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Friday, September 30, 2016

Nimotop

Generic Name: Nimodipine
Class: Dihydropyridines
VA Class: CV200
Chemical Name: 1,4-Dihydro-2,6-dimethyl-4-(3-nitrophenyl)-3,5-pyridinedicarboxylic acid 2-methoxyethyl 1-methylethyl ester
Molecular Formula: C₂₁H₂₆N₂O₇
CAS Number: 66085-59-4

Do not administer contents of nimodipine oral capsules by IV or other parenteral routes.¹ ²⁴⁵ ²⁴⁶ ²⁴⁸ ²⁴⁹ ²⁵⁰

Death and serious, life-threatening adverse effects reported following parenteral injection of the contents of nimodipine capsules.¹ ²⁴⁵ ²⁴⁶ ²⁴⁸ ²⁴⁹ ²⁵⁰ (See Parenteral Administration under Cautions and see Hypotension and Other Cardiovascular Effects under Cautions and see Oral Administration under Dosage and Administration.)

Introduction

A dihydropyridine-derivative calcium-channel blocking agent that affects the CNS preferentially.¹ ⁴ ⁵ ¹³ ²² ⁹⁶ ^d

Uses for Nimotop

Subarachnoid Hemorrhage

Used to improve neurologic outcome by reducing the incidence and severity of ischemic deficits in patients with subarachnoid hemorrhage resulting from ruptured intracranial berry aneurysms regardless of the patient’s postictal neurologic condition (e.g., Hunt and Hess grades I–V).¹ ² ⁴ ⁵ ⁸ ²⁰ ²¹ ²² ²³ ⁶⁹ ⁹⁵ ¹⁰⁹ ²³⁰ ²³¹

Decreases severity and incidence of delayed ischemic neurologic deficits associated with subarachnoid hemorrhage.¹ ² ⁵ ²⁰ ²¹ ²² ²³ ⁴⁰ ⁸² ⁹⁵ ²³¹

Efficacy in reducing mortality from subarachnoid hemorrhage after oral administration not fully established.¹ ²⁰ ⁶⁹ ⁹⁵

Acute Ischemic Stroke

Limited evidence suggests that nimodipine may improve neurologic recovery and reduce mortality compared with plasma volume expansion therapy or placebo in some patients with acute ischemic stroke†.⁴ ¹⁰ ⁷⁶ ⁷⁷ ²²⁰ ²⁴⁰ ²⁴¹ ²⁴⁷

Migraine

Has been used with equivocal results for reduction of frequency and possibly severity and duration of vascular headaches (e.g., migraine attacks) in patients with classic or common migraine†.⁴ ⁸ ¹¹ ¹² ⁷⁸ ⁷⁹ ⁸⁰ ⁹⁰ ¹⁰¹ ¹¹⁴ ²⁰⁶ ²³³ ²⁴⁴

Also has been used in a few patients with cluster headache†.⁹⁰ ¹⁰⁰ ¹¹⁴

Additional studies are needed to determine the role of nimodipine relative to that of other therapies used in the management of migraine headaches⁷⁸ ⁷⁹ ⁸⁰ ²⁰⁶ ²³⁰ ²³¹ and to determine whether tolerance to the prophylactic effects of the drug develops during chronic therapy.²⁰⁶

Nimotop Dosage and Administration

Administration

Oral Administration

Nimodipine capsules are for oral administration only.¹ ²⁴⁵ ²⁴⁶ ²⁴⁸ ²⁴⁹ ²⁵⁰ (See Boxed Warning.)

Administer orally every 4 hours, preferably at least 1 hour before or 2 hours after meals.¹

Nasogastric Tube

If the oral capsule cannot be swallowed (e.g., when administered at the time of surgery or to an unconscious patient), puncture the capsule at both ends with an 18-gauge needle and empty the contents into a syringe,¹ ²⁴⁹ ²⁵⁰ preferably using a syringe designed for nasogastric or percutaneous endoscopic gastrostomy administration (e.g., Toomey syringe).²⁴⁶ ²⁵⁰ To help minimize administration errors, label the syringe for oral use only; not for IV use.¹ ²⁴⁵ ²⁴⁸ ²⁴⁹ ²⁵⁰ The contents of the capsule should then be emptied into the patient’s nasogastric tube.¹ ²⁴⁹ ²⁵⁰ Following administration, flush with 30 mL of 0.9% sodium chloride solution.¹ ²⁴⁵ ²⁴⁶ ²⁴⁹

Reinforce awareness among health-care professionals of potential medical errors that may result in inadvertent injection of syringe contents into an IV line or via other parenteral routes.²⁴⁶ ²⁴⁸ ²⁴⁹ ²⁵⁰ (See Parenteral Administration under Cautions, see Hypotension and Other Cardiovascular Effects under Cautions, and see Boxed Warning.)

If inadvertent IV administration of contents of nimodipine capsules occurs, administer vasopressor agents for cardiovascular support if required for clinically important hypotension and promptly administer specific treatment for overdosage associated with calcium-channel blocking agents.¹ ²⁴⁶

The contents of the capsule should not be admixed with any solution prior to oral administration because of the possibility of drug decomposition.²³⁰

IV Administration

The contents of nimodipine capsules must not be administered by IV injection or any other parenteral route; serious adverse effects such as hypotension, cardiovascular collapse, and cardiac arrest have occurred with such administration.¹ ²⁴⁸ ²⁴⁹ ²⁵⁰ Report adverse events or medication errors involving nimodipine capsules to the FDA MedWatch program.²⁴⁸ ²⁵⁰

Has been administered by IV infusion† (IV dosage form currently is not commercially available in the US)^d in patients with subarachnoid hemorrhage, often in conjunction with intracisternal† application during surgery⁶⁷ ¹¹⁷ ¹¹⁹ ¹²⁰ ²¹⁴ and usually followed by oral therapy.⁵ ⁶⁷ ⁹³ ¹¹⁶ ¹¹⁷ ¹¹⁸ ¹¹⁹ ¹²⁰ ²¹⁴

Dosage

Adults

Subarachnoid Hemorrhage

Oral

60 mg every 4 hours for 21 consecutive days.¹ ⁵ Initiate therapy as soon as possible after the occurrence of subarachnoid hemorrhage, preferably within 96 hours.¹ ⁴ ⁵ ²⁰ ²³⁰ ²³¹

It has been suggested that the drug may be discontinued after 14 consecutive days (but not earlier) in some uncomplicated cases in which early aneurysm surgery is performed.²³¹

In patients in whom surgical repair of the aneurysm is performed relatively late (e.g., day 20), some clinicians suggest continuation of therapy for ≥5 days after surgery to minimize the possibility of postoperative vasospasm.⁴ ²³¹

It has been suggested that patients with unstable BP receive a lower dosage (e.g., 30 mg every 4 hours);⁴ ²³¹ however, the manufacturer states that the usual adult dosage should be used in such patients.²³⁰ (See Hypotension and Other Cardiovascular Effects under Cautions.)

Acute Ischemic Stroke†

Oral

120 mg daily given in divided doses for 21 or 28 days has been used.⁷⁶ ⁷⁷ ²⁴² ²⁴⁷

Migraine†

Prophylaxis of Classic or Common Migraine†

Oral

120 mg daily given in divided doses has been used.⁴ ⁸ ¹¹ ¹² ⁷⁸ ⁷⁹ ⁸⁰ ¹⁰¹ ¹¹⁴ ²⁰⁶

Special Populations

Hepatic Impairment

Subarachnoid Hemorrhage

Oral

Initially, 30 mg every 4 hours.¹ ⁵ ⁸⁹

Monitor BP and heart rate closely.¹ ⁵ ⁸⁹ May use pharmacologic support of BP (e.g., vasopressors such as norepinephrine or dopamine), if necessary.²³⁰ ²³¹

Renal Impairment

No specific dosage recommendations.¹

Geriatric Patients

Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.¹

Cautions for Nimotop

Contraindications

No known contraindications in patients with subarachnoid hemorrhage.¹

Warnings/Precautions

Warnings

Parenteral Administration

Do not administer contents of nimodipine oral capsules by IV or other parenteral routes.¹ ²⁴⁵ ²⁴⁶ ²⁴⁸ ²⁴⁹ ²⁵⁰ Death and serious life-threatening adverse effects (e.g., cardiac arrest, cardiovascular collapse, hypotension, bradycardia) reported following parenteral injection of nimodipine capsule contents.¹ ²⁴⁵ ²⁴⁶ ²⁴⁸ ²⁴⁹ ²⁵⁰ (See Hypotension and Other Cardiovascular Effects under Cautions and see Boxed Warning.)

IV use of nimodipine, with serious and sometimes fatal outcomes, continues to be reported despite revisions to the drug’s labeling (including addition of a boxed warning) that warn against such use.²⁴⁸ ²⁴⁹ ²⁵⁰

Factors identified by FDA as contributing to this error include use of IV syringes to administer the drug by NG tube (IV syringes sometimes are used to remove the liquid contents from the capsules) and the fact that most patients receiving the drug are in critical care settings and are receiving other IV therapy.²⁴⁹ ²⁵⁰

Report adverse events or medication errors involving nimodipine capsules to the FDA MedWatch program.²⁴⁸ ²⁵⁰

General Precautions

Hypotension and Other Cardiovascular Effects

IV administration of the contents of nimodipine capsules† has resulted in serious cardiovascular effects.¹ ²⁴⁸ ²⁴⁹ ²⁵⁰ (See Parenteral Administration under Cautions and see Boxed Warning.)

Possible decreased systemic BP;¹ decreases generally are not marked with usual oral dosages.¹ ² ⁶ ⁷ ²⁰ ²¹ ²² ²³ ⁵⁴ ⁶⁹ ¹³²

Monitor BP closely during therapy.¹ In patients with unstable BP, frequently monitor BP and heart rate; a lower dosage has been suggested.²³¹ (See Subarachnoid Hemorrhage under Dosage and Administration.)

Shares the toxic potentials of other calcium-channel blocking agents; consider possible occurrence of other adverse effects associated with these drugs (e.g., AV-conduction disturbances).¹ ⁷ ¹²⁸ ²³⁰ ²³¹

GI Effects

Intestinal pseudo-obstruction and ileus responsive to conservative management has been reported rarely.¹ ¹²⁷

Specific Populations

Pregnancy

Category C.¹

Lactation

Distributed into milk in rats;¹ ⁹¹ not known whether distributed into human milk.¹ Discontinue nursing because of potential risk to nursing infants.¹

Pediatric Use

Safety and efficacy not established in children <18 years of age.¹ ²³⁰

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults; select dosage with caution.¹

Hepatic Impairment

Possible decreased metabolism, substantially reduced clearance, and increased peak plasma concentrations.¹ ⁸⁹ (See Absorption: Special Populations and see also Elimination: Special Populations, under Pharmacokinetics.)

Possible hypotension.¹ ⁴ ⁹⁰ ²³⁰ ²³¹ Use with caution; monitor BP and pulse rate closely; dosage adjustment recommended.¹ (See Hepatic Impairment under Dosage and Administration.)

Renal Impairment

Clearance may be decreased.⁸⁸ (See Elimination: Special Populations, under Pharmacokinetics.)

Common Adverse Effects

Decreased BP, headache.¹ ⁴ ⁵ ²³ ¹¹² ¹²² ¹⁵⁴ ²³⁰ ²³¹

Interactions for Nimotop

Specific Drugs

Drug	Interaction	Comments
Anesthetic agents	Does not appear to potentiate hemodynamic effects of anesthetic agents during surgery⁵⁴ ²³⁰ ²³¹
Antineoplastic agents	Risk of enhanced cytotoxic effects of certain antineoplastic agents¹⁴⁰ ¹⁴¹ ¹⁹⁰ ¹⁹¹ ¹⁹² ¹⁹³ ¹⁹⁵ ²¹⁵ ²¹⁶ ²¹⁷ ²¹⁸ ²¹⁹	Clinical importance not known²³⁰ ²³¹
Antihypertensive agents	Possible additive antihypertensive effects¹ ⁹³	Monitor BP carefully if used concomitantly; when possible use short-acting antihypertensive agents²³¹ Reduced dosage or cautious discontinuance of the antihypertensive agent and/or initiation of pharmacologic support of BP may be required²³⁰ ²³¹
Calcium-channel blockers (e.g., diltiazem)	Possible potentiation of cardiovascular effects of nimodipine (e.g., negative inotropic effect)¹⁵⁵	Clinical importance not known;¹ ²³⁰ ²³¹ avoid combined therapy if possible²³¹
Cimetidine	Decreased clearance and increased plasma nimodipine concentrations¹ ²⁴³	Clinical importance not known²⁴³
Digoxin	Low doses (i.e., 30 mg twice daily) of nimodipine do not alter the pharmacokinetics or hemodynamic effects of digoxin¹³⁷
Fentanyl	Possible potentiation of analgesia in patients undergoing heart surgery¹⁵⁴
Phenytoin	Possible decreased phenytoin metabolism¹ ¹⁷⁹	Monitor plasma phenytoin concentrations when nimodipine is initiated or discontinued¹⁷⁹ No drug interactions reported in patients with subarachnoid hemorrhage receiving concomitant therapy ²³⁰

Nimotop Pharmacokinetics

Absorption

Bioavailability

Rapidly¹ ⁴⁶ ⁸⁵ ⁸⁹ ²¹³ and almost completely⁴ ⁵ ²¹³ absorbed following oral administration, with peak concentrations attained within 1 hour.¹ ⁴⁶ ⁸⁹ ²¹³

Bioavailability is about 13% and variable due to extensive first-pass metabolism in the liver.¹ ⁴⁶ ⁸⁵ ²¹³ ²³⁰

Food

Food substantially decreases the extent of absorption; peak plasma concentrations reduced by 68% and bioavailability by 38%.¹

Special Populations

In patients with hepatic cirrhosis, systemic availability, peak serum drug concentrations, and AUCs may be increased substantially.¹ ⁸⁹ ²³⁰

Distribution

Extent

Widely distributed into body tissues after oral or IV administration in animals.⁸⁷

Distributes to a limited extent into CSF.⁴ ²² ⁸⁶ ²³¹

May distribute more extensively into CSF in patients with subarachnoid hemorrhage.¹ ²³⁰

In animals, nimodipine crosses the placenta⁴ ⁸⁷ and is distributed into milk.¹ ⁹¹

Plasma Protein Binding

>95%.¹ ⁴ ²¹³

Elimination

Metabolism

Extensively metabolized in the liver¹ ⁵ ⁴ ⁸⁸ ⁸⁹ ²¹³ to either inactive or substantially less active metabolites¹ ¹²⁴ ¹²⁵ ²¹³ principally via demethylation followed by dehydrogenation.⁴ ⁸⁵ ⁸⁶

Elimination Route

Following oral administration, approximately 50% excreted in urine as metabolites and to a lesser extent in feces (possibly secondary to biliary excretion).⁴

In animals, nimodipine and/or its metabolites appear to undergo extensive enterohepatic circulation;¹²³ possible enterohepatic circulation in humans.⁸⁹

Half-life

Following oral administration: 1.7–9 hours.¹ ⁴ ⁵ ⁴⁶ ⁸⁵ ⁸⁶ ⁸⁸ ⁸⁹ ²¹³

Following IV (IV dosage form currently is not commercially available in the US)^d administration: 0.9–1.5 hours.⁴ ⁴⁶ ⁸⁵ ⁸⁶ ²¹³

Special Populations

Substantially decreased clearance in patients with hepatic dysfunction.⁴ ⁸⁹ ²³¹ Mean clearance rates in patients with hepatic cirrhosis were decreased by >50% in one study.⁸⁹

Increased half-life and reduced plasma clearance reported in patients with renal impairment; findings may have been related in part to age-related reductions in liver function.⁸⁸

Hemodialysis or peritoneal dialysis not likely to affect elimination.¹ ²³⁰ ²³¹

Stability

Storage

Oral

Capsules

25°C (may be exposed to 15–30°C) in the original container.¹ Do not freeze; protect from light.¹ ¹²⁹

ActionsActions

Inhibits transmembrane influx of extracellular calcium ions across the membranes of myocardial, vascular smooth muscle, and neuronal cells.¹ ⁴ ⁷ ¹⁰ ¹⁴ ⁴¹ ⁴⁸ ⁴⁹ ⁵³ ¹²⁶ ¹²⁸ ¹³² ¹³³ ²³⁶

Appears to affect the CNS preferentially.¹ ⁴ ⁷ ⁸ ¹³ ¹⁷ ³⁵ ⁴² ⁴⁵ ⁵⁵ ⁸² ¹⁵⁵ ¹⁸⁵ ²⁰⁶ ²²⁹ ²³⁰

Mechanism of selectivity for cerebral tissue is complex and has not been fully elucidated; tissue selectivity of 1,4-dihydropyridine calcium-channel blockers may be related to differences in chemical structure, binding site characteristics, and/or calcium-channel gating behavior.⁴⁷ ⁴⁸ ²¹⁰

Mechanism(s) of clinical benefit in patients with subarachnoid hemorrhage has not been fully elucidated;¹ ⁴ ²⁰ ⁶⁹ ¹⁰² current evidence suggests that dilation of small cerebral resistance vessels,² ²³ ³⁶ ¹⁰² ¹³¹ with a resultant increase in collateral circulation,⁴ ⁵ ²³ ⁵² ⁶⁷ ⁸³ ⁹⁸ ¹³¹ and/or a direct effect involving prevention of calcium overload in neurons² ⁴ ⁵ ¹³ ²³ ⁶⁸ ⁶⁹ ⁸² ⁸³ ⁹⁶ ¹⁰² ¹⁰⁴ ¹³² ²⁰⁶ may be responsible.

Advice to Patients

Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.¹

Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

Importance of advising patients of other important precautionary information.¹ (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Nimodipine
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Capsules, liquid-filled	30 mg	Nimotop	Bayer

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions February 2011. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

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57. Haws CW, Heistad DD. Effects of nimodipine on cerebral vasoconstrictor responses. Am J Physiol. 1984; 247(2 Part 2):H170-6. [PubMed 6431830]

58. Tanaka K, Gotoh F, Muramatsu F et al. Effects of nimodipine (Bay e 9736) on cerebral circulation in cats. Arzneimittelforschung. 1980; 30:1494-7. [PubMed 7193015]

59. Rosenblum WI. Effects of calcium channel blockers on pial vascular responses to receptor mediated constrictors. Stroke. 1984; 15:284-7. [PubMed 6583878]

60. Grabowski M, Johansson BB. Nifedipine and nimodipine: effect on blood pressure and regional cerebral blood flow in conscious normotensive and hypertensive rats. J Cardiovasc Pharmacol. 1985; 7:1127-33. [PubMed 2418299]

61. Takayasu M, Bassett JE, Dacey RG Jr. Effects of calcium antagonists on intracerebral penetrating arterioles in rats. J Neurosurg. 1988; 69:104-9. [PubMed 3379464]

62. Haws CW, Gourley JK, Heistad DD. Effects of nimodipine on cerebral blood flow. J Pharmacol Exp Ther. 1983; 225:24-8. [PubMed 6834275]

63. McCalden TA, Nath RG, Thiele K. The effects of a calcium antagonist (nimodipine) on basal cerebral blood flow and reactivity to various agonists. Stroke. 1984; 15:527-30. [PubMed 6427982]

64. Mohamed AA, McCulloch J, Mendelow AD et al. Effect of the calcium antagonist nimodipine on local cerebral blood flow: relationship to arterial blood pressure. J Cereb Blood Flow Metab. 1984; 4:206-11. [PubMed 6725433]

65. Auer LM, Suzuki A, Yasui N et al. Intraoperative topical nimodipine after aneurysm clipping. Neurochirurgia. 1984; 27:36-8. [PubMed 6728093]

66. Gelmers HJ. Effect of nimodipine (Bay e 9736) on postischaemic cerebrovascular reactivity, as revealed by measuring regional cerebral blood flow (rCBF). Acta Neurochir. 1982; 63:283-90.

67. Ljunggren B, Brandt L, Saveland H et al. Outcome in 60 consecutive patients treated with early aneurysm operation and intravenous nimodipine. J Neurosurg. 1984; 61:864-73. [PubMed 6491732]

68. Baethmann A, Jansen M. Possible role of calcium entry blockers in brain protection. Eur Neurol. 1986; 25(Suppl 1):102-14. [PubMed 3758107]

69. Mee E, Dorrance D, Lowe D et al. Controlled study of nimodipine in aneurysm patients treated early after subarachnoid hemorrhage. Neurosurgery. 1988; 22:484-91. [PubMed 3283595]

70. Kazda S, Garthoff B, Luckhaus G. Calcium antagonists prevent brain damage in stroke-prone spontaneously hypertensive rats independent of their effect on blood pressure. J Cereb Blood Flow Metab. 1983; 3(Suppl 1):S526-7.

71. Ulrich G. Zur Wirkung von Nimodipin auf die topische Verteilung der absoluten Alpha-Leistung im EEG sowie die aktuelle Befindlichkeit gesunder Probanden. (German; with English abstract.) Arzneim-Forsch. 1987; 37:541-5.

72. Ulrich G, Stieglitz RD. Effect of nimodipine upon electroencephalographic vigilance in elderly persons

Acetaminophen/Brompheniramine/Pseudoephedrine

Pronunciation: ah-seet-ah-MIN-oh-fen/brome-fen-EER-a-meen/soo-doe-e-FED-rin
Generic Name: Acetaminophen/Brompheniramine/Pseudoephedrine
Brand Name: Comtrex Acute Head Cold

Acetaminophen/Brompheniramine/Pseudoephedrine is used for:

Relieving symptoms of colds, hay fever, and allergies such as headache, sinus pain, nasal and sinus congestion, sneezing, watery eyes, runny nose, fever, and itching of the nose or throat. It may also be used for other conditions as determined by your doctor.

Acetaminophen/Brompheniramine/Pseudoephedrine is an antihistamine, decongestant, and pain reliever combination. It works by blocking histamine, a substance in the body that causes sneezing, runny nose, and watery eyes. It also relieves nasal congestion and pain associated with sinus pressure, and dries the nose and chest.

Do NOT use Acetaminophen/Brompheniramine/Pseudoephedrine if:

you are allergic to any ingredient in Acetaminophen/Brompheniramine/Pseudoephedrine

you are taking sodium oxybate (GHB) or you have taken furazolidone or a monoamine oxidase (MAO) inhibitor (eg, phenelzine) within the last 14 days

you have severe high blood pressure, severe heart blood vessel disease, rapid heartbeat, or severe heart problems

you are unable to urinate or are having an asthma attack

Contact your doctor or health care provider right away if any of these apply to you.

Before using Acetaminophen/Brompheniramine/Pseudoephedrine:

Some medical conditions may interact with Acetaminophen/Brompheniramine/Pseudoephedrine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

if you have allergies to medicines, foods, or other substances

if you have a fast, slow, or irregular heartbeat

if you have a history of asthma; lung problems (eg, emphysema); heart problems; diabetes; difficulty urinating; an enlarged prostate or other prostate problems; glaucoma; high blood pressure; an overactive thyroid; liver problems (eg, hepatitis) or severe kidney problems; adrenal gland problems (eg, pheochromocytoma); sleep apnea; trouble sleeping; stomach problems; ulcers; seizures; heart blood vessel problems; stroke; or a blockage of your stomach, intestines, or bladder

if you consume more than 3 alcoholic drinks per day

Some MEDICINES MAY INTERACT with Acetaminophen/Brompheniramine/Pseudoephedrine. Tell your health care provider if you are taking any other medicines, especially any of the following:

Catechol-O-methyltransferase (COMT) inhibitors (eg, entacapone), droxidopa, isoniazid, sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline) because the risk of side effects may be increased

Blood thinners (eg, warfarin), bromocriptine, furazolidone, MAO inhibitors (eg, phenelzine), or selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine) because the actions and side effects may be increased

Certain high blood pressure medicines such as beta-blockers (eg, atenolol) and guanethidine because these medicines may be less effective

This may not be a complete list of all interactions that may occur. Ask your health care provider if Acetaminophen/Brompheniramine/Pseudoephedrine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Acetaminophen/Brompheniramine/Pseudoephedrine:

Use Acetaminophen/Brompheniramine/Pseudoephedrine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Acetaminophen/Brompheniramine/Pseudoephedrine may be taken with food if it upsets your stomach.

If you miss a dose of Acetaminophen/Brompheniramine/Pseudoephedrine and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Acetaminophen/Brompheniramine/Pseudoephedrine.

Important safety information:

Acetaminophen/Brompheniramine/Pseudoephedrine may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Acetaminophen/Brompheniramine/Pseudoephedrine. Using Acetaminophen/Brompheniramine/Pseudoephedrine alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.

Acetaminophen/Brompheniramine/Pseudoephedrine will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants.

Do not exceed the recommended dose of Acetaminophen/Brompheniramine/Pseudoephedrine. Doing so will not improve your condition faster and may increase your risk for side effects.

If your symptoms do not improve within a few days or if they become worse, check with your doctor.

Acetaminophen/Brompheniramine/Pseudoephedrine contains acetaminophen, brompheniramine, and pseudoephedrine. Before you begin taking any new prescription or nonprescription medicine, read the ingredients to see if it also contains acetaminophen, brompheniramine, or pseudoephedrine. If it does or if you are uncertain, contact your doctor or pharmacist.

Do not take diet or appetite control medicines while you are taking Acetaminophen/Brompheniramine/Pseudoephedrine without checking with your doctor.

If you consume 3 or more alcohol-containing drinks every day, ask your doctor whether you should take Acetaminophen/Brompheniramine/Pseudoephedrine or other pain relievers/fever reducers. Acetaminophen may cause liver damage. Alcohol use combined with Acetaminophen/Brompheniramine/Pseudoephedrine may increase your risk for liver damage.

If you are scheduled for allergy skin testing, do not take Acetaminophen/Brompheniramine/Pseudoephedrine for several days before the test because it may decrease your response to the skin tests.

If you have trouble sleeping, ask your doctor or pharmacist about the best time of the day to take Acetaminophen/Brompheniramine/Pseudoephedrine.

Caution is advised when using Acetaminophen/Brompheniramine/Pseudoephedrine in the ELDERLY because they may be more sensitive to its effects.

Use Acetaminophen/Brompheniramine/Pseudoephedrine with extreme caution in CHILDREN younger than 12 years of age. Safety and effectiveness in this age group have not been confirmed.

PREGNANCY and BREAST-FEEDING: It is unknown if Acetaminophen/Brompheniramine/Pseudoephedrine can cause harm to the fetus. If you become pregnant while taking Acetaminophen/Brompheniramine/Pseudoephedrine, discuss with your doctor the benefits and risks of using Acetaminophen/Brompheniramine/Pseudoephedrine during pregnancy. Some of the ingredients in Acetaminophen/Brompheniramine/Pseudoephedrine are excreted in breast milk. If you are or will be breast-feeding while you are using Acetaminophen/Brompheniramine/Pseudoephedrine, check with your doctor or pharmacist to discuss the risks to your baby.

Possible side effects of Acetaminophen/Brompheniramine/Pseudoephedrine:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Dizziness; drowsiness; dry mouth, nose, or throat; headache; nausea; nervousness; trouble sleeping.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; dark urine or pale stools; difficulty urinating; excessive sweating; frequent urination; hallucinations; pounding in the chest; rapid pulse; severe nervousness; stomach pain; tremors; unusual fatigue; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Acetaminophen/Brompheniramine/Pseudoephedrine side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include fast or irregular heartbeat; fever; hallucinations; nausea; seizures; sweating; tremors; trouble breathing; unusual drowsiness or dizziness; vomiting.

Proper storage of Acetaminophen/Brompheniramine/Pseudoephedrine:

Store Acetaminophen/Brompheniramine/Pseudoephedrine at 77 degrees F (25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Acetaminophen/Brompheniramine/Pseudoephedrine out of the reach of children and away from pets.

General information:

If you have any questions about Acetaminophen/Brompheniramine/Pseudoephedrine, please talk with your doctor, pharmacist, or other health care provider.

Acetaminophen/Brompheniramine/Pseudoephedrine is to be used only by the patient for whom it is prescribed. Do not share it with other people.

If your symptoms do not improve or if they become worse, check with your doctor.

Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Acetaminophen/Brompheniramine/Pseudoephedrine. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

More Acetaminophen/Brompheniramine/Pseudoephedrine resources

Acetaminophen/Brompheniramine/Pseudoephedrine Side Effects (in more detail)
Acetaminophen/Brompheniramine/Pseudoephedrine Use in Pregnancy & Breastfeeding
Acetaminophen/Brompheniramine/Pseudoephedrine Drug Interactions
Acetaminophen/Brompheniramine/Pseudoephedrine Support Group
0 Reviews for Acetaminophen/Brompheniramine/Pseudoephedrine - Add your own review/rating

Compare Acetaminophen/Brompheniramine/Pseudoephedrine with other medications

Cold Symptoms
Hay Fever

Mepivacaine hydrochloride

Ingredient matches for Mepivacaine hydrochloride

Mepivacaine

Mepivacaine hydrochloride (BANM, JAN) is known as Mepivacaine in the US.

International Drug Name Search

Glossary

BANM	British Approved Name (Modified)
JAN	Japanese Accepted Name

Click for further information on drug naming conventions and International Nonproprietary Names.

Alka-Mints

Generic Name: calcium carbonate (KAL see um KAR boe nate)

Brand Names: Alka-Mints, Cal-Gest, Calcarb, Calci Mix, Calci-Chew, Calci-Mix, Calcium Concentrate, Calcium Liquid Softgel, Calcium Oyster Shell, Caltrate, Chooz, Extra Strength Mylanta Calci Tabs, Icar Prenatal Chewable Calcium, Maalox Antacid Barrier, Maalox Childrens', Maalox Quick Dissolve, Maalox Quick Dissolve Maximum Strength, Maalox Regular Strength, Mylanta Child, Nephro Calci, Os-Cal 500, Oysco 500, Oyst Cal 500, Oyster Cal, Oyster Calcium, Oyster Shell, Pepto Children's, Rolaids Sodium Free, Rolaids Soft Chew, Titralac, Tums, Tums 500, Tums E-X, Tums Kids, Tums QuikPak, Tums Ultra

What is Alka-Mints (calcium carbonate)?

Calcium is a mineral that is found naturally in foods. Calcium is necessary for many normal functions of the body, especially bone formation and maintenance. Calcium can also bind to other minerals (such as phosphate) and aid in their removal from the body.

Calcium carbonate is used to prevent and to treat calcium deficiencies.

Calcium carbonate may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Alka-Mints (calcium carbonate)?

Do not take calcium carbonate or antacids that contain calcium without first asking your doctor if you also take other medicines. Calcium can make it harder for your body to absorb certain medicines. Calcium carbonate works best if you take it with food.

What should I discuss with my healthcare provider before taking Alka-Mints (calcium carbonate)?

To make sure you can safely take calcium carbonate, tell your doctor if you have any of these other conditions:

a history of kidney stones; or

a parathyroid gland disorder.

Talk to your doctor before taking calcium carbonate if you are pregnant. Talk to your doctor before taking calcium carbonate if you are breast-feeding a baby.

How should I take Alka-Mints (calcium carbonate)?

Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Calcium carbonate works best if you take it with food. Swallow the calcium carbonate tablet or capsule with a full glass of water.

The chewable tablet should be chewed before you swallow it.

Use the calcium carbonate powder as directed. Allow the powder to dissolve completely, then consume the mixture.

Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, decreased appetite, constipation, confusion, delirium, stupor, and coma.

What should I avoid while taking Alka-Mints (calcium carbonate)?

Follow your healthcare provider's instructions about any restrictions on food, beverages, or activity.

Alka-Mints (calcium carbonate) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Less serious side effects may include:

nausea or vomiting;

decreased appetite;

constipation;

dry mouth or increased thirst; or

urinating more than usual.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs can affect Alka-Mints (calcium carbonate)?

Calcium carbonate can make it harder for your body to absorb other medications you take by mouth. Tell your doctor if you are taking:

digoxin (Lanoxin, Lanoxicaps);

antacids or other calcium supplements;

calcitriol (Rocaltrol) or vitamin D supplements; or

doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

This list is not complete and other drugs may interact with calcium carbonate. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Alka-Mints resources

Alka-Mints Side Effects (in more detail)
Alka-Mints Use in Pregnancy & Breastfeeding
Alka-Mints Drug Interactions
Alka-Mints Support Group
0 Reviews for Alka-Mints - Add your own review/rating

Calcium Carbonate MedFacts Consumer Leaflet (Wolters Kluwer)

Titralac Consumer Overview

Titralac MedFacts Consumer Leaflet (Wolters Kluwer)

Tums Chewable Tablets MedFacts Consumer Leaflet (Wolters Kluwer)

Compare Alka-Mints with other medications

Duodenal Ulcer
Erosive Esophagitis
GERD
Indigestion
Stomach Ulcer

Where can I get more information?

Your doctor or pharmacist can provide more information about calcium carbonate.

See also: Alka-Mints side effects (in more detail)

Thursday, September 29, 2016

Filcrin

Filcrin may be available in the countries listed below.

Ingredient matches for Filcrin

Vinorelbine

Vinorelbine tartrate (a derivative of Vinorelbine) is reported as an ingredient of Filcrin in the following countries:

Argentina

International Drug Name Search

Interome

Interome may be available in the countries listed below.

Ingredient matches for Interome

Cefpirome

Cefpirome sulfate (a derivative of Cefpirome) is reported as an ingredient of Interome in the following countries:

Indonesia

International Drug Name Search

Indican

Indican may be available in the countries listed below.

Ingredient matches for Indican

Lidocaine

Lidocaine hydrochloride (a derivative of Lidocaine) is reported as an ingredient of Indican in the following countries:

Argentina

International Drug Name Search

Zolpidem Streuli

Zolpidem Streuli may be available in the countries listed below.

Ingredient matches for Zolpidem Streuli

Zolpidem

Zolpidem tartrate (a derivative of Zolpidem) is reported as an ingredient of Zolpidem Streuli in the following countries:

Switzerland

International Drug Name Search

Wednesday, September 28, 2016

alfuzosin

al-FUE-zoe-sin

Commonly used brand name(s)

In the U.S.

Uroxatral

Available Dosage Forms:

Tablet, Extended Release

Therapeutic Class: Benign Prostatic Hypertrophy Agent

Pharmacologic Class: Alpha-1 Adrenergic Blocker

Uses For alfuzosin

Alfuzosin is used to treat the signs and symptoms of benign enlargement of the prostate (benign prostatic hyperplasia or BPH). Benign enlargement of the prostate is a problem that can occur in men as they get older. The prostate gland is located below the bladder. As the prostate gland enlarges, certain muscles in the gland may become tight and get in the way of the tube that drains urine from the bladder. This can cause problems with urinating, such as a need to urinate often, a weak stream when urinating, or a feeling of not being able to empty the bladder completely.

Alfuzosin helps relax the muscles in the prostate and the opening of the bladder. This may help increase the flow of urine or decrease the symptoms. However, alfuzosin will not shrink the prostate. The prostate may continue to get larger. This may cause the symptoms to become worse over time. Therefore, even though alfuzosin may lessen the problems caused by enlarged prostate now, surgery still may be needed in the future.

alfuzosin is usually given only to men. It is not normally given to women or children.

alfuzosin is available only with your doctor's prescription.

Before Using alfuzosin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For alfuzosin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to alfuzosin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Alfuzosin is not indicated for use in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of alfuzosin in the elderly. However, elderly patients are more like to have age-related kidney or liver problems, which may require caution in patients receiving alfuzosin.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	B	Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking alfuzosin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using alfuzosin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Atazanavir

Boceprevir

Cisapride

Darunavir

Dronedarone

Fluconazole

Fosamprenavir

Indinavir

Itraconazole

Ketoconazole

Lopinavir

Nelfinavir

Pimozide

Posaconazole

Ritonavir

Saquinavir

Sparfloxacin

Telaprevir

Telithromycin

Thioridazine

Tipranavir

Using alfuzosin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Amitriptyline

Amoxapine

Apomorphine

Arsenic Trioxide

Asenapine

Astemizole

Azithromycin

Chloroquine

Chlorpromazine

Ciprofloxacin

Citalopram

Clomipramine

Clozapine

Crizotinib

Dasatinib

Desipramine

Disopyramide

Dofetilide

Dolasetron

Droperidol

Flecainide

Gatifloxacin

Gemifloxacin

Granisetron

Halofantrine

Haloperidol

Ibutilide

Iloperidone

Imipramine

Lapatinib

Levofloxacin

Lumefantrine

Mefloquine

Moxifloxacin

Nilotinib

Norfloxacin

Nortriptyline

Ofloxacin

Ondansetron

Paliperidone

Pazopanib

Perflutren Lipid Microsphere

Procainamide

Prochlorperazine

Promethazine

Propafenone

Protriptyline

Quetiapine

Quinidine

Quinine

Ranolazine

Salmeterol

Sodium Phosphate

Sodium Phosphate, Dibasic

Sodium Phosphate, Monobasic

Solifenacin

Sorafenib

Sunitinib

Tadalafil

Telavancin

Terfenadine

Tetrabenazine

Toremifene

Trazodone

Trifluoperazine

Trimipramine

Vandetanib

Vemurafenib

Ziprasidone

Using alfuzosin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acebutolol

Alprenolol

Atenolol

Betaxolol

Bevantolol

Bisoprolol

Bucindolol

Carteolol

Carvedilol

Celiprolol

Dilevalol

Diltiazem

Esmolol

Labetalol

Levobunolol

Mepindolol

Metipranolol

Metoprolol

Nadolol

Nebivolol

Oxprenolol

Penbutolol

Pindolol

Propranolol

Sildenafil

Sotalol

Talinolol

Tertatolol

Timolol

Vardenafil

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Proper Use of alfuzosin

Take alfuzosin exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

alfuzosin should be taken with food and with the same meal every day.

Swallow the extended-release tablet whole. Do not break, crush, or chew it.

alfuzosin comes with a patient information leaflet. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

Dosing

The dose of alfuzosin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of alfuzosin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (extended release tablets):
- For benign prostatic hyperplasia (BPH):
  - Adults—10 milligrams (mg) once a day.
  - Children—Use is not recommended.

Missed Dose

If you miss a dose of alfuzosin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using alfuzosin

It is very important that your doctor check your progress at regular visits to make sure that alfuzosin is working properly and for any problems that may be caused by alfuzosin.

Do not use alfuzosin if you are taking certain medicines such as ketoconazole (Nizoral®), itraconazole (Sporanox®), or ritonavir (Norvir®).

Dizziness, lightheadedness, or fainting may occur after you take alfuzosin, especially when you get up from a lying or sitting position. Getting up slowly may help lessen this problem. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning.

alfuzosin may cause some people to become dizzy or less alert than they are normally. Make sure you know how you react to alfuzosin before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.

You should seek medical attention right away if you experience a prolonged erection. This is an extremely rare side effect, but if it goes untreated, can result in permanent erectile dysfunction (impotence).

Stop using alfuzosin and check with your doctor right away if you have arm, back or jaw pain; chest pain or discomfort; chest tightness or heaviness; fast or irregular heartbeat; nausea; shortness of breath; or sweating.

alfuzosin may affect the results of the prostate specific antigen (PSA) test, which may be used to detect prostate cancer. Make sure you tell all of your doctors that you are using alfuzosin.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

alfuzosin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare

Chest pain

chills

cold sweats

confusion

dizziness, faintness, or lightheadedness when getting up from a lying or sitting position

fainting

fast, pounding, or irregular heartbeat or pulse

painful or prolonged erection of the penis

Incidence not known

Arm, back, or jaw pain

chest discomfort

chest tightness or heaviness

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

nausea

shortness of breath

sweating

swelling

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Dizziness

Less common

Abdominal or stomach pain

acid or sour stomach

belching

body aches or pain

congestion

cough

cough producing mucus

decreased interest in sexual intercourse

difficulty breathing

difficulty having a bowel movement (stool)

dryness or soreness of the throat

ear congestion

fever

headache

heartburn

hoarseness

inability to have or keep an erection

indigestion

loss in sexual ability, desire, drive, or performance

loss of voice

nasal congestion

pain

pain or tenderness around the eyes and cheekbones

sneezing

sore throat

stomach discomfort, upset, or pain

stuffy or runny nose

tender, swollen glands in the neck

tightness in the chest

trouble with swallowing

unusual tiredness or weakness

voice changes

wheezing

Rare

Rash

Incidence not known

Diarrhea

feeling of warmth

hives or welts

itching skin

redness of the skin

redness of the face, neck, arms, and occasionally, upper chest

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: alfuzosin side effects (in more detail)

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More alfuzosin resources

Alfuzosin Side Effects (in more detail)
Alfuzosin Use in Pregnancy & Breastfeeding
Drug Images
Alfuzosin Drug Interactions
Alfuzosin Support Group
12 Reviews for Alfuzosin - Add your own review/rating

Alfuzosin MedFacts Consumer Leaflet (Wolters Kluwer)

Alfuzosin Prescribing Information (FDA)

Alfuzosin Hydrochloride Monograph (AHFS DI)

Uroxatral Prescribing Information (FDA)

Uroxatral Consumer Overview

Compare alfuzosin with other medications

Benign Prostatic Hyperplasia

disopyramide

dye-soe-PIR-a-mide

Oral route(Capsule;Capsule, Extended Release)

Considering the known proarrhythmic properties of disopyramide and the lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, the use of disopyramide as well as other antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmias .

Commonly used brand name(s)

In the U.S.

Norpace

Norpace CR

Available Dosage Forms:

Capsule

Tablet, Extended Release

Capsule, Extended Release

Therapeutic Class: Antiarrhythmic, Group IA

Uses For disopyramide

Disopyramide is used to treat abnormal heart rhythms.

It is available only with your doctor's prescription.

Before Using disopyramide

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For disopyramide, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to disopyramide or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

disopyramide has been tested in children and has not been shown to cause different side effects or problems than it does in adults.

Geriatric

Some side effects, such as difficult urination and dry mouth, may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of disopyramide.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking disopyramide, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using disopyramide with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Bepridil

Cisapride

Dronedarone

Levomethadyl

Mesoridazine

Pimozide

Posaconazole

Sparfloxacin

Terfenadine

Thioridazine

Ziprasidone

Using disopyramide with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Ajmaline

Alfuzosin

Amiodarone

Amisulpride

Amitriptyline

Amoxapine

Apomorphine

Aprindine

Arsenic Trioxide

Asenapine

Astemizole

Atazanavir

Azithromycin

Betaxolol

Chloral Hydrate

Chloroquine

Chlorpromazine

Chlorpropamide

Ciprofloxacin

Citalopram

Clarithromycin

Clomipramine

Clozapine

Crizotinib

Dasatinib

Desipramine

Disopyramide

Dofetilide

Dolasetron

Doxepin

Droperidol

Enflurane

Erythromycin

Etravirine

Fingolimod

Flecainide

Fluconazole

Fluoxetine

Foscarnet

Gatifloxacin

Gemifloxacin

Glimepiride

Glipizide

Glyburide

Granisetron

Halofantrine

Haloperidol

Halothane

Hydroquinidine

Ibutilide

Iloperidone

Imipramine

Isoflurane

Isradipine

Itraconazole

Lapatinib

Levofloxacin

Lidocaine

Lidoflazine

Lorcainide

Lumefantrine

Mefloquine

Methadone

Mexiletine

Moxifloxacin

Nalidixic Acid

Nilotinib

Norfloxacin

Nortriptyline

Octreotide

Ofloxacin

Ondansetron

Paliperidone

Pazopanib

Pentamidine

Perflutren Lipid Microsphere

Pimozide

Pirmenol

Prajmaline

Prilocaine

Probucol

Procainamide

Prochlorperazine

Promethazine

Propafenone

Protriptyline

Quetiapine

Quinidine

Quinine

Ranolazine

Risperidone

Salmeterol

Sertindole

Sodium Phosphate

Sodium Phosphate, Dibasic

Sodium Phosphate, Monobasic

Solifenacin

Sorafenib

Sotalol

Spiramycin

Sulfamethoxazole

Sultopride

Sunitinib

Telavancin

Telithromycin

Tetrabenazine

Tolazamide

Tolbutamide

Toremifene

Trazodone

Trifluoperazine

Trimethoprim

Trimipramine

Vandetanib

Vardenafil

Vasopressin

Vemurafenib

Voriconazole

Ziprasidone

Zolmitriptan

Zotepine

Using disopyramide with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Atenolol

Dalfopristin

Digoxin

Fosphenytoin

Nevirapine

Phenytoin

Propranolol

Quinupristin

Rifampin

Rifapentine

Ritonavir

Warfarin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use of disopyramide

Take disopyramide exactly as directed by your doctor even though you may feel well. Do not take more medicine than ordered.

For patients taking the extended-release capsules :

Swallow the capsule whole without breaking, crushing, or chewing.

For patients taking the extended-release tablets:

Do not crush or chew the tablet.

disopyramide works best when there is a constant amount in the blood. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times day and night. For example, if you are to take four doses a day, the doses should be spaced about 6 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your health care professional.

Dosing

The dose of disopyramide will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of disopyramide. If your dose is different, do not change it unless your doctor tells you to do so.

For treatment of arrhythmias:
- For short-acting oral dosage form (capsules):
  - Adults—100 to 150 mg taken every six to eight hours.
  - Children—Dose is based on body weight and age and must be determined by your doctor. The dose is usually 6 to 30 mg per kilogram (kg) (2.73 to 13.64 mg per pound) of body weight per day. This dose is evenly divided and taken every six hours.
- For long-acting oral dosage forms (extended-release capsules or tablets):
  - Adults—200 or 400 mg every twelve hours.
  - Children—Use is not recommended.

Missed Dose

If you miss a dose of disopyramide, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using disopyramide

Your doctor should check your progress at regular visits to make sure the medicine is working properly.

Do not stop taking disopyramide without first checking with your doctor. Stopping suddenly may cause a serious change in heart function .

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. This is due to lowered blood pressure. Getting up slowly may help. This effect does not occur often at doses of disopyramide usually used; however, make sure you know how you react to disopyramide before you drive, use machines, or do anything else that could be dangerous if you are not alert. If the problem continues or gets worse, check with your doctor.

Disopyramide may rarely cause hypoglycemia (low blood sugar) in some people. (See the Side Effects of disopyramide section below.) If these signs appear, eat or drink a food containing sugar and call your doctor right away.

disopyramide may cause blurred vision or other vision problems. If any of these occur, do not drive, use machines, or do anything else that could be dangerous if you are not able to see well.

Disopyramide may cause dryness of the eyes, mouth, and nose. For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if dry mouth continues for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and oral yeast infections.

disopyramide often will make you sweat less, allowing your body temperature to increase. Use extra care not to become overheated during exercise or hot weather while you are taking disopyramide, since becoming overheated could possibly result in heatstroke.

disopyramide Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

Dizziness, feeling of faintness

fainting

heartbeat sensations

shortness of breath

unusual tiredness

Less common

Chest pain

fast or slow heartbeat, rapid weight gain, swelling of feet or lower legs

lightheadedness

rash and/or itching

Rare

Enlargement of breasts in men

fever

mental depression

nosebleeds or bleeding gums

sore throat and fever

yellow eyes or skin

Signs and symptoms of hypoglycemia (low blood sugar)

Anxious feeling

chills

cold sweats

confusion

cool, pale skin

drowsiness

fast heartbeat

headache

hunger (excessive)

nausea

nervousness

shakiness

unsteady walk

unusual tiredness or weakness

More common

Blurred vision

constipation

dry eyes, mouth, nose, or throat

problems with urination

Less common

Bloating or stomach pain

diarrhea

headache

impotence

loss of appetite

muscle weakness

nausea

nervousness

trouble in sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: disopyramide side effects (in more detail)

More disopyramide resources

Disopyramide Side Effects (in more detail)
Disopyramide Use in Pregnancy & Breastfeeding
Drug Images
Disopyramide Drug Interactions
Disopyramide Support Group
4 Reviews for Disopyramide - Add your own review/rating

disopyramide Concise Consumer Information (Cerner Multum)

Disopyramide MedFacts Consumer Leaflet (Wolters Kluwer)

Disopyramide Prescribing Information (FDA)

Disopyramide Phosphate Monograph (AHFS DI)

Norpace Prescribing Information (FDA)

Norpace CR Sustained-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)

Compare disopyramide with other medications

Arrhythmia