety and effectiveness have not been established for clomipramine in children younger than 10 years of age. Trimipramine, nortriptyline, desipramine, imipramine pamoate, and protriptyline are not recommended for use in children.

Elderly: Elderly patients are particularly sensitive to the anticholinergic effects (eg, constipation; difficulty urinating; confusion) of tricyclic antideprossants and may be at increased risk for falls. Lower than normal adult doses are generally used when starting therapy.

Type of Drug:

Antidepressant; mood-elevating agent
How the Venlafaxie Product Works:

Venlafaxine inhibits neuronal uptake of serotonin and norepinephrine in the central nervous system, which is believed to combat depression and other behavioral disorders.
Uses of The Venlafaxie:

The treatment of depression. The extended-release form is also used to treat generalized anxiety disorder.

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

Breastfeeding: Venlafaxine appears the breast milk. A decision should be made to either discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Children: Safety and effectiveness in children younger than 18 years of age have not been established.
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 venlafaxine HCI. Doses of one or both drugs may need to be modified or a different drug may need to be prescribod. The following drugs and drug classes interact with venlafaxino HCl.

*

MAOls (eg, phenelzine)
* Sibutramine (Meridia)

Side Effects:

Every drug is capable of producing side effects. Many venlafaxine HCI 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: Increased blood pressure; increased heart rate; decreased blood pressure upon rising; flushing.

Digestive Tract: Nausea; constipation; appetite loss; diarrhea; vomiting; indigestion; stomach pain; gas; difficulty swallowing; dry mouth;belching.

Nervous System: Drowsiness; sleeplessness; dizziness; nervousness; headache; vertigo (feeling of whirling motion); migraine; anxiety; tremor; abnormal dreams; abnormal skin sensations; agitation; confusion; impaired memory; depression; abnormal thinking; unstable emotions; lockjaw; twitching; depersonalization; decreased sex drive; muscle stiffness.

Respiratory System: Yawning; bronchitis; difficulty breathing; runny nose; cough.

Senses: Blurred vision; taste changes; ringing in the ears; dilated pupils; ear pain; vision changes.

Skin: Sweating; rash; itching; flushing.

Urinary and Reproductive Tract: Abnormal ejaculation or orgasm; impotence; impaired urination; urinary frequency; menstrual disorders; blood in the urine; painful or difficult urination; irregular bleeding between periods; inflammation of the vagina with itching or abnormal discharge; urinary retention.

Other: Weakness; infection; chills; chest pain; weight gain or loss; accidental injury; general body discomfort; neck pain; muscle pain; joint pain; swelling of hands or feet; unusual bruising.
Guidelines for Use:

*

Tablets - Usual adult starting dose is 75 mg/day, taken in 2 or 3 divided doses. Dosage may be gradually increased to achieve the desired effect.
*

Extended-release capsules - Usual adult starting dose is 75 mg/day taken as a single dose.
*

Take each dose with food.
*

Do not crush, chew, or dissolve extended-release capsules in water. Swallow extended-release capsules whole, with fluid.
*

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 several doses are missed or it is necessary to establish a new dosage schedule, con­tact your doctor or pharmacist. Use exactly as prescribed.
*

Do not change the dose or stop taking venlafaxine unless advised to do so by your doctor.
*

If venlafaxine therapy is discontinued, the dose should be gradually reduced over a 2-week period.
*

Smaller doses should be used in patients with moderate liver or kidney impairment.
*

Venlafaxine should not be used in combination with an MAOI, or within at least 14 days of discontinuing treatment with an MAOI. After stop­ping venlafaxine, at least 7 days should elapse before starting an MAOI.
*

Because any psychoactive drug may impair judgment, thinking, or motor skills, do not operate hazardous machinery, including automobiles, until you are reasonably certain that venlafaxine does not adversely affect your ability to engage in such activities.
*

Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or if you are breastfeeding during therapy.
*

Notify your doctor if rash, hives, or other allergic reactions occur.
*

Blood pressure will be monitored during treatment.
*

Notify your doctor or pharmacist if you are taking other prescription drugs, over-the-counter drugs, or supplements.
*

Avoid alcohol use during venlafaxine therapy.
*

Store at room temperature (68 to 77°F). Keep container tightly closed.

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Type of Drug:

Anticonvulsant; antiepileptic.

How the Felbamate Product Works:

Felbamate acts on the central nervous system to decrease the frequency of seizures.

Uses of The Felbamate:

Felbamate is not indicated as a first-line antiepileptic treatment. Felbamate is recommended for use only in those patients who respond inadequately to alternative treatments and whose epilepsy is so severe that a substantial risk of aplastic anemia or liver failure is deemed acceptable in light of the benefits conferred by its use.

Felbamate is indicated as monotherapy or adjunctive therapy in the treatment of partial seizures with and without generalization in adults with epilepsy.

Also indicated as adjunctive therapy in the treatment of partial or generalized seizures associated with Lennox-Gastaut syndrome in children.

Precations:

Alastic anemia: This drug should be used only in cases so severe that the risk of a plastic anemia (bone marrow failure) is seemed acceptable.

Liver failure: There have been cases of acute liver failure, some fatal, in association with the use of felbamate.

Discontinuation: Antiepileptic drugs should not be suddenly discontinued because of the risk of increasing seizure frequency.

Sensitivity to light: May cause photosensitivity (sensitivity to sunlight). Avoid prolonged exposure to the sun and other ultraviolet light. Use sunscreens and wear protective clothing until tolerance is determined.

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

Children: Safety and effectiveness in children other than those with Lennox­Gastaut syndrome have not been established.

Lab Tests: Lab tests may be required to monitor therapy. Tests may include liver function tests (ALT, AST, and bilirubin).

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 felbamate. 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 felbamate:

Carbamazepine (eg, Tegretol)

Hydantoins (eg, phenytoin)

Methsuximide (celontin)

Phenobarbital (eg, Solfoton)

Valproic acid (eg, depakene)

Side Effects:

Every drug is capable of producing side effects. Many felbamate 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; vomiting; constipation; indigestion; diarrhea; nausea; appetite loss; stomach pain or bloating; hiccough.

Nervous System: Sleeplessness; headache; anxiety; drowsiness; dizziness; nervousness; tremor; depression; abnormal walking; abnormal skin sensations; stupor; confusion; mood changes (especially in children); unstable emotions; abnormal thinking; pinpoint pupils; incoordination; agitation.

Respiratory System: Upper respiratory tract (eg, nose, throat) infection; nasal congestion; sinus inflammation; sore throat; coughing.

Skin: Acne; rash; itching; yellowing of the skin; unusual bruising; sensitivity to light.

Urinary and Reproductive Tract: Urinary incontinence; irregular menstrual bleeding; urinary tract infection.

Other: Aplastic anemia (bone marrow failure); acute liver failure; fatigue; fever; chest pain; palpitations (pounding in the chest); weight fluctuation; face edema (fluid retention or swelling); pain; weakness; impaired vision; chnnges in taste perception; dry mouth; muscle pain; bleeding or brusung; flu symptoms; general body discomfort; fast heartbeat; middle ear infection; abnormal blood counts; abnormal lab tests.

Guidelines for Use:

Dosage is individualized. Take exactly as prescribed.

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

May be taken with or without food.

Shake suspension well before use.

Do not discontinue use without first checking with your doctor. If you stop taking this drug suddenly, the frequency of your seizures could increase.

May cause photosensitivity (sensitivity to sunlight). Avoid prolonged exposure to the sun and other ultraviolet (UV) light. Use sunscreens and wear protective clothing until tolerance is determined.

Notify your doctor immediately if you experience fever, yellowing of the skin or eyes, appetite loss, stomach pain or bloating, weakness, sore throat, unusual bleeding or bruising, rash, or dark urine.

Lab tests will be required to monitor therapy. Be sure to keep appointments.

Store at room temperature in a tightly closed container.

Type of Drug:

Atypical antipsychotic.

How the Drug Works:

Atypical anti psychotics act upon several neurotransmitter systems, including antagonism at one or more types of dopamine receptors, antagonism at alphacadrenergic receptors, and activity at muscarinic, histamine H1 , or nicotinic receptors.

Uses:

For the treatment of schizophrenia.

Olanzapine: For the short-term treatment of acute manic episodes associated with Bipolar I disorder.

Precautions:

Tardive dyskinesia: InvOluntary and uncontrollable movements may develop in patients treated with antipsychotic drugs. Occurrence is high­Specially women. However, it is impossible to predict which patients are likely to develop the syndrome. The risk of developing these involuntary movements and the likelihood they will become permanent are increased with long-term use and with high doses. However, it is possible to develop these symptoms after short­term treatment at low doses. The syndrome is characterized by rhythmical, involuntary movements of tongue, face, mouth, or jaw (eg, protrusion of toQue, puffing of cheeks, puckering of mouth, chewing movements), sometimes accompanied by involuntary movements of the arms and legs. Fine worm-like movement of the tongue may be an early sign of the syndrome. If the medication is stopped at this time, the syndrome may not develop further. There is no known treatment for established cases of tardive dyskinexia, although the syndrome may stop, partially or completely, if the drug is Withdrawn. Antipsychotic treatment, however, may suppress or partially suppress the signs and symptoms of the syndrome and thereby possibly mask the underlying disease process. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown.

Neuroleptic Malignant Syndrome (NMS): Is a potetially fatal syndrome oscillated with antipsychotic drugs. Symptoms Include fever, muscle rigidity, altered mental abilities, irregular pulse and blood pressure, increased heart rate, sweating, and irregular heart rhythm.

Seizures: Seizures have occurred during therapy with some antipsychotic agents. The likelihood of seizure becomes greater at higher doses.

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

Breastfeeding: It is not known if these drugs are excreted in breast milk. Do not use breastfeed while taking one of these drugs.

Children: Safety and effectiveness of loxapine in patients younger than 16 years of age have not been established. Safety and effectiveness of clozapine, olanzapine, and quetiapine have not been established.

Lab Tests: Lab tests will be required to monitor therapy. Tests include blood counts and liver function.

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 these drugs. Doses of one or both drugs may need t o be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with these drugs:

• Anticholinergics (eg, diphenhydramme)
• Antihypertensives (eg, methyldopa)
• Dopamine agonists (eg, bromo criptine)
• Phonyton (eg, Dilantin)

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:

Circulatory System: Increased heart rate; changes in blood pressure; chest pain; abnormal blood counts; increased cholesterol levels.

Nervous System: Drowsiness; dizziness; agitation; confusion; seizures; aggressiveness; amnesia; anxiety; disturbed sleep; personality disorder; restlessness; rigidity; slurred speech; stuttering; fainting; tremor.

Digestive Tract: Constipation; dry mouth; stomach pain; diarrhea; nausea; vomiting; increased appetite.

Respiratory System: Coughing; difficulty breathing; runny nose; nasal; gestion; upper respiratory tract infection.

Other: Rash; orthostatic hypotension (dizziness or light-headednes that occurs when rising quickly from a seated or lying position); prolontion erection; Parkinson-like symptoms; Neuroleptic Malignant Syndromo; dive dyskinesia; dry skin; toothache; premenstrual syndrome; swelling of the arms or legs; joint, muscle, or back pain; twitching; sore thronl; weakness; fever; sweating; visual disturbances; weight gain; false­positive pregnancy tests.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor.
• Orally-disintegrating tablets - Peel back foil blister; do not push tablet through the foil. Using dry hands, remove and place the entire tablet in your mouth. The tablet will dissolve with or without liquid.
• 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 take several weeks before maximum benefit is obtained.
• May cause drowsiness, dizziness, or seizures. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Orthostatic hypotension (dizziness or drowsiness when rising quickly from a seated or lying position) may occur. Avoid sudden changes in posture.
• Notify your doctor immediately if you experience abnormal or impaired vision, lethargy, weakness, sore throat, general body discomfort, mucous membrane ulcerations, flu-like symptoms, tremor, muscle twitching or stiffness, or yellowing of the skin or eyes (jaundice).
• Use caution in hot weather. These drugs may increase the possibility of heat stroke. Avoid overheating and dehydration.
• Avoid consuming alcoholic beverages and other mental depressants (eg, narcotics, antihistamines) while taking this medicine.
• Inform your doctor if you are pregnant, become pregnant, plan on becoming pregnant, or are breastfeeding.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store at controlled room temperature (59° to 86°F). Protect from light and moisture.

Type of Drug:

Typical (conventional) antipsychotic.

How the Drug Works:

The exact mechanism is not known. Drugs of this type usually work by altering nerve transmission in the brain.

Uses:

For the management of the manifestations of psychotic mental disorders

Precautions:

Neuroleptic Malignant Syndrome (NMS): NMS is a potentially fatal syndrome associated with antipsychotic drugs. Symptoms include fever, muscle rigidity, altered mental abilities, irregular pulse and blood pressure, increased heart rate, sweating, and irregular heart rhythm.

Tardive dyskinesia: Involuntary and uncontrollable movements may develop in patients treated with antipsychotic drugs. Occurrence is highest in the elderly, especially women. However, it is impossible to predict which patients are likely to develop the syndrome. The risk of developing these involuntary movements and the likelihood they will become permanent are increased with long-term use and with high doses. However, it is possible to develop these symptoms after short­term treatment at low doses. The syndrome is characterized by rhythmical, involuntary movements of tongue, face, mouth, or jaw (eg, protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements), sometimes accompanied by involuntary movements of the arms and legs. Fine worm-like movement of the tongue may be an early sign of the syndrome. If the medication is stopped at this time, the syndrome may not develop further. There is no known treatment for established cases of tardive dyskinexia, although the syndrome may stop, partially or completely, if the drug is withdrawn. Antipsychotic treatment, however, may suppress or partially suppress the signs and symptoms of the syndrome and thereby may possibly mask the underlying disease process. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown.

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

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

Children: Safety and effectiveness in children younger than 12 years of age have not been established.

Lab Tests: Lab tests or exams may be required to monitor treatment. Tests include blood and liver tests and periodic eye exams.

Drug Interactions:

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

• alcohol atropine (eg, lsopto Atropine)
• barbiturates (eg, phenobarbital)
• benztropine (eg, Cogentin)
• bromocriptine (Parlodel)
• chloroquine (eg, Aralen)
• guanadrel (eg, Hylorel)
• guanethidine (eg, Ismelin)
• levodopa (eg, Larodopa)
• lithium (eg, Eskalith)
• phenytoin (eg, Dilantin)
• propranolol (eg, Inderal)
• trazodone (eg, Desyrel)

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: Indigestion; stomach pain; constipation; appetite changes; diarrhea; nausea; vomiting.

Nervous System: Altered mental status; orthostatic hypotension (dizzines or light-headedness when rising quickly from a sitting or lying position); fainting; drowsiness; impaired judgment, thinking or motor skills; head­ache; restlessness; agitation; light-headedness; sleeplessness; seizures.

Circulatory System: Rapid heartbeat; changes in blood pressure; pounding in the chest (palpitations); abnormal blood counts.

Other: Rash; fever; muscle rigidity; sweating; acute kidney failure; involuntary and uncontrollable movements (eg, protrusion of tongue, puffing of cheeks; puckering of mouth, chewing movements); lens problems; dry mouth; weakness; weight gain; tight muscles; joint pain; swelling of arms and legs; lactation; moderate breast enlargement (women); absence of menstruation; increased or decreased blood sugar; blurred vision; nasal congestion; increased salivation; impotence; increased thirst; itching; sensitivity to light.

Guidelines for Use:

• Dosage is individualized. Take 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 if it is necessary to establish a new dosage schedule, con­tact your doctor or pharmacist.
• May cause dizziness, light-headedness, or fainting, especially when rising or standing and during the first 3 to 5 days. If these symptoms should occur, sit or lie down and contact your doctor. Use caution while driving or performing hazardous tasks requiring alertness, coordination, or physical dexterity.
• Do not take other medications without your doctor’s approval. This includes nonprescription medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
• Avoid alcohol and other mental depressants (eg, narcotics, tranquilizers, antihistamines) while you are taking this medicine.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Avoid overheating and dehydration.
• Lab tests may be required to monitor treatment. Be sure to keep appointments.
• Store at a controlled room temperature (59 to 77°F).

Type of Drug:

Antirheumatic agents.

How the Drug Works:

The exact merchanism of action of gold compounds is unknown. They suppress or prevent joint swelling and retard cartilage and bone destruction, but do not cure rheumatoid arthritis.

Therapeutic effects from gold compounds occur slowly. Early improvement, often limited to reduction in morning stiffness, may begin after 6 to 8 weeks of treatment, but other beneficial effects may not be observed until after months of therapy.

Uses:

To treat early active adult or juvenile rheumatoid arthritis not adequately controlled by other therapies (eg, NSAIDs).

Unlabeled Uses: Occasionally doctors may prescribe gold compounds for pemphigus and psoriatic arthritis.

Precautions:

Injection reaction: Increased joint pain may occur for 1 or 2 days after ejection. They usually subside after the first few injections. These reacllon are usually mild, but occasionally may be so severe that treatment It; stopped prematurely.

Use of other antirheumatic drugs: Use of salicylates, aspirin, NSAIDs, systemic corticosteroids may be continued when gold injection theory is started. After improvement begins, slowly discontinue pain rollovers and NSAIDs as symptoms permit. Safety of arranging with able gold or high doses of corticosteroids has not been establisllod. salts should not be used concomitantly with penicillamine or hydroxy chloroquine. See Drug Interactions.

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

Breastfeeding: Gold appears in breast milk. A decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness of auranofin and gold sodium have been established. Safety and effectiveness of aurothioglucoso it children younger than 6 years of age have not been established.

Elderly: Tolerance to gold usually decreases with advancing age.

Lab Tests: Lab tests will be required during treatment. Tests include complete blood cell and platelet counts, urinalysis, and kidney and liver functional All women of child-bearing potential must have a pregnancy test before treatment begins to rule out the possibility of pregnancy.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are take any over-the-counter or prescription medications or dietary supplements with gold compounds. Doses of one or both drugs need to be modified or a different drug may need to be prescribe following drugs and drug classes interact with gold compounds:

• Antimalarials (eg, hydroxychloroquine)
• Immunosuppressive agents (eg, azathioprine, cyclophosphamide, methotrexate)
• Penicillamine (eg, depen)
• Phenytoin (eg, dilantin) (auranofine only)

Side Effects:

Every drug is capable of producing side effects. Many gold 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: Indigestion; nausea; vomiting; diarrhea; constipation; stomach cramps; appetite loss; gas; dark or loose stools; mouth inflammation or ulcers.

Skin: Rash; itching; hives; redness; unusual bruising.Oher: Blood in the urine; skin inflammation; metallic taste; abnormal blood cell counts; abnormal liver or kidney function tests; anemia; yellowing of the skin or eyes.

Guidelines for Use:

• Dosage will be individualized. Do not exceed the recommended dosage.
• Injectable gold products - The appropriate dose will be prepared and administered by your health care provider.
• Notify your doctor immediately if any of the following occurs: Rash, mouth inflammation, persistent diarrhea, sore mouth, indigestion, metallic taste, unusual bleeding or bruising, itching, blood in the urine, fainting, slow heartbeat, thickening of the tongue, difficulty swallowing or breathing, yellowing of the skin or eyes.
• Notify your doctor immediately if you suspect you have become pregnant during therapy. All women of child-bearing potential must have a pregnancy test before treatment begins to rule out the possibility of pregnancy.
• Increased joint pain may occur for 1 or 2 days after injection. This usually subsides after the first few injections.
• Observe good oral hygiene during therapy.
• Improvement of symptoms is not immediate. Improvement may be seen after 6 to 8 weeks of treatment, although it has not been seen in some patients for up to several months.
• Lab tests and exams will be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59 0 to 86°F). Protect from light.

Type of Drug:

Anticonvulsant; drug used to treat a variety of seizure disorders.

How the Oxcarbazepine Product Works:

Oxcarbazepine prevents or reduces some types of seizures by controlling abnormal nerve impulses in the brain.

Uses of The Oxcarbazepine:

For use alone or in combination therapy for the treatment of partial seizures in adults with epilepsy and as combination therapy for the treatment of partial seizures in children 4 to 16 years of age with epilepsy.

Unlabeled Uses: Oxcarbazepine has been used for atypical panic disorder.

Precautions:

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

Pregnancy: There are no adequate and well-controlled clinical studies in pregnant women; however, it is closely related structurally to carbamazepine, which is considered to be teratogenic in humans. Use during pregnancy only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Oxcarbazepine and its active metabolite MHO are excreted in human breast milk. Because of the potential for serious adverse reactions, decide whether to discontinue nursing or to discontinue the drug in nursing women, taking into account the importance of the drug to the mother.

Children: Oxcarbazepine has been shown to be effective as adjunctive therapy combined with other drugs for partial seizures in patients 4 to 16 years of age.

Lab Tests: Lab tests will be required to monitor therapy. Tests may include blood sodium levels, liver function, kidney function, and blood 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 with oxcarbazepine. 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 oxcarbazepine:

• Calcium channel blockers (eg, felodipine)
• Carbamazepine (eg, tegretol)
• Phenobarbital (eg, solfoton)
• Phenytoin (eg, dilantin)
• Valproic acid (eg, depakene)

Side Effects:

Every drug is capable of producing side effects. Many oxcarbazepine 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; stomach pain; inflammation of the stomach; appetite changes; dry mouth; toothache; diarrhea; indigestion; constipation; rectal bleeding or pain.

Nervous System: Headache; dizziness; drowsiness; anxiety; fatigue; weak­ness; incoordination; tremors; continual rapid eye movement; abnormal gait; sleeplessness; impaired concentration; amnesia; worsening of seizures; involuntary muscle contractions; unstable emotions; decreased sensation to stimuli; nervousness; agitation; speech disorder; confusion; feeling of whirling motion; abnormal EEG; abnormal thinking.

Respiratory System: Sinus congestion; runny nose; upper respiratory infection; cough; breathing difficulties; sore throat; nosebleed; chest infection.

Skin: Acne; hot flashes; flushing; rash; unusual bruising; increased sweating; itching.

Other: Double vision; abnormal vision; earache; ear infection; fever; allergy; swelling of the legs; chest pain; weight increase; low blood pressure; following down; swollen lymph nodes; viral infection; urinary tract infection; frequent urination; inflammation or pain of the vagina; low blood sodium levels; thirst.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose unless advised to do so by your doctor.
• May be taken without regard to meals.
• Avoid alcohol and other mental depressants (eg, narcotics, tranquilizers, antihistamines) while you are taking this medicine.
• Treatment should be withdrawn gradually to minimize the potential of increased seizure frequency.
• 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 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.
• Additional non hormonal forms of contraception (eg, latex condoms) are recommended because of a reduction in hormonal contraceptive efficacy during therapy.
• Avoid alcohol during therapy; it may cause drowsiness.
• May cause drowsiness, dizziness, or blurred vision. Use caution while driving or performing hazardous tasks requiring alertness, coordination, or physical dexterity until tolerance is determined.
• Store at controlled room temperature (59° to 86°F). Keep tightly closed

Type of Drug:

Anticonvulsant; drug used to treat epilepsy, seizures, and other conditions.

How the Drug Works:

Valproic acid prevents or reduces the number of seizures by controlling the abnormal activity of nerve impulses in the brain and central nervous system. Sodium valproate and divalproex sodium are converted to valproic acid in the body.

Uses:

Used alone or in combination with other anticonvulsants to control simple and complex absence seizures (petit mal).

Used alone or in combination with other anticonvulsants to control isolated complex partial seizures or complex partial seizures associated with other types of seizures.

Delayed-release tablets: To treat manic episodes associated with bipolar disorder.

Delayed-release, extended-release tablets: For the prevention of migraine headaches.

Unlabeled Uses: May be effective as an adjunct to antipsychotic drugs in the symptomatic management of schizophrenia in patients who fail to respond to an adequate trial of the antipsychotic agent alone. Also may be a useful adjunct in schizophrenic patients with EEG abnormalities suggestive of seizure activity, or in those patients with agitated or violent behavior. May be effective in relieving tardive dyskinesia in patient receiving long-term antipsychotic drug therapy. For the treatment of aggressive outbursts in children with attention deficit hyperactivity disorder. Has been shown to be effective in a limited number of nations with organic brain syndrome.

Precautions:

Liver disease: Liver failure resulting in death has occurred in patients receiving valproic acid and its derivatives. Children younger than 2 years of age are at an increased risk of developing fatal liver toxicity, especially if they are taking several anticonvulsant medications or have birth­related metabolic disorders, severe seizure disorders accompanied by mental retardation, or brain damage. Liver problems usually occur during the first 6 months of treatment. Loss of seizure control, general feeling of ill health, weakness, drowsiness, facial swelling, appetite loss, yellowing of skin and eyes, or persistent or unexplained vomiting may be warning signs of possible liver problems.

Pancreatitis: Cases of life-threatening pancreatitis have been reported in children and adults receiving valproate. Pancreatitis can occur at any time while using valproic acid. Abdominal pain, nausea, vomiting, or anorexia can be symptoms of pancreatitis that require prompt medical evaluation.

Pregnancy: Studies have shown a potential risk to the fetus. Using these drugs during pregnancy may result in birth defects. If you are pregnant or are planning to become pregnant, discuss with your doctor the possible risks to the unborn infant. Use only if clearly needed and the potential benefits outweigh the possible risks.

Breastfeeding: Valproic acid appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Children younger than 2 years of age may be particularly sensitive to the possible liver damage caused by valproic acid, especially if taking other anticonvulsant drugs at the same time. Safety and effectiveness have not been established in children younger than 18 years of age for treatment of acute mania. Safety and efficacy of divalproex sodium for the prevention of migraines has not been established in children younger than 16 years of age. Safety and effectiveness of divalproex sodium extended-release tablets for the prevention of migraine headache and treatment of epilepsy have not been established in children younger than 18 years of age. Sprinkle capsules me for adults and children 10 years of age and older. Consult your doctor See Liver disease.

Elderly: Elderly patients may be at an increased risk of drowsiness and tremor. Lower doses are usually used when starting therapy.

Lab Tests: Lab tests will be required during treatment. Tests may include liver function, blood cell counts, blood-clotting tests, and valproic acid blood levels.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over-the-counter or prescription medications or dietary supplements with this drug. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with this drug:

• Carbamazepine (eg, Tegretol)
• Diazepam (eg, Valium)
• Ethosuximide (eg, Zarontin)
• Felbamate (Felbatol)
• Hydantoins (eg, phenytoin)
• Lamotrigine (Lamictal)
• Phenobarbital (eg, Solfoton)
• Primidone (eg, Mysoline)
• Salicylates (eg, aspirin)

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:

Senses: Abnormal vision; eye redness or pain; blurred or double vision; spots before the eyes; unusual eye movements; dry eyes; hearing loss; ear pain or disorder; ringing in the ears; taste perversion.

Digestive Tract: Appetite changes; nausea; vomiting; stomach cramps or pain; indigestion; diarrhea; fecal incontinence; constipation; gas; tongue inflammation; vomiting of blood; belching; pancreatitis.

Nervous System: Weakness; tiredness; nervousness; forgetfulness; clumsiness; drowsiness; behavior changes; depression; headache; tremors; hallucinations; dizziness; slurred speech; abnormal dreams; abnormal thinking; agitation; abnormal gait; twitching; abnormal skin sensations (eg, burning, prickling, tingling); feeling of whirling motion; exaggerated sense of well-being; decreased sense of stimulation; difficulty moving; increased reflexes; confusion; sleeplessness; behavioral deterioration; anxiety.

Circulatory System: Changes in blood pressure; pounding in the chest (eg pitations); dizziness or light-headedness when rising from a sitting or lying position (postural hypotension); fast heartbeat; flushing; chest pain

Skin: Yellowing of skin or eyes; unusual bleeding or bruising; sensitivity 10 sunlight; rash; itching; dry or oily skin; skin redness; hair follicle infection; hair loss.

Other: Swelling of the face, hands, or feet; weight changes; abscessed teeth; muscle, joint, and back pain; leg cramps; tight muscles; difficulty breathing; increased cough; runny nose; frequent, painful, or difficult urination; loss of bladder control; chills; fever; neck pain or stiffness; changes in menstrual periods; painful menstruation; injection site reactions; sore throat; flu-like syndrome; sweating; general body discomfort; vaginal infection; bronchitis; respiratory infection; muscle weakness; nosebleed; sinus infection; difficulty speaking.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor. If you stop taking this medicine suddenly, your seizures may suddenly begin again.
• May cause stomach upset. Take with food.
• Tablets, capsules - Swallow whole; do not chew or crush. Chewing or crushing may cause irritation in the mouth or throat.
• Sprinkle capsules - May be swallowed whole or taken by opening the capsule and sprinkling the contents on a small amount (teaspoonful) of soft foods such as applesauce or pudding. Swallow quickly without chewing. Do not store drug/food mixture for future use. Some of the specially coated sprinkles may be seen in the stool. This is normal and no cause for concern.
• May cause dizziness, drowsiness, or sleepiness. Use caution when driving or performing other tasks requiring alertness, coordination, or physical dexterity until tolerance is determined. Taking at bedtime may help decrease drowsiness.
• Contact your doctor immediately if you experience loss of seizure control, weakness, swelling of the face, unusual bleeding or bruising, skin reactions, lethargy, general body discomfort, appetite loss, yellowing of skin or eyes, vomiting, nausea, or stomach pain.
• If dose is missed, take 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 if missed or it is necessary to establish a new dosage schedule, con­tact your doctor or pharmacist.
• When you first begin taking this medicine, see your doctor regularly. Your doctor may want to adjust the dose you are taking to make sure it is the best dose to control your condition and minimize side effects. Checkups are particularly important if you are taking other anticonvulsant drugs with valproic acid.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Diabetes - These drugs may interfere with urine tests for ketones and may give inaccurate test results.
• Using these drugs with alcohol or other central nervous system depressants (eg, narcotic pain relievers, sedatives) may cause additional drowsiness.
• Carry Medic Alert identification indicating that you are taking these drugs and have epilepsy.
• May cause sensitivity to sunlight. Avoid prolonged exposure to the sun and other ultraviolet light. Use sunscreens and wear protective clothing until tolerance is determined.
• Store capsules at 59° to 77°F. Store tablets and syrup below 86°F.