Drugs Blog

Type of Drug:

Hormone; antidiabetic agent.

How the Insulin Product Works:

Insulin, normally produced in the pancreas gland, is the major hormone that regulates glucose (sugar) use in the body. Without insulin, sugar

is trapped in the bloodstream and cannot enter the cells of the body where it can be utilized for energy, so blood sugar levels increase, resulting in diabetes. In type 1 (insulin-dependent) and advanced type 2 (non­insulin-dependent) diabetes, the pancreas is not able to make enough insulin to control sugar levels.

Insulin must be injected. If taken by mouth, it would be digested by the acids and enzymes in the stomach.

Uses of The Insulin:

To treat type 1 (insulin-dependent) diabetes mellitus.

To treat type 2 (non-insulin-dependent) diabetes mellitus that cannot be properly controlled by diet, exercise, or weight reduction.

Used in a hospital setting to treat dangerously high blood levels of potassium.

Precautions:

Diet and exercise: It is important to follow the diet and exercise regimen prescribed by your doctor in order to effectively control diabetes. Do not change this regimen unless advised to do so by your doctor.

High blood pressure: High blood pressure in combination with diabetes increases the risk for other health problems (eg, eye or kidney problems, heart attack, stroke). Blood pressure should be monitored frequently. Regular checkups and eye examinations are important.

Smoking: Avoid tobacco products. If you are a smoker and stop, your dose of insulin may need to be reduced.

Brand interchange: Do not change from one insulin product to another unless advised to do so by your doctor. Insulins vary by strength, brand, onset, maximum effect, and duration of activity (see the following table). Become familiar with how the products you are using affect your blood sugar levels.

Insulin mixtures: Patients stabilized on mixtures should have a consistent response. Unexpected responses are most likely to occur when switching from separate injections to mixtures (or vice versa). When mixing 2 types of insulin, always draw the clear regular insulin into the syring first. To avoid dosage errors, do not alter the order of mixing insulin’s or change the model or brand of syringe or needle.

It is recommended to use the self-prepared mixtures within the first 5 minutes after mixing. If this is not Possible, clnrify with your doctor, pharmacist, or health care provider the Installs on how to mixtures.

NPH/regular mixtures of insulin are available in premixed formulations of 70% NPH and 30% regular, and of 50% NPH and 50% regular. Insulin lisper NPH/regular mixtures are available in premixed formulations of 75% NPH and 25% regular and of 50% NPH and 50% regular. These mixtures are stable and are absorbed as if injected separately.

High blood sugar: In patients with type 1 diabetes mellitus, high blood sugar levels (hyperglycemia) that are not treated properly with insulin can develop into diabetic retroactions, a life-threatening condition requiring prompt diagnosis and treatment (see the following table for symptoms). Close monitoring and control of blood sugar levels are required to prevent high blood sugar levels from developing.

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 insulin. 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 insulin:

Decrease the glucose-lowering effect of insulin

AIDS antiviral’s (EEG, sauna) ionized (EEG, Android) abutter (EEG, Provencal) lithium carbonate (EEG, Desalt) sporangia (El spar) loop diuretics calcimining (EEG, Calcium) (EEG, nursemaid) condone (EEG, Attars) morphine sulfate (EEG, MS contraceptives, oral Nov um niacin (vitamin 8 3 nicotinic acid) cortices (eg, prednisone) nicotine cyclophosphamide (eg, phenothiazines (eg, prometha- Cytosine) danazol (eg, Danocrine) phenytoin (eg, Dilantin)dextrothyroxine (Choloxin) somatropin (eg, Genotropin) diazoxide (Proglycem) terbutaline (eg, Brethine) diltiazem (eg, Cardizem) thiazide diuretics (eg, hydrodobutamide (eg, Dobutrex) chlorothiazide) epinephrine (eg, Adrenalin thyroid hormone Chloride) (eg, levothyroxine)

Increase the glucose-lowering effect of insulin

ACE inhibitors (eg, ramipril) MAOls (eg, phenelzine) alcohol propoxyphene (eg, Darvon-N) antidiabetic products, oral (eg, alicylates (eg, aspirin) glipizide) somatostatin analog (eg, Notre beta blockers (eg, propranolol) clofibrate (Atromid-S) sulfonamides (eg, trimethoprim disopyramide (eg, Norpace) and sulfamethoxazole) fluoxetine (eg, Prozac) tetracyclines (eg, oxytetracyc- lithium carbonate (eg, Eskalith)

Side Effects of Insulin:

Every drug is capable of producing side effects. Many insulin 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: Rash, itching, redness, or other allergic symptoms at injection site; skin puckering at injection site; skin depression at injection site; skin thickening at injection site; fatty lumps at injection site. For symptoms of high blood sugar and low blood sugar, see Precautions.

Low blood sugar: Insulin use has the potential to cause hypoglycemia, or low blood sugar (refer to the preceding table for symptoms). Hypoglycemia may be due to taking too much insulin, exercising or working more than usual, not eating enough food, or not eating at the appropriate times. Eating sugar or a sugar-sweetened product will often correct the condition and prevent more serious symptoms. Establish a plan with your doctor on how best to treat hypoglycemic reactions. All diabetic patients should carry a source of rapid-acting sugar (eg, candy mints, glucose tablets) to take if symptoms of low blood sugar develop. Commercial products containing 40% glucose are available, such as B-D Glucose tablets. Close self-monitoring of blood glucose is necessary to determine when blood sugar levels are too low. Notify your doctor immediately if you experience ongoing symptoms of low blood sugar.

All patients using insulin should also have a Glucagon emergency kit available, so that family members, Coworkers, or friends can administer the Glucagon to raise blood sugar levels in an unconscious patient with diabetes (see the Glucose Elevating Agents - Glucagon monograph in this chapter). Make sure these people know how to prepare and administer Glucagon.

Pregnancy: If you are using insulin and become pregnant, management of your diabetes will require a greater effort and you should self monitor blood glucose and ketones more often. Rigid control of blood sugar and avoidance of ketones in the blood are desired throughout pregnancy. Insulin requirements may drop immediately following delivery, then increase to pregnancy levels over time.

Breastfeeding: Insulin appears in breast milk, but is destroyed in the stomach of the infant and not absorbed. 8reastfeeding women may require adjustments in insulin dose and diet.

Lab tests may be required to monitor therapy. Tests may include blood glucose, urine ketones, and glycohemoglobin tests.

• 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.

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:

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.

Type of Drug:Human antidiuretic hormone (ADH).

How the Drug Works:

A hormone which makes the kidneys reabsorb (retain) water and increases the concentration/activity of certain blood factors necessary for normal blood clotting.

Uses:

DDA VP: As antidiuretic hormone replacement therapy in the management of central cranial diabetes insipidus and for temporary excessive urination and excessive thirst following head injury or surgery in the pituitary region. This will allow return to a more normal lifestyle with decreased urinary frequency and nighttime urination.

To treat nighttime bed-wetting (nasal solution only). May be used alone or in combination with behavioral conditioning or other non medicinal intervention.

To control bleeding in hemophilia A patients during and after surgery, and to stop spontaneous or trauma-induced bleeding in hemophilia A patients (injection only).

To control bleeding in patients with mild to moderate von Willebrand disease (Type I) during and after surgery, and to stop spontaneous or trauma-induced bleeding in patients with von Willebrand disease (injection only).

Stimate: To stop spontaneous or trauma-induced bleeding in patients with hemophilia A or mild to moderate von Willebrand disease (Type I).

Unlabeled Uses:

Nasal solution - To treat chronic autonomic failure (eg, nighttime bed­wetting, over-night weight loss and morning dizziness or lightheadedness when rising from a sitting or lying position).

Water intoxication: Very young and elderly patients should drink only enough fluids to satisfy thirst in order to decrease the potential occurrence of water intoxication (over-load) and salt depletion in the blood.

Long-term use: There have been reports of reduced responsiveness or duration of effect in patients using the drug for more than 6 months. Consult your doctor if such changes occur.

Precautions:

Pregnancy: Studies in pregnant women or in animals have been judged not to show a risk to the fetus. However, no drug should be used during pregnancy unless clearly needed.

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

Children: Infants and children need careful fluid intake restrictions to prevent possible salt depletion in the blood and water intoxication (over­load). Nasal solution has been used safely and is modestly effective for short-term use (4 to 8 weeks) in children 6 years of age and older for the treatment of nighttime bed-wetting. Do not use injection in children under 3 months of age or the nasal solution in children under 11 months of age in the treatment of hemophilia A or von Willebrand disease. Safety and effectiveness have not been established in children under 12 years of age (injection) or under 3 months of age (nasal solution) with diabetes insipid us. Decompressing tablets have been used safely in children 4 years of age and older for periods of up to 44 months.

Lab tests may be necessary to monitor therapy. Be sure to keep appointments.

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 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 and drug classes interact with this medicine.

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:

DDA VP nasal solutions - Headache; runny nose; nausea; stomach cramps; vaginal pain; high blood pressure; facial flushing; nosebleed; sore throat; cough; difficulty breathing.

DDA VP injection - Redness, swelling or burning at injection site; head­ache; runny nose; nausea; stomach cramps; vaginal pain; high blood pressure; facial flushing.

Stimate nasal solution - Sleepiness; dizziness; itchy or light-sensitive eyes; sleeplessness; chills; warm feeling; pain; chest pain; palpitations (pounding in the chest); fast heartbeat; indigestion; fluid retention; vomiting; agitation; genital inflammation; difficulty breathing.

Guidelines for Use:

• Read and follow patient instructions carefully and use exactly as prescribed.
• If a dose is missed, take or use 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.
• If bleeding is not controlled or worsens, contact your doctor.
• Contact your doctor if headache, shortness of breath, heartburn, nausea, stomach cramps or vaginal pain OCcurs.
• Nasal solutions - For nasal use only. Use one spray per nostril. If used before surgery, administer 2 hours before the scheduled procedure.
• Stimate Spray pump must be primed before the first use. To prime the pump, press down 4 times. The pump will stay primed for 1 week if refrigerated. Repair the pump after 1 week if not used. Discard any solution remaining after 25 doses since the amount delivered thereafter may be less than the required dose. Do not transfer the remaining solution to another bottle.
• Storage- Refrigerate nasal solutions and injection at 36° to 46°F. When travel­ling, closed nasal solution containers may be kept at room temperature (72°F) for up to 3 weeks. Store tablets at room temperature (59° to 86°F) protected from heat and light.

Type of Drug:A blood glucose (sugar) elevating agent.

How the Glucagon Products Works:

Glucagon is a natural hormone that is released from the pancreas. It elevates blood sugar in a variety of ways (eg, inhibition of glucogen synthesis, enhanced formation of glucose from noncarbohydrates and fat, increased hydrolysis of glucogen to glucose).

Uses of The Glucagon:

Used to treat severe hypoglycemia (low blood glucose levels). Because patients with type 1 diabetes may have less of an increase in blood glucose levels compared with a stable type 2 diabetes patient, a supplementary carbohydrate should be given as soon as possible, especially to a pediatric patient.

Used as a diagnostic aid in the x-ray examination of the stomach, duodenum, small intestine, and colon when decreased intestinal motility is desired.

Unlabeled Uses: Occasionally doctors may prescribe glucagon for treatment of an overdose of propranolol and in cardiovascular emergencies (eg, severely reduced heart rates).

Precautions:

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

Use with caution in the following situations: pheochromocytoma, active or history of tumor of the pancreas, history of Hypoglycemia (low blood sugar levels): Although glycogen may be used for emergency treatment of low blood sugar levels, notify your doctor so that adjustments in insulin dose and dietary factors can be made. In addition, patients should be given food after they become conscious and alert. Frequently self monitor blood glucose so that blood sugar levels are not allowed to get too low.

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

Children: Safety and effectiveness for use in the treatment of hypoglycemia in children have been established.

Lab Tests: Lab tetras will be required to monitor therapy. Tests include blood glucose 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 while taking glucagon. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. Oral anticoagulants (eg, warfarin) interact with glucagon.

Side Effects of Glucagon:

Every drug is capable of producing side effects. Many glucagon 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: Nausea; vomiting; hives; low blood pressure; difficulty breathing.

Guidelines for Use:

• Carefully read the patient instructions provided with the product.
• All patients with. diabetes should have a Glucagon Emergency Kit. Low blood sugar (conscious patent)- Consume fast-acting sugars (eg, B-D Glucose, Glutose).
• Low blood sugar (unconsciouspati.ent) Intravenous (IV; into a vein) glucose use is encouraged, if available and feasible. If not, glucagon is the treatment of choice. Instruct friends, coworkers, and family members of patients with diabetes how to administer glucagon. Prompt treatment is essential.
• The patient will usually awaken within 15 minutes of glucagon use. If not, repeat the dose. Upon awakening, give the patient food (eg, a carbohydrate) as soon as possible and follow the usual dietary regimen.
• The glucagon emergency kit has a diluting fluid in a.unit (one) dose syringe. This diluting fluid is injected into a vial of the glucagon Crystals. The vial is then shaken and the contents brought back into the syringe. The glucagon crystals now in the diluting fluid are given IV, intra­muscularly (IM; into a muscle), or subcutaneous (SG; undertheskin).
• Notify your doctor if you experience a hypoglycemic reaction $0 that your treatment regimen may be adjusted if necessary.
• Lab tests will be required. Be sure to keep appointments.
• Store at controlled room temperature (68° to 77° F) before mixing with the diluting fluid.
• Use glucagon immediately after it has been mixed with the diluting fluid because the drug is stable for only a short time. Discard any unused portion.

Type of Drug:Topical anti-inflammatory, anti-itching agents; anti-inflammatory steroids.

How the Corticosteroids, Topical Works:

Topical adrenocortical steroids reduce skin inflammation (eg, redness, swelling), itching, and irritation. The exact manner in which the drug works is not fully understood. The effectiveness of the drug depends on many factors, including: The extent of absorption of the drug, the potency of the drug, the size of the area treated, and the dose form (eg, cream, ointment).

Uses of The Corticosteroids, Topical:

To treat inflammation and itching caused by corticosteroid-responsive skin disorders.

OTC Hydrocortisone: To treat minor skin irritation, itching, and rashes due to eczema; insect bites; poison ivy, oak, or sumac; allergic inflammation from soaps, detergents, cosmetics, or jewelry; itchy genital and anal areas; psoriasis; seborrheic dermatitis; or other minor skin irritations

Precautions:

Do not use in the following situations: acne allergy to corticosteroids or any of their ingredients bacterial infections of the skin, single therapy for cellulitus facial, groin, or armpit areas (high potency agents only) prolonged use near eyes or eye­lids rosacea

Use with caution in the following situations: blistered, raw, or oozing areas of skin diaper dermntosis skin infection

Absorption into the body: Absorption into the body of topical corticosteroids has produced manifestations of Cushing’s syndrome, reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, and increased blood and urine sugar. This is more likely to occur with application to large body surfaces, use of occlusive dressings, and with the more potent steroids. Patients at higher risk include young children.

Side effects may include growth retardation, delayed weight gain, low plasma cortisol levels and absence of response to ACTH stimulation, including bulging “soft spots,” headaches, and bilateral papilledema.

Alcohol-containing preparations: Alcohol-containing preparations may cause drying, burning, or irritation of open lesions.

Formulations: Corticosteroids are specially formulated to maximize their release and potency. Mixing these products with other products is discouraged because it may affect potency and effectiveness.

Occlusive vehicles: A transparent plastic wrap or other vehicles that will not allow air to pass through to the treated area will enhance absorption at least 10 times. These kinds of dressings are not generally recommended (eg, when using clobetasol or halobetasol, when treating children).

Greasy ointment bases are more occlusive and are preferred for dry, scaly lesions. Gels are less occlusive. The aerosols, lotions and solutions are best suited for hairy areas.

Skin atrophy: Skin atrophy may occur in 3 to 4 weeks if the most potent corticosteroids are employed. Skin atrophy occurs most readily at sites where absorption through the skin is highest.

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. Do not use large doses or for prolonged periods of time if you are pregnant.

Breastfeeding: It is not known if topical corticosteroids appear in breast milk. Oral corticosteroids appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Limit therapy to the lowest possible dosage because children may be more susceptible to topical corticosteroid-induced side effects. Safety and effectiveness of alclometasone in children less than 1 year of age have not been established. Clobetasol is not recommended in children less than 12 years of age. Safety and effectiveness of hydrocortisone probutate in children less than 18 years of age have not been established.

Lab tests may be required to monitor therapy. Tests may include urinary­free cortisol, ACTH stimulation, and early morning plasma cortisol test.

Side Effects of Corticosteroids Topical:

Every drug is capable of producing side effects. Many topical corticosteroid 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: Burning; itching; irritation; redness; dryness; allergic inflammation; acne; decreased pigmentation in the area being treated; streaks in skin; skin atrophy; infection; stinging; cracking; rash; tingling; scalp pustules (scalp application only); unusual hair growth.

Other: Elevated blood or urine sugar; cataracts and glaucoma (prolonged use near eyes); numbness of fingers; worsening of condition being treated.

Also consider all side effects for oral corticosteroids..

Guidelines for Use:

• Dosage is individualized.
• Application frequency and duration of therapy are dependent on the condition treated, its location, the potency of the drug, and the vehicle employed. For assistance in product-specific drug selection and dos­age guidelines, consult your doctor or pharmacist.
• Wash hands before and after application.
• Wash or soak the affected area before application. This may increase drug penetration.
• Apply sparingly as a thin film. Rub in lightly until the medication disappears.
• For external use only. Avoid contact with the eyes.
• Avoid prolonged use, especially near the eyes, on the face, on genital and rectal areas, and in skin folds.
• The treated area should not be bandaged, covered, or wrapped to be occlusive, unless advised to do so by your doctor.
• Do not use tight-fitting diapers or plastic pants on children treated with topical corticosteroids in the diaper area. Such garments function as occlusive dressings.
• Skin infections may worsen. It may be necessary to stop the corticosteroid and treat the infection.
• Do not use these agents to treat acne, the lesions of rosacea, skin inflammation near the mouth, or for any disorder other than that for which it was prescribed.
• Allergic reactions may Occur. Contact your doctor if the condition being treated worsens or irritation, burning, redness, swelling, or stinging persists. Do not reapply the drug.
• If you do not notice improvement within 2 weeks (or 1 week when using aTC hydrocortisone), consult your doctor.
• Aerosol/Spray - Take care to cover the eyes while spraying close to the face. Avoid inhalation. Spray the affected area for 3 seconds or less at a time and at a distance of at least 6 inches between the nozzle and skin.
• Scalp application - Apply to the affected scalp areas twice daily, once in the morning and once at night. Do not use more than 50 week. Treatment must be limited to 2 consecutive weeks.
• Tape - Skin should be clean and dry before the tape is applied. Tape should always be cut, never torn. Replacement of the tape every 12 hours produces the lowest incidence of side effects, but it may be left in place for 24 hours if it is well­tolerated and adheres well. When replacing the tape, cleanse the skin and allow to dry for 1 hour before applying new tape. When necessary, the tape may be used at night only and removed during the day. If the ends of the tape loosen prematurely, they may be trimmed off and replaced with fresh tape.
• Lab tests may be required to monitor therapy. Bo sure to keep appointments.
• Store at controlled room temperature (59 to 86 F),protect solution and lotions from freezing.

Type of Drug:Synthetic hormone closely related to the natural hormone somatostatin (growth hormone inhibitor).

How the Octreotide Acetate Works:

Octreotide reduces blood levels of a variety of hormones (eg, growth hormone) and chemical messengers (eg, gastrin).

Uses of the Octreotide Acetate

To reduce the blood levels of growth hormone and IGF-I in patients with acromegaly who have had inadequate response to or cannot be treated with surgical resection, pituitary irradiation and bromocriptine mesylate at maximally tolerated doses. The goal is to achieve normalization of growth hormone and IGF-I levels.

To treat symptoms of patients with metastatic carcinoid tumors where it suppresses or inhibits severe diarrhea and flushing episodes.

Treatment of the profuse watery diarrhea associated with vasoactive intestinal peptide (VIP) tumors.

Unlabeled Uses: Occasionally doctors may prescribe this medicine to reduce output from gastrointestinal or pancreatic sores; treat variceal bleeding, diarrheal states associated with a variety of conditions, irritable bowel syndrome, dumping syndrome, enteric fistula, pancreatitis, pan creatic surgery, glucagonoma, insulinoma, gastrinoma (Zollinger-Ellison syndrome), intestinal obstruction, local radiotherapy, thyrotropin and TSH-secreting tumors; for chronic pain management, antineoplastic (anti-cancer) therapy or to decrease insulin requirements in diabetes mellitus.

Precautions:

Do not use in the following situations: Sensitivity to any component of this medicine.

Use with caution in the following situations: diabetes kidney disease

Pregnancy: Studies in pregnant women or in animals have been judged not to show a risk to the fetus. However, no drug should be used during pregnancy unless clearly needed.

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

Elderly: Lower doses may be necessary

Lab tests may be required to monitor therapy. Lab tests may include blood tests and thyroid 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 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 and drug classes may interact with this medicine.

Side Effects of Octreotide Acetate:

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: Diarrhea; loose stools; nausea; stomach pain; vomiting; gas; bloating; constipation.

Nervous System: Headache; dizziness; tiredness; weakness; depression. Circulatory System: Slow or irregular heart rate.

Skin: Injection site pain or bruising; swelling; itching; hair loss; bruising; flushing.

Other: Gallbladder problems, especially stones or biliary sludge; back or joint pain; cold or flu symptoms; visual problems; blurred vision; frequent urination; urinary tract infection; changes in blood sugar levels; under active thyroid; goiter.

Guidelines for Use:

• Use exactly as prescribed.
• Follow the injection procedures taught to you by your health care provider. Use proper technique; inject deep under the skin, not into muscle. Rotate injection sites.
• If a dose is missed, inject 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.
• Diabetics - Insulin requirements may increase or decrease. Be prepared to monitor blood sugar more often.
• May cause dizziness. Use caution when driving or performing other tasks requiring alertness, coordination or physical dexterity.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Visually inspect solution for particles or discoloration before use.
• Ampules - Open just prior to administration. Discard any unused portion.
• Vials - Discard any unused portion within 14 days of first use.
• Store at room temperature (70 to 86°F) away from light, for up to 14 days. For prolonged storage, store in the refrigerator (36 to 46°F) away from light. Solution may be warmed to room temperature naturally. Do not warm artificially.

Content in the table above is given per serving of capsule, tablet, or teaspoon (5 milliliters). Products containing the greatest amount of Vitamin B 1 are listed first.

Type of Drug:

Vitamin combinations.

Uses:

Dietary supplement

Guidelines for Use:

• Dosage will be individualized.
• Do not exceed the recommended dose, unless advised to do so by your doctor.
• Most people on regular diets do not need vitamin supplements.
• Sotre at controlled room temperature (59 degree to 86 degree F). Protect from moisture.

Doses:

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.