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affordable [0.05:35 years), hypertensive women who also smoke. Hypertension was found to be a risk factor for both users and nonusers, for both types of strokes, while smoking interacted to increase the risk for hemorrhagic strokes. Transient ischemic attacks have also been associated with oral contraceptive use. In a large study, the relative risk of thrombotic strokes has been shown to range from 3 for normotensive users to 14 for users with severe hypertension. The relative risk of hemorrhagic stroke is reported to be 1.2 for nonsmokers who used oral contraceptives, 2.6 for smokers who did not use oral contraceptives, 7.6 for smokers who used oral contraceptives, 1.8 for normotensive users and 25.7 for users with severe hypertension. The attributable risk is also greater in older women. Oral contraceptives also increase the risk for stroke in women with other underlying risk factors such as certain inherited or acquired thrombophilias. Women with migraine (particularly migraine/headaches with focal neurological symptoms such as aura) who take combination oral contraceptives may be at an increased risk of stroke. (See CONTRAINDICATIONS ). d. Dose-Related Risk of Vascular Disease from Oral Contraceptives A positive association has been observed between the amount of estrogen and progestogen in oral contraceptives and the risk of vascular disease. A decline in serum high-density lipoproteins (HDL) has been reported with many progestational agents. A decline in serum high-density lipoproteins has been associated with an increased incidence of ischemic heart disease. Because estrogens increase HDL cholesterol, the net effect of an oral contraceptive depends on a balance achieved between doses of estrogen and progestogen and the nature and absolute amount of progestogen used in the contraceptive. The amount of both hormones should be considered in the choice of an oral contraceptive. Minimizing exposure to estrogen and progestogen is in keeping with good principles of therapeutics. For any particular estrogen/progestogen combination, the dosage regimen prescribed should be one which contains the least amount of estrogen and progestogen that is compatible with a low failure rate and the needs of the individual patient. New acceptors of oral contraceptive agents should be started on preparations containing the lowest estrogen content which is judged appropriate for the individual patient. e. Persistence of Risk of Vascular Disease There are two studies which have shown persistence of risk of vascular disease for ever-users of oral contraceptives. In a study in the , the risk of developing myocardial infarction after discontinuing oral contraceptives persisted for at least 9 years for women 40 to 49 years who had used oral contraceptives for five or more years, but this increased risk was not demonstrated in other age groups. In another study in , the risk of developing cerebrovascular disease persisted for at least 6 years after discontinuation of oral contraceptives, although excess risk was very small. However, both studies were performed with oral contraceptive formulations containing 0.05 mg or higher of estrogens. 2. Estimates of Mortality from Contraceptive Use One study gathered data from a variety of sources which have estimated the mortality rate associated with different methods of contraception at different ages (Table 3). These estimates include the combined risk of death associated with contraceptive methods plus the risk attributable to pregnancy in the event of method failure. Each method of contraception has its specific benefits and risks. The study concluded that with the exception of oral contraceptive users 35 and older who smoke and 40 and older who do not smoke, mortality associated with all methods of birth control is less than that associated with childbirth. The observation of a possible increase in risk of mortality with age for oral contraceptive users is based on data gathered in the 1970 s but not reported until 1983. However, current clinical practice involves the use of lower estrogen dose formulations combined with careful restriction of oral contraceptive use to women who do not have the various risk factors listed in this labeling. Because of these changes in practice, and also because of some limited new data which suggest that the risk of cardiovascular disease with the use of oral contraceptives may now be less than previously observed, the Fertility and Maternal Health Drugs Advisory Committee was asked to review the topic in 1989. The Committee concluded that although cardiovascular disease risks may be increased with oral contraceptive use after age 40 in healthy nonsmoking women (even with the newer low-dose formulations), there are greater potential health risks associated with pregnancy in older women and with the alternative surgical and medical procedures which may be necessary if such women do not have access to effective and acceptable means of contraception. Therefore, the Committee recommended that the benefits of oral contraceptive use by healthy nonsmoking women over 40 may outweigh the possible risks. Of course, older women, as all women who take oral contraceptives, should take the lowest possible dose formulation that is effective. Table 3: Annual Number of Birth-Related or Method-Related Deaths Associated with Control of Fertility per 100,000 Nonsterile Women, by Fertility-Control Method and According to Age AGE Method of control and outcome 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 No fertility-control methods* 7.0 7.4 9.1 14.8 25.7 28.2 Oral contraceptives nonsmoker** 0.3 0.5 0.9 1.9 13.8 31.6 Oral contraceptives smoker** 2.2 3.4 6.6 13.5 51.1 117.2 IUD** 0.8 0.8 1.0 1.0 1.4 1.4 Condom* 1.1 1.6 0.7 0.2 0.3 0.4 Diaphragm/spermicide* 1.9 1.2 1.2 1.3 2.2 2.8 Periodic abstinence* 2.5 1.6 1.6 1.7 2.9 3.6 * Deaths are birth-related **Deaths are method-related Adapted from H.W. Ory, Family Planning Perspectives, -63, 1983. 3. Carcinoma of the Reproductive Organs and Breasts Numerous epidemiological studies have examined the association between the use of oral contraceptives and the incidence of breast and cervical cancer. The risk of having breast cancer diagnosed may be slightly increased among current and recent users of combination oral contraceptives. However, this excess risk appears to decrease over time after combination oral contraceptive discontinuation and by 10 years after cessation the increased risk disappears. Some studies report an increased risk with duration of use while other studies do not and no consistent relationships have been found with dose or type of steroid. Some studies have reported a small increase in risk for women who first use combination oral contraceptives at a younger age. Most studies show a similar pattern of risk with combination oral contraceptive use regardless of a woman s reproductive history or her family breast cancer history. Breast cancers diagnosed in current or previous oral contraceptive users tend to be less clinically advanced than in nonusers. Women with known or suspected carcinoma of the breast or personal history of breast cancer should not use oral contraceptives because breast cancer is usually a hormonally sensitive tumor. Some studies suggest that oral contraceptive use has been associated with an increase in the risk of cervical intraepithelial neoplasia or invasive cervical cancer in some populations of women. However, there continues to be controversy about the extent to which such findings may be due to differences in sexual behavior and other factors. In spite of many studies of the relationship between combination oral contraceptive use and breast and cervical cancers, a cause-and-effect relationship has not been established. Endometrial biopsies performed in a subset of subjects (Study 1; n = 93) ages 18 to 49 years, after 6 to 12 months of use of levonorgestrel and ethinyl estradiol tablets, did not reveal any hyperplasias or malignancies. Endometrial malignancy is rare in this age group, so change in the risk is unlikely to be detected with a study of this size. 4. Hepatic Neoplasia Benign hepatic adenomas are associated with oral contraceptive use, although the incidence of these benign tumors is rare in the . Indirect calculations have estimated the attributable risk to be in the range of 3.3 cases/100,000 for users, a risk that increases after four or more years of use. Rupture of rare, benign, hepatic adenomas may cause death through intra-abdominal hemorrhage. Studies from have shown an increased risk of developing hepatocellular carcinoma in long-term (>8 years) oral contraceptive user. However, these cancers are extremely rare in the and the attributable risk (the excess incidence) of liver cancers in oral contraceptive users approaches less than one per million users. 5. Ocular Lesions There have been clinical case reports of retinal thrombosis associated with the use of oral contraceptives that may lead to partial or complete loss of vision. Oral contraceptives should be discontinued if there is unexplained partial or complete loss of vision; onset of proptosis or diplopia; papilledema; or retinal vascular lesions. Appropriate diagnostic and therapeutic measures should be undertaken immediately. 6. Oral Contraceptive Use Before or During Early Pregnancy Extensive epidemiological studies have revealed no increased risk of birth defects in infants born to women who have used oral contraceptives prior to pregnancy. Studies also do not suggest a teratogenic effect, particularly insofar as cardiac anomalies and limb-reduction defects are concerned, when taken inadvertently during early pregnancy (see CONTRAINDICATIONS section). The administration of oral contraceptives to induce withdrawal bleeding should not be used as a test for pregnancy. Oral contraceptives should not be used during pregnancy to treat threatened or habitual abortion. The possibility of pregnancy should be considered in any patient who may be experiencing symptoms of pregnancy, especially if she has not adhered to the prescribed schedule. Oral contraceptive use must be discontinued if pregnancy is confirmed. 7. Gallbladder Disease Combination oral contraceptives may worsen existing gallbladder disease and may accelerate the development of this disease in previously asymptomatic women. Earlier studies have reported an increased lifetime relative risk of gallbladder surgery in users of oral contraceptives and estrogens. More recent studies, however, have shown that the relative risk of developing gallbladder disease among oral contraceptive users may be minimal. The recent findings of minimal risk may be related to the use of oral contraceptive formulations containing lower hormonal doses of estrogens and progestogens. 8. Carbohydrate and Lipid Metabolic Effects Oral contraceptives have been shown to cause glucose intolerance in a significant percentage of users. Oral contraceptives containing greater than 0.075 mg of estrogens cause hyperinsulinism, while lower doses of estrogen cause less glucose intolerance. Progestogens increase insulin secretion and create insulin resistance, this effect varying with different progestational agents. However, in the nondiabetic woman, oral contraceptives appear to have no effect on fasting blood glucose. Because of these demonstrated effects, prediabetic and diabetic women should be carefully observed while taking oral contraceptives. A small proportion of women will have persistent hypertriglyceridemia while on the pill. As discussed earlier (see WARNINGS , 1a. and 1d.; PRECAUTIONS , 3.), changes in serum triglycerides and lipoprotein levels have been reported in oral contraceptive users. 9. Elevated Blood Pressure An increase in blood pressure has been reported in women taking oral contraceptives and this increase is more likely in older oral contraceptive users and with continued use. Data from the Royal College of General Practitioners and subsequent randomized trials have shown that the incidence of hypertension increases with increasing quantities of progestogens. Women with a history of hypertension or hypertension-related diseases, or renal disease should be encouraged to use another method of contraception. If women with hypertension elect to use oral contraceptives, they should be monitored closely and if significant elevation of blood pressure occurs, oral contraceptives should be discontinued (see CONTRAINDICATIONS section). For most women, elevated blood pressure will return to normal after stopping oral contraceptives, and there is no difference in the occurrence of hypertension among ever- and never-users. 10. Headache The onset or exacerbation of migraine or development of headache with a new pattern that is recurrent, persistent, or severe requires discontinuation of oral contraceptives and evaluation of the cause. (See WARNINGS , 1c. and CONTRAINDICATIONS ). 11. Bleeding Irregularities When prescribing Amethyst, the convenience of having no scheduled menstrual bleeding should be weighed against the inconvenience of unscheduled breakthrough bleeding and spotting. In Study 313-NA, 385/2,134 (18%) of women discontinued prematurely due to bleeding that was reported either as an adverse event or where bleeding was given as one of the reasons for discontinuation (see INDICATIONS AND USAGE, Clinical Studies ). Figure 4 shows the percentage of levonorgestrel and ethinyl estradiol tablets subjects in study 313-NA by pill pack who experienced unscheduled bleeding or spotting only (Defined as No sanitary protection required ). Figure 4: Percentage of Subjects Reporting Bleeding or Spotting Only per Pill Pack *: The N for each pill pack is the number of subjects with 28 days of data. Bleeding required sanitary protection; spotting only did not require sanitary protection. Figure 5 shows the percentage of levonorgestrel and ethinyl estradiol tablets subjects with complete bleeding data in Study 313-NA who had 4 or more and 7 or more days of bleeding and/or spotting during each pill pack cycle. During pill pack 2, 67% of subjects experienced 4 or more days of bleeding and/or spotting and 54% of these subjects experienced 7 or more days of bleeding and/or spotting. During the final cycle of use of levonorgestrel and ethinyl estradiol tablets (pill pack 13), these percentages were 31% and 20%, respectively. Figure 5: Percentage of Subjects Reporting Greater than or Equal to 4 or 7 Days of Bleeding and/or Spotting per Pill Pack (Study 313-NA) *: The N for each pill pack is the number of subjects with 28 days of data. As in any case of bleeding irregularities, nonhormonal causes should be considered and adequate diagnostic measures may be indicated to rule out pregnancy, infection, malignancy, or other conditions. Some women may encounter post-pill amenorrhea or oligomenorrhea (possibly with anovulation), especially when such a condition was preexistent. 12. Ectopic Pregnancy Ectopic as well as intrauterine pregnancy may occur in contraceptive failures. PRECAUTIONS 1. General Patients should be counseled that oral contraceptives do not protect against transmission of HIV (AIDS) and other sexually transmitted diseases (STDs) such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis. Scheduled withdrawal bleeding does not occur with the use of levonorgestrel and ethinyl estradiol, therefore, the absence of withdrawal bleeding cannot be used as a sign of an unexpected pregnancy and as such, unexpected pregnancy may be difficult to recognize. Although pregnancy is unlikely if levonorgestrel and ethinyl estradiol are taken as directed, if for any reason, pregnancy is suspected in a woman using levonorgestrel and ethinyl estradiol, a pregnancy test should be performed. 2. Physical Examination and Follow-Up A periodic personal and family medical history and complete physical examination are appropriate for all women, including women using oral contraceptives. The physical examination, however, may be deferred until after initiation of oral contraceptives if requested by the woman and judged appropriate by the clinician. The physical examination should include special reference to blood pressure, breasts, abdomen, and pelvic organs, including cervical cytology, and relevant laboratory tests. In case of undiagnosed, persistent, or recurrent abnormal vaginal bleeding, appropriate diagnostic measures should be conducted to rule out malignancy. Women with a strong family history of breast cancer or who have breast nodules should be monitored with particular care. 3. Lipid Disorders Women who are being treated for hyperlipidemias should be followed closely if they elect to use oral contraceptives. Some progestogens may elevate LDL levels and may render the control of hyperlipidemias more difficult. (See WARNINGS , 1a., 1d., and 8.) A small proportion of women will have adverse lipid changes while taking oral contraceptives. Nonhormonal contraception should be considered in women with uncontrolled dyslipidemias. Persistent hypertriglyceridemia may occur in a small population of combination oral contraceptive users. Elevations of plasma triglycerides may lead to pancreatitis and other complications. 4. Liver Function If jaundice develops in any woman receiving such drugs, the medication should be discontinued. Steroid hormones may be poorly metabolized in patients with impaired liver function. 5. Fluid Retention Oral contraceptives may cause some degree of fluid retention. They should be prescribed with caution, and only with careful monitoring, in patients with conditions which might be aggravated by fluid retention. 6. Emotional Disorders Patients becoming significantly depressed while taking oral contraceptives should stop the medication and use an alternate method of contraception in an attempt to determine whether the symptom is drug related. Women with a history of depression should be carefully observed and the drug discontinued if depression recurs to a serious degree. 7. Contact Lenses Contact lens wearers who develop visual changes or changes in lens tolerance should be assessed by an ophthalmologist. 8. Gastrointestinal Diarrhea and/or vomiting may reduce hormone absorption resulting in decreased serum concentrations. 9. Drug Interactions Changes in Contraceptive Effectiveness Associated with Coadministration of Other Products: Contraceptive effectiveness may be reduced when hormonal contraceptives are coadministered with antibiotics, anticonvulsants, and other drugs that increase the metabolism of contraceptive steroids. This could result in unintended pregnancy or unscheduled bleeding. Examples include rifampin, rifabutin, barbiturates, primidone, phenylbutazone, phenytoin, dexamethasone, carbamazepine, felbamate, oxcarbazepine, topiramate, griseofulvin, and modafinil. In such cases a nonhormonal back-up method of birth control should be considered. Several cases of contraceptive failure and unscheduled bleeding have been reported in the literature with concomitant administration of antibiotics such as ampicillin and other penicillins, and tetracyclines. However, clinical pharmacology studies investigating drug interactions between combined oral contraceptives and these antibiotics have reported inconsistent results. Enterohepatic recirculation of estrogens may also be decreased by substances that reduce gut transit time. Several of the anti-HIV protease inhibitors have been studied with coadministration of oral combination hormonal contraceptives; significant changes (increase and decrease) in the plasma levels of the estrogen and progestin have been noted in some cases. The safety and efficacy of oral contraceptive products may be affected with coadministration of anti-HIV protease inhibitors. Health care professionals should refer to the label of the individual anti-HIV protease inhibitors for further drug-drug interaction information. Herbal products containing Wort (Hypericum perforatum) may induce hepatic enzymes (cytochrome P 450) and p-glycoprotein transporter and may reduce the effectiveness of contraceptive steroids. This may also result in unscheduled bleeding. Increase in Plasma Levels Associated with Coadministered Drugs: Coadministration of atorvastatin and certain oral contraceptives containing ethinyl estradiol increases AUC values for ethinyl estradiol by approximately 20%. Ascorbic acid and acetaminophen increase the bioavailability of ethinyl estradiol since these drugs act as competitive inhibitors for sulfation of ethinyl estradiol in the gastrointestinal wall, a known pathway of elimination for ethinyl estradiol. CYP 3A4 inhibitors such as indinavir, itraconazole, ketoconazole, fluconazole, and troleandomycin may increase plasma hormone levels. Troleandomycin may also increase the risk of intrahepatic cholestasis during coadministration with combination oral contraceptives. Changes in Plasma Levels of Coadministered Drugs: Combination hormonal contraceptives containing some synthetic estrogens (e.g., ethinyl estradiol) may inhibit the metabolism of other compounds. Increased plasma concentrations of cyclosporine, prednisolone and other corticosteroids, and theophylline have been reported with concomitant administration of oral contraceptives. Decreased plasma concentrations of acetaminophen and lamotrigine, and increased clearance of temazepam, salicylic acid, morphine, and clofibric acid, due to induction of conjugation (particularly glucuronidation), have been noted when these drugs were administered with oral contraceptives. The prescribing information of concomitant medications should be consulted to identify potential interactions. 10. Interactions with Laboratory Tests Certain endocrine- and liver-function tests and blood components may be affected by oral contraceptives: a. Increased prothrombin and factors VII, VIII, IX, and X; decreased antithrombin 3; increased norepinephrine-induced platelet aggregability. b. Increased thyroid-binding globulin (TBG) leading to increased circulating total thyroid hormone, as measured by protein-bound iodine (PBI), T 4 by column or by radioimmunoassay. Free T 3 resin uptake is decreased, reflecting the elevated TBG; free T 4 concentration is unaltered. c. Other binding proteins may be elevated in serum i.e., corticosteroid binding globulin (), sex hormone-binding globulins (SHBG) leading to increased levels of total circulating corticosteroids and sex steroids, respectively. Free or biologically active hormone concentrations are unchanged. d. Triglycerides may be increased and levels of various other lipids and lipoproteins may be affected. e. Glucose tolerance may be decreased. f. Serum folate levels may be depressed by oral contraceptive therapy. This may be of clinical significance if a woman becomes pregnant shortly after discontinuing oral contraceptives. 11. Carcinogenesis See WARNINGS section. 12. Pregnancy Pregnancy Category X. See CONTRAINDICATIONS and WARNINGS sections. 13. Nursing Mothers Small amounts of oral contraceptive steroids and/or metabolites have been identified in the milk of nursing mothers, and a few adverse effects on the child have been reported, including jaundice and breast enlargement. In addition, combination oral contraceptives given in the postpartum period may interfere with lactation by decreasing the quantity and quality of breast milk. If possible, the nursing mother should be advised not to use combination oral contraceptives, but to use other forms of contraception until she has completely weaned her child. 14. Pediatric Use Safety and efficacy of levonorgestrel and ethinyl estradiol tablets have been established in women of reproductive age. Safety and efficacy are expected to be the same for postpubertal adolescents under the age of 16 and for users 16 years and older. Use of this product before menarche is not indicated. 15. Geriatric Use This product has not been studied in women over 65 years of age and is not indicated in this population. 16. Information for the Patient See DETAILED PATIENT LABELING printed below. Adverse Reactions An increased risk of the following serious adverse reactions (see WARNINGS section for additional information) has been associated with the use of oral contraceptives: Thromboembolic and thrombotic disorders and other vascular problems (including thrombophlebitis and venous thrombosis with or without pulmonary embolism, mesenteric thrombosis, arterial thromboembolism, myocardial infarction, cerebral hemorrhage, cerebral thrombosis, transient ischemic attack) Carcinoma of the reproductive organs and breasts Hepatic neoplasia/liver disease (including hepatic adenomas or benign liver tumors) Ocular lesions (including retinal vascular thrombosis) Gallbladder disease Carbohydrate and lipid effects Elevated blood pressure Headache including migraine The following adverse reactions have been reported in patients receiving oral contraceptives and are believed to be drug related (alphabetically listed): Acne Amenorrhea Anaphylactic/anaphylactoid reactions, including urticaria, angioedema, and severe reactions with respiratory and circulatory symptoms Breast changes: tenderness, pain, enlargement, secretion Budd-Chiari syndrome Cervical erosion and secretion, change in Cholestatic jaundice Chorea, exacerbation of Colitis Contact lenses, intolerance to Corneal curvature (steepening), change in Dizziness Edema/fluid retention Erythema multiforme Erythema nodosum Focal nodular hyperplasia Gastrointestinal symptoms (such as abdominal pain, cramps, and bloating) Hirsutism Infertility after discontinuation of treatment, temporary Lactation, diminution in, when given immediately postpartum Libido, change in Melasma/chloasma which may persist Menstrual flow, change in Mood changes, including depression Nausea Nervousness Pancreatitis Porphyria, exacerbation of Rash (allergic) Scalp hair, loss of Serum folate levels, decrease in Spotting Systemic lupus erythematosus, exacerbation of Unscheduled bleeding Vaginitis, including candidiasis Varicose veins, aggravation of Vomiting Weight or appetite (increase or decrease), change in The following adverse reactions have been reported in users of oral contraceptives: Cataracts Cystitis-like syndrome Dysmenorrhea Hemolytic uremic syndrome Hemorrhagic eruption Optic neuritis, which may lead to partial or complete loss of vision Premenstrual syndrome Renal function, impaired OVERDOSAGE Symptoms of oral contraceptive overdosage in adults and children may include nausea, vomiting, breast tenderness, dizziness, abdominal pain, drowsiness/fatigue; withdrawal bleeding may occur in females. There is no specific antidote and further treatment of overdose, if necessary, is directed to the symptoms. NONCONTRACEPTIVE HEALTH BENEFITS The following noncontraceptive health benefits related to the use of oral contraceptives are supported by epidemiological studies which largely utilized oral contraceptive formulations containing doses exceeding 0.035 mg of ethinyl estradiol or 0.05 mg of mestranol. Effects on menses: May decrease blood loss and may decrease the incidence of iron-deficiency anemia May decrease incidence of dysmenorrhea Effects related to inhibition of ovulation: May decrease incidence of functional ovarian cysts May decrease incidence of ectopic pregnancies Effects from long-term use: May decrease incidence of fibroadenomas and fibrocystic disease of the breast May decrease incidence of acute pelvic inflammatory disease May decrease incidence of endometrial cancer May decrease incidence of ovarian cancer DOSAGE AND ADMINISTRATION To achieve maximum contraceptive effectiveness, Amethyst must be taken exactly as directed and at intervals not exceeding 24 hours. The possibility of ovulation and conception prior to initiation of medication should be considered. Women who do not wish to become pregnant after discontinuation should be advised to immediately use another method of birth control. The dosage of Amethyst is one white tablet daily without any tablet-free interval. It is recommended that Amethyst be taken at the same time each day. Initiation of Therapy Instructions for beginning Amethyst are provided in Table 4 below. Table 4 Current contraceptive therapy Amethyst start day Nonhormonal back-up method of birth control needed when correctly starting Amethyst ? None Day 1 of patient s menstrual cycle (during the first 24 hours of her period) No 21-day COC regimen OR 28-day COC regimen Day 1 of patient s withdrawal bleed, at the latest 7 days after her last active tablet No Progestin-only pill Day after taking a progestin-only pill Yes, for the first 7 days of Amethyst tablet-taking Implant Day of implant removal Yes, for the first 7 days of Amethyst tablet-taking Injection Day the next injection is due Yes, for the first 7 days of Amethyst tablet-taking If spotting or unscheduled bleeding occurs, the patient is instructed to continue on the same regimen. This type of bleeding is usually transient and without significance; however, if the bleeding is persistent or prolonged, the patient is advised to consult her health care professional. The possibility of ovulation increases with each successive day that scheduled white tablets are missed. If the patient has not adhered to the prescribed schedule (missed one or more tablets or started taking them on a day later than she should have), the probability of pregnancy should be considered. Hormonal contraception must be discontinued if pregnancy is confirmed. The risk of pregnancy increases with each tablet missed. For additional patient instructions regarding missed tablets, see the WHAT TO DO IF YOU MISS PILLS section in the DETAILED PATIENT LABELING below. Amethyst may be initiated no earlier than day 28 postpartum in the nonlactating mother or after a second-trimester abortion due to the increased risk for thromboembolism (see CONTRAINDICATIONS , WARNINGS , and PRECAUTIONS concerning thromboembolic disease). The patient should be advised to use a nonhormonal back-up method for the first 7 days of tablet-taking. However, if intercourse has already occurred, pregnancy should be excluded before the start of combined oral contraceptive use or the patient must wait for her first menstrual period. In the case of first-trimester abortion, if the patient starts Amethyst immediately, additional contraceptive measures are not needed. HOW SUPPLIED Amethyst (levonorgestrel and ethinyl estradiol tablets, USP 90 mcg levonorgestrel and 20 mcg ethinyl estradiol) is available in a 28 tablet dispenser, arranged in 4 rows of 7 active tablets as follows: 28 round, white, flat face, beveled edge, uncoated tablets debossed with 295 on one side and WATSON on the other side ( 52544-295-28). Store at 20 to 25 C (68 to 77 F) [See USP Controlled Room Temperature]. References available upon request. Manufactured by: Warner Chilcott Company, LLC Fajardo, Puerto Rico 00738 Distributed by: Actavis Pharma, Inc. Parsippany, NJ 07054 USA Revised: June 2016 INFORMATION FOR THE PATIENT Brief Summary Patient Package Insert Amethyst ( Levonorgestrel and Ethinyl Estradiol Tablets , USP 90 mcg / 20 mcg ) Rx O nly This product (like all oral contraceptives) is intended to prevent pregnancy. Oral contraceptives do not protect against transmission of HIV (AIDS) and other sexually transmitted diseases (STDs) such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis. Oral contraceptives, also known as birth-control pills or the pill, are taken to prevent pregnancy, and when taken correctly, have a failure rate of approximately 1 to 2% per year (1 to 2 pregnancies per 100 women per year of use) when used without missing any pills. The average failure rate of large numbers of pill users is approximately 5% per year (5 pregnancies per 100 women per year of use) when women who miss pills are included. However, forgetting to take pills considerably increases the chances of pregnancy. Amethyst is a birth-control pill that is taken every day. When you take Amethyst, the lining of your uterus does not undergo the changes needed for menstruation, and therefore you do not have regular menstrual periods. You are likely to have unscheduled or unplanned bleeding or spotting when you start to use Amethyst. The number of days each month with unscheduled bleeding and spotting usually decreases over time for the majority of women. When using Amethyst, the convenience of having no regular menstrual periods should be weighed against the inconvenience of unsch for lavatory


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distant places How to meditate in 3 minutes a day By Kristen D Eramo, Wellness Coach 10/30/2017 I wanted to learn to meditate. After reading the umpteenth article on how meditation relieves stress, improves concentration, slows aging and makes you happier, I decided to try it. Everything I read made it sound so easy, too. But it wasn t. Instead of feeling calm, I was antsy and distracted. I became acutely aware of every little twitch and spasm in my body. The breathing was hard enough but I was overwhelmed by the swirling river of random thoughts that coursed through my mind endlessly. But after my bumpy start, I began to make progress and you will too. So let s start small. You can lie down or stand up, eyes open or closed. Just take it super slow, and plan for your first few sessions to be super short. Every meditation session starts this way The starting point for meditation is to focus on your breath. You want to notice it coming into your body through your nostrils and then be aware of it flowing out, again through your nostrils. Try it right now, for three breaths. So did your mind start to wander during that third breath? If yes — you are normal! Instead of being discouraged, be glad. These wandering moments lead you to where you want to be: aware . Being aware of your thoughts, as random as they may seem, is the absolute right starting point for a new meditator. Now let s consider how to handle these thoughts as they pop into your head. This is what will move you forward in your meditation. When a thought enters your mind — Did I feed the dog? I like avocados. My knee hurts a little bit. —meditation teachers say, “Return to your breath, and it s the right advice. Okay, try the three breaths again, and now try to keep the inhales and the exhales about the same length. When you start thinking about something else, bring your mind back to those inhales and exhales. Go. It s hard to stay there, laser-pointing your mind on your inhales and exhales, isn t it? It s normal for this to feel unnatural. This is the exact point when many people give up on meditation, and this, unfortunately, is normal too. The best but most annoying secret to successful meditation You have arrived at the first big secret to meditating: don t give up. Meditation is not a destination — it is a flowing process, kind of like everything else in life. You can t meditate for 3 minutes until you can meditate for 3 breaths, then 4 and so on. So keep going. When I was starting out, my thoughts quickly overtook my best intentions to focus on my breathing. I thought, what s the use in this? I m just getting aggravated! I ve got a ton of things to do anyway so I ll just wrap this up This is the reason people say that they “practice meditation. Meditative states are moving targets that shift from moment to moment. So you keep taking those steady inhales and exhales even as your thoughts run around your head like squirrels in a tree. If your breathing speeds up, or you start to subconsciously hold your breath, just start again. Every moment is a fresh start. Just notice, I am breathing fast again. My next breath — which is happening right now — is slower. Good, now here comes my next exhale. Counting your breaths If you re struggling as a beginning meditator, I recommend counting your breaths to help unite your mind with your breathing. Be patient and let this happen naturally, or it won t happen at all. Sometimes I get all the way to 20, feeling as if there hasn t been much change in my mental state. But when I stop breathing and counting and return to my natural breath, I feel different. I am calmer and my breathing is more regulated. Each inhale and exhale lasts about 4 seconds, with a little 1-second pause between them. Each full cycle is about 10 seconds long. When you breathe like this for a count of 20, you have meditated for 3 minutes. When you do this 3-minute routine every day, your focus sharpens. Your memory is crisper and you move through your day with more intention to your actions. Congratulations, dear reader, you are now a meditator. Learn more about deep breathing and relaxation from our YouTube video . newcomers


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most pretty Dimetapp Generic Name: Brompheniramine and Pseudoephedrine Elixir, Liquid, and Syrup (brome fen IR a meen & soo doe e FED rin) Brand Name: Cardec, Dimetapp Overview Side Effects Dosage Interactions Pregnancy More User Reviews Support Group Q & A The Dimetapp Elixir brand name has been discontinued in the U.S. If generic versions of this product have been approved by the FDA, there may be generic equivalents available . Uses of Dimetapp: It is used to treat nose stuffiness. It is used to ease allergy signs. Slideshow Flonase: Avoid These Top 9 Mistakes What do I need to tell my doctor BEFORE I take Dimetapp? If you have an allergy to brompheniramine, pseudoephedrine, or any other part of Dimetapp (brompheniramine and pseudoephedrine elixir, liquid, and syrup). If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. If you have taken certain drugs used for low mood (depression) like isocarboxazid, phenelzine, or tranylcypromine or drugs used for Parkinson's disease like selegiline or rasagiline in the last 14 days. Taking this medicine within 14 days of those drugs can cause very bad high blood pressure. This is not a list of all drugs or health problems that interact with Dimetapp. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor. What are some things I need to know or do while I take Dimetapp? Tell all of your health care providers that you take Dimetapp. This includes your doctors, nurses, pharmacists, and dentists. Do not take more than what your doctor told you to take. Taking more than you are told may raise your chance of very bad side effects. Do not take this medicine for longer than you were told by your doctor. Avoid driving and doing other tasks or actions that call for you to be alert until you see how Dimetapp affects you. Avoid drinking alcohol while taking this medicine. Talk with your doctor before you use other drugs and natural products that slow your actions. Use with care in children. 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 Dimetapp 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 (Dimetapp) best taken? Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely. Take with or without food. Take with food if it causes an upset stomach. Measure liquid doses carefully. Use the measuring device that comes with Dimetapp. If there is none, ask the pharmacist for a device to measure this medicine. What do I do if I miss a dose? If you take Dimetapp on a regular basis, take a missed dose as soon as you think about it. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Do not take 2 doses at the same time or extra doses. Many times this medicine is taken on an as needed basis. Do not take more often than told by the doctor. Dosage Information (comprehensive) What are some side effects that I need to call my doctor about right away? WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. What are some other side effects of Dimetapp? 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. Feeling nervous and excitable. Not able to sleep. Feeling sleepy. 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 Dimetapp? Store at room temperature. Store in a dry place. Do not store in a bathroom. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Check with your pharmacist about how to throw out unused drugs. Consumer Information Use and Disclaimer If your symptoms or health problems do not get better or if they become worse, call your doctor. Do not share your drugs with others and do not take anyone else's drugs. Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor. Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins. Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about Dimetapp (brompheniramine and pseudoephedrine elixir, liquid, and syrup), 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 Dimetapp. 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 Dimetapp. Review Date: November 1, 2017 Next Side Effects Print this page Add to My Med List More about Dimetapp Elixir (brompheniramine / pseudoephedrine) Side Effects During Pregnancy Dosage Information Drug Interactions Support Group 0 Reviews Add your own review/rating Drug class: upper respiratory combinations Consumer resources Other brands: Bromaline , Brotapp , J-TanD PD , Lodrane D , Q-Tapp Professional resources Related treatment guides Allergic Rhinitis Nasal Congestion Drug Status Availability Discontinued C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug WADA Class Anti-Doping Classification Dimetapp Elixir Rating No Reviews - Be the first! 10 /10 No Reviews - Be the first! 10 Rate it! Drug Class Upper respiratory combinations Related Drugs Allergic Rhinitis prednisone , Zyrtec , promethazine , fluticasone nasal , loratadine , cetirizine , Flonase , triamcinolone , montelukast , Claritin , Singulair , More... Nasal Congestion sodium chloride nasal , epinephrine topical , pseudoephedrine , phenylephrine , Afrin , doxylamine , Sudafed Congestion , Claritin-D , loratadine / pseudoephedrine , Loratadine-D 24 Hour , Saline Nasal Mist , More... Related: Hay Fever (Allergic Rhinitis) expenditures


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due to NSI-189 For Depression: New Drug Grows Hippocampus fit

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Photo :NSI-189 For Depression: New Drug Grows Hippocampus

police officers Share 68 +1 Pin 3 Stumble Reddit Shares 71 Individuals diagnosed with major depression often are found to have reduced volume within their hippocampus. The hippocampus is a small region of the brain that is responsible for regulating various memory and spatial navigation functions. It is also believed to play a pivotal role in the regulation of mood. Modern day antidepressants such as SSRIs tend to improve functioning within the hippocampus and are capable of prompting a process called neurogenesis , allowing for the growth of new brain cells. A biotech company named Neuralstem is taking a different approach towards developing a new antidepressant. Their goal is to develop a medication that actually stimulates growth of various regions within the brain. They are attempting to essentially treat depression, and potentially a variety of other conditions (e.g. Alzheimer s disease) with a experimental drug called NSI-189. Unlike traditional antidepressants, NSI-189 doesn t function by solely altering neurotransmitter levels. Rather, it attempts to increase hippocampus volume, neurons, and change neurotransmitter functions. The company s CEO believes that depression is largely influenced by hippocampal size and by increasing its overall volume, many cases can be reversed or cured. What is NSI-189? NSI-189 is an experimental medication that is currently being investigated for the treatment of major depression. It is being developed by a company called Neuralstem, Inc. and is funded by DARPA (Defense Advanced Research Projects Agency) and the NIH (National Institute of Health). Based on the fact that DARPA is invested in this particular drug, it is thought to be relatively promising for the treatment of a variety of conditions including: depression, Alzheimer s disease, PTSD, and age-related cognitive decline. How does NSI-189 work? From a pharmacological standpoint, administration of NSI-189 tends to stimulate neurogenesis (growth of new brain cells) and increase overall volume in the hippocampus. It is thought that this drug may result in improvements in both short and long-term memory functions as well as with spatial navigation. It is believed that targeting the hippocampus is how the drug helps regulate mood and elicit an antidepressant response. The goal of Neuralstem is to essentially treat what they consider to be three major aspects of depression including: Hippocampal volume : The primary target of this drug appears to be increasing volume within the hippocampus. It is thought that by increasing the size of the hippocampus as well as the density of healthy neurons, this will improve mood and cognition. Neurogenesis : The developers have suggested that this drug will improve the functionality of neurons. It will obviously help grow new brain cells and repair damaged regions. Based on preliminary statements from Neuralstem, it could be speculated that neuronal functioning will improve. Neurotransmission : The developers have not yet indicated how the drug will affect neurotransmitter levels. They do state that it does affect neurotransmitters, but the particular ones that it affects are currently undocumented. Potential benefits of NSI-189 There are a few potential benefits of this experimental drug including: antidepressant effects, potential to cure certain conditions, its mechanism of action, and the fact that it increases brain volume in certain regions of the brain with a targeted approach. Brain volume increase : It has the potential to increase overall brain volume in areas that have shrunken as a result of disease or stress. This is significantly different from other current-market medications that attempt to solely address neurotransmitter levels. Increasing the brain volume would allow patients to actually see size differences on an MRI. A direct quote from the CEO: If we can show by MRI that we ve increased hippocampus volume and at the same time reversed depression symptoms for six months after patients have stopped taking the drug, then we ll have a cure. Ironically, using an MRI has been one of my suggestions to improve psychiatric treatment outcomes . Cure potential : Dr. Karl Johe (CEO of Neuralstem) has implied that this drug may have the potential to cure people with conditions related to reduced hippocampal volume. In other words, taking the drug will elicit neurogenesis and initiate growth of certain regions within the brain. When a person stops taking the drug, these regions will have already grown to healthier sizes and functions will be maintained. Hippocampus-targeted : This particular drug appears to target the hippocampus, suggesting that it will improve memory-related functions. It may also help improve performance at tasks that require a high level of spatial navigation. The primary reason for targeting the hippocampus is due to the fact that a major contributor to certain conditions is a shrunken or undersized hippocampus. Improves brain functioning : The drug may prove to enhance or improve overall brain functioning including mental speed, dexterity, and performance, particularly in the hippocampus. This could result in improved ability to retrieve memories (both short and long-term). Mechanism of action : At this time NSI-189 s mechanism of action remains a mystery. As clinical trials progress, more data will surface discussing how the drug elicits its neurogenesis, growth-oriented response upon the hippocampal region of the brain. Neuroprotective / Nootropic potential : Some would surmise that it may carry neuroprotective and/or nootropic properties. It seems relatively obvious that if it works to increase hippocampal volume and functionality, it will improve memory and cognitive functions. It may also help prevent age-related cognitive decline and/or development of neurodegenerative disorders. Neurotransmitter adjustments : Based on preliminary statements from the developers, it is thought that this drug will affect levels of various neurotransmitters. It may affect the speed and/or processing of neurotransmission as well as various receptors. As of now, the mechanism by which it accomplishes this is unknown. Neuralstem s Theory: Reduced Hippocampal Volume Contributes to Depression Among rodents and animals, smaller than average size of the hippocampus has been shown to be a cause of depression. In humans, this is somewhat of an unverified theory, but researchers do know that if NSI-189 is capable of instating growth of the hippocampus, and depression significantly improves, the theory will gain more credibility. Creators of this drug first tested it thoroughly in the lab to determine how well it worked. They utilized neural stem cells and began administering various compounds that they thought may contribute to growth. Many of these substances had promise, but the company couldn t afford to invest in all seven as it would ve been too costly. So they chose one substance of the seven (NSI-189) which they believed would have the best chance of working in humans. Prior to initiating clinical trials, the substance was tested in mice. Results indicated that the mice had significantly increased the size of their hippocampi following administration. A small sample size of human participants were recruited to try this drug and no major adverse effects were observed. Following this, the FDA granted Neuralstem approval to test their drug in those who suffer from major depression. NSI-189 Clinical Trials / Research At the moment, research is too early to determine whether this substance guaranteed to be a safe, effective treatment for major depression. It has completed Phase I clinical trials in 2011 with a sample size of 41 people, and Phase I(B) clinical trials that finished in 2014 with a sample size of 24 people. Therefore at the moment, the drug has only been tested on a sum total of 65 individuals which should be considered a very small sample size. Based on results from the trials though, participants depression improved when administered 40 mg to 80 mg per day of NSI-189. Higher dosages were tested , but no noticeable improvements were noted at doses exceeding 120 mg per day. Therefore one can assume that Neuralstem and other cohorts are trying to determine the ideal dosages to administer moving forward. The interesting aspect of the NSI-189 drug is that it is unlikely to be limited solely to treating depression. Neuralstem plans to initiate additional clinical trials of the drug to determine whether it effectively helps individuals with traumatic brain injuries, neurodegenerative disorders, PTSD, stroke, and age-related cognitive decline. Due to small sample sizes and insufficient evidence, bold claims cannot yet be made regarding using this drug for the treatment of any condition. The first Phase of the clinical trials was conducted primarily to evaluate the drug s safety and calibrate the dosing. Sometime in 2015 the company should be able to advance to Phase II of the trials, assuming no adverse reactions. If results indicate that the drug is helpful and that it is safe in larger populations, the FDA may eventually grant fast track status to the developers, allowing for quicker approval. Final thoughts on NSI-189 as an antidepressant It is impressive that Neuralstem (cool name by the way) is attempting to get creative and come up with a treatment that differs from modern day antidepressants. The drug seems to work solely by affecting growth in the hippocampal region of the brain. It is however unclear as to whether this growth is targeted to this particular region and whether taking the drug could potentially trigger unwanted growth (e.g. a tumor). From an objective standpoint, it could be hypothesized that the drug will have major potential to help repair broken structures within the brain. However, other data including adverse effects, side effects, and average efficacy are unavailable to the public. This drug will certainly be a project to monitor in forthcoming years as biotechnology and pharmaceutical developments continue to progress. On the surface, this treatment seems to be unique. We just don t know whether it is affecting various neurotransmitters and creating neurochemical changes in addition to the growth that it is inducing. It should also be noted that its ability to grow new brain cells sounds exciting, but really shouldn t be considering the fact that SSRIs are capable of the exact same feat. Feel free to share your thoughts on NSI-189 in the comments section below. Share 68 +1 Pin 3 Stumble Reddit Shares 71 Related Posts: New Antidepressant NRX-1074 (NMDA Receptor Modulator) In Development Buspar (Buspirone) For Depression: Exploring The Antidepressant Potential LY-2456302 For Depression: Kappa Opioid Receptor (KOR) Antagonist New Antidepressant GLYX-13 (Clinical Trials): Partial NMDA Receptor Agonist Magnesium For Depression: An Underexplored Treatment all of the sudden


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expecting Honoring Black History While Honoring Mental Health to 15

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Photo :Honoring Black History While Honoring Mental Health

the workers February 16, 2017 MHA has traditionally maintained its blog, Chiming In, to be a vehicle for MHA leadership and staff to post thoughts about current events. This month, we are taking a different turn and highlighting some of MHA s amazing affiliates, partners and associate members as a way to share some of the great work and ideas of our many collaborators. If you are an MHA affiliate, official partner or associate member, and are interested in submitting a blog post, please contact America Paredes at aparedes@mentalhealthamerica.net . As part of Black History Month, the following blog post comes from Minaa B. with Respect Your Struggle, a MHA partner. Trigger Warning: Content discussed addresses suicide and suicidal thoughts. For more than twenty years of my life I struggled with major depression and suicide ideation. Thought after thought, I was consumed with the idea of death and sadness and how to eliminate myself from the rest of the world. I grew tired of carrying my burdens, and when my back could no longer stand up straight from the weight of my pain that I carried in silence - I attempted suicide. The cuts on my wrists were indicators that this brown girl was not okay. I hid myself. Learning how to be bold and brave about my struggles was a behavior that I was never taught. Instead, I was constantly reminded through television, music, the church and conversations, that weak-minded people don t get far in life. The stigmas of society told me that black women didn t complain - they pushed through. Black women didn t get tired - they worked hard. And black people don t struggle with depression - we pray. Then carry on. What a detrimental and debilitating pressure to put on folks who are subjected not only to environmental trauma such as racism, discrimination, oppression and marginalization - but also to the everyday effects of simply being human. Since when is it not okay for black people to find healing? Since when is having a mental illness a reason why I wouldn t make it to heaven? Since when is struggling a form of weakness, when no person in this world is void of mishap and misfortunes? Since when is being imperfect a deficit, when perfection doesn t even exist? This tired rhetoric that people within the African-American community are weak, fragile or touched by the devil if they have a mental illness is man-made propaganda that has been used to keep people of color stuck in their debilitating circumstances, with fewer chances on thriving alongside the rest of the world. The supposition that our ancestors made through slavery - therefore we can make it through anything - is crass and insensitive, not only to the needs of people living in modern times, but also to our ancestors who fought hard for people of color to have access to fair treatment and equality - including health care. We must remember folks like Dr. Solomon Carter Fuller who was a pioneering African-American psychiatrist who made significant contributions to the study of Alzheimer's disease. Or people like Dr. Paul Cornely whose professional work focused on the development of public health initiatives aimed at reducing healthcare disparities among the chronically underserved. Mamie Phipps Clark was the first African-American woman to earn a doctorate degree in psychology from Columbia University. Her groundbreaking research on the impact of race on child development helped end segregation, and was influential in desegregation efforts including the Brown vs. Board of Education in 1954. These people, plus many more, have paved the way for people of color to receive adequate physical and emotional health care. But the lessons they also taught us is that hurt does exists, and people should never be ashamed to talk about it or address it. Even when you think you are isolated in your problems and worries - you are never alone. Your life matters and you deserve to give yourself your best chance - despite what others say. If you are worried that you or a loved one may be struggling with a mental health condition, there is hope. To start, consider taking a free mental health screening to assess your symptoms and find out how to seek help. Understand that though hurt can make you feel as if you are alone - you never are. MHA began the campaign #mentalillnessfeelslike as a way to show individuals struggling through pain and confusing symptoms that they are not alone. . We encourage you to participate too - share your story tell us what #mentalillnessfeelslike to you. Because there is power in sharing. And there is power in knowing that you are not alone. Minaa B. who was born Jessmina Archbold, is a NYC based licensed psychotherapist and founder of the digital mental health magazine Respect Your Struggle . She works in private practice providing wellness services to clients with different complex mental health issues and she works as a mental health advocate and freelance writer for various publications. Minaa is also the author of the book Rivers Are Coming , a collection of essays and poems on healing from depression and trauma. More can be learned about her on www.minaab.com . Tags: respect your struggle black history month african american mental health Mental Health America Blog stressful


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is famous [2:<2 minutes). 1 To avoid excessive foaming, do not shake vial and avoid vigorous agitation. 1 Preferably, prepare immediately before use. 1 Discard if not used within 4 hours. 1 (See Storage under Stability.) Dosage Monitor CD4 + T-cell counts before initiation of therapy and every 2 weeks throughout the 12-week course of therapy. 1 Do not initiate if CD4 + T-cell counts are below normal range. 1 If CD4 + T-cell counts are> <250/mm 3 , withhold therapy and monitor CD4 + T-cell counts weekly . 1 Discontinue if CD4 + T-cell counts remain> <250/mm 3 for 1 month. 1 Adults Psoriasis IV 7.5 mg once weekly for 12 weeks. 1 Monitor CD4 + T-cell counts and adjust dosage accordingly. 1 May initiate retreatment with additional 12-week course if CD4 + T-cell counts are within normal range and 12 weeks have elapsed since previous course. 1 IM 15 mg once weekly for 12 weeks. 1 Monitor CD4 + T-cell counts and adjust dosage accordingly. 1 May initiate retreatment with additional 12-week course if CD4 + T-cell counts are within normal range and 12 weeks have elapsed since previous course. 1 Cautions for Amevive Contraindications HIV infection. 1 11 (See Lymphopenia and also see Infectious Complications under Cautions.) Known hypersensitivity to alefacept or any ingredient in the formulation. 1 Warnings/Precautions Warnings Lymphopenia Risk of lymphopenia, including dose-dependent reductions in circulating CD4 + and CD8 + T-cell counts. 1 Do not initiate in patients with CD4 + T-cell counts below normal range. 1 Monitor CD4 + T-cell counts before initiation of therapy and every 2 weeks throughout the 12-week course of therapy; dosage adjustment may be necessary. 1 (See Dosage under Dosage and Administration.) Do not use in patients with HIV infection. 1 Potential for accelerated progression of HIV or increased infectious complications. 1 11 (See Contraindications under Cautions.) Malignancies Possible increased risk of malignancies (e.g., basal or squamous cell skin cancers, melanoma, other solid tumors, lymphomas). 1 Do not use in patients with history of malignancy. 1 Caution advised when considering use in patients at high risk for malignancy; discontinue if malignancy develops. 1 Infectious Complications Possible increased risk of infection, including reactivation of latent infections. 1 Do not use in patients with clinically important infections (e.g., HIV infection). 1 (See Contraindications and also Lymphopenia, under Cautions.) Caution advised if used in patients with chronic infection or history of recurrent infections. 1 Monitor carefully for manifestations of infection during and after treatment; discontinue if serious infection develops. 1 Sensitivity Reactions Hypersensitivity Hypersensitivity reactions (e.g., urticaria, angioedema) reported; if serious hypersensitivity reaction occurs, discontinue immediately and initiate appropriate therapy. 1 General Precautions Immunosuppressive Effects Do not use concomitantly with other immunosuppressive agents or phototherapy (due to potential for excessive immunosuppression). 1 Immunization Safety and efficacy of live virus vaccine administration in patients receiving alefacept not established. 1 Hepatic Effects Asymptomatic increases in serum AST and/or ALT concentrations, fatty infiltration of the liver, hepatitis, decompensation of cirrhosis with hepatic failure, and acute hepatic failure reported during postmarketing experience; causal relationship to drug not established. 1 Fully evaluate patients with manifestations of hepatic injury. 1 Discontinue alefacept if clinically important hepatic injury develops. 1 Antibody Formation Possible development of low-titer antibodies to alefacept; relationship between development of antibodies and clinical response or incidence of adverse effects not observed. 1 Long-term immunogenicity remains to be determined. 1 Specific Populations Pregnancy Category B. 1 Biogen Pregnancy Registry at 866-263-8483. 1 Lactation Not known whether distributed into milk; discontinue nursing or the drug. 1 Pediatric Use Safety and efficacy not established in children. 1 Geriatric Use No overall differences in safety or efficacy relative to younger adults, but experience insufficient to exclude important differences. 1 Use with caution due to increased incidence of infections and certain malignancies in geriatric patients. 1 Common Adverse Effects Pharyngitis, dizziness, increased cough, nausea, pruritus, myalgia, chills, injection site pain/inflammation, accidental injury. 1 Interactions for Amevive No formal drug interaction studies to date. 1 Specific Drugs Drug Interaction Comments Immunosuppressive agents Possible excessive immunosuppression 1 Concomitant use not recommended; optimal time between alefacept discontinuance and initiation of other agents not established 1 Vaccines, live virus Safety and efficacy not established 1 Amevive Pharmacokinetics Absorption Bioavailability Bioavailability after IM administration is 63%. 1 Distribution Extent Crosses placenta in monkeys. 1 Not known whether distributed into human milk. 1 Elimination Half-life Approximately 270 hours. 1 Stability Storage Parenteral Powder for Injection 2 8 C. 1 Protect from light; retain dose tray in carton until time of use. 1 Store reconstituted solution in vial at 2 8 C; use within 4 hours. 1 Actions Consists of extracellular CD2-binding portion of human leukocyte function-related antigen 3 (LFA-3) linked to Fc portion (hinge region and C H 2 and C H 3 domains) of human IgG 1 . 1 2 3 4 5 7 Interferes with T-cell activation by specifically binding to the antigen CD2 on T cells and inhibiting the interaction between LFA-3 on antigen-presenting cells and CD2. 1 2 3 4 5 Causes reduction in subsets of CD2 + T cells (principally CD45RO + T cells), 6 presumably by bridging between CD2 on target lymphocytes and immunoglobulin Fc receptors on cytotoxic cells such as natural killer cells. 1 Causes dose-dependent decrease in total circulating lymphocytes, principally affecting the memory effector subset of CD4 + and CD8 + T cells (i.e., CD4 + CD45RO + and CD8 + CD45RO + T cells). 1 2 3 4 May affect activation and numbers of cells other than T cells, since CD2 also is expressed at low levels on the surface of natural killer cells and certain bone marrow B cells. 1 Advice to Patients Potential for reduction of lymphocyte counts, which could increase risk of infection or malignancy. 1 Importance of informing clinicians promptly if any signs or symptoms of infection or malignancy occur. 1 Necessity of administration under supervision of a clinician, with regular monitoring of T-cell counts. 1 Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed during or within 8 weeks following discontinuance. 1 For any woman who becomes pregnant, availability of pregnancy registry (see Pregnancy under Cautions). 1 Risk of serious hepatic injury. 1 Importance of reporting persistent nausea, anorexia, fatigue, vomiting, abdominal pain, jaundice, easy bruising, dark urine, or pale stools to clinicians. 1 Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses. 1 Importance of informing patients of other important precautionary information. 1 (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Alefacept (Recombinant) Routes Dosage Forms Strengths Brand Names Manufacturer Parenteral For injection, for IV use 7.5 mg Amevive (available with sterile water for injection diluent, administration set, needles, and syringe) Biogen Idec For injection, for IM use 15 mg Amevive (available with sterile water for injection diluent, needles, and syringe) Biogen Idec AHFS DI Essentials. Copyright 2017, Selected Revisions July 1, 2006. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. References 1. Biogen Idec, Inc. Amevive (alefacept) for injection prescribing information. Cambridge, MA; 2005 Sep. 2. Krueger GG, Papp KA, Stough DB et al. A randomized, double-blind, placebo-controlled phase III study evaluating efficacy and tolerability of 2 courses of alefacept in patients with chronic plaque psoriasis. J Am Acad Dermatol . 2002; 47:821-33. [PubMed 12451365] 3. Pham DQ, Bandy V, Song JC. Alefacept: a T-cell specific immunosuppressant to treat moderate to severe plaque psoriasis. Formulary . 2002; 37:346-53. 4. Ellis CN, Krueger GG, for the Alefacept Clinical Study Group. Treatment of chronic plaque psoriasis by selective targeting of memory effector T lymphocytes. N Engl J Med . 2001; 345:248-55. [PubMed 11474662] 5. Gottlieb AB, Bos JD. Recombinantly engineered human proteins: transforming the treatment of psoriasis. Clin Immunol . 2002; 105:105-16. [PubMed 12482385] 6. Kraan MC, van Kuijk AW, Dinant HJ et al. Alefacept treatment in psoriatic arthritis: reduction of the effector T cell population in peripheral blood and synovial tissue is associated with improvement of clinical signs of arthritis. Arthritis Rheum . 2002; 46:2776-84. [PubMed 12384938] 7. Anon. Alefacept (Amevive) for treatment of psoriasis. Med Lett Drugs Ther . 2003; 45:31-2. 8. Lebwohl M, Christophers E, Langley R et al, for the Alefacept Clinical Study Group. An international, randomized, double-blind, placebo-controlled phase 3 trial of intramuscular alefacept in patients with chronic plaque psoriasis. Arch Dermatol . 2003; 139:719-27. [PubMed 12810502] 9. Biogen, Inc, Cambridge, MA: Personal communication. 10. Center for Biologics Evaluation and Research, US Food and Drug Administration. Biologics license application approval letter for alefacept. Rockville, MD; 2003 Jan 30. 11. Bozic C. Dear healthcare provider letter: important prescribing information for Amevive (alefacept). Cambridge, MA: Biogen Idec; 2005 Oct. Next Interactions Print this page Add to My Med List More about Amevive (alefacept) Side Effects During Pregnancy Dosage Information Drug Interactions Support Group 1 Review Add your own review/rating Drug class: selective immunosuppressants Consumer resources Amevive Amevive Intramuscular (Advanced Reading) Professional resources Amevive (FDA) Alefacept (AHFS Monograph) Related treatment guides Plaque Psoriasis Psoriasis> ]} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Availability Discontinued B Pregnancy Category No proven risk in humans N/A CSA Schedule Not a controlled drug Drug Class Selective immunosuppressants Related Drugs Psoriasis Humira , methotrexate , cyclosporine , Remicade , adalimumab , infliximab , Stelara , Trexall , Rasuvo , acitretin , Neoral , More... Plaque Psoriasis Humira , dexamethasone , methylprednisolone , betamethasone topical , Enbrel , Remicade , Otezla , adalimumab , calcipotriene topical , infliximab , etanercept , Cosentyx , More... Amevive Rating 1 User Review 10 /10 1 User Review 10 Rate it!} } from time to time


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Photo :How memories can go from bad to good

place of work How memories can go from bad to good By Dr. Julie Schwartzbard, MD 11/02/2017 Traumatic memories have a nasty habit of rearing their ugly heads and making us anxious, fearful, angry or resentful. These types of memories can take on outsized proportions, effectively magnifying the size of the event and its aftereffects. Bad memories can take over your conscious mind, often when you re feeling vulnerable or depressed, and plunge you into the past. Recalling a traumatic event over and over again can drop you into a doom loop where you re compelled to rehash the trauma you experienced previously. This can have the unfortunate effect of imprisoning you in the past, instead of allowing you to live in the present, where you re supposed to hang out most of the time. But what if you were able to separate the way the memory makes you feel from the memory itself? If that sounds like some sort of brain-zapping science fiction, amazingly — it s not. Though the science is still emerging, researchers think it may be possible to divorce your feelings from really bad memories. In this case, the traumatic event would still be there lodged in the past but it might not be able to trigger the same fears and anxieties as before. If you were free of those feelings, you d be able to remember bad events without being at their mercy emotionally. Can your brain “erase disturbing image-based memories? When you re struggling with a particularly distressing memory, defining the emotions you feel around that memory is the first step toward ridding yourself of them for good. Even though it s natural to feel sympathy for yourself as you recall something dreadful that happened to you, ironically it s that attachment of emotion that actually perpetuates the negative effects of the initial trauma. Disconnecting the memory itself from how you felt at the time of the event can reduce the negative effects of that memory. The trick is to learn to distract yourself from the emotions by focusing on aspects surrounding the event itself (the song that was playing, the friend who held your hand, how hard it was raining, etc.) instead of how sad or traumatized you felt way back when. This may sound a little simpler to do than it truly is, especially for people who have endured terrible abuse, loss or pain. A psychiatrist or trained therapist can help usher patients through the process gradually, but steadily. But it still suggests that the brain can be lured into protecting us from our memories of traumatic events by letting go of some of the worst details. And that can make a big difference going forward since we have a strong tendency to dwell on these events simply because they ve had such a big impact on our lives. So even though your brain can t prevent trauma from occurring, after the fact, it may be able to deemphasize some of the painful specifics of that event in your memory. Let your memory paint a rosier picture of the past By intentionally tapping into your mind s predisposition to wander, it s possible over time to shrink the power a bad memory holds as well as the difficult emotions that you ve attached to it. Many scientists think this method of separating out the most emotional components of traumatic memories can be more effective, and perhaps healthier, than overtly trying to suppress bad memories. But you may still have work to do, with or without a therapist, in order to be able to fully process the trauma of the original event and how it s affected you. Your brain uses memory to help you bounce back and thrive after a traumatic event. You may not get to choose exactly how it does that, but it s still an undeniable part of your incredibly strong instinct to survive — no matter what. We are resilient life-loving beings and even though it s sometimes misguided, your memory has your back. Really it does. References Denkova, Ekaterina. 2015. Neural Correlates of ‘Distracting from Emotion during Autobiographical Recollection. Soc Cogn Affect Neurosci 10 (2): 219-230. URL: http://beckman.illinois.edu/news/2014/04/emotion-regulation-strategy. Accessed 12.02.15. Read more from Dr. Schwartzbard with her blog: Bad memories can you really forget them? that supply


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you're still Dimetane DX fit

you're still Dimetane DX fit

to socialise Dimetane DX individual that
 
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gorgeous Dimetane DX Generic Name: Brompheniramine, Pseudoephedrine, and Dextromethorphan (brome fen IR a meen, soo doe e FED rin, & deks troe meth OR fan) Brand Name: Bromfed DM, Brotapp-DM, Dimetane DX, Neo DM, Q-Tapp DM, ...show all 7 brand names. TGQ 30PSE/3BRM/15DM, TGQ 50PSE/3BRM/30DM Overview Side Effects Dosage Interactions Reviews More Support Group Q & A Uses of Dimetane DX: It is used to treat nose stuffiness. It is used to ease allergy signs. It is used to relieve coughing. Slideshow Over the Counter Cold Remedies - Which One is Right For You? What do I need to tell my doctor BEFORE I take Dimetane DX? If you have an allergy to brompheniramine, pseudoephedrine, dextromethorphan, or any other part of Dimetane DX (brompheniramine, pseudoephedrine, and dextromethorphan). If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. If you have taken certain drugs used for low mood (depression) like isocarboxazid, phenelzine, or tranylcypromine or drugs used for Parkinson's disease like selegiline or rasagiline in the last 14 days. Taking this medicine within 14 days of those drugs can cause very bad high blood pressure. If you have a cough with a lot of mucous. If you have a long-term cough caused by smoking or being around smoke, or lung problems like asthma or emphysema. This is not a list of all drugs or health problems that interact with Dimetane DX. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor. What are some things I need to know or do while I take Dimetane DX? Tell all of your health care providers that you take Dimetane DX. This includes your doctors, nurses, pharmacists, and dentists. Do not take more than what your doctor told you to take. Taking more than you are told may raise your chance of very bad side effects. Do not take this medicine for longer than you were told by your doctor. Avoid driving and doing other tasks or actions that call for you to be alert until you see how Dimetane DX affects you. Avoid drinking alcohol while taking this medicine. Talk with your doctor before you use other drugs and natural products that slow your actions. Use with care in children. Talk with the doctor. Do not use to make a child sleepy. Talk with the doctor. Different brands of Dimetane DX may have different doses for children. Talk with the doctor before giving this medicine to a child. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using Dimetane DX 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 (Dimetane DX) best taken? Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely. Take with or without food. Take with food if it causes an upset stomach. Measure liquid doses carefully. Use the measuring device that comes with Dimetane DX. If there is none, ask the pharmacist for a device to measure this medicine. What do I do if I miss a dose? If you take Dimetane DX (brompheniramine, pseudoephedrine, and dextromethorphan) on a regular basis, take a missed dose as soon as you think about it. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Do not take 2 doses at the same time or extra doses. Many times this medicine is taken on an as needed basis. Do not take more often than told by the doctor. Dosage Information (comprehensive) What are some side effects that I need to call my doctor about right away? WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. Trouble passing urine. A fast heartbeat. A heartbeat that does not feel normal. Very bad dizziness or passing out. Shortness of breath. Shakiness. Seizures. Blurred eyesight. What are some other side effects of Dimetane DX? 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. Feeling nervous and excitable. Not able to sleep. Feeling sleepy. 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 Dimetane DX? Store at room temperature. Do not freeze. Store in a dry place. Do not store in a bathroom. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Check with your pharmacist about how to throw out unused drugs. Consumer Information Use and Disclaimer If your symptoms or health problems do not get better or if they become worse, call your doctor. Do not share your drugs with others and do not take anyone else's drugs. Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor. Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins. Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about Dimetane DX, 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 Dimetane DX. 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 Dimetane DX. Review Date: November 1, 2017 Next Side Effects Print this page Add to My Med List More about Dimetane DX (brompheniramine / dextromethorphan / pseudoephedrine) Side Effects Dosage Information Drug Interactions Support Group En Espaรฑol 0 Reviews Add your own review/rating Drug class: upper respiratory combinations Consumer resources Dimetane DX Other brands: Bromfed DM , Resperal-DM , Robitussin Allergy & Cough , Brotapp-DM , ... +8 more Professional resources Brompheniramine, Pseudoephedrine, Dextromethorpan Syrup (FDA) Related treatment guides Cough and Nasal Congestion} Drug Status Rx OTC Availability Rx and/or OTC C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug WADA Class Anti-Doping Classification Dimetane DX Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Drug Class Upper respiratory combinations Related Drugs Cough and Nasal Congestion Promethazine VC with Codeine , Bromfed DM , Mucinex D , Vanacof , Deconex , codeine / phenylephrine / promethazine , Vicks NyQuil Severe Cold & Flu , Resperal-DM , Vicks Nyquil Cough , Coricidin HBP Cough & Cold , Deconex DMX , Crantex , Tussin CF , Robitussin Allergy & Cough , Robitussin Nighttime Cough DM , Dimetapp Children's Cold & Cough , Mucinex Fast-Max Severe Congestion & Cough , Relasin-HC , Tusnel , More...} } dependancy


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could be Seroquel (Quetiapine) Side Effects: List of Possibilities get older

could be Seroquel (Quetiapine) Side Effects: List of Possibilities get older

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authorized Share 20 +1 Pin Stumble Reddit Shares 20 Seroquel (Quetiapine) is an atypical antipsychotic drug that is used primarily for the treatment of schizophrenia and in some cases, bipolar disorder. It is also a relatively popular antidepressant augmentation strategy for individuals who don t respond to monotherapeutic options. Off-label some doctors prescribe it at low doses for Tourette syndrome, insomnia and anxiety disorders, despite having no medical (FDA) approval for such conditions. This drug is considered short-acting and acts as an antagonist on the neurotransmitters dopamine, serotonin, and norepinephrine. It also carries significant antihistamine properties like many other antipsychotics, which tends to result in sedation. In comparison to other antipsychotics, it has rapid-action on the D2 dopamine receptor, which in theory should minimize the likelihood of dangerous side effects and significant increases in prolactin. When used to treat a disease like schizophrenia, it can be a very effective drug. Unfortunately, most people that take antipsychotics have a difficult time dealing with the side effects that they cause. If you are taking Seroquel, it is important to understand that potential side effects that you may experience and various factors that contribute to their prevalence. Factors that influence Seroquel side effects There are always factors that influence the occurrence and intensity of side effects that you may experience while taking Seroquel. These factors include things like: individual variation, dose of your medication, how long you ve been taking it, and whether you take any other medications. 1. Individual Variation It should be understood that your reaction to taking this drug will be completely unique to you. The side effects that you experience at your dose, may be completely different for someone else who s taking the same dose. Since everyone has differences in genetics, the way your nervous system reacts to this drug may be completely different than that of another individual. Some people may report significant sexual dysfunction and restlessness, while others may report vomiting and fatigue. There s really no telling what specific side effects will be most problematic for you until you give the medication a shot. Certain individuals will tolerate this antipsychotic well, while others will find the side effects debilitating. 2. Dosage (25 mg to 400 mg) What dosage of Seroquel have you been taking? In general, the greater the dose you take, the more likely you will be to experience side effects. At lower doses, the drug isn t having as much of an influence over your nervous system functioning as it does at higher doses. Therefore lower doses are much less likely to cause significant side effects. As the dosage increases, a person not only will build up more of a tolerance, but the drug will be more influential over their nervous system. At higher doses your body will have to accommodate for a greater amount of the drug, which will impair many natural processes within your body. To minimize side effects, it is always recommended to stay on as low of a dose as possible while still getting benefit from the drug. 3. Time Span The amount of time that you ve been taking Seroquel can also influence side effects. If you just started taking the drug, experiencing some side effects is actually expected. Most people experience a significant number of unwanted effects during the first couple weeks that they take the drug. This is because the nervous system hasn t yet adjusted to the effects of the drug and accommodated for it in everyday functioning. After a month or so, most preliminary side effects should subside and your body should be adjusted to the drug. You may notice some side effects that never go away even after the initial adjustment period these effects can be expected to stay throughout treatment. Finally, as you stay on this drug for a longer time period, you may notice that side effects continue to worsen. For some individuals, they end up increasing the dose because they ve become tolerant to the effects of the drug over time. Increasing the dose is much more likely to also increase side effects. Additionally even if you don t increase the dose over time, for some individuals the drug takes a toll on their nerves and unwanted side effects can intensify or emerge after months or years. 4. Other Drugs Do you currently take any other medications with Seroquel? It is important to realize that many psychotropic medications and illicit drugs can interact and lead to increased side effects. Seroquel is known to interact with antidepressants, steroids, anxiolytics, and even some antifungal drugs. Your doctor should be aware of any contraindications (interactions) with other medications that you are currently taking. If you are unsure about how a drug will interact with Seroquel or suspect an interaction problem, be sure to talk to your doctor. Some people notice that when a new drug is introduced (as in poly-drug treatment) that the new medication causes many unwanted side effects. Understand that this may be a result of an interaction that it is having with Seroquel. Seroquel Side Effects: List of Possibilities Below is a list of common side effects that have been reported while taking Seroquel. Realize that you may not experience every side effect on this list and that most side effects are subject to individual variation. Anxiety : At low doses, this medication is actually used to treat anxiety. However, in some people, this medication can make anxiety even more intense. Anxiety is a common side effect to experience while taking an antipsychotic because you never know how you ll react to the neurotransmitter changes its making. Appetite changes : You may notice an increase or decrease in appetite when initially starting this drug. As you continue taking this drug for awhile, you ll likely notice an increase in appetite. Increased appetite is commonly reported and is associated with weight gain on antipsychotics. Balance problems : This isn t considered a serious side effect, but many people experience difficulties with balance and coordination. If you feel as if your equilibrium is thrown out of whack and you have a tough time maintaining balance, it is likely due to the drug. Blurred vision : If you start taking Seroquel and notice your vision has become blurred, you are not alone. Many people note visual changes as long as they continue taking the medication. It isn t known what causes blurred vision, but some speculate that neurotransmitter changes as well as the drug affecting electrical activity in the retina. Chills : Some people report feeling chilled when they take this drug. The chills may be a sign of a bad reaction or that the drug is making you sick. This drug can cause temperature changes throughout the body. If you feel chills, keep in mind that it s likely from the drug and should eventually subside. Confusion : Another side effect that certain people experience is that of confusion. You may experience disorientation, foggy thinking, memory issues, and feel unable to focus. This state of confusion is usually significant enough to impair cognition. If you feel as though the confusion is overwhelming, talk to your doctor about a solution. Constipation : Inability to pass a bowel movement is another effect people report. If you feel constipated after you ve been taking this drug awhile, realize that it s a common side effect and nothing you can really control. Depression : Despite the fact that this drug is used to help some people with depression, others find that it makes them even more depressed. Most psychotropic drugs have different effects depending on the person. For some individuals, this drug may make them increasingly depressed. Dizziness : Do you feel really dizzy now that you ve been taking Seroquel? Feeling dizzy is usually a result of the brain adapting to changes being made by the drug. You may notice sensations of dizziness and vertigo while on this drug. Usually dizziness is more severe during Seroquel withdrawal than it is while taking it. Drowsiness : It is important to note that the potent antihistamine properties of this drug can lead to significant drowsiness. Therefore it is recommended to avoid operating any motor vehicles or heavy machinery while on this drug. If you are unable to function as a result of the drowsiness, consult your doctor. Dry mouth : This is a very common side effect that most people are able to tolerate. It can be uncomfortable to feel as though your mouth is unable to produce saliva, but most people notice that it improves over time. Unfortunately compared to many other antipsychotics, dry mouth is very common on Seroquel. Extrapyramidal effects : This particular drug is associated with lower rates of extrapyramidal side effects, but that doesn t mean they don t occur. If you experience akathisia (inability to sit still) from restlessness or akinesia (inability to move) you could be having extrapyramidal effects. These are usually caused by the drugs influence over the D2 dopamine receptors. Fatigue : While taking this drug you may notice that you feel more sluggish than usual. Feelings of fatigue and lethargy are commonly reported while on Seroquel. Talk to your doctor if you need to come up with a way to combat this side effect. Headaches : This is a common side effect that can be experienced when taking nearly any medication. If you notice an increase in headaches after you start taking the drug, chances are that it s a side effect. Be sure you are staying hydrated and doing your best to avoid stress as this can help reduce headaches. High blood pressure : Antipsychotics are known to increase a person s blood pressure over time. Be sure to closely monitor your blood pressure to make sure that it falls within a healthy range. If you notice that it increases to a significant extent, your doctor should make medical adjustments. Insomnia : Despite usually causing drowsiness and sleepiness, some people may have the opposite reaction. Depending on the dose and how long a person has been taking it, some people may experience insomnia as a side effect. Memory loss : You may notice that your memory becomes significantly impaired while taking this drug. You may have a tough time remembering recent events and/or retrieving long-term memories. Long term usage of this drug at high doses is associated with permanent unwanted cognitive deficits. Mood swings : Some people have noticed that their moods become erratic and prone to swings while on this drug. You may notice you feel good at times, then depressed other times, and experience an array of mixed emotions. This drug is supposed to help with mood swings, but can make things worse for others. Nausea : A common side effect to experience in the first few weeks of taking the drug is that of nausea. You may feel nauseated to the point that you are about to vomit. Realize that this nausea may be overwhelming, but should subside as you adapt to the drug. Poor concentration : Having poor concentration from this drug is a common side effect, yet one that isn t considered a big deal to doctors. If you are unable to focus on schoolwork and/or job-related tasks, you may need to come up with a solution to combat this effect. Drugs that reduce dopamine activity make concentration very difficult. Restlessness : For certain people, this drug can make them feel restless and unable to sit still. If you exhibit restlessness as a side effect, it may be associated with akathisia. Those who become restless as a result of this antipsychotic may need to take another medication to offset this effect. Sexual dysfunction : Your sex drive may completely diminish while taking Seroquel. Side effects such as erectile dysfunction and inability to orgasm have been reported. If you experience reductions in libido, just know that this effect is likely a result of the drug. Sleepiness : This drug is commonly used as a sleep aid due to the fact that it tends to make people sleepy. If you notice an increase in sleepiness, it is likely a result of the drug acting as an antihistamine. If the sleepiness becomes excessive, you may need to evaluate whether it is tolerable. Sweating : You may notice an increase in sweating throughout the day or night sweats while sleeping. The sweating may be minor or profuse and usually doesn t improve over time. If you notice an increase in sweating, it will likely be a side effect you ll need to put up with. Suicidal thoughts : Even though this medication is supposed to help with depression and suicidal thinking, some people experience a worsening of suicidal thinking. If you become agitated, anxious, and more depressed, then suicidal thoughts may occur. Be sure to talk to your doctor if you notice an increase in suicidal thoughts. Vomiting : Some people can feel sick as a result of taking Seroquel. The medication may prompt nausea, which can become extreme enough to lead a person to vomit. If you start vomiting, it could be a temporary side effect that lasts a few days. Always report this to your doctor, but realize that it may eventually stop as your body adapts to the drug. Weakness : Many people report feeling weakness and/or pain throughout their bodies. These drugs are very sedating and can reduce bone density, thus decreasing our physical strength. This may lead us to feel pain throughout the body and noticeably weak. Weight gain : Most people pack on serious weight when taking antipsychotics. Gaining weight can be depressing and is a reason why many people discontinue their antipsychotic treatment. The weight gain is a result of lethargy, slowed metabolism, and increased appetite while taking the drug. Seroquel Severe Side Effects / Adverse Reactions It is important to realize that many people also have adverse reactions or more severe side effects while taking this drug. If you notice any of the following side effects, be sure to report them to your doctor immediately. Breast enlargement : Even though Seroquel isn t associated with as much prolactin release as other antipsychotics, it can still elevate prolactin levels. When elevated enough, the increase in prolactin will enlarge breasts in both males and females. In males, this side effect is known as gynecomastia and should be reported immediately. Cataracts : Taking an antipsychotic medication has been thought to increase risk of developing cataracts. If you notice changes in your vision, be sure to talk to your doctor. Makers of this drug recommend getting an eye examination every 6 months. Death risk : Taking this drug is associated with an overall increased risk of death. The increase risk is not a result of one particular cause, rather a culmination of possible adverse reactions and overdose while taking an antipsychotic. The increase in death risk is significant among elderly patients with dementia. Diabetes : An unfortunate side effect of taking antipsychotic medications is that they alter functioning in the body, and can lead to permanent development of Type 2 diabetes. Although this isn t a common side effect, it has been reported by a considerable number of people. Heart rate changes : You may notice heart palpitations or sensations that your heart is beating abnormally or loudly in your chest. However, you may also notice that your heart rate becomes irregular or subject to change. This is a known side effect of antipsychotics that should be closely monitored by your doctor. High cholesterol : Your cholesterol and triglycerides may increase to a significant extent while on Seroquel. A medical professional should be able to tell you whether your cholesterol and triglyceride levels are safe. If you notice sudden increases, it s pretty safe to assume that it s from the medication. Low white blood cell count : It is important to monitor your blood cell counts while taking Seroquel. This drug has been found to lower white blood cells in some people. Most doctors will recommend routine blood samples be taken to make sure the drug isn t causing this effect. Neuroleptic Malignant Syndrome : This is a rare reaction that usually results from taking this drug at high doses for extended periods of time. Signs typically include: rigid posture, fever, severe confusion, and an abnormally fast heart rate. If you notice signs of this potential side effect, seek immediate medical attention. Seizures : An adverse reaction that some people report is that of seizures. Having a seizure on this drug isn t very common, but if you experience one, be sure to report it to your doctor. Tardive Dyskinesia : This is an irreversible condition that occurs when a person takes an antipsychotic medication for an extended period (usually at a high dose). The reduction in dopamine tends to cause a person to experience uncontrollable movements, particularly in the face (e.g. lips and tongue). Fortunately this is less common in newer, atypical antipsychotics compared to older typical ones. Seroquel: Weighing the Side Effects (Cons) vs. Benefits (Pros) It can be difficult to decide whether the side effects of Seroquel are worth any perceived benefits that you are getting from the drug. If this is the first antipsychotic medication you ve tried and you are experiencing a lot of unwanted side effects, it may not be a good fit. On the other hand, if you ve tried many antipsychotics and this is the only drug that is providing you with symptom relief, you may be more willing to put up with a few unwanted side effects. Most professionals consider Seroquel to be among the most sedating atypical antipsychotics on the market. It can work well if you are experiencing a lot of agitation and inability to sleep as the antihistamine effects promote drowsiness. It may work great to manage positive symptoms of schizophrenia such as hallucinations and delusions, but may make you so tired that you can t focus or function on any cognitively demanding tasks. It is always recommended to work closely with your doctor to come up with possible solutions to mitigate any side effects caused by the medication. Most people will experience some side effects while taking this medication. It will be up to you to determine whether the drug is providing you with enough benefit to justify the unwanted side effects. 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