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assist you to capreomycin Generic Name: capreomycin (KAP ree oh MYE sin) Brand Name: Capastat Sulfate Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings Breastfeeding Warnings User Reviews Support Group Q & A What is capreomycin? Capreomycin is an antibiotic that fights bacteria in the body. Capreomycin is used in combination with other medicines to treat Mycobacterium tuberculosis. Capreomycin is usually given after other tuberculosis medications have been tried without success. Capreomycin may also be used for purposes not listed in this medication guide. Slideshow Drug Treatments for Rheumatoid Arthritis - What Are Your Options? What is the most important information I should know about capreomycin? Capreomycin can harm your kidneys or damage the nerve that controls your hearing. These effects are increased if you already have kidney disease or hearing problems, or when you also use certain other medicines, including injected antibiotics. Before you use capreomycin, tell your doctor about all your medical conditions and any medicines you are using. It is not known whether capreomycin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine. Capreomycin is usually given over long periods (in some cases up to 2 years). What should I discuss with my health care provider before using capreomycin? You should not use capreomycin if you are allergic to it. Capreomycin can harm your kidneys or damage the nerve that controls your hearing. To make sure capreomycin is safe for you, tell your doctor if you have: kidney disease; or hearing problems. FDA pregnancy category C. It is not known whether capreomycin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine. It is not known whether capreomycin passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby. Do not give this medication to anyone under 18 years old without medical advice. How is capreomycin given? Before you start treatment with capreomycin, your doctor may perform tests to make sure you have the type of tuberculosis that is treatable with this medicine. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended. Capreomycin is injected into a muscle or into a vein through an IV. A healthcare provider will give you this injection. You may be shown how to use injections at home. Do not self-inject this medicine if you do not understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine. Capreomycin must be mixed with a liquid (diluent) before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medicine. Prepare your dose only when you are ready to give an injection. Do not use capreomycin if it has changed colors or has particles in it. Call your pharmacist for new medication. Use a disposable needle only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets. Capreomycin is sometimes given daily and later given 2 or 3 times per week. Follow your doctor's instructions. Tuberculosis is often treated over a long period of time (12 to 24 months). Do not change your doses or medication schedule without your doctor's advice. Every person with tuberculosis should remain under the care of a doctor. While using capreomycin, you may need frequent blood tests. Your kidney function and hearing may also need to be checked. If you need surgery, tell the surgeon ahead of time that you are using capreomycin. You may need to stop using the medicine for a short time. Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Capreomycin will not treat a viral infection such as the common cold or flu. Store at room temperature away from moisture and heat. What happens if I miss a dose? Call your doctor for instructions if you miss a dose of capreomycin. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include hearing problems, ringing in your ears, dizziness, weak or shallow breathing, and little or no urinating. What should I avoid while using capreomycin? Follow your doctor's instructions about any restrictions on food, beverages, or activity. Capreomycin side effects Get emergency medical help if you have any of these signs of an allergic reaction : hives, itching, rash; fever; difficult breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have: swelling, rapid weight gain, little or no urinating; severe dizziness, spinning sensation, ringing or roaring sound in your ears, hearing loss; skin rash, bruising, severe tingling, numbness, pain, muscle weakness; low calcium--numbness or tingly feeling around your mouth, fast or slow heart rate, muscle tightness or contraction, overactive reflexes; or low potassium--confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling. Common side effects may include: pain, swelling, or a hard lump where the injection was given. 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. Side Effects (complete list) Capreomycin dosing information Usual Adult Dose for Tuberculosis -- Active: 10 to 15 mg/kg (up to 1 g) IM or IV once every 24 hours or 5 days a week. Usual Pediatric Dose for Tuberculosis -- Active: 15 to 30 mg/kg (up to 1 g) IM or IV 5 to 7 days per week, in 1 or 2 divided doses. What other drugs will affect capreomycin? Capreomycin can harm your kidneys or damage the nerve that controls your hearing. These effects are increased when you also use certain other medicines. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with capreomycin, especially: other antibiotics (oral, injected, or inhaled); antivirals; chemotherapy; medicine for bowel disorders; medicine to prevent organ transplant rejection; or some pain or arthritis medicines (including aspirin, Tylenol, Advil, and Aleve). This list is not complete. Other drugs may interact with capreomycin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Next Side Effects Print this page Add to My Med List More about capreomycin Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: streptomyces derivatives Consumer resources Capreomycin Capreomycin Injection (Advanced Reading) Other brands: Capastat Sulfate Professional resources Capreomycin Sulfate (AHFS Monograph) Capreomycin (Wolters Kluwer) Related treatment guides Tuberculosis, Active Where can I get more information? Your doctor or pharmacist can provide more information about capreomycin. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Copyright 1996-2012 Cerner Multum, Inc. Version: 2.01. Date modified: December 03, 2017 Last reviewed: March 06, 2014} Antibiotics 101 Everything you need to know about antibiotics: List of Common Antibiotics & Types Antibiotics & Drinking Alcohol - Is it Safe? Antibiotics For UTI - What Are My Options? Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Drug Class Streptomyces derivatives Related Drugs Tuberculosis, Active ciprofloxacin , Levaquin , levofloxacin , rifampin , moxifloxacin , Avelox , isoniazid , ethambutol , amikacin , gatifloxacin , streptomycin , pyrazinamide , Floxin , Rifadin , Amikin , Myambutol , cycloserine , Tequin , isoniazid / pyrazinamide / rifampin , rifapentine , kanamycin , ethionamide , Rifamate , More... Capreomycin Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Help and Support Looking for answers? Ask a question or go join the capreomycin support group to connect with others who have similar interests.} } really unique


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pics Aldactazide Generic Name: spironolactone and hydrochlorothiazide Dosage Form: tablet, film coated Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings User Reviews Drug Images Support Group Q & A Pricing & Coupons Warning Spironolactone, an ingredient of Aldactazide, has been shown to be a tumorigen in chronic toxicity studies in rats (see Precautions ). Aldactazide should be used only in those conditions described under Indications and Usage . Unnecessary use of this drug should be avoided. Fixed-dose combination drugs are not indicated for initial therapy of edema or hypertension. Edema or hypertension requires therapy titrated to the individual patient. If the fixed combination represents the dosage so determined, its use may be more convenient in patient management. The treatment of hypertension and edema is not static but must be reevaluated as conditions in each patient warrant. Aldactazide Description Aldactazide oral tablets contain: spironolactone . . . . . . . . . . . . . . . . . . . . 25 mg hydrochlorothiazide . . . . . . . . . . . . . . . . 25 mg or spironolactone . . . . . . . . . . . . . . . . . . . . 50 mg hydrochlorothiazide . . . . . . . . . . . . . . . . 50 mg Spironolactone (ALDACTONE ), an aldosterone antagonist, is 17-hydroxy-7α-mercapto-3-oxo-17α-pregn-4-ene-21-carboxylic acid γ-lactone acetate and has the following structural formula: Spironolactone is practically insoluble in water, soluble in alcohol, and freely soluble in benzene and in chloroform. Hydrochlorothiazide, a diuretic and antihypertensive, is 6-chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide 1,1-dioxide and has the following structural formula: Hydrochlorothiazide is slightly soluble in water and freely soluble in sodium hydroxide solution. Inactive ingredients include calcium sulfate, corn starch, flavor, hydroxypropyl cellulose, hypromellose, iron oxide, magnesium stearate, polyethylene glycol, povidone, and titanium dioxide. Slideshow COPD: Could You Be At Risk? ACTIONS / CLINICAL PHARMACOLOGY Mechanism of action Aldactazide is a combination of two diuretic agents with different but complementary mechanisms and sites of action, thereby providing additive diuretic and antihypertensive effects. Additionally, the spironolactone component helps to minimize the potassium loss characteristically induced by the thiazide component. The diuretic effect of spironolactone is mediated through its action as a specific pharmacologic antagonist of aldosterone, primarily by competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. Hydrochlorothiazide promotes the excretion of sodium and water primarily by inhibiting their reabsorption in the cortical diluting segment of the distal renal tubule. Aldactazide is effective in significantly lowering the systolic and diastolic blood pressure in many patients with essential hypertension, even when aldosterone secretion is within normal limits. Both spironolactone and hydrochlorothiazide reduce exchangeable sodium, plasma volume, body weight, and blood pressure. The diuretic and antihypertensive effects of the individual components are potentiated when spironolactone and hydrochlorothiazide are given concurrently. Pharmacokinetics Spironolactone is rapidly and extensively metabolized. Sulfur-containing products are the predominant metabolites and are thought to be primarily responsible, together with spironolactone, for the therapeutic effects of the drug. The following pharmacokinetic data were obtained from 12 healthy volunteers following the administration of 100 mg of spironolactone (ALDACTONE film-coated tablets) daily for 15 days. On the 15th day, spironolactone was given immediately after a lowfat breakfast and blood was drawn thereafter. Accumulation Factor: AUC (0 24 hr, day 15)/AUC (0 24 hr, day 1) Mean Peak Serum Concentration Mean (SD) Post-Steady State Half-Life 7-α-(thiomethyl) spirolactone (TMS) 1.25 391 ng/mL at 3.2 hr 13.8 hr (6.4) (terminal) 6-β-hydroxy-7-α-(thiomethyl) spirolactone (HTMS) 1.50 125 ng/mL at 5.1 hr 15.0 hr (4.0) (terminal) Canrenone (C) 1.41 181 ng/mL at 4.3 hr 16.5 hr (6.3) (terminal) Spironolactone 1.30 80 ng/mL at 2.6 hr Approximately 1.4 hr (0.5) (β half-life) The pharmacological activity of spironolactone metabolites in man is not known. However, in the adrenalectomized rat the antimineralocorticoid activities of the metabolites C, TMS, and HTMS, relative to spironolactone, were 1.10, 1.28, and 0.32, respectively. Relative to spironolactone, their binding affinities to the aldosterone receptors in rat kidney slices were 0.19, 0.86, and 0.06, respectively. In humans, the potencies of TMS and 7-α-thiospirolactone in reversing the effects of the synthetic mineralocorticoid, fludrocortisone, on urinary electrolyte composition were 0.33 and 0.26, respectively, relative to spironolactone. However, since the serum concentrations of these steroids were not determined, their incomplete absorption and/or first-pass metabolism could not be ruled out as a reason for their reduced in vivo activities. Spironolactone and its metabolites are more than 90% bound to plasma proteins. The metabolites are excreted primarily in the urine and secondarily in bile. The effect of food on spironolactone absorption (two 100 mg ALDACTONE tablets) was assessed in a single dose study of 9 healthy, drug-free volunteers. Food increased the bioavailability of unmetabolized spironolactone by almost 100%. The clinical importance of this finding is not known. Hydrochlorothiazide is rapidly absorbed following oral administration. Onset of action of hydrochlorothiazide is observed within one hour and persists for 6 to 12 hours. Hydrochlorothiazide plasma concentrations attain peak levels at one to two hours and decline with a half-life of four to five hours. Hydrochlorothiazide undergoes only slight metabolic alteration and is excreted in urine. It is distributed throughout the extracellular space, with essentially no tissue accumulation except in the kidney. Indications and Usage for Aldactazide Spironolactone, an ingredient of Aldactazide, has been shown to be a tumorigen in chronic toxicity studies in rats (see Precautions section). Aldactazide should be used only in those conditions described below. Unnecessary use of this drug should be avoided. Aldactazide is indicated for: Edematous conditions for patients with: Congestive heart failure: For the management of edema and sodium retention when the patient is only partially responsive to, or is intolerant of, other therapeutic measures; The treatment of diuretic-induced hypokalemia in patients with congestive heart failure when other measures are considered inappropriate; The treatment of patients with congestive heart failure taking digitalis when other therapies are considered inadequate or inappropriate. Cirrhosis of the liver accompanied by edema and/or ascites: Aldosterone levels may be exceptionally high in this condition. Aldactazide is indicated for maintenance therapy together with bed rest and the restriction of fluid and sodium. The nephrotic syndrome: For nephrotic patients when treatment of the underlying disease, restriction of fluid and sodium intake, and the use of other diuretics do not provide an adequate response. Essential hypertension: For patients with essential hypertension in whom other measures are considered inadequate or inappropriate; In hypertensive patients for the treatment of a diuretic-induced hypokalemia when other measures are considered inappropriate; Aldactazide is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes, including the classes to which this drug principally belongs. There are no controlled trials demonstrating risk reduction with Aldactazide. Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than one drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC). Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly. Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal. Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy. Usage in Pregnancy The routine use of diuretics in an otherwise healthy woman is inappropriate and exposes mother and fetus to unnecessary hazard. Diuretics do not prevent development of toxemia of pregnancy, and there is no satisfactory evidence that they are useful in the treatment of developing toxemia. Edema during pregnancy may arise from pathologic causes or from the physiologic and mechanical consequences of pregnancy. Aldactazide is indicated in pregnancy when edema is due to pathologic causes just as it is in the absence of pregnancy (however, see Precautions: Pregnancy ). Dependent edema in pregnancy, resulting from restriction of venous return by the expanded uterus, is properly treated through elevation of the lower extremities and use of support hose; use of diuretics to lower intravascular volume in this case is unsupported and unnecessary. There is hypervolemia during normal pregnancy which is not harmful to either the fetus or the mother (in the absence of cardiovascular disease), but which is associated with edema, including generalized edema, in the majority of pregnant women. If this edema produces discomfort, increased recumbency will often provide relief. In rare instances, this edema may cause extreme discomfort that is not relieved by rest. In these cases, a short course of diuretics may provide relief and may be appropriate. Contraindications Aldactazide is contraindicated in patients with anuria, acute renal insufficiency, significant impairment of renal excretory function, hypercalcemia, hyperkalemia, Addison's disease, and in patients who are allergic to thiazide diuretics or to other sulfonamide-derived drugs. Aldactazide may also be contraindicated in acute or severe hepatic failure. Warnings Potassium supplementation, either in the form of medication or as a diet rich in potassium, should not ordinarily be given in association with Aldactazide therapy. Excessive potassium intake may cause hyperkalemia in patients receiving Aldactazide (see Precautions: General ). Concomitant administration of Aldactazide with the following drugs or potassium sources may lead to severe hyperkalemia: other potassium-sparing diuretics ACE inhibitors angiotensin II receptor antagonists aldosterone blockers non-steroidal anti-inflammatory drugs (NSAIDs), e.g., indomethacin heparin and low molecular weight heparin other drugs or conditions known to cause hyperkalemia potassium supplements diet rich in potassium salt substitutes containing potassium Aldactazide should not be administered concurrently with other potassium-sparing diuretics. Spironolactone, when used with ACE inhibitors or indomethacin, even in the presence of a diuretic, has been associated with severe hyperkalemia. Extreme caution should be exercised when Aldactazide is given concomitantly with these drugs (see Precautions: Drug interactions ). Aldactazide should be used with caution in patients with impaired hepatic function because minor alterations of fluid and electrolyte balance may precipitate hepatic coma. Lithium generally should not be given with diuretics (see Precautions: Drug interactions ). Thiazides should be used with caution in severe renal disease. In patients with renal disease, thiazides may precipitate azotemia. Cumulative effects of the drug may develop in patients with impaired renal function. Thiazides may add to or potentiate the action of other antihypertensive drugs. Sensitivity reactions to thiazides may occur in patients with or without a history of allergy or bronchial asthma. Sulfonamide derivatives, including thiazides, have been reported to exacerbate or activate systemic lupus erythematosus. Acute Myopia and Secondary Angle-Closure Glaucoma Hydrochlorothiazide, a sulfonamide, can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma. Symptoms include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation. Untreated acute angle-closure glaucoma can lead to permanent vision loss. The primary treatment is to discontinue hydrochlorothiazide as rapidly as possible. Prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled. Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. Precautions General Serum Electrolyte Abnormalities Spironolactone can cause hyperkalemia. The risk of hyperkalemia may be increased in patients with renal insufficiency, diabetes mellitus or with concomitant use of drugs that raise serum potassium (see Drug Interactions ). Hydrochlorothiazide can cause hypokalemia and hyponatremia. The risk of hypokalemia may be increased in patients with cirrhosis, brisk diuresis, or with concomitant use of drugs that lower serum potassium. Hypomagnesemia can result in hypokalemia which appears difficult to treat despite potassium repletion. Monitor serum electrolytes periodically. Other Metabolic Disturbances Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides. Hydrochlorothiazide may raise the serum uric acid level due to reduced clearance of uric acid and may cause or exacerbate hyperuricemia and precipitate gout in susceptible patients. Hydrochlorothiazide decreases urinary calcium excretion and may cause elevations of serum calcium. Monitor calcium levels in patients with hypercalcemia receiving Aldactazide. Gynecomastia Gynecomastia may develop in association with the use of spironolactone; physicians should be alert to its possible onset. The development of gynecomastia appears to be related to both dosage level and duration of therapy and is normally reversible when Aldactazide is discontinued. In rare instances, some breast enlargement may persist when Aldactazide is discontinued. Somnolence Somnolence and dizziness have been reported to occur in some patients. Caution is advised when driving or operating machinery until the response to initial treatment has been determined. Information for patients Patients who receive Aldactazide should be advised to avoid potassium supplements and foods containing high levels of potassium including salt substitutes. Laboratory tests Periodic determination of serum electrolytes to detect possible electrolyte imbalance should be done at appropriate intervals, particularly in the elderly and those with significant renal or hepatic impairments. Drug interactions ACE inhibitors, Angiotensin II receptor antagonists, aldosterone blockers, potassium supplements, heparin, low molecular weight heparin, and other drugs known to cause hyperkalemia: Concomitant administration may lead to severe hyperkalemia. Alcohol, barbiturates, or narcotics: Potentiation of orthostatic hypotension may occur. Antidiabetic drugs (e.g., oral agents, insulin): Dosage adjustment of the antidiabetic drug may be required (see Precautions ). Corticosteroids, ACTH: Intensified electrolyte depletion, particularly hypokalemia, may occur. Pressor amines (e.g., norepinephrine): Both spironolactone and hydrochlorothiazide reduce the vascular responsiveness to norepinephrine. Therefore, caution should be exercised in the management of patients subjected to regional or general anesthesia while they are being treated with Aldactazide. Skeletal muscle relaxants, nondepolarizing (e.g., tubocurarine): Possible increased responsiveness to the muscle relaxant may result. Lithium: Lithium generally should not be given with diuretics. Diuretic agents reduce the renal clearance of lithium and add a high risk of lithium toxicity. Nonsteroidal anti-inflammatory drugs (NSAIDs): In some patients, the administration of an NSAID can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing, and thiazide diuretics. Combination of NSAIDs, e.g., indomethacin, with potassium-sparing diuretics has been associated with severe hyperkalemia. Therefore, when Aldactazide and NSAIDs are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained. Digoxin: Spironolactone has been shown to increase the half-life of digoxin. This may result in increased serum digoxin levels and subsequent digitalis toxicity. Monitor serum digoxin levels and adjust dose accordingly. Thiazide-induced electrolyte disturbances, i.e. hypokalemia, hypomagnesemia, increase the risk of digoxin toxicity, which may lead to fatal arrhythmic events (see Precautions ). Cholestyramine: Hyperkalemic metabolic acidosis has been reported in patients given spironolactone concurrently with cholestyramine. Drug/Laboratory test interactions Thiazides should be discontinued before carrying out tests for parathyroid function (see Precautions: General ). Thiazides may also decrease serum PBI levels without evidence of alteration of thyroid function. Several reports of possible interference with digoxin radioimmunoassays by spironolactone or its metabolites have appeared in the literature. Neither the extent nor the potential clinical significance of its interference (which may be assay specific) has been fully established. Carcinogenesis, mutagenesis, impairment of fertility Spironolactone Orally administered spironolactone has been shown to be a tumorigen in dietary administration studies performed in rats, with its proliferative effects manifested on endocrine organs and the liver. In an 18-month study using doses of about 50, 150, and 500 mg/kg/day, there were statistically significant increases in benign adenomas of the thyroid and testes and, in male rats, a dose-related increase in proliferative changes in the liver (including hepatocytomegaly and hyperplastic nodules). In a 24-month study in which the same strain of rat was administered doses of about 10, 30 and 100 mg spironolactone/kg/day, the range of proliferative effects included significant increases in hepatocellular adenomas and testicular interstitial cell tumors in males, and significant increases in thyroid follicular cell adenomas and carcinomas in both sexes. There was also a statistically significant, but not dose-related, increase in benign uterine endometrial stromal polyps in females. A dose-related (above 30 mg/kg/day) incidence of myelocytic leukemia was observed in rats fed daily doses of potassium canrenoate (a compound chemically similar to spironolactone and whose primary metabolite, canrenone, is also a major product of spironolactone in man) for a period of one year. In two year studies in the rat, oral administration of potassium canrenoate was associated with myelocytic leukemia and hepatic, thyroid, testicular, and mammary tumors. Neither spironolactone nor potassium canrenoate produced mutagenic effects in tests using bacteria or yeast. In the absence of metabolic activation, neither spironolactone nor potassium canrenoate has been shown to be mutagenic in mammalian tests in vitro. In the presence of metabolic activation, spironolactone has been reported to be negative in some mammalian mutagenicity tests in vitro and inconclusive (but slightly positive) for mutagenicity in other mammalian tests in vitro. In the presence of metabolic activation, potassium canrenoate has been reported to test positive for mutagenicity in some mammalian tests in vitro, inconclusive in others, and negative in still others. In a three-litter reproduction study in which female rats received dietary doses of 15 and 500 mg spironolactone/kg/day, there were no effects on mating and fertility, but there was a small increase in incidence of stillborn pups at 500 mg/kg/day. When injected into female rats (100 mg/kg/day for 7 days, i.p.), spironolactone was found to increase the length of the estrous cycle by prolonging diestrus during treatment and inducing constant diestrus during a two week posttreatment observation period. These effects were associated with retarded ovarian follicle development and a reduction in circulating estrogen levels, which would be expected to impair mating, fertility, and fecundity. Spironolactone (100 mg/kg/day), administered i.p. to female mice during a two week cohabitation period with untreated males, decreased the number of mated mice that conceived (effect shown to be caused by an inhibition of ovulation) and decreased the number of implanted embryos in those that became pregnant (effect shown to be caused by an inhibition of implantation), and at 200 mg/kg, also increased the latency period to mating. Hydrochlorothiazide Two year feeding studies in mice and rats conducted under the auspices of the National Toxicology Program (NTP) uncovered no evidence of a carcinogenic potential of hydrochlorothiazide in female mice (at doses of up to approximately 600 mg/kg/day) or in male and female rats (at doses of up to approximately 100 mg/kg/day). The NTP, however, found equivocal evidence for hepatocarcinogenicity in male mice. Hydrochlorothiazide was not genotoxic in in vitro assays using strains TA 98, TA 100, TA 1535, TA 1537, and TA 1538 of Salmonella typhimurium (Ames assay) and in the Chinese Hamster Ovary (CHO) test for chromosomal aberrations, or in in vivo assays using mouse germinal cell chromosomes, Chinese hamster bone marrow chromosomes, and the Drosophila sex-linked recessive lethal trait gene. Positive test results were obtained only in the in vitro CHO Sister Chromatid Exchange (clastogenicity) and in the Mouse Lymphoma Cell (mutagenicity) assays, using concentrations of hydrochlorothiazide from 43 to 1300 µg/mL, and in the Aspergillus nidulans non-disjunction assay at an unspecified concentration. Hydrochlorothiazide had no adverse effects on the fertility of mice and rats of either sex in studies wherein these species were exposed, via their diet, to doses of up to 100 and 4 mg/kg, respectively, prior to mating and throughout gestation. Pregnancy Teratogenic effects. Hydrochlorothiazide Studies in which hydrochlorothiazide was orally administered to pregnant mice and rats during their respective periods of major organogenesis at doses up to 3000 and 1000 mg hydrochlorothiazide/kg, respectively, provided no evidence of harm to the fetus. There are, however, no adequate and well-controlled studies in pregnant women. Spironolactone Teratology studies with spironolactone have been carried out in mice and rabbits at doses of up to 20 mg/kg/day. On a body surface area basis, this dose in the mouse is substantially below the maximum recommended human dose and, in the rabbit, approximates the maximum recommended human dose. No teratogenic or other embryo-toxic effects were observed in mice, but the 20 mg/kg dose caused an increased rate of resorption and a lower number of live fetuses in rabbits. Because of its antiandrogenic activity and the requirement of testosterone for male morphogenesis, spironolactone may have the potential for adversely affecting sex differentiation of the male during embryogenesis. When administered to rats at 200 mg/kg/day between gestation days 13 and 21 (late embryogenesis and fetal development), feminization of male fetuses was observed. Offspring exposed during late pregnancy to 50 and 100 mg/kg/day doses of spironolactone exhibited changes in the reproductive tract including dose-dependent decreases in weights of the ventral prostate and seminal vesicle in males, ovaries and uteri that were enlarged in females, and other indications of endocrine dysfunction, that persisted into adulthood. There are no adequate and well-controlled studies with Aldactazide in pregnant women. Spironolactone has known endocrine effects in animals including progestational and antiandrogenic effects. The antiandrogenic effects can result in apparent estrogenic side effects in humans, such as gynecomastia. Therefore, the use of Aldactazide in pregnant women requires that the anticipated benefit be weighed against the possible hazards to the fetus. Non-teratogenic effects Spironolactone or its metabolites may, and hydrochlorothiazide does, cross the placental barrier and appear in cord blood. Therefore, the use of Aldactazide in pregnant women requires that the anticipated benefit be weighed against possible hazards to the fetus. The hazards include fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions that have occurred in adults. Nursing mothers Canrenone, a major (and active) metabolite of spironolactone, appears in human breast milk. Because spironolactone has been found to be tumorigenic in rats, a decision should be made whether to discontinue the drug, taking into account the importance of the drug to the mother. If use of the drug is deemed essential, an alternative method of infant feeding should be instituted. Thiazides are excreted in human milk in small amounts. Thiazides when given at high doses can cause intense diuresis which can in turn inhibit milk production. The use of Aldactazide during breast feeding is not recommended. If Aldactazide is used during breast feeding, doses should be kept as low as possible. Pediatric use Safety and effectiveness in pediatric patients have not been established. Adverse Reactions The following adverse reactions have been reported and, within each category (body system), are listed in order of decreasing severity. Hydrochlorothiazide Body as a whole: Weakness. Cardiovascular: Hypotension including orthostatic hypotension (may be aggravated by alcohol, barbiturates, narcotics, or antihypertensive drugs). Digestive: Pancreatitis, jaundice (intrahepatic cholestatic jaundice), diarrhea, vomiting, sialoadenitis, cramping, constipation, gastric irritation, nausea, anorexia. Eye Disorders : acute myopia and acute angle closure glaucoma ( see Warnings ). Hematologic: Aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia. Hypersensitivity: Anaphylactic reactions, necrotizing angitis (vasculitis and cutaneous vasculitis), respiratory distress including pneumonitis and pulmonary edema, photosensitivity, fever, urticaria, rash, purpura. Metabolic: Electrolyte imbalance (see Precautions ), hyperglycemia, glycosuria, hyperuricemia. Musculoskeletal: Muscle spasm. Nervous system/psychiatric: Vertigo, paresthesias, dizziness, headache, restlessness. Renal: Renal failure, renal dysfunction, interstitial nephritis (see Warnings ). Skin: Erythema multiforme, pruritus. Special senses: Transient blurred vision, xanthopsia. Spironolactone Digestive: Gastric bleeding, ulceration, gastritis, diarrhea and cramping, nausea, vomiting. Reproductive: Gynecomastia (see Precautions ), inability to achieve or maintain erection, irregular menses or amenorrhea, postmenopausal bleeding, breast pain. Carcinoma of the breast has been reported in patients taking spironolactone but a cause and effect relationship has not been established. Hematologic: Leukopenia (including agranulocytosis), thrombocytopenia. Hypersensitivity: Fever, urticaria, maculopapular or erythematous cutaneous eruptions, anaphylactic reactions, vasculitis. Metabolism: Hyperkalemia, electrolyte disturbances (see Warnings and Precautions ). Musculoskeletal: Leg cramps. Nervous system/psychiatric: Lethargy, mental confusion, ataxia, dizziness, headache, drowsiness. Liver/biliary: A very few cases of mixed cholestatic/hepatocellular toxicity, with one reported fatality, have been reported with spironolactone administration. Renal: Renal dysfunction (including renal failure). Skin: Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), alopecia, pruritus. Overdosage The oral LD 50 of spironolactone is greater than 1000 mg/kg in mice, rats, and rabbits. The oral LD 50 of hydrochlorothiazide is greater than 10 g/kg in both mice and rats. Acute overdosage of spironolactone may be manifested by drowsiness, mental confusion, maculopapular or erythematous rash, nausea, vomiting, dizziness, or diarrhea. Rarely, instances of hyponatremia, hyperkalemia (less commonly seen with Aldactazide because the hydrochlorothiazide component tends to produce hypokalemia), or hepatic coma may occur in patients with severe liver disease, but these are unlikely due to acute overdosage. However, because Aldactazide contains both spironolactone and hydrochlorothiazide, the toxic effects may be intensified, and signs of thiazide overdosage may be present. These include electrolyte imbalance such as hypokalemia and/or hyponatremia. The potassium-sparing action of spironolactone may predominate and hyperkalemia may occur, especially in patients with impaired renal function. BUN determinations have been reported to rise transiently with hydrochlorothiazide. There may be CNS depression with lethargy or even coma. Treatment Induce vomiting or evacuate the stomach by lavage. There is no specific antidote. Treatment is supportive to maintain hydration, electrolyte balance, and vital functions. Patients who have renal impairment may develop spironolactone-induced hyperkalemia. In such cases, Aldactazide should be discontinued immediately. With severe hyperkalemia, the clinical situation dictates the procedures to be employed. These include the intravenous administration of calcium chloride solution, sodium bicarbonate solution, and/or the oral or parenteral administration of glucose with a rapid-acting insulin preparation. These are temporary measures to be repeated as required. Cationic exchange resins such as sodium polystyrene sulfonate may be orally or rectally administered. Persistent hyperkalemia may require dialysis. Aldactazide Dosage and Administration Optimal dosage should be established by individual titration of the components (see boxed Warning ). Edema in adults (congestive heart failure, hepatic cirrhosis, or nephrotic syndrome) The usual maintenance dose of Aldactazide is 100 mg each of spironolactone and hydrochlorothiazide daily, administered in a single dose or in divided doses, but may range from 25 mg to 200 mg of each component daily depending on the response to the initial titration. In some instances it may be desirable to administer separate tablets of either ALDACTONE (spironolactone) or hydrochlorothiazide in addition to Aldactazide in order to provide optimal individual therapy. The onset of diuresis with Aldactazide occurs promptly and, due to prolonged effect of the spironolactone component, persists for two to three days after Aldactazide is discontinued. Essential hypertension Although the dosage will vary depending on the results of titratio which looking back


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song Despec-DM Generic Name: Guaifenesin, Pseudoephedrine, and Dextromethorphan Tablets and Capsules (gwye FEN e sin, soo doe e FED rin, & deks troe meth OR fan) Brand Name: Aldex GS DM, Capmist DM, Desgen, Despec-DM, Maxifed DM, ...show all 8 brand names. Medi-Tussin Cough/Cold, Poly-Vent DM, Tussin Cold/Congestion Overview Side Effects Dosage Interactions Pregnancy More User Reviews Support Group Q & A Uses of Despec-DM: It is used to treat nose stuffiness. It is used to thin mucus so it can be taken from the body by coughing. It is used to relieve coughing. Slideshow Over the Counter Cold Remedies - Which One is Right For You? What do I need to tell my doctor BEFORE I take Despec-DM? If you have an allergy to guaifenesin, pseudoephedrine, dextromethorphan, or any other part of Despec-DM (guaifenesin, pseudoephedrine, and dextromethorphan tablets and capsules). If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. If you have taken certain drugs used for low mood (depression) like isocarboxazid, phenelzine, or tranylcypromine or drugs used for Parkinson's disease like selegiline or rasagiline in the last 14 days. Taking this medicine within 14 days of those drugs can cause very bad high blood pressure. If you have a cough with a lot of mucous. If you have a long-term cough caused by smoking or being around smoke, or lung problems like asthma or emphysema. This is not a list of all drugs or health problems that interact with Despec-DM. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor. What are some things I need to know or do while I take Despec-DM? Tell all of your health care providers that you take Despec-DM. This includes your doctors, nurses, pharmacists, and dentists. Do not take more than what your doctor told you to take. Taking more than you are told may raise your chance of very bad side effects. Do not take this medicine for longer than you were told by your doctor. Different brands of Despec-DM may be for use in different ages of children. Talk with the doctor before giving this medicine to a child. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using Despec-DM while you are pregnant. Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby. How is this medicine (Despec-DM) best taken? Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely. Take with or without food. Take with food if it causes an upset stomach. Drink lots of noncaffeine liquids unless told to drink less liquid by your doctor. What do I do if I miss a dose? If you take Despec-DM on a regular basis, take a missed dose as soon as you think about it. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Do not take 2 doses at the same time or extra doses. Many times this medicine is taken on an as needed basis. Do not take more often than told by the doctor. Dosage Information (comprehensive) What are some side effects that I need to call my doctor about right away? WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. What are some other side effects of Despec-DM? All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: Dizziness. Not able to sleep. Feeling nervous and excitable. These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch. Side Effects (complete list) If OVERDOSE is suspected: If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened. How do I store and/or throw out Despec-DM? Store at room temperature. Store in a dry place. Do not store in a bathroom. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Check with your pharmacist about how to throw out unused drugs. Consumer Information Use and Disclaimer If your symptoms or health problems do not get better or if they become worse, call your doctor. Do not share your drugs with others and do not take anyone else's drugs. Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor. Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins. Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about Despec-DM, please talk with your doctor, nurse, pharmacist, or other health care provider. If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened. This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Despec-DM (guaifenesin, pseudoephedrine, and dextromethorphan tablets and capsules). It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using Despec-DM. Review Date: November 1, 2017 Next Side Effects Print this page Add to My Med List More about Despec DM (dextromethorphan / guaifenesin / pseudoephedrine) Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: upper respiratory combinations Consumer resources Despec DM Other brands: Tusnel , Poly-Vent DM , Capmist DM , Robitussin Cough & Cold D , ... +6 more Professional resources Other Formulations Despec-SR Related treatment guides Cough and Nasal Congestion Drug Status Rx OTC Availability Rx and/or OTC C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug WADA Class Anti-Doping Classification Despec DM Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Drug Class Upper respiratory combinations Related Drugs Cough and Nasal Congestion Promethazine VC with Codeine , Bromfed DM , Mucinex D , Vanacof , Deconex , codeine / phenylephrine / promethazine , Resperal-DM , Vicks NyQuil Severe Cold & Flu , Vicks Nyquil Cough , Coricidin HBP Cough & Cold , Crantex , Deconex DMX , Robitussin Allergy & Cough , Tussin CF , Dimetapp Children's Cold & Cough , Robitussin Nighttime Cough DM , Mucinex Fast-Max Severe Congestion & Cough , Relasin-HC , Tusnel , More... vastly


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exceptional [30:<40 mL/minute) impairment: Prevention of cardiomyopathy: Reduce dose to 50% of the usual dose, using a 5:1 dexrazoxane:doxorubicin ratio (eg, dexrazoxane 250 mg/m 2 :doxorubicin 50 mg/m 2 ) Anthracycline extravasation: Reduce dose to 50% of the usual dose Dosing: Hepatic Impairment Prevention of cardiomyopathy: Since doxorubicin dosage is reduced in hyperbilirubinemia, a proportional reduction in dexrazoxane dosage is recommended (maintain a 10:1 ratio of dexrazoxane:doxorubicin) Anthracycline extravasation: There are no dosage adjustments provided in the manufacturer's labeling (has not been studied). Reconstitution Note: Preparation and storage are product specific; refer to individual product labeling for further details. Discard unused solutions. Do not mix in the same container with other medications. Totect: Reconstitute 500 mg vial with 50 mL of 0.167 Molar sodium lactate injection solution to a reconstituted concentration of 10 mg/mL. To prepare the diluent, add 1.67 mL of 5 mEq/mL sodium lactate injection to 50 mL SWFI to make 50 mL of 0.167 Molar sodium lactate injection. Prior to infusion, further dilute reconstituted dexrazoxane solution in NS 1,000 mL. Zinecard: Reconstitute vial with sterile water for injection to a reconstituted concentration of dexrazoxane 10 mg/mL. Prior to infusion, further dilute reconstituted dexrazoxane solution in LR injection to a final concentration of 1.3 to 3 mg/mL. Dexrazoxane generic formulation (Mylan): Reconstitute with the supplied diluent (0.167 Molar sodium lactate injection) to a reconstituted concentration of 10 mg/mL. Prior to infusion, further dilute reconstituted dexrazoxane solution with D5W or NS to a final concentration of 1.3 to 5 mg/mL. Administration Prevention of doxorubicin cardiomyopathy: Administer doxorubicin within 30 minutes after completion of the dexrazoxane infusion (do not administer doxorubicin before dexrazoxane). Zinecard: Administer by rapid drip infusion over 15 minutes; do not administer by IV push Dexrazoxane generic formulation (Mylan): Administer by slow IV push or rapid drip infusion Treatment of anthracycline extravasation: Stop vesicant infusion immediately and disconnect IV line (leave needle/cannula in place); gently aspirate extravasated solution from the IV line (do NOT flush the line); remove needle/cannula; elevate extremity. Administer dexrazoxane IV over 1 to 2 hours; begin infusion as soon as possible, within 6 hours of extravasation. Day 2 and 3 doses should be administered at approximately the same time ( 3 hours) as the dose on day 1. Infusion solution should be at room temperature prior to administration. Infuse in a large vein in an area remote from the extravasation. For IV administration only; not for local infiltration into extravasation. Apply dry cold compresses for 20 minutes 4 times daily for 1 to 2 days (Pérez Fidalgo 2012); withhold cooling beginning 15 minutes before dexrazoxane infusion; continue withholding cooling until 15 minutes after infusion is completed. Do not use DMSO in combination with dexrazoxane; may lessen efficacy. Storage Note: Preparation and storage are product specific; refer to individual product labeling for further details. Discard unused solutions. Totect: Store intact vials at 25 C (77 F); excursions permitted to 15 C to 30 C (59 F to 86 F). Protect from light. Reconstituted solution (10 mg/mL) is stable for 2 hours (must be further diluted within 2 hours). Solutions diluted for infusion in NS are stable for 4 hours when stored at> <25 C (77 F). Zinecard: Store intact vials at 25 C (77 F); excursions permitted to 15 C to 30 C (59 F to 86 F). When reconstituted with SWFI, the reconstituted solution is stable for 30 minutes at room temperature or 3 hours refrigerated at 2 C to 8 C (36 F to 46 F). Solutions diluted for infusion in LR are stable for 1 hour when stored at room temperature or 4 hours refrigerated. Dexrazoxane generic formulation (Mylan): Store intact vials at 20 C to 25 C (68 F to 77 F). Reconstituted solutions and solutions diluted for infusion in NS or D5W are stable for 6 hours when stored at room temperature or refrigerated at 2 C to 8 C (36 F to 46 F). Additional stability information: When studied as a 24-hour continuous infusion for the prevention of cardiomyopathy, solutions prepared with sodium lactate diluent and diluted to a final concentration of 0.1 or 0.5 mg/mL in D5W were found to retain 90% of their initial concentration when stored at room temperature (ambient light conditions) for 24 hours (Tetef, 2001). Drug Interactions BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Avoid combination CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Monitor therapy Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Avoid combination Dimethyl Sulfoxide: May diminish the therapeutic effect of Dexrazoxane. Avoid combination Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Avoid combination DOXOrubicin (Conventional): Dexrazoxane may diminish the therapeutic effect of DOXOrubicin (Conventional). Management: Do not administer dexrazoxane for cardioprotection at the time of doxorubicin initiation. This recommendation does not apply to the use of dexrazoxane for other indications (e.g., extravasation), or to the use of dexrazoxane later in treatment. Consider therapy modification Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Monitor therapy Adverse Reactions Note: Most adverse reactions are thought to be attributed to chemotherapy, except for increased myelosuppression, pain at injection site, and phlebitis. Prevention of doxorubicin cardiomyopathy (reactions listed are those which were greater in the dexrazoxane arm in a comparison of chemotherapy plus dexrazoxane vs chemotherapy alone): Cardiovascular: Phlebitis (6%) Central nervous system: Fatigue (61%), neurotoxicity (17%) Dermatologic: Erythema (5%) Hematologic & oncologic: Bone marrow depression, granulocytopenia, leukopenia, thrombocytopenia Infection: Infection (23%), sepsis (17%) Local: Pain at injection site pain (12%) Miscellaneous: Fever (34%) Postmarketing, and/or case reports: Metastases (including acute myeloid leukemia, myelodysplastic syndrome) Anthracycline extravasation: Cardiovascular: Peripheral edema (10%), localized phlebitis (6%) Central nervous system: Fatigue (13%), dizziness (11%), depression (8%), headache (6%), insomnia (5%) Dermatologic: Alopecia (14%) Endocrine & metabolic: Hypercalcemia (7%), hyponatremia (6%), increased lactate dehydrogenase (5%) Gastrointestinal: Nausea (43%), vomiting (19%), diarrhea (11%), abdominal pain (6%), constipation (6%), anorexia (5%) Hematologic & oncologic: Decreased white blood cell count (73%; grade 3: 25%; grade 4: 20%), decreased neutrophils (61%; grade 3: 22%; grade 4: 24%), decreased hemoglobin (43%; grade 3: 3%), anemia (6%), febrile neutropenia (3%), neutropenia (3%), leukopenia, thrombocytopenia Hepatic: Increased serum AST (28%), increased serum ALT (22%), increased serum bilirubin (11%), increased serum alkaline phosphatase (4%) Infection: Postoperative infection (16%) Local: Pain at injection site (16%) Renal: Increased serum creatinine (14%) Respiratory: Dyspnea (8%), pneumonia (6%), cough (5%) Miscellaneous: Fever (21%) Warnings/Precautions Concerns related to adverse effects: Bone marrow suppression: Dexrazoxane may cause mild myelosuppression (leukopenia, neutropenia, and thrombocytopenia); myelosuppression may be additive with concurrently administered chemotherapeutic agents. Cardioprotection: Dexrazoxane does not eliminate the potential for anthracycline-induced cardiac toxicity; carefully monitor cardiac function (left ventricular ejection fraction [LVEF]) prior to and periodically during treatment. Secondary malignancies: Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) have been reported in pediatric patients and some adult patients receiving dexrazoxane in combination with chemotherapy. Tumor response: Dexrazoxane may interfere with the antitumor effect of chemotherapy when given concurrently with fluorouracil, doxorubicin, and cyclophosphamide (FAC). Disease-related concerns: Hepatic impairment: Due to dosage adjustments for doxorubicin in hepatic impairment, a proportional dose reduction in dexrazoxane is recommended to maintain the dosage ratio of 10:1. Renal impairment: Use with caution in patients with renal dysfunction (clearance is reduced); dosage adjustment required for CrCl> <40 mL/minute. Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Other warnings/precautions: Administration (extravasation): For IV administration; not for local infiltration into extravasation site. Do not use DMSO in patients receiving dexrazoxane for anthracycline extravasation; may diminish dexrazoxane efficacy. Administration sequence (cardioprotection): When used for the prevention of cardiomyopathy, doxorubicin should be administered within 30 minutes after completion of the dexrazoxane infusion (do not administer doxorubicin before dexrazoxane). Monitoring Parameters CBC with differential (frequent); liver function; serum creatinine; cardiac function (repeat monitoring at 400 mg/m 2 , 500 mg/m 2 and with every 50 mg/m 2 of doxorubicin thereafter); monitor site of extravasation Pregnancy Risk Factor D Pregnancy Considerations Adverse events were observed in animal reproduction studies using doses less than the equivalent human dose (based on BSA). Based on the mechanism of action, dexrazoxane may cause fetal harm if administered during pregnancy. Women of reproductive potential should use highly effective contraception to prevent pregnancy during treatment. Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience nausea, vomiting, headache, dizziness, constipation, abdominal pain, diarrhea, lack of appetite, insomnia, injection site pain, mouth irritation, mouth sores, or hair loss. Have patient report immediately to prescriber signs of infection, signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; hematuria; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding); shortness of breath; excessive weight gain; swelling of arms or legs; severe loss of strength and energy; burning or numbness feeling; depression; or severe injection site irritation (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients. Next Interactions Print this page Add to My Med List More about dexrazoxane Side Effects During Pregnancy Dosage Information Drug Interactions Support Group Pricing & Coupons En Español 0 Reviews Add your own review/rating Drug class: miscellaneous uncategorized agents Consumer resources Dexrazoxane Dexrazoxane Intravenous (Advanced Reading) Professional resources Dexrazoxane Hydrochloride (AHFS Monograph) Dexrazoxane (FDA) Other brands: Totect , Zinecard Related treatment guides Cardiomyopathy Prophylaxis Extravasation> ]} Drug Status Rx Availability Prescription only D Pregnancy Category Positive evidence of risk N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Dexrazoxane Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Manufacturer Mylan Pharmaceuticals Inc. Drug Class Miscellaneous uncategorized agents Related Drugs miscellaneous uncategorized agents Accutane , isotretinoin , anagrelide , Esbriet , Claravis Cardiomyopathy Prophylaxis Zinecard , More... Extravasation hyaluronidase , Amphadase , Hylenex , Vitrase , Totect , More...} } offers you


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break day March 20, 2017 By: Paul Gionfriddo, president and CEO As the past few days and weeks have unfolded, it is becoming increasingly clear how the American Health Care Act of 2017 (AHCA) as currently drafted will have mostly unintended, mostly negative consequences for people with behavioral health conditions. We believe that these consequences easily could and should be mitigated. At a very high level, the Congressional Budget Office (CBO) scoring analysis suggests that millions of Americans with mental health and substance use conditions will have less access to the treatment they need. This could include up to five million people by 2026 who were covered by Medicaid expansion, based on reliable estimates of the number of people with behavioral health conditions included within the expansion population. This will be mitigated to some extent by individuals living below the poverty level who will now be eligible for tax credits to purchase insurance in both expansion and non-expansion states. But let s be honest. The CBO estimates that the number of newly insured will be no more than one million, and people with behavioral health concerns will represent only a fraction of those. We continue to see these elements as essential to the health and well-being of people with behavioral health conditions: Maintaining behavioral health benefits at parity with other benefits; Maintaining guaranteed, continuous, and affordable insurance coverage for people with pre-existing and chronic conditions; Maintaining a healthy Medicaid program for people with chronic conditions; and Giving states more flexibility within Medicaid to cover earlier interventions. The AHCA as it stands today will adversely affect these essential elements. While the intent of AHCA was not to repeal behavioral health parity, as was made clear in the Energy and Commerce Committee colloquy between Rep. Murphy and Committee Counsel during the mark-up, according to the CBO the law will lead to broader availability of plans that cover a lower share of health care costs, and that individuals cost-sharing payments, including deductibles, in the nongroup market would tend to be higher than those anticipated under current law. That s clear. If plans cover less and prices go up, the concept of parity won t mean tomorrow the same thing as it does today. Plus, if the Essential Health Benefits are fully repealed in the future as they are in the Medicaid program through the AHCA, then many insurance products might not contain behavioral health benefits at all. While the AHCA does not repeal protections for individuals with pre-existing conditions, it does include a continuous coverage penalty. That s inconsistent with our position that people are harmed by making it harder for them to maintain continuous insurance coverage. And finally, Medicaid is cut big-time through a major shifting of costs to states. So, what should be done to fix these flaws? Here are three recommendations that flow naturally from what sponsors intended in crafting the AHCA. First, let s make sure that the dollars that remain are used for their intended purpose. For example, giving $8 billion in new short-term Medicaid funding to non-expansion states could help get more people with behavioral health needs the care and services they need, but only if states are obligated to use these dollars for that purpose, and not just to balance their budgets. Second, let s recognize the importance of early intervention across the board. The only reason insurance costs in the nongroup market will go down is because the AHCA is incentivizing younger, healthier people to purchase insurance. The Medicaid program should offer similar incentives to states to enroll eligible individuals at the earliest stages of their illnesses and move them along pathways to recovery well before Stage 4. And Congress shouldn t be trying to save money by eliminating prevention funding, yet again, as the AHCA does. Third, states who will receive billions of dollars less from the AHCA than they would from existing law must be given greater much greater flexibility through AHCA to use their Medicaid dollars for social support services for their future Medicaid populations. But the AHCA could go a step farther. It could incorporate everything we ve learned from past successful waivers which, by definition, all saved money while improving care, services, and supports and build them into the new Medicaid program rules. Otherwise, everyone loses. Congress has a long way to go to make this AHCA right, and if it is going to move forward it should get there as soon as it can. Tags: congress Medicaid Parity AHCA Mental Health America Blog cutting-edge


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a loyal Cee-500 Side Effects Generic Name: ascorbic acid Overview Side Effects Dosage Interactions Pregnancy More User Reviews Support Group Q & A Note: This document contains side effect information about ascorbic acid. Some of the dosage forms listed on this page may not apply to the brand name Cee-500. For the Consumer Applies to ascorbic acid: oral capsule, oral capsule extended release, oral capsule liquid filled, oral granule, oral liquid, oral lozenge/troche, oral powder, oral powder for solution, oral powder for suspension, oral solution, oral syrup, oral tablet, oral tablet chewable, oral tablet extended release, oral wafer Along with its needed effects, ascorbic acid (the active ingredient contained in Cee-500) 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 while taking ascorbic acid: Less common or rare - with high doses Side or lower back pain Some side effects of ascorbic acid 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: Less common or rare - with high doses Diarrhea dizziness or faintness (with the injection only) flushing or redness of skin headache increase in urination (mild) nausea or vomiting stomach cramps For Healthcare Professionals Applies to ascorbic acid: compounding powder, injectable solution, oral capsule, oral gum, oral liquid, oral tablet, oral tablet chewable, oral tablet disintegrating, oral tablet extended release Renal Renal side effects have included oxalate and urate kidney stones. [ Ref ] Hyperoxaluria appears to be dose-related. [ Ref ] Nervous system Migraine headache has been reported with a daily dose of 6 grams. The manufacturer reports temporary dizziness and faintness may be associated with too rapid of a rate during intravenous administration. [ Ref ] Nervous system side effects have included dizziness, faintness, fatigue, and headache in less than 1% of patients. Migraine headache has also been reported. [ Ref ] Other Conditional scurvy is reported to occur following excessive doses of ascorbic acid (the active ingredient contained in Cee-500) over a prolonged period of time. The mechanism of action for this condition is thought to be that large doses of ascorbic acid condition the patient over time for rapid clearance of ascorbic acid resulting in scurvy. The plasma levels of ascorbic acid appear to remain within normal limits. The actual existence of conditional scurvy remains controversial. [ Ref ] Other side effects have included flank pain in less than 1% of patients. Conditional scurvy has also been reported. [ Ref ] Gastrointestinal Gastrointestinal side effects have included nausea, diarrhea, abdominal cramps, and esophagitis. [ Ref ] Nausea, diarrhea, and abdominal cramps appears to be associated with doses exceeding 2 g per day, although there have been some reports with as little as 1 g per day. Esophagitis appears to be associated with prolonged or increased contact of ascorbic acid tablets with the esophageal mucosa. [ Ref ] Hematologic The majority of hemolysis reports have been associated with patients who have concurrent glucose-6-phosphate dehydrogenase deficiency. [ Ref ] Hematologic side effects have included hemolysis. [ Ref ] Local Local side effects have included transient mild soreness at the site of injection. [ Ref ] References 1. Levine M, Dhariwal KR, Welch RW, Wang Y, Park JB "Determination of optimal vitamin C requirements in humans." Am J Clin Nutr 62(6 Suppl) (1995): s1347-56 2. Hathcock JN "Vitamins and minerals: Efficacy and safety." Am J Clin Nutr 66 (1997): 427-37 3. "How much vitamin C do you need?" JAMA 281 (1999): 1460 4. "Product Information. Cemill (ascorbic acid)." Abbott Pharmaceutical, Abbott Park, IL. Some side effects of Cee-500 may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA . Next Dosage Print this page More about Cee-500 (ascorbic acid) Side Effects During Pregnancy Dosage Information Drug Interactions Support Group 0 Reviews Add your own review/rating Drug class: vitamins Consumer resources C-500 (Advanced Reading) Other brands: Vitamin C , Ester-C , Ascorbic Acid Quick Melts , Protexin , ... +15 more Professional resources Ascorbic Acid (AHFS Monograph) Ascorbic Acid Injection (FDA) Related treatment guides Dietary Supplementation Scurvy Urinary Acidification Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist. Drug Status Rx OTC Availability Rx and/or OTC N Pregnancy Category Not classified N/A CSA Schedule Not a controlled drug Drug Class Vitamins Related Drugs Urinary Acidification ascorbic acid , Vitamin C , Ester-C , Protexin , More... Dietary Supplementation biotin , multivitamin , Fish Oil , ascorbic acid , Coenzyme Q10 , Lovaza , More... Scurvy ascorbic acid , Vitamin C , Ester-C , Protexin , More... Cee-500 Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! it will


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and can't scorpion (CENTRUROIDES) IMMUNE F(AB)2 (Intravenous route) SKOR-pee-on SEN-troo-roy-deez i-MUNE fab-too Overview Side Effects Dosage Professional Pregnancy More User Reviews Support Group Q & A Commonly used brand name(s) In the U.S. Anascorp Available Dosage Forms: Powder for Solution Therapeutic Class: Antivenom Slideshow Amyotrophic Lateral Sclerosis (ALS): Evolving Science For a Fatal Disease Uses For scorpion (centruroides) immune f(ab)2 Scorpion (Centruroides) immune F(ab)2 injection is used to treat scorpion stings. A scorpion sting may cause abnormal eye movements, increased watering of the mouth, loss of muscle control, shortness of breath, slurred speech, troubled breathing, or vomiting. scorpion (centruroides) immune f(ab)2 is made from horse proteins that have been immunized with the scorpion s venom. scorpion (centruroides) immune f(ab)2 is to be given only by or under the direct supervision of a doctor. Before Using scorpion (centruroides) immune f(ab)2 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 scorpion (centruroides) immune f(ab)2, the following should be considered: Allergies Tell your doctor if you have ever had any unusual or allergic reaction to scorpion (centruroides) immune f(ab)2 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 Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of scorpion (Centruroides) immune F(ab)2 injection in children. Geriatric Although appropriate studies on the relationship of age to the effects of scorpion (Centruroides) immune F(ab)2 injection have not been performed in the geriatric population, no geriatric-specific problems have been documented to date. 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 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. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. 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. Other Medical Problems The presence of other medical problems may affect the use of scorpion (centruroides) immune f(ab)2. Make sure you tell your doctor if you have any other medical problems, especially: Allergy to horse protein or Prior use of an antivenom containing horse protein Use with caution. May increase the likelihood for an allergic reaction. Proper Use of scorpion (centruroides) immune f(ab)2 A nurse or other trained health professional will give you scorpion (centruroides) immune f(ab)2 in a hospital. scorpion (centruroides) immune f(ab)2 is given through a needle placed in one of your veins. Precautions While Using scorpion (centruroides) immune f(ab)2 Your doctor will check your or your child's progress closely while you are receiving scorpion (centruroides) immune f(ab)2. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to receive it. scorpion (centruroides) immune f(ab)2 may cause serious types of allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you or your child have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth while you are receiving scorpion (centruroides) immune f(ab)2. Call your doctor or the emergency department right away if you or your child have a delayed allergic reaction or serum sickness, which may occur up to 14 days after receiving scorpion (centruroides) immune f(ab)2 . The symptoms may include a rash, itching skin, fever, general feeling of discomfort or illness, joint or muscle pain, unusual tiredness or weakness, or swollen, painful, or tender lymph glands in the neck, armpit, or groin. scorpion (centruroides) immune f(ab)2 is made from horse blood. Some horse blood products have transmitted certain viruses to people who have received them. The risk of getting a virus from medicines made from horse blood has been greatly reduced in recent years. This is the result of required testing of horses for certain viruses, and testing during the making of these medicines. Although the risk is low, talk with your doctor if you have concerns. scorpion (centruroides) immune f(ab)2 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 or nurse immediately if any of the following side effects occur: Less common Chest pain confusion cough dizziness fast heartbeat feeling of discomfort fever or chills inflammation of the joints itching muscle aches rash shakiness and unsteady walk shortness of breath sneezing sore throat swelling of the eye swollen lymph glands tightness in the chest troubled breathing unsteadiness, trembling, or other problems with muscle control or coordination weakness wheezing Incidence not known Fast, irregular, pounding, or racing heartbeat or pulse 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: Less common Diarrhea difficulty with moving headache joint pain muscle cramping muscle pains or stiffness nausea runny nose swollen joints unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness vomiting 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. Side Effects (complete list) The information contained in the Truven Health Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you. The use of the Truven Health products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Truven Health and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. Copyright 2017 Truven Health Analytics, Inc. All Rights Reserved. Next Side Effects Print this page Add to My Med List More about antivenom (centruroides scorpion) Side Effects During Pregnancy Dosage Information Support Group En Español 0 Reviews Add your own review/rating Drug class: antitoxins and antivenins Consumer resources Antivenom Centruroides scorpion Immune F(ab ) (Equine) Other brands: Anascorp Professional resources Centruroides (Scorpion) Immune F(ab′)2 (Equine) (AHFS Monograph) Centruroides Immune F(ab )2 (Equine) (Wolters Kluwer) Related treatment guides Venomous Scorpion Bite} Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Drug Class Antitoxins and antivenins Related Drugs Venomous Scorpion Bite Anascorp , More... Antivenom (centruroides scorpion) Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Help and Support Looking for answers? 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starting stage sa 300 mg (n=231) versus placebo (n=100). The primary objective was demonstration of improvement in progression-free survival (PFS) with Caprelsa compared to placebo. Other endpoints included evaluation of overall survival and overall objective response rate (ORR). Centralized land up

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Bacon [1:20% of body surface area. c d The risk of adrenal suppression appears to increase with decreasing age. b (See Systemic Effects under Cautions.) Manifestations of adrenal suppression in children include linear growth retardation, delayed weight gain, low plasma cortisol concentrations, and lack of response to corticotropin (ACTH) stimulation. b c d Children also are at greater risk of glucocorticoid insufficiency during and/or after withdrawal of treatment. b c d Intracranial hypertension has occurred in children; manifestations include bulging fontanelles, headaches, and bilateral papilledema. b c d Striae have been reported in children treated inappropriately with topical corticosteroids. b c d Topical corticosteroid therapy in children should be limited to the minimum amount necessary for therapeutic efficacy; chronic topical corticosteroid therapy may interfere with growth and development. b Geriatric Use Response in limited number of patients 65 years of age does not appear to differ from that in younger adults. c d Common Adverse Effects Burning, itching, erythema, irritation,, dryness, papular rash, folliculitis, acneiform eruptions, hypopigmentation c , perioral dermatitis, allergic contact dermatitis, secondary infection, skin atrophy, striae, miliaria. c d Interactions for Alclometasone Dipropionate Specific Drugs and Laboratory Tests Drug or Test Interaction Nitroblue-tetrazolium test for bacterial infection Concurrent use of corticosteroids reportedly may result in false-negative results b Alclometasone Dipropionate Pharmacokinetics Absorption Bioavailability Topically applied alclometasone can be absorbed through normal intact skin. 4 22 b c d Percutaneous penetration varies among individuals 14 and can be altered by using occlusive dressings, 1 4 16 17 d high corticosteroid concentrations, and certain vehicles. 1 15 16 b d Only minimal amounts of topical corticosteroid reach the dermis and subsequently the systemic circulation after application to most normal skin areas; more absorption occurs from the scrotum, axilla, eyelid, face, and scalp than from the forearm, knee, elbow, palm, and sole. b Absorption is markedly increased by loss of the skin s keratin layer and by inflammation and/or diseases of the epidermal barrier (e.g., psoriasis, eczema). 1 16 17 b d Distribution Extent Not known whether topical alclometasone is distributed into milk. c d Elimination Metabolism Once absorbed through the skin, topically applied corticosteroids are metabolized primarily in the liver. 22 b Elimination Route Topical corticosteroids and metabolites are excreted by the kidneys and, to a lesser extent, in bile. 1 22 Stability Storage Topical Cream and ointment: 2 30 C. 1 Some manufacturers state 20 25 C. d Consult product information for specific recommendations. Actions Precise mechanism of action for topical anti-inflammatory activity is unknown; therapeutic benefit in the management of corticosteroid-responsive dermatoses mediated primarily through anti-inflammatory, antipruritic, and vasoconstrictive actions. c d Anti-inflammatory effects may occur through induction of phospholipase A 2 inhibitory proteins (lipocortins); decreased arachidonic acid release from membrane phospholipids. d Decreased arachidonic acid precursors may downregulate biosynthesis of potent inflammatory mediators (e.g., prostaglandins, leukotrienes). d Decreases inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes; inhibiting macrophage accumulation in inflamed areas; reducing leukocyte adhesion to capillary endothelium; reducing capillary wall permeability and edema formation; decreasing complement components; antagonizing histamine activity and release of kinin from substrates; reducing fibroblast proliferation, collagen deposition, and subsequent scar tissue formation; and possibly by other mechanisms as yet unknown. b Advice to Patients Importance of using only as directed, only for the disorder for which it was prescribed, and for no longer than prescribed; avoid contact with the eyes and only apply externally as directed. c d (See Topical Administration under Dosage and Administration.) Importance of not applying on the face, underarms, or groin unless directed by clinician. c d Importance of informing patients that treated areas of the skin should not be bandaged or otherwise covered or wrapped as to be occlusive unless directed by a clinician. c d Importance of reporting any local adverse reactions, especially those occurring under occlusive bandage, to a clinician. b c d Importance of informing parents of children not to use in the treatment of diaper dermatitis and not to apply in the diaper area as diapers or plastic pants may constitute occlusive dressings. c d Importance of discontinuing use when control is achieved; importance of contacting clinician if no improvement is seen in 2 weeks. c d Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs. c d Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. c d Importance of advising patients of other important precautionary information. (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Alclometasone Dipropionate Routes Dosage Forms Strengths Brand Names Manufacturer Topical Cream 0.05%* Alclometasone Dipropionate Cream (with propylene glycol) Fougera, Taro Aclovate (with propylene glycol) GlaxoSmithKline Ointment 0.05%* Alclometasone Dipropionate Ointment Fougera, Taro Aclovate (with propylene glycol) GlaxoSmithKline AHFS DI Essentials. Copyright 2017, Selected Revisions January 1, 2008. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. References 1. Glaxo Inc. Aclovate prescribing information. Research Triangle Park, NC; 1986 Sep. 2. Windholz M, ed. The Merck index. 10th ed. Rahway, NJ: Merck & Co, Inc; 1983:34. 3. Cornell RC, Stoughton RB. Correlation of the vasoconstriction assay and clinical activity in psoriasis. Arch Dermatol . 1985; 121:63-7. [PubMed 3881088] 4. Thornfeldt C, Cornell RC, Stoughton RB. The effect of alclometasone dipropionate cream 0.05% on the hypothalamic-pituitary-adrenal axis of normal volunteers. J Int Med Res . 1985; 13:276-80. [PubMed 4054428] 5. Lassus A. Clinical comparison of alclometasone dipropionate cream 0.05% with hydrocortisone butyrate cream 0.1% in the treatment of atopic dermatitis in children. J Int Med Res . 1983; 11:315-9. [PubMed 6357892] 6. Bagatell FK, Barkoff JR, Cohen HJ et al. A multicenter comparison of alclometasone dipropionate cream 0.05% and hydrocortisone cream 1.0% in the treatment of atopic dermatitis. Curr Ther Res . 1983; 33:46-52. 7. Cornell RC. Atrophogenic potential of alclometasone dipropionate ointment 0.05% vs hydrocortisone ointment 1.0%. Curr Ther Res . 1986; 39:260-8. 8. Kalivas J, Kanof NB, Miller OF III et al. A controlled clinical comparison of alclometasone dipropionate cream 0.05% and hydrocortisone cream 1.0% in patients with psoriasis. Curr Ther Res . 1983; 33:408-14. 9. Aggerwal A, Maddin S. Alclometasone dipropionate in psoriasis: a clinical study. J Int Med Res . 1982; 10:414-8. [PubMed 7152079] 10. Frost P. Clinical comparison of alclometasone dipropionate and desonide ointments (0.05%) in the management of psoriasis. J Int Med Res . 1982; 10:375-8. [PubMed 6754511] 11. Lassus A. Alclometasone dipropionate cream 0.05% versus clobetasone butyrate cream 0.05%: a controlled clinical comparison in the treatment of atopic dermatitis in children. Int J Dermatol . 1984; 23:565-6. [PubMed 6389385] 12. Green MJ, Berkenkopf J, Xiomara F et al. Synthesis and structure-activity relationships in a novel series of topically active corticosteroids. J Steroid Biochem . 1979; 11:61-6. [PubMed 491605] 13. Duke EE, Maddin S, Aggerwal A. Alclometasone dipropionate in atopic dermatitis: a clinical study. Curr Ther Res . 1983; 33:769-74. 14. Crespi HG. Topical corticosteroid therapy for children: alclometasone dipropionate cream 0.05%. Clin Ther . 1986; 8:203-10. [PubMed 2938740] 15. Cornell RC, Stoughton RB. The use of topical steroids in psoriasis. Dermatol Clin . 1984; 2:397-409. 16. Cornell RC, Stoughton RB. Use of glucocorticosteroids in psoriasis. Pharmacol Ther . 1980; 2:497-508. 17. Food and Drug Administration. Topical corticosteroids class labeling guideline. (Undated.) Available from: Professional Labeling Branch, Division of Drug Advertising and Labeling, Food and Drug Administration, Rockville, MD. 18. Mobacken H, Hersle K. Alclometasone dipropionate ointment 0.05% versus hydrocortisone ointment 1.0% in children with eczema. Acta Ther . 1986; 12:269-78. 19. Green MJ, Shue HJ, Tiberi R et al. The influence of esterification on the topical antiinflammatory activity of 7 alpha-chloro- and 7 alpha-bromo-16 alpha-methylprednisolones. Arzneimittelforschung . 1980; 30:1618-20. [PubMed 7192095] 20. Lutsky BN, Berkenkopf J, Fernandez X et al. Selective effects of 7 alpha-halogeno substitution on corticosteroid activity: Sch 22219 and Sch 23409. Arzneimittelforschung . 1979; 29:992-8. [PubMed 583002] 21. Lutsky BN, Berkenkopf J, Fernandez X et al. A novel class of potent topical antiinflammatory agents: 17-benzoylated, 7 alpha-halogeno substituted corticosteroids. Arzneimittelforschung . 1979; 29:1662-7. [PubMed 543873] 22. Vonderweidt J (Glaxo, Research Triangle Park, NC): Personal communication; 1987 Apr 15. 23. Reviewers comments (personal observations); 1987 Apr. 24. Tokiwa T, Oyama T, Kimura S et al. [Studies on the primary dermal irritation, ocular mucosa irritation and local anaesthetic effect of alclometasone dipropionate (ADP)]. (Japanese; with English abstract.) Oyo Yakuri . 1986; 32:937-43. 25. Fujii K, Uda F, Yamamoto K. [Phototoxicity and photosensitivity tests of alclometasone dipropionate (ADP).] (Japanese; with English abstract.) Oyo Yakuri . 1986; 32:945-51. 26. Hasegawa T, Tujita K, Fujino A et al. [Immunogenicity study on alclometasone dipropionate (ADP)]. (Japanese; with English abstract.) Oyo Yakuri . 1986; 32:953-60. 27. Sills J (Schering, Kenilworth, NJ): Personal communication; 1987 May 28. 28. Lechner D (Schering, Kenilworth, NJ): Personal communication; 1987 June 3. a. AHFS drug information 2007. McEvoy GK, ed. Alclometasone dipropionate. Bethesda, MD: American Society of Health-Systems Pharmacists; 2007: 3525 6. b. AHFS drug information 2007 McEvoy GK, ed. Topical corticosteroids general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2007:3423 5. c. GlaxoSmithKline. Aclovate (alclometasone dipropionate) cream and ointment 0.05% prescribing information. Pittsburgh, PA; 2002 Aug. d. Taro Pharmaceuticals. Alclometasone dipropionate ointment USP, 0.05% prescribing information. Hawthorne, NY; 2004 Jul. Next Interactions Print this page Add to My Med List More about alclometasone topical Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Interactions Support Group Pricing & Coupons En Español 2 Reviews Add your own review/rating Drug class: topical steroids Consumer resources Alclometasone topical Alclometasone Professional resources Alclometasone (FDA) Alclometasone Ointment (FDA) Alclometasone (Wolters Kluwer) Other brands: Aclovate Related treatment guides Eczema Atopic Dermatitis Dermatitis Psoriasis]} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Manufacturers Sandoz Inc. Taro Pharmaceuticals U.S.A., Inc. Glenmark Pharmaceuticals Inc., USA Drug Class Topical steroids Related Drugs Eczema prednisone , fluticasone topical , triamcinolone topical , hydrocortisone topical , dexamethasone , clobetasol topical , More... Atopic Dermatitis prednisone , fluticasone topical , triamcinolone topical , hydrocortisone topical , dexamethasone , methylprednisolone , More... Dermatitis fluticasone topical , triamcinolone , hydrocortisone topical , prednisolone , clobetasol topical , More... Psoriasis Humira , methotrexate , cyclosporine , Remicade , adalimumab , infliximab , More... Alclometasone topical Rating 2 User Reviews 8.7 /10 2 User Reviews 8.7 Rate it!} } is well known


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