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plenty of Dilatrate-SR Generic Name: isosorbide dinitrate Dosage Form: capsule, extended release Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings User Reviews Drug Images Support Group Q & A Pricing & Coupons Dilatrate-SR Description Isosorbide dinitrate (ISDN) is 1,4:3,6-dianhydro-D-glucitol 2,5 dinitrate, an organic nitrate whose structural formula is: and whose molecular weight is 236.14. The organic nitrates are vasodilators, active on both arteries and veins. Each dilatrate -SR sustained release capsule contains 40 mg of isosorbide dinitrate, in a microdialysis delivery system that causes the active drug to be released over an extended period. Each capsule also contains ethylcellulose, lactose, pharmaceutical glaze, starch, sucrose and talc. The capsule shells contain D&C Red 33, D&C Yellow 10, gelatin and titanium dioxide. Slideshow Love Your Dad? Here's 10 Heart-Healthy Gifts For Father's Day Dilatrate-SR - Clinical Pharmacology The principal pharmacological action of isosorbide dinitrate is relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins, especially the latter. Dilatation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Dilatation of the coronary arteries also occurs. The relative importance of preload reduction, afterload reduction, and coronary dilatation remains undefined. Dosing regimens for most chronically used drugs are designed to provide plasma concentrations that are continuously greater than a minimally effective concentration. This strategy is inappropriate for organic nitrates. Several well-controlled clinical trials have used exercise testing to assess the antianginal efficacy of continuously-delivered nitrates. In the large majority of these trials, active agents were no more effective than placebo after 24 hours (or less) of continuous therapy. Attempts to overcome nitrate tolerance by dose escalation, even to doses far in excess of those used acutely, have consistently failed. Only after nitrates have been absent from the body for several hours has their antianginal efficacy been restored. Pharmacokinetics The kinetics of absorption of isosorbide dinitrate from dilatrate -SR sustained release capsules have not been well studied. Studies of immediate-release formulations of ISDN have found highly variable bioavailability (10 to 90%), with extensive first-pass metabolism in the liver. Most such studies have observed progressive increases in bioavailability during chronic therapy; it is not known whether similar increases in bioavailability appear during the course of chronic therapy with dilatrate -SR sustained release capsules. Once absorbed, the distribution volume of isosorbide dinitrate is 2-4 L/kg and this volume is cleared at the rate of 2-4 L/min, so ISDN's half-life in serum is about an hour. Since the clearance exceeds hepatic blood flow, considerable extrahepatic metabolism must also occur. Clearance is affected primarily by denitration to the 2-mononitrate (15 to 25%) and the 5-mononitrate (75 to 85%). Both metabolites have biological activity, especially the 5-mononitrate. With an overall half-life of about 5 hours, the 5-mononitrate is cleared from the serum by denitration to isosorbide; glucuronidation to the 5-mononitrate glucuronide; and denitration/hydration to sorbitol. The 2-mononitrate has been less well studied, but it appears to participate in the same metabolic pathways with a half-life of about 2 hours. The interdosing interval sufficient to avoid tolerance to ISDN has not been well defined. Studies of nitroglycerin (an organic nitrate with a very short half-life) have shown that dosing intervals of 10-12 hours are usually sufficient to prevent or attenuate tolerance. Dosing intervals that have succeeded in avoiding tolerance during trials of moderate doses (e.g., 30 mg) of immediate release ISDN have generally been somewhat longer (at least 14 hours), but this is consistent with the longer half-lives of ISDN and its active metabolites. An interdosing interval sufficient to avoid tolerance with dilatrate -SR has not been demonstrated. In an eccentric dosing study, 40 mg capsules of dilatrate -SR were administered daily at 0800 and 1400 hours. After two weeks of this regimen, dilatrate -SR was statistically indistinguishable from placebo. Thus, the necessary interdosing interval sufficient to avoid tolerance remains unknown, but it must be greater than 18 hours. Few well-controlled clinical trials of organic nitrates have been designed to detect rebound or withdrawal effects. In one such trial, however, subjects receiving nitroglycerin had less exercise tolerance at the end of the daily interdosing interval than the parallel group receiving placebo. The incidence, magnitude, and clinical significance of similar phenomena in patients receiving ISDN have not been studied. Clinical Trials In clinical trials, extended-release oral isosorbide dinitrate has been administered in a variety of regimens, with total daily doses ranging from 40 to 160 mg. A controlled trial using a single 40 mg sustained-release oral dose of isosorbide dinitrate (dilatrate -SR) has demonstrated effective reductions in exercise-related angina for up to 8 hours. Antianginal activity is present about 1 hour after dosing. Adequate multiple-dose trials of dilatrate -SR sustained release capsules have not been reported. Most controlled trials of multiple-dose immediate-release oral ISDN taken every 12 hours (or more frequently) for several weeks have shown statistically significant antianginal efficacy for only 2 hours after dosing. Once-daily regimens, and regimens with one daily interdosing interval of at least 14 hours (e.g., a regimen providing doses at 0800, 1400 and 1800 hours), have shown efficacy after the first dose of each day that was similar to that shown in the single dose studies cited above. The efficacy of subsequent doses has not been demonstrated. From large, well-controlled studies of other nitrates, it is reasonable to believe that the maximal achievable daily duration of antianginal effect from isosorbide dinitrate is about 12 hours. No dosing regimen for dilatrate -SR sustained release capsules has actually been shown to achieve this duration of effect. Indications and Usage for Dilatrate-SR dilatrate -SR sustained release capsules are indicated for the prevention of angina pectoris due to coronary artery disease. The onset of action of controlled-release oral isosorbide dinitrate is not sufficiently rapid for this product to be useful in aborting an acute anginal episode. Contraindications Isosorbide dinitrate is contraindicated in patients who are allergic to it. Do not use dilatrate -SR in patients who are taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), such as sildenafil, tadalafil, vardenafil, or avanafil. Concomitant use can cause severe hypotension, syncope, or myocardial ischemia. Do not use dilatrate -SR in patients who are taking the soluble guanylate cyclase stimulator riociguat. Concomitant use can cause hypotension. Warnings Amplification of the vasodilatory effects of dilatrate - SR by sildenafil can result in severe hypotension. The time course and dose dependence of this interaction have not been studied. Appropriate supportive care has not been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion. The benefits of extended-release oral isosorbide dinitrate in patients with acute myocardial infarction or congestive heart failure have not been established. If one elects to use isosorbide dinitrate in these conditions, careful clinical or hemodynamic monitoring must be used to avoid the hazards of hypotension and tachycardia. Because the effects of extended-release oral isosorbide dinitrate are so difficult to terminate rapidly, this formulation is not recommended in these settings. Precautions General Severe hypotension, particularly with upright posture, may occur with even small doses of isosorbide dinitrate. This drug should therefore be used with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive. Hypotension induced by isosorbide dinitrate may be accompanied by paradoxical bradycardia and increased angina pectoris. Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy. As tolerance to isosorbide dinitrate develops, the effect of sublingual nitroglycerin on exercise tolerance, although still observable, is somewhat blunted. Some clinical trials in angina patients have provided nitroglycerin for about 12 continuous hours of every 24-hour day. During the interdosing intervals in some of these trials, anginal attacks have been more easily provoked than before treatment and patients have demonstrated hemodynamic rebound and decreased exercise tolerance. The importance of these observations to the routine, clinical use of controlled-release oral isosorbide dinitrate is not known. In industrial workers who have had long-term exposure to unknown (presumably high) doses of organic nitrates, tolerance clearly occurs. Chest pain, acute myocardial infarction, and even sudden death have occurred during temporary withdrawal of nitrates from these workers demonstrating the existence of true physical dependence. Information for Patients Patients should be told that the antianginal efficacy of isosorbide dinitrate is strongly related to its dosing regimen, so the prescribed schedule of dosing should be followed carefully. In particular, daily headaches sometimes accompany treatment with isosorbide dinitrate. In patients who get these headaches, the headaches are a marker of the activity of the drug. Patients should resist the temptation to avoid headaches by altering the schedule of their treatment with isosorbide dinitrate, since loss of headache may be associated with simultaneous loss of antianginal efficacy. Aspirin and/or acetaminophen, on the other hand, often successfully relieve isosorbide dinitrate-induced headaches with no deleterious effect on isosorbide dinitrate's antianginal efficacy. Treatment with isosorbide dinitrate may be associated with lightheadedness on standing, especially just after rising from a recumbent or seated position. This effect may be more frequent in patients who have also consumed alcohol. Drug Interactions Concomitant use of dilatrate -SR with phosphodiesterase inhibitors in any form is contraindicated (see CONTRAINDICATIONS ). Concomitant use of dilatrate -SR with riociguat, a soluble guanylate cyclase stimulator, is contraindicated (see CONTRAINDICATIONS ). The vasodilating effects of isosorbide dinitrate may be additive with those of other vasodilators. Alcohol, in particular, has been found to exhibit additive effects of this variety. Carcinogenesis, Mutagenesis and Impairment of Fertility No long-term studies in animals have been performed to evaluate the carcinogenic potential of isosorbide dinitrate. In a modified two-litter reproduction study, there was no remarkable gross pathology and no altered fertility or gestation among rats fed isosorbide dinitrate at 25 or 100 mg/kg/day. Pregnancy Category C At oral doses 35 and 150 times the daily Maximum Recommended Human Dose (MRHD), isosorbide dinitrate has been shown to cause a dose related increase in embryotoxicity (increase in mummified pups) in rabbits. There are no adequate, well-controlled studies in pregnant women. Isosorbide dinitrate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Nursing Mothers It is not known whether isosorbide dinitrate is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when isosorbide dinitrate is administered to a nursing woman. Pediatric Use Safety and effectiveness in pediatric patients have not been established. Geriatric Use Clinical studies of dilatrate -SR did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Adverse Reactions Adverse reactions to isosorbide dinitrate are generally dose related, and almost all of these reactions are the result of isosorbide dinitrate's activity as a vasodilator. Headache, which may be severe, is the most commonly reported side effect. Headache may be recurrent with each daily dose, especially at higher doses. Transient episodes of lightheadedness, occasionally related to blood pressure changes, may also occur. Hypotension occurs infrequently, but in some patients it may be severe enough to warrant discontinuation of therapy. Syncope, crescendo angina, and rebound hypertension have been reported but are uncommon. Extremely rarely, ordinary doses of organic nitrates have caused methemoglobinemia in normal-seeming patients. Methemoglobinemia is so infrequent at these doses that further discussion of its diagnosis and treatment is deferred (see OVERDOSAGE ). Data are not available to allow estimation of the frequency of adverse reactions during treatment with dilatrate -SR sustained release capsules. Overdosage Hemodynamic Effects The ill effects of isosorbide dinitrate overdose are generally the results of isosorbide dinitrate's capacity to induce vasodilatation, venous pooling, reduced cardiac output, and hypotension. These hemodynamic changes may have protean manifestations, including increased intracranial pressure, with any or all of persistent throbbing headache, confusion, and moderate fever; vertigo; palpitations; visual disturbances; nausea and vomiting (possibly with colic and even bloody diarrhea); syncope (especially in the upright posture); air hunger and dyspnea, later followed by reduced ventilatory effort; diaphoresis, with the skin either flushed or cold and clammy; heart block and bradycardia; paralysis; coma; seizures and death. Laboratory determinations of serum levels of isosorbide dinitrate and its metabolites are not widely available, and such determinations have, in any event, no established role in the management of isosorbide dinitrate overdose. There are no data suggesting what dose of isosorbide dinitrate is likely to be life-threatening in humans. In rats, the median acute lethal dose (LD 50 ) was found to be 1100 mg/kg. No data are available to suggest physiological maneuvers (e.g., maneuvers to change the pH of the urine) that might accelerate elimination of isosorbide dinitrate and its active metabolites. Similarly, it is not known which, if any, of these substances can usefully be removed from the body by hemodialysis. No specific antagonist to the vasodilator effects of isosorbide dinitrate is known, and no intervention has been subject to controlled study as a therapy of isosorbide dinitrate overdose. Because the hypotension associated with isosorbide dinitrate overdose is the result of venodilatation and arterial hypovolemia, prudent therapy in this situation should be directed toward an increase in central fluid volume. Passive elevation of the patient's legs may be sufficient, but intravenous infusion of normal saline or similar fluid may also be necessary. The use of epinephrine or other arterial vasoconstrictors in this setting is likely to do more harm than good. In patients with renal disease or congestive heart failure, therapy resulting in central volume expansion is not without hazard. Treatment of isosorbide dinitrate overdose in these patients may be subtle and difficult, and invasive monitoring may be required. Methemoglobinemia Nitrate ions liberated during metabolism of isosorbide dinitrate can oxidize hemoglobin into methemoglobin. Even in patients totally without cytochrome b 5 reductase activity, however, and even assuming that the nitrate moieties of isosorbide dinitrate are quantitatively applied to oxidation of hemoglobin, about 1 mg/kg of isosorbide dinitrate should be required before any of these patients manifests clinically significant ( 10%) methemoglobinemia. In patients with normal reductase function, significant production of methemoglobin should require even larger doses of isosorbide dinitrate. In one study in which 36 patients received 2-4 weeks of continuous nitroglycerin therapy at 3.1 to 4.4 mg/hr (equivalent, in total administered dose of nitrate ions, to 4.8-6.9 mg of bioavailable isosorbide dinitrate per hour), the average methemoglobin level measured was 0.2%; this was comparable to that observed in parallel patients who received placebo. Notwithstanding these observations, there are case reports of significant methemoglobinemia in association with moderate overdoses of organic nitrates. None of the affected patients had been thought to be unusually susceptible. Methemoglobin levels are available from most clinical laboratories. The diagnosis should be suspected in patients who exhibit signs of impaired oxygen delivery despite adequate cardiac output and adequate arterial p0 2 . Classically, methemoglobinemic blood is described as chocolate brown, without color change on exposure to air. When methemoglobinemia is diagnosed, the treatment of choice is methylene blue, 1-2 mg/kg intravenously. Dilatrate-SR Dosage and Administration As noted above ( CLINICAL PHARMACOLOGY ), multiple studies with ISDN and other nitrates have shown that maintenance of continuous 24-hour plasma levels results in refractory tolerance. Every dosing regimen for organic nitrates including dilatrate -SR must provide a daily nitrate-free interval to avoid the development of tolerance. To achieve the necessary nitrate-free interval with immediate-release oral ISDN, it appears that at least one of the daily interdose intervals must be at least 14 hours long. The necessary interdose interval for dilatrate -SR has not been clearly identified, but it must be greater than 18 hours. As noted under Clinical Pharmacology, only one trial has ever studied the use of extended-release isosorbide dinitrate for more than one dose. In that trial, 40 mg of dilatrate -SR was administered twice daily in doses given 6 hours apart. After 4 weeks, dilatrate -SR could not be distinguished from placebo. Large controlled studies with other nitrates suggest that no dosing regimen with dilatrate -SR should be expected to provide more than about 12 hours of continuous antianginal efficacy per day. In clinical trials, immediate-release oral isosorbide dinitrate has been administered in a variety of regimens, with total daily doses ranging from 30 to 480 mg. Do not exceed 160 mg (4 capsules) per day. How is Dilatrate-SR Supplied dilatrate -SR (isosorbide dinitrate) 40 mg sustained-release capsules are opaque pink and colorless capsules with white beadlets and are imprinted "AP" and "0920". They are supplied as follows: Bottles of 100 NDC 52244-920-10 Store at 20 - 25 C (68 - 77 F); excursions permitted between 15 - 30 C (59 - 86 F) [See USP Controlled Room Temperature]. For more information, call Endo Pharmaceuticals Inc. at 1-800-462-3636. Distributed by: Endo Pharmaceuticals Inc. Malvern, PA 19355 Manufactured by: Epic Pharma, LLC Laurelton, NY 11413 Revised 10/2016 MF5317REV10/16 Rev. 3 10/16 OE1350 Principal Display Panel PRINCIPAL DISPLAY PANEL - 40 mg- Bottle Label DILATRATE SR isosorbide dinitrate capsule, extended release Product Information Product Type HUMAN PRESCRIPTION DRUG LABEL Item Code (Source) NDC:52244-920 Route of Administration ORAL DEA Schedule Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength ISOSORBIDE DINITRATE (ISOSORBIDE DINITRATE) ISOSORBIDE DINITRATE 40 mg Inactive Ingredients Ingredient Name Strength ETHYLCELLULOSES LACTOSE SUCROSE TALC D&C RED NO. 33 D&C YELLOW NO. 10 GELATIN TITANIUM DIOXIDE Product Characteristics Color PINK (opaque) Score no score Shape CAPSULE Size 19mm Flavor Imprint Code AP;0920 Contains Packaging # Item Code Package Description 1 NDC:52244-920-10 100 CAPSULE, EXTENDED RELEASE in 1 BOTTLE Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date NDA NDA019790 02/15/2012 Labeler - Endo Pharmaceuticals, Inc. (962685223) Revised: 11/2016 Endo Pharmaceuticals, Inc. Next Interactions Print this page Add to My Med List More about Dilatrate-SR (isosorbide dinitrate) Side Effects During Pregnancy Dosage Information Drug Images Drug Interactions Support Group Pricing & Coupons En Español 0 Reviews Add your own review/rating Drug class: antianginal agents Consumer resources Dilatrate-SR Dilatrate-SR (Advanced Reading) Professional resources Isosorbide Dinitrate (FDA) Other brands: Isordil , Isordil Titradose , IsoDitrate Related treatment guides Angina Pectoris Prophylaxis Angina Esophageal Spasm Heart Failure Pulmonary Hypertension} 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 Manufacturer Endo Pharmaceuticals Inc. Drug Class Antianginal agents Related Drugs antianginal agents nitroglycerin , Nitrostat , isosorbide mononitrate , Ranexa , Imdur Angina aspirin , amlodipine , carvedilol , metoprolol , atenolol , Norvasc , nitroglycerin , propranolol , Nitrostat , Coreg , More... Angina Pectoris Prophylaxis aspirin , metoprolol , atenolol , diltiazem , nitroglycerin , Nitrostat , nifedipine , isosorbide mononitrate , Toprol-XL , Lopressor , More... Dilatrate-SR Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Dilatrate-SR Images Dilatrate-SR 40 mg (SCHWARZ 0920) View larger images} } to procure


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seller Pain Relief Maximum Strength Generic Name: Menthol Gel, Liquid, and Solution (MEN thole) Brand Name: Aspercreme Heat, Aspercreme Max Roll-On, Bengay Cold Therapy, Bengay Vanishing Scent, Bengay Zero Degrees, ...show all 32 brand names. Berri-Freez Pain Relieving, Biofreeze, Biofreeze Colorless Gel, Biofreeze Roll-On Colorless Gel, Blue Gel, Blue-Emu Maximum Strength, Cold Therapy Pain Relief, Cool N Heat Maximum Strength, Fast Freeze Pro Style Therapy, Flexall, Gold Bond Pain Relieving Foot, Ice Blue, Icy Hot, Icy Hot Medicated Spray, Icy Hot Pain Relieving Gel, Icy Hot Power, Mineral Freeze, Mineral Ice, Pain Relief Maximum Strength, Pain Relieving Gel, PolarFrost, Sombra Cool Therapy, Stopain, Stopain Roll-On, Therapeutic Ice, Therapeutic Menthol, Zims Max-Freeze Overview Side Effects Dosage Pregnancy Reviews More Support Group Q & A Pricing & Coupons Uses of Pain Relief Maximum Strength: It is used to ease muscle and joint aches and pain. What do I need to tell my doctor BEFORE I take Pain Relief Maximum Strength? If you have an allergy to Pain Relief Maximum Strength (menthol gel, liquid, and solution) or any part of this medicine. 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. This medicine may interact with other drugs or health problems. 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 Pain Relief Maximum Strength with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor. Slideshow Sore Throat Remedies And Treatments What are some things I need to know or do while I take Pain Relief Maximum Strength? Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists. This medicine may cause harm if swallowed. If Pain Relief Maximum Strength is swallowed, call a doctor or poison control center right away. Avoid using a heating pad or other heating devices on the treated area. This medicine may catch on fire. Do not use near an open flame or while smoking. Use care in children younger than 12 years of age. Talk with the doctor. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this medicine 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 (Pain Relief Maximum Strength) best taken? Use Pain Relief Maximum Strength as ordered by your doctor. Read all information given to you. Follow all instructions closely. Follow how to use as you have been told by the doctor or read the package insert. Do not take this medicine by mouth. Use on your skin only. Keep out of your mouth, nose, ears, and eyes (may burn). Wash your hands before and after use. Do not wash your hands after use if putting this on your hand. Clean affected part before use. Make sure to dry well. Put a thin layer on the affected skin and rub in gently. Do not put on cuts, scrapes, or damaged skin. Do not put on open wounds. Do not put on irritated skin. Do not bandage tightly. What do I do if I miss a dose? If you use Pain Relief Maximum Strength on a regular basis, put on 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 put on 2 doses at the same time or extra doses. Many times this medicine is used on an as needed basis. Do not use 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. Very bad skin irritation. What are some other side effects of Pain Relief Maximum Strength? 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: Skin irritation. Burning or stinging feeling. Most of the time, this will go away after a few days. 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 Pain Relief Maximum Strength? Store at room temperature. Protect from heat or open flame. 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 Pain Relief Maximum Strength, 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 Pain Relief Maximum Strength. 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 Pain Relief Maximum Strength (menthol gel, liquid, and solution). Review Date: November 1, 2017 Next Side Effects Print this page Add to My Med List More about menthol topical Side Effects During Pregnancy Dosage Information Support Group Pricing & Coupons 4 Reviews Add your own review/rating Drug class: topical rubefacient Consumer resources Menthol topical oral mucous membrane Menthol Aerosol Menthol Aerosol Powder Menthol Cream, Lotion, and Ointment Menthol Gel, Liquid, and Solution ... +3 more Other brands: Biofreeze , Flexall , Therapeutic Menthol , Aspercreme Pain Relieving Heat Gel , ... +28 more Professional resources Related treatment guides Pain Pruritus Cough Sore Throat} Drug Status Rx OTC Availability Rx and/or OTC N Pregnancy Category Not classified N/A CSA Schedule Not a controlled drug Menthol topical Rating 4 User Reviews 9.2 /10 4 User Reviews 9.2 Rate it! Drug Class Topical rubefacient Related Drugs Cough benzonatate , acetaminophen / hydrocodone , diphenhydramine , Benadryl , Mucinex , guaifenesin , More... Pain tramadol , acetaminophen , Tylenol , naproxen , oxycodone , More... Sore Throat menthol topical , benzocaine topical , Cepacol Sore Throat , phenol topical , Chloraseptic Sore Throat Spray , Cepacol Ultra , More... Pruritus hydroxyzine , lidocaine topical , hydrocortisone topical , diphenhydramine , Benadryl , More...} } growing old


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to illustrate Share 2K +1 8 Pin 409 Stumble Reddit Shares 2K Microbiota is classified as an ecological community of microorganisms that share a specific host. Within the human body it is estimated that there are trillions of microorganisms, accounting for approximately 1% to 3% of total body mass; equating to an average net weight of around 3 lbs. Though scientists these days are attempting to elucidate the importance of specific microorganisms and combinations within the human body, research in this field is relatively complex. Additionally, compared to other areas of health research, the human microbiota particularly within the gut never received as much attention as it may have warranted; hence the reason it is now commonly referenced as the forgotten organ. It wasn t until the late 1990s that scientists began ambitiously investigating the implications of gut bacteria on immune function. From the 1990s to present day, researchers have managed to unravel links between gut bacteria and numerous conditions including: arthritis, cancer, diabetes, fibromyalgia, multiple sclerosis, and obesity. Though we know that the gut microbiota mediates propensity to develop deleterious general health conditions, there s increasing evidence that it may affect a person s psychological state (e.g. mood, anxiety level, etc.). Abnormally high concentrations of specific microorganisms in the gut are now linked to major depression, whereas others are associated with better moods. This has lead many experts to speculate that supplementation with single and/or multi-strain probiotics may attenuate symptoms of depression and anxiety, while simultaneously improving general health. Source: https://www.ncbi.nlm.nih.gov/pubmed/16819463 10 Best Probiotics for Depression & Anxiety: Bacterial Strains Included below are 10 strains of probiotics supported by science to improve depression and anxiety. Keep in mind that not all of these strains have been clinically evaluated in humans many have only been assessed in animal models (e.g. rats/mice). For this reason, we cannot automatically assume that they will prove efficacious among humans, particularly those with severe depression and/or anxiety. Moreover, until further research is conducted, no probiotic should be regarded as a replacement for scientifically-supported, first-line antidepressants and anxiolytics. Bifidobacterium Longum This is a Gram-positive, catalase-negative, rod-shaped bacterium found in the GI tract of humans. It is one of 32 species associated with the Bifidobacterium genus and implicated in many processes within the human body. Specifically, Bifidobacterium longum inhibits growth of pathogenic species and maintains normative function of the gastrointestinal tract. Studies have shown that it may decrease lactose intolerance, prevent diarrhea, attenuate food allergies, and have an antioxidant effect. Other research indicates that Bifidobacterium longum may lower cholesterol, reduce tumor growth, and may decrease likelihood of certain cancers (e.g. colorectal). In addition to evidence suggesting that Bifidobacterium longum improves a person s general health, there s research indicating that it may be beneficial for mental health. Particularly, research in animal models shows that Bifidobacterium longum significantly reduces symptoms of anxiety. It accomplishes this in a number of ways, but is believed to alter neural function via its action upon the vagal nerve. Bifidobacterium longum mediates vagal tone and as a result, reduces symptoms of anxiety in mice. Its effect upon vagal function was pinpointed by researchers who removed the vagus nerve (via a vagotomy) from mice. Mice without the vagus nerve experienced no changes in anxiety following administration of Bifidobacterium longum. It is logical to assume that similar gut-vagal-brain innervations occur in humans administered this particular probiotic strain. The evidence is not limited to support the therapeutic effects of Bifidobacterium longum is not confined to a standalone mouse study. Another study involved administration of Bifidobacterium longum to rats following parasitic infection with Trichuris muris. Trichuris muris altered neurophysiological function in such a way that important biomarkers such as hippocampal BDNF (brain-derived neurotrophic factor) were nearly depleted. Abnormally low BDNF is associated with a multitude of neuropsychiatric conditions, perhaps most prominently, major depression. Upon administration of Bifidobacterium longum after parasitic infection, rats exhibited significant increases in BDNF this is associated with an antidepressant response. Perhaps administration of this probiotic strain in humans may be beneficial for mood while simultaneously reducing anxiety. Fortunately, research of Bifidobacterium longum was also conducted in human volunteers. A two-part study assessed the effect of Bifidobacterium longum when administered with Lactobacillus helveticus in both animal models and humans. The first part of the study with the animal models (rats) demonstrated that the combination of Bifidobacterium longum with Lactobacillus helveticus significantly reduced anxiety (as evidenced by a defensive burying test). The second part of the study with human participants discovered that the concurrent Bifidobacterium longum with Lactobacillus helveticus improved scores on numerous clinical measures. Measures of significant improvement included: Hopkins Symptom Checklist (HSCL-90), Hospital Anxiety and Depression Scale (HADS), Coping Checklist (CCL), and urinary free cortisol (UFC). It was concluded that the combination of these probiotics exhibit anxiolytic and therapeutic effects conducive to psychological health. However, it remains unclear as to whether Bifidobacterium longum necessitates the presence of Lactobacillus helveticus for a clinically significant anxiolytic or antidepressant effect in humans. Further research of this strain in animal models was published in 2014 by Savignac et al. who assessed the effects of Bifidobacterium longum compared to Celexa (a pharmaceutical SSRI ) among BALB/c mice. The BALB/c mice were administered Bifidobacterium longum (strain) 1714, Celexa, another Bifidobacterium strain, or a placebo each for a duration of 6 weeks. Behavioral measures were conducted in a stress-induced hyperthermia test, marble burying task, elevated plus maze, open field assessment, tail suspension test, and forced swim test. Physiological markers of stress were also collected from each of the mice. Results indicated that Bifidobacterium longum 1714 (and the other strain) and Celexa reduced anxiety on the marble burying test. However, only Bifidobacterium longum 1714 decreased stress-induced hyperthermia and facilitated an antidepressant response on the tai suspension test. This evidence supports the idea that Bifidobacterium longum 1714 decreases anxiety and may improve mood among anxious animal models. Another study published by Savignac et al. (2015) documented the ability of Bifidobacterium longum to modulate cognitive processes among BALB/c mice with anxiety. Adult BALB/c mice were fed Bifidobacterium longum 1714, another probiotic strain (B. breve 1205) or a control (vehicle treatment) for 11 weeks. After 4 weeks of administration, assessments were conducted to evaluate cognitive function, locomotor activity, and visceral pain. Mice administered Bifidobacterium longum 1714 exhibited quicker object recognition and made fewer errors within a Barnes maze than mice receiving other interventions. From this study, researchers were able to conclude that not all Bifidobacterium subspecies elicit equal neurophysiological effects. Moreover, administration of Bifidobacterium longum 1714 (in particular) is associated with cognitive enhancement among mice with anxiety. From the culmination of research assessing the neurophysiologic effects of Bifidobacterium longum, we can conclude that it may improve symptoms of depression and anxiety among humans. Additionally, individuals with anxiety (and possibly those without) may derive additional cognitive enhancement from the Bifidobacterium longum 1714 strain. If your goal is to reduce anxiety and depression via modifying your gut, you may want to consider regular supplementation with Bifidobacterium longum. Source: http://www.ncbi.nlm.nih.gov/pubmed/20600016/ Source: http://www.ncbi.nlm.nih.gov/pubmed/20974015/ Source: http://www.ncbi.nlm.nih.gov/pubmed/25251188 Source: http://www.ncbi.nlm.nih.gov/pubmed/25794930 Lactobacillus Rhamnosus Lactobacillus rhamnosus is a Gram-positive, anaerobic rod that commonly appears in chains. Initially it was thought to be a member of the Lactobacillus casei species, but additional investigation would reveal its status as a standalone species. Preliminary research has documented its therapeutic efficacy for a variety of conditions including: preventing peanut allergies, reducing diarrhea, treating dermatitis, genital tract infections, and obesity. In animal models, Lactobacillus rhamnosus has been shown to attenuate symptoms of depression and anxiety. A study published in 2011 specifically documented the effect of Lactobacillus rhamnosus upon neurotransmitter systems within the central nervous system. The study discovered that chronic administration of Lactobacillus rhamnosus to mice altered the neurotransmission of GABA (gamma-aminobutyric acid), an important inhibitory neurotransmitter. They noted that GABA biomarkers were upregulated in certain regions and downregulated in others, indicative of significant neural changes resulting from the probiotic. Regions in which GABAergic transmission was modified following Lactobacillus rhamnosus ingestion included the: amygdala, cingulate, hippocampus, locus coeruleus, and prefrontal cortex. Like the aforementioned Bifidobacterium longum strain, Lactobacillus rhamnosus exerted its effect upon the brain through the vagal nerve. This specifically lead to modified neurotransmission of GABA, which was ultimately associated with decreased anxiety and depression in the animal models. Whether similar antidepressant and anxiolytic effects can be attained by chronic administration of Lactobacillus rhamnosus in humans isn t known. That said, the preliminary evidence suggests that it is likely to provide some sort of benefit. It should be noted that in a small percentage of the population, probiotic therapy with Lactobacillus rhamnosus has lead to sepsis, a condition characterized by tissue and organ injuries resulting from the body s innate response to infectious pathogens. While sepsis only occurs in a small percentage of the population, particularly those with compromised immune function, it should be noted as a potential adverse reaction. That said, the potential antidepressant and anxiolytic benefits of Lactobacillus rhamnosus among non-immunocompromised populations likely outweigh the small risk of sepsis. Source: http://www.ncbi.nlm.nih.gov/pubmed/21876150/ Lactobacillus Helveticus Lactobacillus helveticus is a bacterium named after Helvetia, a Latin reference to the national female goddess of Switzerland. This particular bacterium is rod-shaped, belongs to the genus Lactobacillus, and facilitates production of lactic-acid. It is perhaps most well-known for being utilized to enhance the production of cheeses (e.g. Swiss, Cheddar, Parmesean, etc.) by inhibiting bitter taste and optimizing flavors. Preliminary research of Lactobacillus helveticus suggests that it may reduce blood pressure with a similar mechanism to ACE inhibitors. Additionally, this appears to be yet another strain of bacteria that, when supplemented as a probiotic, alleviates symptoms of depression and anxiety. One study investigated the effect of Lactobacillus helveticus administration to animal models exhibiting hyperammonemia. Hyperammonemia or excessive ammonia within the bloodstream is considered dangerous in that it can inflict severe brain damage and ultimately cause death. Animal models were made hyperammonemic via injections of ammonium acetate for 4-weeks. This caused significant neuroinflammation and altered neurotransmission, particularly of serotonin. Thereafter, they treated the rats with the probiotic Lactobacillus helveticus (strain NS8). Results indicated that the rats treated with Lactobacillus helveticus experienced significant changes in biomarkers. More specifically, the Lactobacillus helveticus NS8 strain decreased neuroinflammation, reduced serotonin metabolism, decreased anxiety, and restored cognitive function. A second study published in 2013 assessed the interaction between diet, gut microbiota, and genetics of mice. Wild-type (WT) and IL-10 deficient mice were placed on either: a standard mouse feed vs. Western-style diet (33% fat and 49% carbs) plus Lactobacillus helveticus probiotics for 21 days. Throughout the study, researchers collected biomarker data and measured anxiety along with spatial memory function. Thereafter, they tested microorganism content within fecal excrement of the mice to determine how quantities of microorganisms affected various measures. Results indicated that all mice (regardless of whether WT or IL-10) eating the Western diet had weight gain along with anxiety and increased cytokine expression (signifying inflammation). It appeared as though Lactobacillus helveticus administration attenuated anxiety and memory deficits associated with Western diet consumption and also reduced anxiety among WT mice on a standard mouse feed diet. Mice with less inflammation responded better to the probiotic than those with high inflammation. Nonetheless, this provides evidence to support the therapeutic potential of Lactobacillus helveticus in reducing anxiety and correcting cognitive deficits. Currently, it is unclear as to what the effects of Lactobacillus helveticus are in humans, particularly healthy ones. That said, Lactobacillus helveticus may reduce inflammation and mediate serotonergic transmission possibly eliciting an anxiolytic and/or antidepressant response. Source: http://www.ncbi.nlm.nih.gov/pubmed/24554471 Source: http://www.ncbi.nlm.nih.gov/pubmed/23566632 Source: http://www.ncbi.nlm.nih.gov/pubmed/23181058 Lactobacillus Plantarum Lactobacillus plantarum is a bacterium that was first isolated from human saliva and is ubiquitous in fermented foods such as: sauerkraut, pickles, and kimchi. It is a member of the Lactobacillus species and may have numerous therapeutic effects in humans. Preliminary evidence suggests that it may decrease soy allergies, attenuate adverse viral effects of HIV, and reduce inflammatory biomarkers throughout the body. A study suggests that Lactobacillus plantarum is capable of enhancing memory, possibly acting as a nootropic and/or neuroprotective agent . This study involved assessing the effects of Lactobacillus plantarum C29 in a sample of 344 aged Fischer rats. Researchers administered each of the probiotic strains orally once per day, 6/7 days per week, for a total of 8 weeks. Results indicated that Lactobacillus plantarum C29 strains restored age-reduced cognitive function, minimized escape latency time (on task), and increased swimming times compared to a control group. Biomarkers had been altered among the rats receiving Lactobacillus plantarum as well, namely: doublecortin (DCX), brain-derived neurotrophic factor (BDNF), and cAMP response element binding protein (CREB) activation. Lactobacillus plantarum also altered expression of: p16, cyclooxygenase-2, mTOR, NF-kappa-beta, Akt, and nitric oxide synthase. It is understood that deficits in BDNF are associated with major depression, as are upregulated inflammatory biomarkers. Lactobacillus plantarum appears to increase BDNF and decrease inflammation, thereby improving neuropsychiatric function in animal models. While this specific strain hasn t been evaluated in humans, it may confer similar benefits to those observed in the trial with aged rats. Source: http://www.ncbi.nlm.nih.gov/pubmed/25598393 Bifidobacterium Animalis Bifidobacterium animalis is a bacterium localized principally within the large intestines of humans with Gram-positive, anaerobic, and rod-shaped features. This probiotic is commonly found within dairy products, but also appears within an array of foods and dietary supplements. Though the health benefits of Bifidobacterium animalis aren t clear, initial studies suggest it may reduce bloating and intestinal discomfort associated with IBS (irritable bowel syndrome). However, the thereapeutic potential of Bifidobacterium animalis is not limited to those with IBS. It appears as though this species acts as an antioxidant by reducing oxidative stress, while simultaneously decreasing enzymatic activity of monoamine oxidase. Assuming it is an effective antioxidant, it may inhibit and/or reduce neuroinflammation resulting from heightened oxidative stress. The reduction in neuroinflammation has potential to decrease likelihood of anxiety, depression, and possibly interfere with the pathogenesis of certain diseases. What s equally exciting as the antioxidative properties associated with Bifidobacterium animalis is its ability to inhibit activity of MAO (monoamine oxidase). Inhibition of MAO allows neurotransmitters (serotonin, dopamine, norepinephrine) to remain in the synaptic cleft for a longer duration without being scavenged by the monoamine oxidase enzyme. As a result, this improves neuronal signaling and possibly the user s mood and/or anxiety. The potency of Bifidobacterium animalis MAO inhibition is unclear, however, an entire class of antidepressants (the MAOIs ) function with this exact mechanism. A 2011 study assessed the activity of Bifidobacterium animalis (strain 01) in vitro and in vivo among aging mice. Results from this study indicated that Bifidobacterium animalis scavenged free radicals and decreased MAO activity. Source: http://www.ncbi.nlm.nih.gov/pubmed/21132298 Lactobacillus Casei Lactobacillus casei is a species of bacterium that inhabits the intestine and oral mucosa of humans. The presence of Lactobacillus casei is considered complementary and conducive to the growth of Lactobacillus acidophilus, another healthy bacterium. Industrially, Lactobacillus casei is often utilized to aid in the production of dairy products such as cheeses. Medically, some evidence indicates that Lactobacillus casei strains such as Shirota may inhibit Helicobacter pylori growth to a small extent. Certain strains of Lactobacillus casei may be useful as an intervention for pathogenic bacterial diseases affecting the gastrointestinal tract. Usage of Lactobacillus casei along with various other healthy bacteria (in the form of a multistrain probiotic) has been successful in preventing antibiotic-associated diarrhea (AAD) and Clostridium difficile infections (CDIs). A study published in 2009 by Rao et al. investigated the Lactobacillus casei Shirota (LcS) strain as an intervention for chronic fatigue syndrome. Patients with chronic fatigue syndrome are understood to exhibit abnormal densities of microorganisms within the gut flora and commonly experience significant anxiety. For this reason, researchers recruited 39 individuals diagnosed with chronic fatigue syndrome and organized a study to administer either: LcS (Lactobacillus casei Shirota) with 8 billion colony forming units (CFUs) or a placebo once per day for 2 months. Stool samples were collected from patients prior to commencement and following the study. Neuropsychiatric states were assessed with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) pre- and post-study. Results indicated that there were significant differences in stool bacteria among those receiving the probiotic compared to those taking the placebo. Those who had received the probiotic exhibited significant increases in Lactobacillus and Bifidobacteria bacteria within excrement compared to the placebo controls. Additionally, there were significant changes on BAI (Beck Anxiety Inventory) scores among those receiving the Lactobacillus casei Shirota (LcS) strains compared to the controls. Researchers concluded that administration of Lactobacillus casei Shirota (LcS) appears to improve colonic health and symptoms of anxiety among those with chronic fatigue syndrome (CFS). The Lactobacillus casei Shirota (LcS) administration elevated concentrations of Bifidobacteria, which may have contributed largely to the therapeutic effects. Bifidobacteria are reportedly capable of increasing tryptophan concentrations, as well as modulating serotonin (5-HT) and dopamine (DA) turnover in regions implicated in depressive and anxiety disorders. Another study investigated the effects of a milk drink containing Lactobacillus casei compared to a placebo. In this study published by Benton et al. (2007), a total of 132 healthy older adults (average age of 61.8 years) were recruited. A total of 124 adults completed the trail which involved drinking either a probiotic-containing (Lactobacillus casei Shirota) milk or a placebo milk devoid of bacterial cultures for 20 days. Results from the study demonstrated significant improvement in mood among a subset of those receiving the Lactobacillus casei Shirota (LcS) milk. Researchers noted that Lactobacillus casei Shirota (LcS) cultures appeared to improve mood among those only with a low/depressive mood at baseline. This suggests that Lactobacillus casei Shirota (LcS) may improve mood among those with subclinical depression, but may not further enhance mood among those with an already-good mood. It is plausible that those with an already-good mood may already have adequate Lactobacillus casei Shirota (LcS) within their gut, whereas those with poorer moods may have had less Lactobacillus casei Shirota (LcS) and ultimately benefitted. Studies of Lactobacillus casei Shirota (LcS) indicate that it may be more effective for anxiety than depression, but still could improve day-to-day mood after 20 days of administration. Whether it s an effective intervention for cases of severe anxiety and depression is unclear. However, it should be hypothesized that Lactobacillus casei Shirota (LcS) may serve as an effective adjunct for those who fail to attain sufficient benefit from first-line treatments. Source: http://www.ncbi.nlm.nih.gov/pubmed/19338686/ Source: http://www.ncbi.nlm.nih.gov/pubmed/17151594 Bifidobacterium Infantis Technically, Bifidobacterium infantis is a subspecies of Bifidobacterium longum, hence the reason most experts simply refer to it as Bifidobacterium longum. However, scientific reports have documented therapeutic effects of this particular subspecies and have actually tested it against parent species Bifidobacterium longum. The Bifidobacterium infantis strain is known for facilitating the production of acetic acid, lactic acid, and formic acid. A study published by Desbonnet et al. (2008) investigated the antidepressant properties of Bifidobacterium infantis on Sprague-Dawley rats. They noted that lack of beneficial gut bacteria may alter monoaminergic activity, alter the HPA (hypothalamic-pituitary-adrenal axis), and lead to onset of depression. To determine efficacy of Bifidobacterium infantis as an antidepressant, they chronically administered it to the rats for 14 days while simultaneously assessed monoaminergic activity, neuroendocrine responses, and immune function. Results indicated that Bifidobacterium infantis has zero effect on swim behaviors of the rats, but it attenuated detrimental biomarkers such as TNF-alpha, IL-6 cytokines, and IFN-gamma. It also significantly bolstered concentrations of tryptophan (the amino acid precursor to serotonin), as well as kynurenic acid (a metabolic byproduct of tryptophan). This suggests that Bifidobacterium infantis may increase serotonin production and/or concentrations. Of additional interest to researchers was the fact that Bifidobacterium infantis decreased 5-HIAA (serotonin metabolites) in the prefrontal cortex and decreased DOPAC (dopamine metabolites) in the amygdaloid cortex. Researchers concluded that Bifidobacterium infantis may promote antidepressant effects as a result of monoamine (serotonin and dopamine) modulation, as well as its anti-inflammatory effect. That said, the study was unable to conclude whether this strain of probiotics legitimately improves mood. Fortunately, a follow-up study was published in 2010 by the same researcher Desbonnet et al. to investigate the effect of Bifidobacterium infantis administration on mood. For this study, researchers used a rat maternal separation (MS) model that is thought to accurately portray a combination of stress-related mood and gastrointestinal disorders. The maternally-separated rats were administered either Bifidobacterium infantis OR Celexa. Thereafter, they engaged in a forced swim test (FST) to determine their level of motivation. Researchers collected measures such as: cytokine levels, central monoamine concentrations, and activation of the HPA (hypothalamic-pituitary-adrenal axis). The maternal separation decreased swim behaviors and increased likelihood of immobility on the forced swim test (FST). It also decreased levels of norepinephrine in the brain, stimulated release of peripheral IL-6 (interleukin), and increased amygdala corticotrophin-releasing factor (a neuropeptide implicated in stress responses). Administration of Bifidobacterium infantis reversed behavioral abnormalities (e.g. swim behaviors and FST immobility), restored concentrations of norepinephrine in the brain, and attenuated immune dysfunction associated with the maternal separation. Researchers concluded that Bifidobacterium infantis is capable of significantly altering neural function. Although Bifidobacterium infantis hasn t been tested in humans, preliminary evidence suggests that it may improve immune function, reduce inflammation, and combat neural changes associated with stress. Its parent species Bifidobacterium longum is already known to possess antidepressant and anxiolytic properties. Those experiencing stress-related depression may benefit from administration of Bifidobacterium infantis. Source: http://www.ncbi.nlm.nih.gov/pubmed/18456279 Source: http://www.ncbi.nlm.nih.gov/pubmed/20696216 Bifidobacterium Breve Bifidobacterium breve is non-motile, anaerobic, and rod-shaped with a cactus-like appearance. It is thought to prevent the growth of candida albicans, an opportunistic fungus that is associated with the onset of oral and genital yeast infections and simultaneously inhibits the proliferation of disconcerting bacteria such as E. coli. Its inclination to compete with other potentially harmful bacteria makes Bifidobacterium breve relatively unique in its mechanism of action. Research has linked sufficient Bifidobacterium breve in the gut to healthy digestive function. Those with depleted Bifidobacterium breve are more likely to develop allergies, diarrhea, flatulence, and even irritable bowel syndrome (IBS). A study published in 2004 by Li et al. discovered that supplementation with Bifidobacterium breve improves intestinal health among low birth weight infants. Lack of Bifidobacterium breve supplementation results in abnormal gut flora development, which may yield numerous deleterious health consequences potentially for the entire lifetime of the infant. In any regard, Bifidobacterium breve may also provide benefit to individuals with neuropsychiatric anxiety disorders. A study conducted by Savignac et al. (2014) documented the effects of Bifidobacterium breve 1205 (a specific strain) to the antidepressant Celexa, as well as another Bifidobacterium strain, and a vehicle (control) treatment. In the results, it was noted that Bifidobacterium breve 1205 was the only intervention that reduced anxiety in the elevated plus maze. A follow-up study published by the same researcher Savignac et al. (2015) documented the effect of Bifidobacterium breve 1205 administration in anxious mice over an 11-week term. It was compared to a vehicle intervention (control) and another Bifidobacterium strain. Results indicated that the anxious mice receiving the Bifidobacterium breve 1205 strain were able to discriminate faster than the control group in an object recognition test. This indicates that Bifidobacterium breve 1205 may enhance cognitive function among those with anxiety and possibly even those without. Although Bifidobacterium breve may not be as effective as Bifidobacterium longum for alleviation of anxiety and depression, clinical evaluation in humans with anxiety is warranted. Source: http://www.ncbi.nlm.nih.gov/pubmed/26445348 Source: http://www.ncbi.nlm.nih.gov/pubmed/15491374 Source: http://www.ncbi.nlm.nih.gov/pubmed/25251188 Source: http://www.ncbi.nlm.nih.gov/pubmed/25794930 Lactobacillus Acidophilus Lactobacillus acidophilus a Gram-positive, microaerophilic bacterium that is perhaps the most popular of all bacteria in probiotic formulations. Lactobacillus acidophilus is found within the gastrointestinal tract and oral mucosa of humans and certain strains are understood to elicit probiotic effects. There is significant evidence to support the administration of Lactobacillus acidophilus for the treatment of diarrhea, SIBO (small-intestinal bacterial overgrowth), and vaginal infections. It is also thought to improve immune function, inhibit growth of cancer cells, and reduce inflammation. A study conducted by Rousseaux et al. (2007) assessed the effect of Lactobacillus acidophilus on the gut of animal models. This study documented that a specific strain of Lactobacillus acidophilus known as NCFM upregulated peripheral mu-opioid receptors and cannabinoid receptors in epithelial cells within the intestine. Whether this correlated to mood improvements and/or anxiety reductions is unknown. However, research shows that animal models who overexpress the CB2 receptor are resistant to symptoms of depression. Hypothetically, it could be that Lactobacillus acidophilus upregulates peripheral (and possibly central) CB2 receptors and, as a result, improves mood. It is unclear as to how modulation of peripheral (or central) mu-opioid receptor densities affects mood of humans. Assuming the combined cannabinoid and mu-opioid receptor modulation that occurs following administration of Lactobacillus acidophilus NCFM in mice is similar in humans, it may decrease depression, anxiety, and/or pain. That said, the mood enhancing properties of specific Lactobacillus acidophilus strains warrant investigation. A study published by Campana et al. (2012) highlighted the fact that Lactobacillus acidophilus is capable of blunting the growth of the pathogenic Campylobacter jejuni bacteria. Campylobacter jejuni is capable of causing anxiety in mice and is associated with unfavorable gut health in humans. The strain of Lactobacillus acidophilus known as ATCC 4356 significantly decreased growth of Campylobacter jejuni and displaced its adhesion to cells. It could be hypothesized that among those with abnormally high concentrations of Campylobacter jejuni, an anxiolytic benefit may be attained following administration of specific Lactobacillus acidophilus strains. Source: http://www.ncbi.nlm.nih.gov/pubmed/17159985/ Source: http://www.ncbi.nlm.nih.gov/pubmed/20649579 Source: http://www.ncbi.nlm.nih.gov/pubmed/22271268/ Trans-Galactooligosaccharides (TOS) Transgalactooligosaccharide is a prebiotic of the galacto-oligosaccharides (GOS) family generated through enzymatic conversion of lactose. It is a non-digestible food ingredient, that when administered, is thought to stimulate the growth of health-conducive bacteria within the body. Galacto-oligosaccharides are unique in that they contain glycosidic bonds, allowing them to remain unhydrolyzed throughout the salivary and digestive tract. As transgalactooligosaccharides (TOS) make their way through the intestinal tract, they promote growth of therapeutic bacteria such as Bifidobacteria and Lactobacilli. Some also speculate that they may interfere with the growth of deleterious bacteria, thereby enhancing immune function, increasing nutrient absorption, and augmenting vitamin synthesis. A study published in 2009 by Silk et al., specifically investigated the effect of transgalactooligosaccharides among individuals with IBS. Researchers speculated that supplementation of transgalactooligosaccharides would improve colonic health of those with IBS compared to a placebo. They organized a crossover trial with 44 patients diagnosed with Rome II positive IBS over a dur prompted


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self assurance Caverject Generic Name: Alprostadil Injection (al PROS ta dil) Brand Name: Caverject, Edex Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings User Reviews Support Group Q & A Pricing & Coupons Uses of Caverject: It is used to treat erectile dysfunction (ED). It may be given to you for other reasons. Talk with the doctor. Slideshow Viagra: How a Little Blue Pill Changed the World What do I need to tell my doctor BEFORE I take Caverject? If you have an allergy to alprostadil or any other part of Caverject (alprostadil injection). 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 been told that you are not healthy enough to have sex. If you have a deformed penis, penile implant, or other penile problems. If you have any of these health problems: Polycythemia or thrombocythemia. If you have any of these health problems: Leukemia, multiple myeloma, sickle cell anemia, or other health problems that may raise the chance of painful erection (hard penis) or an erection that lasts for longer than 4 hours. Ask your doctor if you are not sure. This is not a list of all drugs or health problems that interact with this medicine. 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 Caverject 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 Caverject? Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists. Avoid driving and doing other tasks or actions that call for you to be alert until you see how Caverject affects you. To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down. Be careful going up and down stairs. Talk with your doctor before you drink alcohol. This medicine does not stop the spread of diseases like HIV or hepatitis that are passed through blood or having sex. Do not have any kind of sex without using a latex or polyurethane condom. Do not share needles or other things like toothbrushes or razors. Talk with your doctor. This medicine is not approved for use in women. There is a chance of the needle breaking when using the injection. Needles have broken with part of the needle still in the penis. If the needle breaks and you can grab the broken end, take it out and call your doctor. If you cannot grab the broken end, call your doctor right away. This medicine has benzyl alcohol in it. Benzyl alcohol may cause very bad and sometimes deadly side effects in newborns or infants. This medicine is not approved for use in children. Talk with the doctor. How is this medicine (Caverject) best taken? Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely. Your doctor will teach you how to take Caverject. Follow how to use as you have been told by the doctor or read the package insert. Wash your hands before and after use. Attach new needle before each dose. Do not use a bent needle. Do not try to straighten a bent needle. It may be more likely to break. Throw away needles in a needle/sharp disposal box. Do not reuse needles or other items. When the box is full, follow all local rules for getting rid of it. Talk with a doctor or pharmacist if you have any questions. Do not use if the solution is cloudy, leaking, or has particles. Do not use if solution changes color. What do I do if I miss a dose? This medicine is used on an as needed basis. Do not use 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. Redness, lumps, swelling, tenderness, or curving of the erection (hard penis). Irritation where this medicine is given. Chest pain or pressure or a fast heartbeat. Very bad dizziness or passing out. Very bad headache. Shortness of breath. Very bad penile pain. Any unexplained bruising or bleeding. Call your doctor right away if you have a painful erection (hard penis) or an erection that lasts for longer than 4 hours. This may happen even when you are not having sex. If this is not treated right away, it may lead to lasting sex problems and you may not be able to have sex. What are some other side effects of Caverject? 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. Headache. Penile pain. 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 Caverject? Store as you have been told by the doctor. 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 Caverject, 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 Caverject. 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 Caverject. Review Date: December 6, 2017 Next Side Effects Print this page Add to My Med List More about Caverject (alprostadil) Side Effects During Pregnancy Dosage Information Drug Interactions Support Group Pricing & Coupons En Español 6 Reviews Add your own review/rating Drug class: impotence agents Consumer resources Caverject injectable and transurethral Caverject (Advanced Reading) Other brands: Edex , Muse , Prostin VR Pediatric Professional resources CaverJect (FDA) Alprostadil (AHFS Monograph) Other Formulations Caverject Impulse injectable and transurethral Related treatment guides Erectile Dysfunction} Drug Status Rx Availability Prescription only X Pregnancy Category Not for use in pregnancy N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Caverject Rating 6 User Reviews 8.3 /10 6 User Reviews 8.3 Rate it! Manufacturer Pfizer Inc. Drug Class Impotence agents Vasodilators Related Drugs Erectile Dysfunction Cialis , Viagra , sildenafil , tadalafil , Levitra , vardenafil , alprostadil , Staxyn , Edex , Muse , Caverject Impulse , Stendra , avanafil , Yohimbe , yohimbine , More... Related: Impotence (Erectile Dysfunction)} } ample


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fashionable Altazine Generic Name: tetrahydrozoline ophthalmic (TE tra hye DROZ oh leen off THAL mik) Brand Name: Altazine, Geneye Extra, Geneyes, Opti-Clear, Optigene 3, Redness Relief, Redness Relief Original, Visine, Visine Maximum Redness Relief, Vision Clear Overview Side Effects Dosage Interactions Pregnancy More User Reviews Support Group Q & A What is Altazine (tetrahydrozoline ophthalmic)? Tetrahydrozoline is a vasoconstrictor. It works by narrowing swollen blood vessels in the eyes to reduce eye redness. Tetrahydrozoline ophthalmic (for the eyes) is for temporary relief of minor eye redness, swelling, or draining caused by minor irritants. Tetrahydrozoline ophthalmic may also be used for purposes not listed in this medication guide. Slideshow Healthy Vision Starts Here: 6 Tips That Look Good What is the most important information I should know about Altazine (tetrahydrozoline ophthalmic)? Tetrahydrozoline ophthalmic is for temporary relief of minor eye redness or discomfort caused by minor irritants. Stop using this medicine and call your doctor at once if you have ongoing or worsening eye redness, eye pain, or vision changes. What should I discuss with my healthcare provider before taking Altazine (tetrahydrozoline ophthalmic)? You should not use tetrahydrozoline ophthalmic if you are allergic to it. Ask a doctor or pharmacist if it is safe for you to take this medicine if you have other medical conditions, especially: glaucoma; heart disease, high blood pressure; diabetes; a thyroid disorder; or an eye injury or infection. It is not known whether tetrahydrozoline ophthalmic will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether tetrahydrozoline ophthalmic passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby. How should I take Altazine (tetrahydrozoline ophthalmic)? Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Using the medication too long or too often may worsen your symptoms and cause damage to the blood vessels in your eyes. Wash your hands before using the eye drops. To apply the eye drops: Tilt your head back slightly and pull down your lower eyelid to create a small pocket. Hold the dropper above the eye with the tip down. Look up and away from the dropper and squeeze out a drop. Close your eye and gently press your finger to the inside corner of the eye for about 1 minute, to keep the liquid from draining into your tear duct. Use only the number of drops recommended. Do not touch the tip of the eye dropper or place it directly on your eye. A contaminated dropper can infect your eye, which could lead to serious vision problems. Do not use the eye drops if the liquid has changed colors or has particles in it. Store at room temperature away from moisture and heat. Do not freeze. Keep the bottle tightly closed when not in use. What happens if I miss a dose? Since tetrahydrozoline ophthalmic is used when needed, you may not be on a dosing schedule. If you are on a schedule, use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose. What happens if I overdose? An overdose of tetrahydrozoline ophthalmic is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication. Keep this medicine out of the reach of children. Certain eye medications can cause serious medical problems in a young child who accidentally sucks on or swallows medicine from the eye dropper. What should I avoid while taking Altazine (tetrahydrozoline ophthalmic)? Do not use this medication while wearing contact lenses. Tetrahydrozoline ophthalmic may contain a preservative that can discolor soft contact lenses. Wait at least 15 minutes after using this medicine before putting in your contact lenses. Altazine (tetrahydrozoline ophthalmic) side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using tetrahydrozoline ophthalmic and call your doctor at once if you have: ongoing or worsening eye redness; eye pain; changes in your vision; chest pain, fast or uneven heart rate; or severe headache, buzzing in your ears, anxiety, confusion, or feeling short of breath. Common side effects may include: mild burning or stinging of the eye; blurred vision, watery eyes; or dilated pupils. 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) What other drugs will affect Altazine (tetrahydrozoline ophthalmic)? It is not likely that other drugs you take orally or inject will have an effect on tetrahydrozoline used in the eyes. But many drugs can interact with each other. Tell each of your healthcare providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products. Next Side Effects Print this page Add to My Med List More about Altazine (tetrahydrozoline ophthalmic) Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: ophthalmic antihistamines and decongestants Consumer resources Altazine Other brands: Visine Original , Visine Maximum Redness Relief , Vision Clear , Optigene 3 , ... +4 more Professional resources Tetrahydrozoline Hydrochloride (AHFS Monograph) Related treatment guides Eye Redness Where can I get more information? Your pharmacist can provide more information about tetrahydrozoline ophthalmic. 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: 8.02. Last reviewed: March 29, 2013 Date modified: December 03, 2017 Drug Status Rx OTC Availability Rx and/or OTC N Pregnancy Category Not classified N/A CSA Schedule Not a controlled drug Drug Class Ophthalmic antihistamines and decongestants Related Drugs Eye Redness phenylephrine ophthalmic , fluorometholone ophthalmic , oxymetazoline ophthalmic , Naphcon , naphazoline ophthalmic , tetrahydrozoline ophthalmic , Visine Original , Flarex , Mydfrin , FML Liquifilm , FML , AK-Con , FML Forte Liquifilm , Vision Clear , FML S.O.P. , Clear Eyes Redness Relief , Visine Maximum Redness Relief , Optigene 3 , More... Altazine 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 Altazine support group to connect with others who have similar interests. asserting


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every day How to have new sex in an old relationship By Barbara Carrellas Lots of people in long-term relationships would love to reboot their sex lives but they don t know how to do it. Asking a longtime partner to make changes to your sexual routine as a couple can feel intimidating and scary even dangerous. You may keep your desires to yourself because you don t want to upset the delicate balance in your relationship. And the last thing you want to do is hurt your partner s feelings by implying that they aren t satisfying you anymore even if that s actually the case. These are normal worries, but trust me, they re probably unfounded. It s important to remember that your desire for something different really has nothing to do with your partner. It s much more about you. You are simply in a new phase of your erotic evolution but guess what? Your partner probably is, too. They might be more than ready to shake things up sexually. If you want to let your partner know you re ready to step out of your sexual routine, here are some ideas to consider: 1. Don t assume it s going to be a difficult conversation. Remember that you re talking about sharing a deeper intimate experience with someone you care about. Sure, you might discover some no-go zones, but that s okay. In fact, it s part of the process. While your goal may be more pleasure and fun, you re also strengthening an existing bond and getting closer, not further apart. 2. It s good to start out with something easy and fun. Bring up a recent sex experience you and your partner shared, emphasizing one or two things that really turned you on. Ask your partner to describe some of their favorite erotic moments with you. 3. Invite your partner to reveal a single detail of their secret sexual fantasy. This little morsel of information lets you know what your partner dreams about. Listen carefully and be open and accepting about what they say. Use this as an organic transition to introduce the concept of exploring new sexual territory and say that you really want to do that together. 4. Brainstorm together to create a list of options. Make a list of sexual possibilities from lots of sources from the mild to the wild. Go through your list and mark each item Yes, No or Maybe, as in Yes, I d love that! , No way, not ever! , and Well, maybe I might if Then share your list with your partner. This is a really fun exercise that always produces lots of laughs and even more aha moments. 5. Realize that it isn t important for the two of you to want exactly the same things. Start with one or two things you d both like to explore and go from there. You might want to play the Yes No Maybe game periodically. A year from now, an item in your No way, not ever! column may have moved to the top of Oh yes, now please! column. 6. Celebrate that you are about to take a Big Sexual Adventure together. Some of your escapades will be mind-blowing and others may be a little scary. Some will work; some won t. Some may even lead to explosions of laughter or a few tears. Be bold together. Remember, the right combination of turn-on, safety and risk leads to peak sexual experiences. Always play safely, of course, but get used to lingering outside of your comfort zone. It s where the thrill lives. You can seldom predict where your erotic evolution will lead you and your partner, but what an amazing journey you ll both have along the way! Want to rewind and get more information about low libido? Here s how to find your bliss . maintaining


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place of work Dilatrate-SR Generic Name: isosorbide dinitrate (Oral route, Sublingual route) eye-soe-SOR-bide dye-NYE-trate Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings User Reviews Drug Images Support Group Q & A Pricing & Coupons Commonly used brand name(s) In the U.S. Dilatrate-SR Isochron IsoDitrate Isordil Titradose In Canada Apo-Isdn Isordil Available Dosage Forms: Tablet, Chewable Tablet Capsule, Extended Release Tablet, Extended Release Therapeutic Class: Antianginal Chemical Class: Nitrate Slideshow COPD: Could You Be At Risk? Uses For Dilatrate-SR Isosorbide dinitrate is used to prevent angina (chest pain) caused by coronary artery disease. It does not work fast enough to relieve the pain of an angina attack that has already started. Isosorbide dinitrate belongs to the group of medicines called nitrates. It works by relaxing the blood vessels and increasing the supply of blood and oxygen to the heart while reducing its work load. When used regularly on a long-term basis, this helps prevent angina attacks from occurring. This medicine is available only with your doctor's prescription. Before Using Dilatrate-SR 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 this medicine, the following should be considered: Allergies Tell your doctor if you have ever had any unusual or allergic reaction to this medicine 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 have not been performed on the relationship of age to the effects of isosorbide dinitrate in the pediatric population. Safety and efficacy have not been established. Geriatric Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of isosorbide dinitrate in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving isosorbide dinitrate. 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. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Avanafil Riociguat Sildenafil Tadalafil Vardenafil Interactions with Food/Tobacco/Alcohol Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. 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 this medicine. Make sure you tell your doctor if you have any other medical problems, especially: Congestive heart failure or Heart attack, recent or Hypertrophic cardiomyopathy (a heart disease) or Hypotension (low blood pressure) or Hypovolemia (low amount of blood) Use with caution. May make these conditions worse. Proper Use of isosorbide dinitrate This section provides information on the proper use of a number of products that contain isosorbide dinitrate. It may not be specific to Dilatrate-SR. Please read with care. Take this medicine exactly as directed by your doctor . Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This form of nitrate is used to reduce the number of angina attacks over a long time. It will not relieve an attack that has already started because it works too slowly. The extended-release form releases medicine gradually to provide its effect for 8 to 10 hours. Check with your doctor if you also need a fast-acting medicine to relieve the pain of an angina attack. You should take this medicine first thing in the morning and follow the same schedule each day. This medicine works best if you have a "drug-free" period of time every day when you do not take it. Your doctor will schedule your doses during the day to allow for a drug-free time. Follow the schedule of dosing carefully so the medicine will work properly. Sublingual tablets should not be chewed, crushed, or swallowed. They work much faster when absorbed through the lining of the mouth. Place the tablet under the tongue and let it dissolve there. Do not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving. Swallow the extended-release tablet or capsule whole. Do not split, crush, or chew it. Dosing The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For angina prevention: For oral dosage forms (extended-release tablets or sustained-release capsules): Adults At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 160 mg per day. Children Use and dose must be determined by your doctor. For oral dosage form (tablets): Adults At first, 5 to 20 milligrams (mg) two or three times a day. Your doctor may increase your dose as needed. Children Use and dose must be determined by your doctor. For sublingual dosage form (tablets): Adults 2.5 to 5 milligrams (mg) about 15 minutes before expected physical or emotional stress. Children Use and dose must be determined by your doctor. Missed Dose If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Storage Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Ask your healthcare professional how you should dispose of any medicine you do not use. Precautions While Using Dilatrate-SR If you will be taking this medicine for a long time, it is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects. Do not take avanafil (Stendra ), riociguat (Adempas ), sildenafil (Viagra ), tadalafil (Cialis ), or vardenafil (Levitra ) while you are using this medicine. Using these medicines together may cause blurred vision, dizziness, lightheadedness, or fainting. If you are taking these medicines and you experience an angina attack, you must go to the hospital right away. This medicine may cause headaches. These headaches are a sign that the medicine is working. Do not stop using the medicine or change the time you use it in order to avoid the headaches. If you have severe pain, talk with your doctor. Dizziness, lightheadedness, or faintness may occur, especially when you get up quickly from a lying or sitting position. Getting up slowly may help. Dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for long periods of time, exercise, or if the weather is hot. While you are taking this medicine, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for long periods of time . Do not stop using this medicine without checking first with your doctor . Your doctor may want you to gradually reduce the amount you are using before stopping it completely. Dilatrate-SR Side Effects Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur: Rare Bluish-colored lips, fingernails, or palms dark urine difficulty with breathing dizziness or lightheadedness fever headache pale skin rapid heart rate sore throat unusual bleeding or bruising unusual tiredness or weakness Incidence not known Arm, back, or jaw pain blurred vision chest pain or discomfort chest tightness or heaviness confusion dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position fainting fast or irregular heartbeat sweating Get emergency help immediately if any of the following symptoms of overdose occur: Symptoms of overdose Blurred or loss of vision bulging soft spot on the head of an infant change in consciousness change in the ability to see colors, especially blue or yellow cold, clammy skin convulsions disturbed color perception double vision fast, irregular, pounding, or racing heartbeat or pulse feeling of constant movement of self or surroundings halos around lights headache, severe and throbbing increased sweating loss of appetite loss of consciousness nausea night blindness overbright appearance of lights paralysis sensation of spinning slow heartbeat tunnel vision 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 Dilatrate-SR (isosorbide dinitrate) Side Effects During Pregnancy Dosage Information Drug Images Drug Interactions Support Group Pricing & Coupons En Español 0 Reviews Add your own review/rating Drug class: antianginal agents Consumer resources Dilatrate-SR Other brands: Isordil , Isordil Titradose , IsoDitrate , Isochron Professional resources Dilatrate-SR (FDA) Related treatment guides Angina Pectoris Prophylaxis Angina Esophageal Spasm Heart Failure Pulmonary Hypertension} 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 Manufacturer Endo Pharmaceuticals Inc. Drug Class Antianginal agents Related Drugs Angina aspirin , amlodipine , carvedilol , metoprolol , atenolol , Norvasc , nitroglycerin , propranolol , Nitrostat , Coreg , More... Angina Pectoris Prophylaxis aspirin , metoprolol , atenolol , diltiazem , nitroglycerin , Nitrostat , nifedipine , isosorbide mononitrate , Toprol-XL , Lopressor , More... Dilatrate-SR Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Dilatrate-SR Images Dilatrate-SR 40 mg (SCHWARZ 0920) View larger images Help and Support Looking for answers? Ask a question or go join the Dilatrate-SR support group to connect with others who have similar interests.} } shopper


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