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this present day [12:<12 years of age is supported by data in older pediatric patients. 1 Additional pharmacokinetic and safety data are available in a limited number of pediatric patients 2 11 years of age. 1 Efficacy in patients> <2 years of age may be extrapolated from pharmacokinetic data. 1 No specific safety issues identified in patients> <12 years of age. 1 Geriatric Use Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger patients. 1 Common Adverse Effects Headache, oral paresthesia. 1 Factor IX (Recombinant), Fc fusion protein Pharmacokinetics Absorption Plasma Concentrations Exhibits dose-proportional pharmacokinetics. 8 9 Rapid onset of action with peak plasma concentrations attained immediately after a dose. 5 Mean recovery of factor IX approximately 1 unit/dL for each 1 unit/kg of factor IX (recombinant), Fc fusion protein administered. 1 Compared with adults, patients> <12 years of age appear to have lower incremental recovery of factor IX. 1 In one study, incremental recovery was approximately 0.6, 0.7, or 0.9 units/dL per each unit/kg administered in pediatric patients 2 5 years, 6 11 years, or 12 17 years of age, respectively. 1 Distribution Extent Not known whether factor IX (recombinant), Fc fusion protein is distributed into milk. 1 Elimination Half-life Following administration of a single 50-unit/kg dose in patients with hemophilia B, mean terminal half-life was 86.52 hours; average time to reach 1% factor IX activity was 11.5 days. 1 Compared with adults, patients> <12 years of age appear to have higher body weight-adjusted clearance and shorter half-life. 1 In one study, half-life was approximately 66, 72, or 84 hours in patients 2 5 years, 6 11 years, or 12 17 years of age, respectively. 1 In a comparative pharmacokinetic analysis, terminal half-life of factor IX (recombinant), Fc fusion protein was substantially longer than that of a conventional recombinant factor IX preparation (82 versus 33.8 hours). 4 9 Stability Storage Parenteral Powder for Injection 2 8°C; do not freeze or expose to direct sunlight. 1 Freezing may damage prefilled diluent syringe. 1 May store at room temperature ( 30°C) for a single period of up to 6 months within expiration dates. 1 Do not place product back under refrigeration after warming to room temperature. 1 Reconstituted Solution May store reconstituted solution at room temperature ( 30°C) prior to administration; protect from direct sunlight. 1 Use solution within 3 hours of reconstitution; do not refrigerate reconstituted solution. 1 Actions Biosynthetic (recombinant DNA-origin) preparation of blood coagulation factor IX covalently linked to the Fc domain of IgG 1 . 1 7 10 13 16 Fc portion prolongs half-life of factor IX through interaction with the Fc neonatal receptor. 1 5 7 8 9 13 Factor IX portion is similar in structure and function to endogenous factor IX. 1 Patients with hemophilia B have decreased levels of endogenous factor IX, resulting in a hemorrhagic tendency and clinical manifestations such as bleeding into soft tissues, muscles, joints, and internal organs. 1 8 171 Clinical severity and frequency of bleeding generally correlate with degree of deficiency of factor IX activity. 171 Patients with mild hemophilia B generally have >5% of normal activity, those with moderate disease generally have 1 5% of normal activity, and those with severe disease have> <1% of normal activity. 171 Administration of factor IX (recombinant), Fc fusion protein to patients with hemophilia B increases plasma levels of factor IX and temporarily corrects coagulation defect. 1 Also may shorten aPTT, which is typically prolonged in patients with hemophilia B. 1 Produced by recombinant DNA technology in a human embryonic kidney (HEK) cell line; undergoes several purification processes (e.g., nanofiltration, column chromatography) and is manufactured without human and animal proteins. 1 8 13 155 156 Advice to Patients Importance of advising patients to read the manufacturer-provided patient information and instructions for use. 1 Importance of patients reporting to their clinician any adverse reactions or other issues following administration of factor IX (recombinant), Fc fusion protein. 1 Importance of discontinuing therapy and informing a clinician if any manifestations of hypersensitivity (e.g., hives, chest tightness, wheezing, difficulty breathing, swelling of the face) or anaphylaxis occur. 1 Possible development of inhibitors; advise patients to inform clinician if they experience a lack of response to factor IX (recombinant), Fc fusion protein therapy. 1 Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses. 1 Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed. 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. Factor IX (Recombinant), Fc Fusion Protein Routes Dosage Forms Strengths Brand Names Manufacturer Parenteral For injection, for IV use only number of units indicated on label (nominally 250, 500, 1000, 2000, or 3000 units) Alprolix (with prefilled diluent syringe; available with vial adapter) Biogen AHFS DI Essentials. Copyright 2017, Selected Revisions February 24, 2017. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. References 1. Biogen Idec. Alprolix coagulation factor IX (recombinant), Fc fusion protein prescribing information. Cambridge, MA; 2016 Feb. 2. Biogen Idec. Alprolix coagulation factor IX (recombinant), Fc fusion protein instructions for use. Cambridge, MA; 2014 Mar . 3. Food and Drug Administration. Orphan designations pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act (P.L. 97-414). Rockville, MD. From FDA web site. 4. Powell JS, Pasi KJ, Ragni MV et al. Phase 3 study of recombinant factor IX Fc fusion protein in hemophilia B. N Engl J Med . 2013; 369:2313-23. [PubMed 24304002] 5. Shapiro AD, Ragni MV, Valentino LA et al. Recombinant factor IX-Fc fusion protein (rFIXFc) demonstrates safety and prolonged activity in a phase 1/2a study in hemophilia B patients. Blood . 2012; 119:666-72. [PubMed 22110246] 6. Powell JS, Apte S, Chambost H et al. Long-acting recombinant factor IX Fc fusion protein (rFIXFc) for perioperative management of subjects with haemophilia B in the phase 3 B-LONG study. Br J Haematol . 2014; :. [PubMed 25208598] 7. Mancuso ME, Mannucci PM. Fc-fusion technology and recombinant FVIII and FIX in the management of the hemophilias. Drug Des Devel Ther . 2014; 8:365-71. [PubMed 24729686] 8. Valentino LA. Recombinant FIXFc: a novel therapy for the royal disease?. Expert Opin Biol Ther . 2011; 11:1361-8. [PubMed 21780945] 9. Ducore JM, Miguelino MG, Powell JS. Alprolix (recombinant Factor IX Fc fusion protein): extended half-life product for the prophylaxis and treatment of hemophilia B. Expert Rev Hematol . 2014; 7:559-71. [PubMed 25142322] 10. Peters RT, Low SC, Kamphaus GD et al. Prolonged activity of factor IX as a monomeric Fc fusion protein. Blood . 2010; 115:2057-64. [PubMed 20056791] 11. Miguelino MG, Powell JS. Clinical utility and patient perspectives on the use of extended half-life rFIXFc in the management of hemophilia B. Patient Prefer Adherence . 2014; 8:1073-83. [PubMed 25143713] 12. Powell J, Shapiro A, Ragni M et al. Switching to recombinant factor IX Fc fusion protein prophylaxis results in fewer infusions, decreased factor IX consumption and lower bleeding rates. Br J Haematol . 2014; :. [PubMed 25209873] 13. McCue J, Osborne D, Dumont J et al. Validation of the manufacturing process used to produce long-acting recombinant factor IX Fc fusion protein. Haemophilia . 2014; 20:e327-35. [PubMed 24811361] 14. Sommer JM, Buyue Y, Bardan S et al. Comparative field study: impact of laboratory assay variability on the assessment of recombinant factor IX Fc fusion protein (rFIXFc) activity. Thromb Haemost . 2014; 112:. [PubMed 25144892] 15. Wyeth. BeneFIX coagulation factor IX (recombinant) prescribing information. Philadelphia, PA; 2012 March. 16. Shapiro A. Development of long-acting recombinant FVIII and FIX Fc fusion proteins for the management of hemophilia. Expert Opin Biol Ther . 2013; 13:1287-97. [PubMed 23930915] 17. Carcao M. Changing paradigm of prophylaxis with longer acting factor concentrates. Haemophilia . 2014; 20 Suppl 4:99-105. [PubMed 24762284] 155. Medical and Scientific Advisory Council (MASAC), National Hemophilia Foundation. MASAC recommendation regarding the use of recombinant clotting factor products with respect to pathogen transmission (May 6, 2014). MASAC recommendation #226. From National Hemophilia Foundation website. 156. Medical and Scientific Advisory Council (MASAC), National Hemophilia Foundation. MASAC recommendations concerning products licensed for the treatment of hemophilia and other bleeding disorders (revised April 2014). MASAC recommendation #225. From National Hemophilia Foundation website. 171. World Federation of Hemophilia. Guidelines for the management of hemophilia 2nd edition. 2012. From the World Federation of Hemophilia website. 176. Medical and Scientific Advisory Council (MASAC), National Hemophilia Foundation. MASAC recommendation concerning prophylaxis (regular administration of clotting factor concentrate to prevent bleeding) (November 4, 2007). MASAC recommendation #179. From National Hemophilia Foundation website. 185. Carcao MD, Aledort L. Prophylactic factor replacement in hemophilia. Blood Rev . 2004; 18:101-13. [PubMed 15010149] 186. Nilsson IM, Berntorp E, Löfqvist T et al. Twenty-five years experience of prophylactic treatment in severe haemophilia A and B. J Intern Med . 1992; 232:25-32. [PubMed 1640190] 187. Medical and Scientific Advisory Council (MASAC), National Hemophilia Foundation. MASAC recommendations regarding factor concentrate prescriptions and formulary development and restrictions (March 12, 2005). MASAC recommendation #159. From National Hemophilia Foundation website. Next Interactions Print this page Add to My Med List More about coagulation factor ix Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 2 Reviews Add your own review/rating Drug class: miscellaneous coagulation modifiers Consumer resources Coagulation factor IX ... +7 more Professional resources Coagulation Factor IX (Recombinant, Human), Albumin Fusion Protein (rIX-FP) (AHFS Monograph) Factor IX (Human), Factor IX Complex (Human) (AHFS Monograph) Factor IX (Recombinant) (AHFS Monograph) Factor IX (Human) (Wolters Kluwer) Other brands: BeneFix , Alprolix , Alphanine SD , Idelvion , ... +2 more Related treatment guides Factor IX Deficiency Hemophilia B> ]} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Drug Class Miscellaneous coagulation modifiers Related Drugs Factor IX Deficiency tranexamic acid , BeneFix , Cyklokapron , Profilnine SD , Alphanine SD , factor ix complex , More... Hemophilia B BeneFix , Alprolix , NovoSeven RT , Profilnine SD , Alphanine SD , Idelvion , coagulation factor viia , More... Coagulation factor ix Rating 2 User Reviews 8.3 /10 2 User Reviews 8.3 Rate it!} } normal


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struggle through Clarifoam EF Generic Name: sulfacetamide sodium and sulfur topical (SUL fa SEET a mide SOE dee um and SUL fur TOP i kal) Brand Name: Avar, BP 10-Wash, Clarifoam EF, Garimide, Plexion, Prascion Cleanser, Rosanil Cleanser, Rosula, Sulfacleans 8/4, Sumadan, Sumaxin, Suphera, Virti-Sulf, Zencia Wash Overview Side Effects Dosage Professional Interactions More User Reviews Support Group Q & A What is sulfacetamide sodium and sulfur topical? Sulfacetamide sodium and sulfur are antibiotic that fight bacteria. Sulfacetamide sodium and sulfur topical (for the skin) is a combination medicine used to treat acne, rosacea, and seborrheic dermatitis (a red, flaking skin rash). Sulfacetamide sodium and sulfur topical may also be used for purposes not listed in this medication guide. Slideshow Newborn Baby Health: 8 Woes From Cradle Cap And Colic To Whooping Cough What is the most important information I should know about sulfacetamide sodium and sulfur topical? You should not use this medicine if you are allergic to sulfa drugs or if you have kidney disease. What should I discuss with my healthcare provider before using sulfacetamide sodium and sulfur topical? You should not use this medicine if you are allergic to sulfa drugs or if you have kidney disease. To make sure sulfacetamide sodium and sulfur topical is safe for you, tell your doctor about all of your medical conditions. It is not known whether sulfacetamide sodium and sulfur topical will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine. It is not known whether this medicine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby. How should I use sulfacetamide sodium and sulfur topical? Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended. Wash your hands before and after applying this medication. Do not cover the treated skin area unless your doctor has told you to. Use sulfacetamide sodium and sulfur topical regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. Store at room temperature away from moisture and heat. What happens if I miss a dose? Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while using sulfacetamide sodium and sulfur topical? Avoid getting this medication in your eyes, nose, or mouth. If this does happen, rinse with water. Do not use on sunburned, windburned, dry, chapped, irritated, or broken skin. Avoid using other medications on the areas you treat with sulfacetamide sodium and sulfur topical unless your doctor tells you to. Sulfacetamide sodium and sulfur topical side effects Get emergency medical help if you have signs of an allergic reaction : hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using this medicine and call your doctor at once if you have: new or worsening skin rash; joint pain; fever; or mouth sores. Common side effects may include: redness, warmth, swelling, itching, stinging, burning, or irritation of treated skin. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Side Effects (complete list) What other drugs will affect sulfacetamide sodium and sulfur topical? It is not likely that other drugs you take orally or inject will have an effect on topically applied sulfacetamide sodium and sulfur. But many drugs can interact with each other. Tell each of your health care providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products. Next Side Effects Print this page Add to My Med List More about Clarifoam EF (sulfacetamide sodium / sulfur topical) Side Effects Dosage Information Drug Interactions Support Group En Español 10 Reviews Add your own review/rating Drug class: topical antibiotics Consumer resources Clarifoam EF Other brands: Sumadan , Avar , Garimide , Plexion , ... +18 more Professional resources Clarifoam EF (FDA) Related treatment guides Rosacea Seborrheic Dermatitis Acne Where can I get more information? Your pharmacist can provide more information about sulfacetamide sodium and sulfur topical. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Copyright 1996-2012 Cerner Multum, Inc. Version: 3.08. Date modified: December 03, 2017 Last reviewed: September 15, 2015 Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Drug Class Topical antibiotics Related Drugs Rosacea doxycycline , metronidazole topical , brimonidine topical , Lotemax , MetroGel , Vibramycin , ivermectin topical , Finacea , More... Seborrheic Dermatitis prednisone , hydrocortisone topical , ketoconazole topical , dexamethasone , Decadron , Deltasone , ciclopirox topical , More... Acne doxycycline , clindamycin topical , erythromycin topical , minocycline , tretinoin topical , tetracycline topical , dapsone topical , More... Clarifoam EF Rating 10 User Reviews 8.3 /10 10 User Reviews 8.3 Rate it! Related Questions & Answers Generic Clarifoam - Is it Available? Clarifoam EF - Can I use clarifoam along with the Zenmed system and if so, can you help me to? Is the original non-generic Clarifoam EF still being manufactured? 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by no means Home Pregnancy Discomfort Vivid Dreams Vivid Dreams Have you been experiencing a lot of strange dreams lately? Perhaps you have dreamt about walking around naked in front of a crowd? Maybe you have dreamt that you have given birth to a chipmunk or even a fish? Though these dreams may be strange, rest assured they are a very common occurrence during pregnancy. In fact, the majority of pregnant women report an increasing number of vivid dreams throughout the three trimesters of pregnancy. But why do these vivid dreams occur so frequently during pregnancy and what can you do about them? Dream Deluge Pregnancy is a time of many changes, both physical and emotional. From morning sickness to breast tenderness , mood swings to constipation , the changes often seem limitless when it comes to pregnancy. And one of the biggest changes that pregnant women notice is an increase in their number of dreams. You may notice that you experience an increase in all types of dreams, including: Why Do Women Get Vivid Dreams When Pregnant? joyful dreams anxiety dreams nightmares You may also notice that your dreams appear to be more detailed than normal, and are filled with fantastic colors and more vivid features than prior to pregnancy. Are Pregnancy Dreams Normal? Though these vivid dreams can often be confusing and even frightening, it is entirely normal to experience a large number of dreams during pregnancy. There are a variety of reasons that can help explain this dramatic increase in dreams: Pregnancy Hormones: Throughout your pregnancy, your body pumps out a variety of different hormones, including progesterone and estrogen. It is thought that these hormones affect the way we sleep at night, causing us to experience longer periods of REM sleep. It is during REM sleep that our minds begin to dream. Increased Waking: Pregnant women are much more likely to wake up during the night than women who aren t pregnant. Whether you have a leg cramp or a backache , you may find that you wake up several times every night. When your body wakes up from a deep sleep, it has better dream recall than it would had you slept through the night. This means that you may be experiencing more vivid dreams simply because your body is better at recalling them. Pregnancy Anxiety: Pregnancy is a time of distinct changes, many of which are scary and overwhelming. You probably have a number of anxieties over becoming a parent: for instance, you may worry how you will handle having a baby and if you will be a capable mother. Our subconscious mind often works through these anxieties while we are sleeping, in the form of dreams. Table of Contents 1. Vivid Dreams 2. Vivid Dreams1 Page 1 Page 2 Login to comment Log in or sign up Forgot Password? Username: Password: CANCEL (1 Comments) Login to add a comment Post a comment You must be logged in to comment. ericaB i keep dreaming about seeing my baby but because i don't know what she looks like so i keep seeing her as an animal. she has shown up in my dreams as a cat and a bird and a dog. and in my dreams i keep asking the doctors why the baby is so furry and the doctors just say it is a skin condition that will go away. funny huh? 6 years ago maybe


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numerous Duocaine Generic Name: lidocaine hydrochloride and bupivacaine hydrochloride Dosage Form: injection Dosage Professional Reviews Q & A More Duocaine (lidocaine HCl - bupivacaine HCl injection) 1% / 0.375% Sterile Duocaine Description Duocaine is a sterile aqueous solution that contains a mixture of local anesthetic agents, 1% lidocaine and 0.375% bupivacaine. Duocaine solution contains lidocaine HCl, which is chemically designated as acetamide, 2-(diethylamino)-N-(2, 6-dimethylphenyl)-, monohydrochloride and has a molecular weight of 270.80. Lidocaine HCl (C 14 H 22 N 2 O HCl) has the following structure: Duocaine solution also contains bupivacaine HCl, which is chemically designated as 2-piperidinecarboxamide, 1-butyl-N-(2,6-dimethylphenyl)-, monohydrochloride, monohydrate, a white crystalline powder that is freely soluble in 95 percent ethanol, soluble in water, and slightly soluble in chloroform or acetone and has a molecular weight of 342.90. Bupivacaine HCl (C 18 H 28 N 2 O HCl H 2 O) has the following structure: Bupivacaine and lidocaine are related chemically and pharmacologically to the aminoacyl local anesthetics. Bupivacaine is a homologue of mepivacaine, and all three of these anesthetics contain an amide linkage between the aromatic nucleus and the amino or piperidine group. They differ in this respect from the procaine-type local anesthetics, which have an ester linkage. The pKa of bupivacaine (8.1) is similar to that of lidocaine (7.86). However, bupivacaine possesses a greater degree of lipid solubility and is protein bound to a greater extent than lidocaine. Each mL of Duocaine contains: Actives: lidocaine HCl 10 mg, bupivaoaine HCl 3.75 mg. Inactives: sodium chloride, purified water, and hydrochloric acid and/or sodium hydroxide to adjust the pH. It has an osmolality of 280 to 350 mOsmol/kg and a pH of 5.0 to 6.5. Slideshow View Frightful (But Dead Serious) Drug Side Effects Duocaine - Clinical Pharmacology Duocaine blocks the generation and conduction of nerve impulses, presumably increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse, and by reducing the rate of rise of the action potential. Systemic absorption of Duocaine produces effects on the cardiovascular and central nervous systems. It may cause changes in cardiac output, total peripheral resistance, and mean arterial pressure. It can also produce central nervous system stimulation, depression, or both. Pharmacokinetics Absorption The rate of systemic absorption of local anesthetics is dependent upon the total dose and concentration of drug administered, the route of administration, the vascularity of the administration site, and the presence or absence of a vasoconstrictor agents in the anesthetic solution. Lidocaine and bupivacaine are absorbed after peribulbar, parabulbar, and retrobulbar blockage administration. The mean (SD) [range] pharmacokinetic parameters of lidocaine and bupivacaine in plasma after a single 10 mL dose (100 mg lidocaine and 37.5 mg bupivacaine) by peribulbar block in 6 subjects were as follows: Cmax (ng/ml) AUC 0 t (ng.h/ml) T max (min) Lidocaine Bupivacaine Lidocaine Bupivacaine Lidocaine Bupivacaine 1287 (522) 552 (218) 2913 (1497) 1291 (536) 20 21 [550 1910] [300 900] [1226 5199] [708 2141] [12 30] [12 33] Therapeutic effects of lidocaine are generally associated with plasma levels at 6 to 25 µmole/L (1500 to 6000 ng free base per mL). The blood to plasma distribution ratio is approximately 0.84. Objective adverse manifestations become increasingly apparent with increasing plasma levels above 6000 ng free base per mL. A dilute concentration of epinephrine, e.g. 1:200,000 or 5µg/mL, usually reduces the rate of systemic absorption and peak plasma concentration of lidocaine and bupivacaine, permitting the use of moderately larger total doses and sometimes prolonging the duration of action. Distribution Depending upon the route of administration, local anesthetics are distributed to some extent to all body tissues, with high concentrations found in highly perfused organs such as the liver, lungs, heart, and brain. The plasma protein binding of lidocaine is dependent on drug concentration, and the fraction bound decreases with increasing concentration. At concentrations of 1 to 4 mcg free base per mL, 60 to 80 percent of lidocaine is protein bound. In addition to lidocaine concentration, the binding is dependent on the plasma concentration of the alpha-1-acid glycoprotein. Lidocaine readily crosses the placental and blood-brain barriers. Bupivacaine hydrochloride has a low fetal/maternal ratio of 0.2 to 0.4. Metabolism Lidocaine is metabolized by the liver, and less than 10% of a dose is excreted unchanged in the urine. Oxidative N dealkylation, a major pathway of metabolism, results in the metabolites monoethylglycinexylidide and glycinexylidide. The pharmacological/toxicological activities of these metabolites are similar to, but less potent than, lidocaine. The primary metabolite in urine is a conjugate of 4-hydroxy-2,6,- dimethylaniline. Because of the rapid rate at which lidocaine is metabolized, any condition that alters liver function, including changes in liver blood flow, which could result from severe congestive heart failure in shock, may alter lidocaine kinetics. The half-life may be two-fold or more, greater in patients with liver dysfunction. Renal dysfunction does not affect lidocaine kinetics, but may increase the accumulation of metabolites. Dialysis has negligible effects on the kinetics of lidocaine. Bupivacaine is metabolized primarily in the liver via conjugation with glucuronic acid. Pipecoloxylidine is the major metabolite of bupivacaine. Only 6% of bupivacaine is excreted unchanged in the urine. Patients with hepatic disease, especially those with severe hepatic disease, may be more susceptible to the potential toxicities of the amidetype local anesthetics. Elimination The Kidney is the main excretory organ for most local anesthetics and their metabolites. The elimination half-life of lidocaine following an intravenous bolus injection is typically 1.5 to 2 hours. The half-life of bupivacaine in adults is 2.7 hours. Indications and Usage for Duocaine Duocaine (lidocaine HCl - bupivacaine HCl injection 1% / 0.375%) is indicated for the production of local or regional anesthesia for ophthalmologic surgery by peripheral nerve block techniques such as parabulbar, retrobulbar and facial blocks. Peribulbar nerve block anesthesia, with or without epinephrine and/or hyaluronidase. Retrobulbar and facial nerve block anesthesia, with or without epinephrine and/or hyaluronidase. Contraindications Duocaine is contraindicated in patients with a known hypersensitivity to lidocaine or bupivacaine or any local anesthetic agent of the amide type or to other components of lidocaine and/or bupivacaine solutions. Duocaine should not be used in patients with Stokes-Adams syndrome. Wolff Parkinson-White syndrome, or with severe degrees of sinoatrial atrioventricular, or intraventricular block in the absence of an artificial pacemaker. Warnings Duocaine , like any local anesthetics, should only be employed by clinicians who are well versed in diagnosis and management of dose-related toxicity and other acute emergencies which might arise from the block to be employed, and then only after ensuring the immediate availability of oxygen, other resuscitative drugs, cardiopulmonary resuscitative equipment, and the personnel resources needed for proper management of toxic reaction and related emergencies (see: ADVERSE REACTIONS , PRECAUTIONS , and OVERDOSAGE ). Delay in proper management of dose-related toxicity, underventilation from any cause and/or altered sensitivity may lead to the development of acidosis, cardiac arrest and, possibly, death. Systemic toxicity of local anesthetics usually results from either accidental intravascular injection or administration of an excessive dose. It is essential that aspiration for blood be done prior to injecting Duocaine , both the original dose and all subsequent doses, to avoid intravascular injection. The needle must be repositioned until no blood can be elicited by aspiration. Note, however, that the absence of blood in the syringe does not guarantee that intravascular injection has been avoided. If a vasoconstrictor, such as epinephrine, has been added for reducing the rate of systemic absorption of anesthetics, Duocaine solution should not be used concomitantly with ergot-type oxytocic drugs, because a severe persistent hypertension may occur. Likewise, Duocaine containing a vasoconstrictor should be used with extreme caution in patients receiving monoamine oxidase (MAO) inhibitors or antidepressants of the triptyline or imipramine types, because severe prolonged hypertension may be the result. Precautions General Clinicians who perform anesthesia for ophthalmic surgery should be aware that the anesthetic potency and toxicity of local anesthetics are additive, though not synergistic. As a mixture of local anesthetics, the total doses of Duocaine should not exceed the maximum recommended dose equivalent for either drug. Being the same chemical classes of local anesthetics, the dose-dependent toxicity of Duocaine is similar for both lidocaine and bupivacaine. To minimize the possibility of toxic reactions of Duocaine , the lowest dosage that results in effective anesthesia should be used to avoid high plasma levels and serious adverse effects. An intravascular injection is still possible even if aspirations for blood are negative. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use. (See: WARNINGS and ADVERSE REACTIONS ). The rapid injection of a large volume of Duocaine solution, especially in retrobulbar block, should be avoided and fractional (incremental) doses should be used when feasible. Repeated doses of Duocaine may cause significant increases in blood levels with each repeated dose because of slow accumulation of the drug or its metabolites. Debilitated, elderly patients, acutely ill patients, and children should be given reduced doses commensurate with their age and physical condition. Duocaine should also be used with caution in patients with severe shock or heart block. Preparations containing a vasoconstrictor should be used with caution in patients during or following the administration of potent general anesthetic agent, since cardiac arrhythmia may occur under such conditions. Careful and constant monitoring of cardiovascular and respiratory (adequacy of ventilation) vital signs and the patient's state of consciousness should be accomplished after each Duocaine (lidocaine HCl - bupivacaine HCl injection 1% / 0.375%). Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness may be early warning signs of central nervous system toxicity. Since amide-type local anesthetics are metabolized by the liver, Duocaine should be used with caution in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at greater risk of developing toxic plasma concentrations. Duocaine should also be used with caution in patients with impaired cardiovascular function since they may be less able to compensate for functional changes associated with the prolongation of A-V conduction produced by these drugs. Duocaine should be used with caution in persons with known drug sensitivities. Patients allergic to para-aminobenzolic acid derivatives (procaine, tetracaine, benzocaine and chloro-procaine, etc.) have not shown cross sensitivity to lidocaine and bupivacaine. Small doses of Duocaine injected into the head area, including periocular blocks, and facial nerve blocks, may produce adverse reactions similar to systemic toxicity seen with unintentional intravascular injections of large doses. Confusion, convulsion, respiratory depression and/or respiratory arrest, and cardio-vascular stimulation or depression have been reported. These reactions may be due to intra-arterial injection of the local anesthetic with retrograde flow to the cerebral circulation. They also may be due to puncture of the dural sheath of the optic nerve during retrobulbar block with diffusion of any local anesthetic along the subdural space to the midbrain. Clinicians who perform retrobulbar and peribulbar blocks should be aware that there have been reports of respiratory arrest following local anesthetic injection. Information for Patients When appropriate, patients should be informed in advance that they may experience temporary loss of sensation and motor activity of their eye(s). Drug Interactions The administration of local anesthetic solutions containing vasoconstrictor such as epinephrine to patients receiving monoamine oxidase inhibitors or tricyclic antidepressants may produce severe, prolonged hypertension. Phenothiazine and butyrophenone may reduce or reverse the pressor effect of epinephrine. Concurrent administration of vasopressor drugs and ergot-type oxytocic drugs may cause severe, persistent hypertension or cerebrovascular accidents. Concurrent use of these agents should generally be avoided. In situations when concurrent therapy is necessary, careful patient monitoring is essential. Lidocaine hydrochloride should be used with caution in patients with digitalis toxicity accompanied by atrioventricular block. Concomitant use of beta-blocking agents may reduce hepatic blood flow and thereby reduce lidocaine clearance. Lidocaine and tocainide are pharmacologically similar. The concomitant use of these two agents may cause an increased incidence of adverse reactions, including central nervous system adverse reactions such as seizure. Carcinogenesis, Mutagenesis, and Impairment of Fertility Long-term studies in animals using most local anesthetics, including lidocaine and bupivacaine, to evaluate the carcinogenic potential have not been conducted. Lidocaine is not mutagenic in the Ames assay, chromosomal aberration test in human lymphocytes in vitro , or in the mouse micronucleus test in vivo. Pregnancy Teratogenic Effects Pregnancy Category C Reproductive studies have been performed in rats at 30 mg/kg subcutaneously, approximately 1.4 times the maximum recommended human dose of 200 mg on the basis of body surface conversion, and have revealed no evidence of harm to the fetus caused by lidocaine. There are no adequate and well-controlled studies in pregnant women of the effect of either lidocaine or bupivacaine on the developing fetus. Duocaine should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. Labor and Delivery It has been demonstrated that Bupivacaine component of Duocaine crosses the placenta when absorbed from the periocular fat after ocular blockage administration, can cause varying degrees of maternal, fetal and neonatal toxicity. (see: CLINICAL PHARMACOLOGY, Pharmacokinetics ). The potential for toxicity depends upon the procedure performed, the type and amount of drug used, and the technique of drug administration. Adverse reactions in the parturient, fetus and neonate involve alterations of the central nervous system, peripheral vascular tone and cardiac function. Nursing Mothers Bupivacaine has been reported to be excreted in human milk suggesting that the nursing infant could be theoretically exposed to a dose of the drug. It is not known if lidocaine is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from Duocaine , a decision should be made whether to discontinue nursing or not administer Duocaine , taking into account the importance of the drug to the mother. Pediatric Use Safey and effectiveness have not been established in pediatric patients below 12 years of age. Geriatric Use No overall differences in safety or effectiveness have been observed between elderly and other adult patients. Adverse Reactions Reactions to Duocaine are characteristic of those associated with other amide-type local anesthetics. A major cause of adverse reactions to this group of drugs may be associated with its excessive plasma levels, which may be due to overdosage, unintentional intravascular injection or slow metabolic degradation. Systemic The most commonly encountered acute adverse experiences that demand immediate countermeasures are related to the central nervous system and the cardiovascular system. These adverse experiences are generally dose related and due to high plasma levels which may result from overdosage, rapid absorption from the injection site, diminished tolerance or from unintentional intravascular injection of the Duocaine . Hypotension due to loss of sympathetic tone and respiratory paralysis or underventilation due to cephalad extension of the motor level of anesthesia may occur. This may lead to the secondary cardiac arrest if untreated. Factors influencing plasma protein binding, such as acidosis, systemic diseases which alter protein production, or competition with other drugs for protein binding sites, may diminish individual tolerance. Central Nervous System Reactions These are characterized by excitation and/or depression. Restlessness, anxiety, dizziness, tinnitus, blurred vision or tremors may occur, possibly proceeding to convulsions. However, excitement may be transient or absent, with depression being the first manifestation of an adverse reaction. This may quickly be followed by drowsiness merging into unconsciousness and respiratory arrest. Drowsiness following the administration of Duocaine is usually an early sign of a high blood level of the drug and may occur as a consequence of rapid absorption. Other central nervous system effects may be nausea, vomiting, chills, and constriction of the pupils. Cardiovascular System Reactions High doses or unintentional intravascular injection may lead to high plasma levels and related depression of the myocardium, decreased cardiac output, heart block, hypotension, bradycardia, ventricular arrhythmia, including ventricular tachycardia and ventricular fibrillation, and cardiac arrest (see: WARNINGS , PRECAUTIONS , and OVERDOSAGE sections). Allergic Duocaine , as a mixture of amide-type local anesthetic, allergic type reactions are rare and may occur as a result of sensitivity to the local anesthetic or to other formulation ingredients, such as sulfites in epinephrine containing solutions (see WARNINGS ). These reactions are characterized by signs such as cutaneous lesions, urticaria, pruritus, erythema, angioneurotic edema (including laryngeal edema), tachycardia, sneezing, nausea, vomiting, dizziness, syncope, excessive sweating, elevated temperature, and possibly, anaphylactoid symptomatology (including severe hypotension). Cross sensitivity among members of the amide-type local anesthetic group has been reported. If allergic reactions occur, they should be managed by conventional means. The detection of sensitivity by skin testing is of doubtful value. Neurologic In the practice of retrobulbar or peribulbar block, occasional unintentional penetration of ophthalmic artery or nerve may occur. Subsequent adverse effects may depend partially on the amount of drug administered intrathecally and the physiological and physical effects of a dural sheath puncture. Inadvertent needle penetration of the optic nerve sheath may result in depositing the local anesthetic directly in the subarachnoid space. Neurologic effects following unintentional subarachnoid administration during ocular block anesthesia may include spinal block by varying magnitude (including high or total spinal block); hypotension secondary to spinal block; urinary retention, fecal and urinary incontinence; loss of perineal sensation and sexual function; persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities and loss of sphincter control, all of which may have slow, incomplete or no recovery; headache; backache; septic meningitis; meningismus; slowing of labor; or cranial nerve palsies due to traction on nerves from loss of cerebrospinal fluid. There have been reported cases of permanent injury to extraocular muscles requiring surgical repair following retrobulbar administration of bupivacaine. Overdosage Acute emergencies from Duocaine overdosage are generally related to high plasma levels encountered during therapeutic use of the drug or to unintended subarachnoid injection of Duocaine solution (see: ADVERSE REACTIONS , WARNINGS , and PRECAUTIONS ). Systemic absorption of large amount of Duocaine reaching the toxicity thresholds of plasma concentration (the toxicity thresholds of drug concentration in humans are 6000 ng/mL for lidocaine and 1600 ng/mL for bupivacaine) produces effects on the cardiovascular and central nervous systems. The toxic blood concentrations depress cardiac conduction and excitability, which may lead to atrioventricular block, ventricular arrhythmias and to cardiac arrest, sometimes resulting in fatalities. In addition, myocardial contractility is depressed and peripheral vasodilation occurs, leading to decreased cardiac output and arterial blood pressure. Following systemic absorption, Duocaine can produce central nervous system stimulation, depression or both. Apparent central stimulation is usually manifested as restlessness, tremors and shivering, progressing to convulsions, followed by depression and coma, progressing ultimately to respiratory arrest. However, Duocaine (bupivacaine) has a primary depressant effect on the medulla and on higher centers. The depressed stage may occur without a prior excited stage. Duocaine Dosage and Administration For retrobulbar injection, 2 5 mL of Duocaine solution (20 50 mg of lidocaine and 7 18 mg of bupivacaine) is injected; a portion of the dose is injected retrobulbarly and the remainder may be used to block the facial nerve. For peribulbar block, the usual dose is 6 12 mL of Duocaine solution (60 120 mg of lidocaine and 22 45 mg of bupivacaine), and this technique produces akinesia of the superior oblique muscle, the eyelids and the orbicularis oculi muscle. Maximum recommended dosage Maximum dosage limit must be individualized in each case after evaluating the size and physical status of the patients, as well as the usual rate of systemic absorption from a particular injection site. For normal healthy adults, the individual maximum recommended dose of Duocaine without epinephrine should not exceed 0.18 mL/kg (0.08 mL/lb) of body weight, and in general it is recommended that the maximum total dose not exceed 12 mL(120 mg of lidocaine and 45 mg of bupivacaine). When used with epinephrine the maximum individual dose should not exceed 0.28 mL/kg (0.14 mL/lb) of body weight, and in general it is recommended that the maximum total dose does not exceed 20 mL(200 mg of lidocaine and 75 mg of bupivacaine). NOTE: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. The Injection is not to be used if it is cloudy or contains a precipitate. Unused portions of solutions in single dose containers should be discarded, since this product form contains no preservatives. How is Duocaine Supplied These solutions are not for spinal anesthesia. Duocaine (lidocaine HCl - bupivacaine HCl injection) 1% / 0.375% Stock No. NDC No. Size 9071 0548-9071-00 10 mL fill in 10 mL container The drug product is aseptically filled into 10 cc clear glass vials with gray rubber stoppers and flip-off seals. Packaged in a carton of 25 single dose vials. Store at 15 to 25 C (59 to 77 F). Discard unused portion after initial use. Preservative Free Amphastar Pharmaceuticals, Inc. Rancho Cucamonga, CA 91730 U.S.A. Rx Only 4-03 6990716C PRINCIPAL DISPLAY PANEL - 10 mL Carton Label Duocaine (lidocaine HCl - bupivacaine HCl injection) 1% / 0.375% Sterile 25 x 10 mL Single Dose Vials Rx Only 10 mL For Retrobulbar and Parabulbar Anesthesia PRESERVATIVE-FREE NDC 0548-9071-00 Duocaine lidocaine hydrochloride and bupivacaine hydrochloride injection Product Information Product Type HUMAN PRESCRIPTION DRUG LABEL Item Code (Source) NDC:0548-9071 Route of Administration RETROBULBAR DEA Schedule Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength lidocaine hydrochloride (lidocaine) lidocaine hydrochloride 10 mg in 1 mL bupivacaine hydrochloride (bupivacaine) bupivacaine hydrochloride 3.75 mg in 1 mL Inactive Ingredients Ingredient Name Strength sodium chloride water hydrochloric acid sodium hydroxide Packaging # Item Code Package Description 1 NDC:0548-9071-00 25 BOTTLE, GLASS (BOTTLE) in 1 CARTON 1 10 mL in 1 BOTTLE, GLASS Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date NDA NDA021496 05/23/2003 05/31/2005 Labeler - Amphastar Pharmaceuticals, Inc. (024736733) Establishment Name Address ID/FEI Operations Amphastar Pharmaceuticals, Inc. 024736733 ANALYSIS, MANUFACTURE Revised: 12/2009 Amphastar Pharmaceuticals, Inc. Next User Reviews Print this page Add to My Med List More about Duocaine (bupivacaine / lidocaine) Dosage Information Support Group 0 Reviews Add your own review/rating Related treatment guides Anesthesia} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Availability Unknown C Pregnancy Category Risk cannot be ruled out Approval History Drug history at FDA Related Drugs Anesthesia lidocaine , fentanyl , hyoscyamine , propofol , Levsin , ketamine , glycopyrrolate , Emla , Robinul , butorphanol , etomidate , succinylcholine , Nubain , Diprivan , benzocaine topical , Stadol , Levbid , rocuronium , Talwin , pentazocine , Sublimaze , sevoflurane , nalbuphine , Anaspaz , HyoMax , More... Duocaine Rating No Reviews - Be the first! 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prompted 04.07.16 Prescription opioid use is at an all-time high in the United States. In fact, although we make up just five percent of the world s population, we use 99 percent of the world s hydrocodone (also known as Vicodin) and 80 percent of its oxycodone (also known as Percocet or Oxycontin). Unfortunately, these medications come with a high potential for addiction and abuse. What starts out as a legitimately prescribed medical treatment following an injury or surgery can quickly spiral out of control, claiming lives and damaging families in the process. Teens are particularly at risk. Peer pressure, ease of access and a general lack of knowledge about the risks of prescription drug abuse can make for a deadly combination. In fact, the Centers for Disease Control and Prevention have reported that someone dies of an unintentional drug overdose every 19 minutes. As part of our ongoing commitment to educating the public about this epidemic, CVS Health has created the Pharmacists Teach program, which provides teens with the facts about prescription drug abuse through the One Choice Changes Everything presentation. Our pharmacists volunteer to visit high school health classes, youth organizations, or faith-based groups and give a powerful presentation that includes stories of real youths whose lives were forever changed by their choice to misuse or abuse prescription painkillers. "Every year, more than 44,000 people in the United States die from accidental drug overdoses, says Tom Davis, RPh, Vice President, Pharmacy Professional Practices. This program provides targeted education to society s most vulnerable population for drug experimentation: pre-teens and teens. Dispelling the widely held belief among kids in this age group that prescription drugs are safer to experiment with and abuse than street drugs is perhaps one of the most valuable lessons they can receive. To date, over 300,000 students in hundreds of communities across the United States have taken part in the program, and feedback from school administrators has been overwhelmingly positive. One high school principal in New York described the program as an effective and powerful message toward preventing further tragedies in the community. However, educating young people is only one facet of addiction prevention. Research shows that children who learn about the risks of drugs from their parents are up to 50 percent less likely to use drugs than those who don t get this information at home. In response, we ve recently expanded our outreach to create a prevention education program for the adults in these teens lives, called Prescription for Parents . The Pharmacists Teach program is offered free of charge to students in grades 7-12 and groups of parents/adults in the communities where our pharmacists live and work. For information about bringing the program to your area, please send an email to PharmacistsTeach@cvshealth.com . This article was originally published on April 7, 2016, and was updated to reflect current data on October 23, 2017. Naloxone availability across the United States 4 6 See States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin CVS Pharmacy patients in 46 states now have access to the opioid overdose-reversal drug, naloxone. Follow our commitment to drug abuse prevention as we increase access to the life-saving opioid overdose reversal drug. Related Articles CVS Health and POLITICO Examine the Opioid Crisis A quick and easy-to-understand explanation of one of the most pressing challenges in public health: the opioid epidemic. Tackling the Nation s Opioid Crisis: POLITICO Pro Health Care Briefing Experts weigh in with personal experiences and multifaceted solutions to addressing the opioid crisis in America. A State of Emergency: Integrative Approaches to Addiction and the Opioid Epidemic Moriarty discusses the power of partnerships in tackling the opioid epidemic. Related Press Releases 10.26.17 CVS Health Recognizes President s Declaration of Public Health Emergency to Help End Opioid Epidemic 09.21.17 CVS Health Fighting National Opioid Abuse Epidemic With Enterprise Initiatives 09.12.17 CVS Health Makes Overdose-Reversal Drug Available Without Individual Prescription at CVS Pharmacy Locations in Kansas 07.27.17 CVS Health Makes Overdose-Reversal Drug Available Without Individual Prescription at CVS Pharmacy Locations in South Dakota 06.07.17 CVS Pharmacy Now Using Time Delay Safes in Ohio for Controlled Substances to Combat Opioid Epidemic, Reduce Robbery Incidents 05.23.17 Attorney General Brnovich, Rep. Carter Join CVS Health to Announce Availability of Naloxone at All CVS Pharmacy Locations in Arizona business enterprise


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corporation There is no cure for Attention Deficit Hyperactivity Disorder (ADHD), but there are a multitude of medications approved to treat the condition. (For the best treatment outcome, the National Institute of Mental Health says a combination of medication and behavioral therapy should be used. 1) Once you or your child has been given a formal diagnosis of ADHD following an evaluation by a neurologist or psychologist, she can recommend a stimulant or non-stimulant medication to help manage symptoms. Finding the right medication and dose to effectively manage ADHD symptoms can take time. So it s important to keep track of how long the effects of the medication last, and to also note any bothersome side effects. Article continues below Concerned about ADHD? Take our 2-minute Attention Deficit Hyperactivity Disorder quiz to see if you may benefit from further diagnosis and treatment. Take ADHD Quiz Stimulants & Non-Stimulants Currently, two types of drugs are approved to treat ADHD: stimulants and non-stimulants. Stimulants. Stimulant drugs are the most commonly used medications to treat ADHD. Stimulants work by increasing brain chemicals, including dopamine, that are critical for transmitting messages between brain neurons. In kids, 70 to 80 percent show improvement in symptoms within one to two hours of taking the medication. In adults, 70 percent report noticeable improvement from stimulants within hours of using the medication. 21 The two generic stimulants, also known as central nervous system stimulants, that are widely used to treat ADHD are methylphenidate ( Concerta , Aptensio XR) and dextro-amphetamine ( Adderall ). Non-stimulants. In cases where a stimulant drug is not well tolerated or preferred, a doctor will recommend a non-stimulant such as atomoexetine ( Straterra ), which helps increase a brain chemical called norepinephrine. This chemical can help improve focus, while tamping down impulsiveness and hyperactivity. Clonidine (Kapvay) and Guanfacine (Intuniv) are also non-stimulants and work slightly differently to achieve similar effects. Article Sources https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml Last Updated: Jul 10, 2017 possibly


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of moral sodium hyaluronate (injection) Generic Name: sodium hyaluronate (injection) (SO dee um HYE al yoo RON ate) Brand Name: Euflexxa, Gel-One, Gelsyn-3, Hyalgan, Supartz, Supartz FX Overview Side Effects Dosage Interactions Pregnancy More User Reviews Support Group Q & A What is sodium hyaluronate? Sodium hyaluronate is similar to the fluid that surrounds the joints in your body. This fluid acts as a lubricant and shock absorber for the joints. Sodium hyaluronate is used to treat knee pain caused by osteoarthritis. Sodium hyaluronate is usually given when other arthritis medications have not been effective. Sodium hyaluronate may also be used for purposes not listed in this medication guide. Slideshow A Joint Effort: A Provider's Guide To Orthopedic Pain Options What is the most important information I should know about sodium hyaluronate? You should not receive a sodium hyaluronate injection if you have an infection in your knee or in the skin around your knee. What should I discuss with my health care provider before receiving sodium hyaluronate? You should not receive sodium hyaluronate if you are allergic to it, or if you have an infection in your knee or in the skin around your knee. To make sure sodium hyaluronate is safe for you, tell your doctor if you have ever had: blood clots or circulation problems in your legs; or an allergy to birds, feathers, or egg products. It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether sodium hyaluronate passes into breast milk or if it could affect the nursing baby. Tell your doctor if you are breast-feeding. How is sodium hyaluronate given? Sodium hyaluronate is injected directly into your knee joint. A healthcare provider will give you this injection. Sodium hyaluronate is usually given once every week for 3 to 5 weeks. Follow your doctor's dosing instructions very carefully. To prevent pain and swelling, your doctor may recommend resting your knee or applying ice for a short time after your injection. Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions. What happens if I miss a dose? Call your doctor for instructions if you miss an appointment for your sodium hyaluronate injection. What happens if I overdose? Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur. What should I avoid after receiving sodium hyaluronate? For at least 48 hours after your injection, avoid jogging, strenuous activity, or high-impact sports such as soccer or tennis. Also avoid weight-bearing activity or standing for longer than 1 hour at a time. Ask your doctor how long to wait before you resume these activities. Sodium hyaluronate side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have: severe pain or swelling around the knee after the injection. Common side effects may include: warmth, pain, redness, stiffness, bruising, or puffiness where the medicine was injected; nausea, stomach pain; trouble walking; back pain, joint pain, muscle pain; headache; or numbness or tingly feeling; runny or stuffy nose, sneezing, sore throat. tired feeling; or itching or skin irritation around the knee. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Side Effects (complete list) Sodium hyaluronate dosing information Usual Adult Dose for Osteoarthritis: Hyalgan(R): 2 mL by intra-articular injection into the knee once weekly for 5 weeks Supartz(TM): 2.5 mL by intra-articular injection into the knee once weekly for 5 weeks What other drugs will affect sodium hyaluronate? Other drugs may interact with sodium hyaluronate, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using. Next Side Effects Print this page Add to My Med List More about sodium hyaluronate Side Effects During Pregnancy Dosage Information Drug Interactions Support Group 178 Reviews Add your own review/rating Drug class: viscosupplementation agents Consumer resources Hyaluronate and Derivatives Injection (Knee) Hyaluronate sodium Injection (Advanced Reading) Other brands: Euflexxa , Hyalgan , Supartz , Gelsyn-3 , Supartz FX Related treatment guides Osteoarthritis Where can I get more information? Your doctor can provide more information about sodium hyaluronate. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Copyright 1996-2012 Cerner Multum, Inc. Version: 4.01. Date modified: December 03, 2017 Last reviewed: October 02, 2017 Drug Status Rx Availability Prescription only N Pregnancy Category Not classified N/A CSA Schedule Not a controlled drug Drug Class Viscosupplementation agents Related Drugs Osteoarthritis prednisone , naproxen , Cymbalta , aspirin , ibuprofen , meloxicam , triamcinolone , duloxetine , diclofenac , glucosamine , Voltaren , Aleve , Celebrex , Mobic , Advil , celecoxib , Ecotrin , Medrol , methylprednisolone , betamethasone , Naprosyn , indomethacin , Motrin , nabumetone , More... Sodium hyaluronate Rating 178 User Reviews 6.7 /10 178 User Reviews 6.7 Rate it! Related Questions & Answers Is Sodium Hyaluronate a drug or medical device? Sodium Hyaluronate - My daughters orthopedist has recommended trying this before we think about? Is sodium hyaluronate made with any egg derivatives? Sodium Hyaluronate - anyone had weird side effects- headaches,altered mental status? Sodium Hyaluronate -? Read more questions guidelines


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unknown creatures Clarifoam EF Generic Name: sulfur,sulfacetamide sodium Dosage Form: aerosol, foam Overview Side Effects Dosage Professional Interactions More User Reviews Support Group Q & A Disclaimer: This drug has not been found by FDA to be safe and effective, and this labeling has not been approved by FDA. For further information about unapproved drugs, click here. Clarifoam EF EMOLLIENT FOAM FOR EXTERNAL USE ONLY Rx Only Slideshow Acne Advice: Skin Care Solutions For Both Teens and Adults Alike Clarifoam EF Description Sodium sulfacetamide is a sulfonamide with antibacterial activity while sulfur acts as a keratolytic agent. Chemically, sodium sulfacetamide is N-[(4-aminophenyl) sulfonyl]- acetamide, monosodium salt, monohydrate. The structural formula is: Each gram of Clarifoam EF (sodium sulfacetamide 10% and sulfur 5%) Emollient Foam contains 100 mg of sodium sulfacetamide and 50 mg of sulfur in an aqueous based emollient foam vehicle containing cetyl alcohol NF, emulsifying wax NF, lactic acid USP, methylparaben NF, propylene glycol USP, propylparaben NF, steareth-10, water USP. Also contains: Propellant HFA-134A (1,1,1,2-tetrafluoroethane). Clarifoam EF - Clinical Pharmacology Sodium sulfacetamide exhibits antibacterial activity. The most widely accepted mechanism of action of sulfonamides is the Woods-Fildes theory which is based on the fact that sulfonamides act as competitive antagonists to para-aminobenzoic acid (PABA), an essential component for bacterial growth. While absorption through intact skin has not been determined, sodium sulfacetamide is readily absorbed from the gastrointestinal tract when taken orally and excreted in the urine, largely unchanged. The biological half-life has variously been reported as 7 to 12.8 hours. It is estimated that 1% of topically applied sulfur is absorbed. Although the exact mode of keratolytic activity of sulfur is unknown, it is reported to result from the interaction of sulfur with the cysteine content of keratinocytes. In combination with sulfacetamide, sulfur has been reported to inhibit the growth of Propionibacterium acnes thereby reducing the associated inflammation. INDICATIONS Clarifoam EF Emollient Foam is indicated in the topical control of acne vulgaris, acne rosacea and seborrheic dermatitis. Contraindications Clarifoam EF Emollient Foam is contraindicated for use by patients having known hypersensitivity to sulfonamides, sulfur or any other component of this preparation. Clarifoam EF Emollient Foam is not to be used by patients with kidney disease. Warnings Although rare, hypersensitivity reactions to products containing sodium sulfacetamide may occur, including Stevens-Johnson syndrome and exfoliative dermatitis. Systemic toxic reactions such as agranulocytosis, acute hemolytic anemia, purpura hemorrhagica, drug fever, jaundice, and contact dermatitis indicate hypersensitivity to sulfonamides. Particular caution should be employed if areas of denuded or abraded skin are involved. FOR EXTERNAL USE ONLY . Keep away from eyes. Keep out of the reach of children . Contents under pressure. Do not puncture or incinerate container. Do not expose to temperatures above 120ºF (49ºC). Precautions General The object of this therapy is to achieve desquamation without irritation, but sodium sulfacetamide and sulfur can cause reddening and scaling of epidermis. These side effects are not unusual in the treatment of acne vulgaris, but patients should be cautioned about the possibility. If irritation develops, use of the product should be discontinued and appropriate therapy instituted. Patients should be carefully observed for possible local irritation or sensitization during long-term therapy. Information for Patients Avoid contact with eyes, eyelids, lips, and mucous membranes. If accidental contact occurs, rinse with water. If excessive irritation develops discontinue use and consult your physician. Carcinogenesis, Mutagenesis and Impairment of Fertility Long-term studies in animals have not been performed to evaluate carcinogenic potential. Pregnancy Category C. Animal reproduction studies have not been conducted with Clarifoam EF Emollient Foam. It is also not known whether Clarifoam EF Emollient Foam can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Clarifoam EF Emollient Foam should be given to a pregnant woman only if clearly needed. Nursing Mothers It is not known whether sodium sulfacetamide is excreted in the human milk following topical use of Clarifoam EF Emollient Foam. However, small amounts of orally administered sulfonamides have been reported to be eliminated in human milk. In view of this and because many drugs are excreted in human milk, caution should be exercised when Clarifoam EF Emollient Foam is administered to a nursing woman. Pediatric Use Safety and effectiveness in children under the age of 12 have not been established. Adverse Reactions Although rare, sodium sulfacetamide may cause local irritation. Clarifoam EF Dosage and Administration IMPORTANT: Prime Can Before Initial Use. To Prime Can: Shake can well (until product moves inside can). Firmly strike bottom of can onto palm of hand at least 3 times. Hold can upright and direct initial spray to a non-skin surface. Until foam dispenses, DO NOT spray directly on the skin as the initial spray may expel cold liquid propellant. Press down on actuator for 1 to 3 seconds until foam begins to dispense. If foam does not dispense within 3 seconds, prime can again. WASH-OFF APPLICATION: Cleanse affected skin thoroughly and pat dry before each application. Holding can upright, dispense Clarifoam EF into palm of hand. Massage the dispensed foam into the affected area and wait 10 minutes. Rinse thoroughly with water and pat dry. Treat the affected area 1 to 3 times daily, or as directed by a physician. Wipe off any excess foam from actuator after use. LEAVE-ON APPLICATION: Cleanse affected skin thoroughly and pat dry before each application. Holding can upright, dispense Clarifoam EF into the palm of hand. Massage the dispensed foam into the affected area 1 to 3 times daily, or as directed by a physician. Wipe off any excess foam from actuator after use. How is Clarifoam EF Supplied Clarifoam EF Emollient Foam is supplied in a 60g (NDC 16781-154-60) and 100g (NDC 16781-154-96) aluminum cans. Will not dispense entire contents. Container is overfilled to guarantee dispensing at least the listed amount. Store between 59 - 86 F (15 - 30 C). Protect from freezing. Store upright. Manufactured for: ONSET DERMATOLOGICS Cumberland, RI 02864 www.onsetdermatologics.com (888)-713-8154 Patent Pending P/N 2603 Rev. 8 Package/Label Display Panel 5 g Carton NDC 16781-154-06 Rx Only Clarifoam EF EMOLLIENT FOAM SODIUM SULFACTETAMIDE (10%), SULFUR (5%) DELIVERED IN Delevo Foam The Science of Compliance For topical control of acne vulgaris, acne rosacea, and seborrheic dermatitis See prescribing information enclosed ONSET DERMATOLOGICS LEAVE-ON OR WASH-OFF Professional Samples Enclosed: Six 5g Samples Available in 60g and 100g Cans Package/Label Display Panel 60 g Carton NDC 16781-154-60 Rx Only Clarifoam EF EMOLLIENT FOAM SODIUM SULFACTETAMIDE (10%) SULFUR (5%) For topical control of acne vulgaris, acne rosacea, and seborrheic dermatitis LEAVE-ON OR WASH-OFF DELIVERED IN Delevo Foam The Science of Compliance Net Weight 60g Will not dispense entire contents. Container is overfilled to guarantee dispensing a minimum of 60 grams. ONSET DERMATOLOGICS Package/Label Display Panel 100 g Carton NDC 16781-154-96 Rx Only Clarifoam EF EMOLLIENT FOAM SODIUM SULFACTETAMIDE (10%) SULFUR (5%) For topical control of acne vulgaris, acne rosacea, and seborrheic dermatitis LEAVE-ON OR WASH-OFF DELIVERED IN Delevo Foam The Science of Compliance Net Weight 100g Will not dispense entire contents. Container is overfilled to guarantee dispensing a minimum of 60 grams. ONSET DERMATOLOGICS Clarifoam EF sulfur,sulfacetamide sodium aerosol, foam Product Information Product Type HUMAN PRESCRIPTION DRUG LABEL Item Code (Source) NDC:16781-154 Route of Administration TOPICAL DEA Schedule Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength SULFUR (SULFUR) SULFUR 5 g in 100 g SULFACETAMIDE SODIUM (SULFACETAMIDE) SULFACETAMIDE SODIUM 10 g in 100 g Inactive Ingredients Ingredient Name Strength CETYL ALCOHOL LACTIC ACID METHYLPARABEN PROPYLENE GLYCOL PROPYLPARABEN STEARETH-10 WATER Packaging # Item Code Package Description 1 NDC:16781-154-06 5 g in 1 CAN 2 NDC:16781-154-60 60 g in 1 CAN 3 NDC:16781-154-96 100 g in 1 CAN Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date Unapproved drug other 06/01/2007 07/31/2015 Labeler - Onset Dermatologics LLC (793223707) Registrant - Onset Dermatologics LLC (964275155) Establishment Name Address ID/FEI Operations Onset Dermatologics LLC 793223707 MANUFACTURE(16781-154) Revised: 06/2011 Onset Dermatologics LLC Next Interactions Print this page Add to My Med List More about Clarifoam EF (sulfacetamide sodium / sulfur topical) Side Effects Dosage Information Drug Interactions Support Group En Español 10 Reviews Add your own review/rating Drug class: topical antibiotics Consumer resources Clarifoam EF Professional resources Sodium Sulfactamide and Sulfur Wash (FDA) Other brands: Sumadan , Plexion , Sulfacleanse 8/4 , Sumaxin , ... +26 more Related treatment guides Rosacea Seborrheic Dermatitis Acne} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Drug Class Topical antibiotics Related Drugs topical antibiotics mupirocin topical , erythromycin topical , Bactroban , neomycin topical , gentamicin topical , bacitracin topical Rosacea doxycycline , metronidazole topical , brimonidine topical , Lotemax , MetroGel , Vibramycin , ivermectin topical , Finacea , More... Seborrheic Dermatitis prednisone , hydrocortisone topical , ketoconazole topical , dexamethasone , Decadron , Deltasone , ciclopirox topical , More... Acne doxycycline , clindamycin topical , erythromycin topical , minocycline , tretinoin topical , tetracycline , dapsone topical , More... Clarifoam EF Rating 10 User Reviews 8.3 /10 10 User Reviews 8.3 Rate it!} } as a result of


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and cannot Aventyl (Oral) Generic Name: nortriptyline (Oral route) nor-TRIP-ti-leen Overview Side Effects Dosage Interactions Pregnancy More Breastfeeding Warnings User Reviews Support Group Q & A Oral route(Capsule;Solution) Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders. This risk must be balanced with the clinical need, as nortriptyline is not approved for use in pediatric patients. Closely monitor patients of all ages for clinical worsening, suicidality, or unusual changes in behavior; not approved for use in pediatric patients . Commonly used brand name(s) In the U.S. Aventyl Pamelor Available Dosage Forms: Tablet Capsule Solution Therapeutic Class: Antidepressant Pharmacologic Class: Antidepressant, Tricyclic Slideshow A Friend In Need: Getting Smart With Mental Illness Uses For Aventyl Nortriptyline is used to treat depression. It is thought to work by increasing the activity of serotonin in the brain. Nortriptyline is a tricyclic antidepressant. This medicine is available only with your doctor's prescription. Before Using Aventyl In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered: Allergies Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Pediatric Appropriate studies have not been performed on the relationship of age to the effects of nortriptyline in the pediatric population. Safety and efficacy have not been established. Geriatric Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of nortriptyline in the elderly. However, elderly patients are more likely to have age-related heart or liver problems, which may require an adjustment in the dose for patients receiving nortriptyline. Breast Feeding Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding. Interactions with Medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Bromopride Dronedarone Furazolidone Grepafloxacin Iproniazid Isocarboxazid Levomethadyl Linezolid Methylene Blue Metoclopramide Moclobemide Pargyline Phenelzine Procarbazine Ranolazine Rasagiline Safinamide Selegiline Tranylcypromine Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Acecainide Aceclofenac Acemetacin Albuterol Alfentanil Alfuzosin Almotriptan Amitriptyline Amoxapine Amphetamine Amtolmetin Guacil Apomorphine Aprindine Arsenic Trioxide Asenapine Aspirin Astemizole Azimilide Azithromycin Benzphetamine Bretylium Bromfenac Bufexamac Buprenorphine Bupropion Butorphanol Celecoxib Chloral Hydrate Chloroquine Chlorpromazine Choline Salicylate Ciprofloxacin Citalopram Clarithromycin Clomipramine Clonidine Clonixin Codeine Crizotinib Cyclobenzaprine Darunavir Dasatinib Desipramine Desmopressin Desvenlafaxine Dexibuprofen Dexketoprofen Dextroamphetamine Dextromethorphan Diclofenac Diflunisal Dihydrocodeine Dipyrone Disopyramide Dofetilide Dolasetron Domperidone Donepezil Droperidol Droxicam Enflurane Epinephrine Erythromycin Etilefrine Etodolac Etofenamate Etoricoxib Felbinac Fenoprofen Fentanyl Fepradinol Feprazone Fingolimod Flecainide Floctafenine Fluconazole Flufenamic Acid Fluoxetine Flurbiprofen Foscarnet Frovatriptan Gatifloxacin Gemifloxacin Granisetron Halofantrine Haloperidol Halothane Hydrocodone Hydromorphone Hydroxytryptophan Ibuprofen Ibutilide Iloperidone Imipramine Indomethacin Iobenguane I 123 Isoflurane Isradipine Ketoprofen Ketorolac Lapatinib Levalbuterol Levomilnacipran Levorphanol Levothyroxine Lidoflazine Lisdexamfetamine Lopinavir Lorcainide Lorcaserin Lornoxicam Loxoprofen Lumefantrine Lumiracoxib Meclofenamate Mefenamic Acid Mefloquine Meloxicam Meperidine Methadone Methamphetamine Methoxamine Midodrine Mifepristone Mirtazapine Moricizine Morniflumate Morphine Morphine Sulfate Liposome Nabumetone Nalbuphine Naproxen Naratriptan Nefopam Nepafenac Niflumic Acid Nilotinib Nimesulide Nimesulide Beta Cyclodextrin Norepinephrine Norfloxacin Octreotide Ofloxacin Ondansetron Oxaprozin Oxilofrine Oxycodone Oxymetazoline Oxymorphone Oxyphenbutazone Paliperidone Palonosetron Parecoxib Paroxetine Pazopanib Peginterferon Alfa-2b Pentamidine Pentazocine Phenylbutazone Phenylephrine Piketoprofen Piroxicam Pranoprofen Procainamide Prochlorperazine Proglumetacin Promethazine Propafenone Propyphenazone Proquazone Protriptyline Quinidine Quinine Remifentanil Risperidone Rofecoxib Salicylic Acid Salsalate Sematilide Sertindole Sertraline Sodium Phosphate Sodium Phosphate, Dibasic Sodium Phosphate, Monobasic Sodium Salicylate Solifenacin Sorafenib Sotalol Spiramycin Sufentanil Sulfamethoxazole Sulindac Sultopride Sumatriptan Sunitinib Tapentadol Tedisamil Telavancin Telithromycin Tenoxicam Tetrabenazine Tiaprofenic Acid Tiotropium Tolfenamic Acid Tolmetin Toremifene Tramadol Trazodone Trifluoperazine Trimethoprim Trimipramine Valdecoxib Vardenafil Vasopressin Venlafaxine Vilanterol Vilazodone Voriconazole Vortioxetine Ziprasidone Zolmitriptan Zotepine Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Acenocoumarol Arbutamine Atomoxetine Carbamazepine Cimetidine Dicumarol Phenprocoumon Rifapentine S-Adenosylmethionine Terbinafine Valproic Acid Interactions with Food/Tobacco/Alcohol Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Other Medical Problems The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially: Behavior or mood changes (eg, aggression, panic attacks) or Bipolar disorder (mood disorder with mania and depression), or risk of or Glaucoma (angle-closure type) or Heart rhythm problems (eg, arrhythmia) or Psychosis (mental illness) or Schizophrenia (mental illness) or Seizures, history of or Urinary retention (trouble urinating), history of Use with caution. May make these conditions worse. Heart attack, recent Should not be used in patients with this condition. Heart or blood vessel disease or Hyperthyroidism (overactive thyroid) Use with caution. May cause side effects to become worse. Proper Use of nortriptyline This section provides information on the proper use of a number of products that contain nortriptyline. It may not be specific to Aventyl. Please read with care. Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Dosing The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For oral dosage forms (capsules or solution): For depression: Adults 25 milligrams (mg) 3 to 4 times per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 150 mg per day. Teenagers and older adults 30 to 50 milligrams (mg) once a day or in divided doses during the day. Children Use and dose must be determined by your doctor. Missed Dose If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Storage Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Ask your healthcare professional how you should dispose of any medicine you do not use. Precautions While Using Aventyl It is very important that your doctor check your progress at regular visits to allow for changes in your dose and to check for any unwanted effects. For some children, teenagers, and young adults, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or get worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide. Do not take nortriptyline with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan ], linezolid (Zyvox ), methylene blue, phenelzine [Nardil ], selegiline [Eldepryl ], tranylcypromine [Parnate ]). Do not start taking nortriptyline during the 2 weeks after you stop a MAO inhibitor and wait 2 weeks after stopping nortriptyline before you start taking a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions. Nortriptyline may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use nortriptyline with buspirone (Buspar ), fentanyl (Abstral , Duragesic ), lithium (Eskalith , Lithobid ), tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova , Maxalt , Relpax , Zomig ). Check with your doctor first before taking any other medicines with nortriptyline . Do not stop taking this medicine without checking first with your doctor . Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms such as headache, nausea, or a general feeling of discomfort or illness. This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that cause drowsiness). Some examples of CNS depressants are antihistamines, medicines for hay fever, other allergies or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, medicines for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of these medicines with nortriptyline . Before having any kind of surgery, tell the medical doctor in charge that you are using this medicine. Taking nortriptyline together with medicines used during surgery may increase the risk of side effects. This medicine may cause some people to become drowsy. Make sure you know how you react to this medicine before you drive, use medicines, or do anything else that could be dangerous if you are drowsy or not alert . Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Aventyl Side Effects Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur: Incidence not known Abdominal or stomach pain agitation blurred vision burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings chest pain or discomfort clay-colored stools cold sweats confusion about identity, place, and time false beliefs that cannot be changed by facts continuing ringing or buzzing or other unexplained noise in the ears decreased urination depression difficulty in passing urine (dribbling) difficulty with speaking dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position double vision fast, pounding, or irregular heartbeat or pulse feeling of warmth feeling, seeing, or hearing things that are not there feeling that others are watching you or controlling your behavior feeling that others can hear your thoughts general feeling of tiredness or weakness hostility hyperventilation inability to move the arms, legs, or facial muscles inability to speak irritability loss of balance control lower back or side pain mood or mental changes muscle spasm or jerking of all extremities muscle trembling, jerking, or stiffness nightmares pain or discomfort in the arms, jaw, back, or neck painful or difficult urination panic perspiration pinpoint red or purple spots on the skin redness of the face, neck, arms, and occasionally, upper chest restlessness seizures slurred speech sores, ulcers, or white spots on the lips or in the mouth stiffness of the limbs sweating swelling of the face, ankles, legs, or hands talking, feeling, and acting with excitement trouble sleeping twisting movements of the body uncontrolled movements, especially of the face, neck, and back weakness in the arms, hands, legs, or feet Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Incidence not known Bigger, dilated, or enlarged pupils (black part of the eye) black tongue decreased interest in sexual ability or desire difficulty having a bowel movement (stool) enlargement of the breast hair loss or thinning of the hair heartburn hives or welts increase in sexual ability or desire increased sensitivity of the eyes or skin to light pain or discomfort in the chest, upper stomach, or throat peculiar taste severe sunburn small red or purple spots on the skin swelling of the testicles swelling or inflammation of the mouth swollen, painful, or tender lymph glands on side of face or neck vision changes waking to urinate at night Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. Side Effects (complete list) The information contained in the Truven Health Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you. The use of the Truven Health products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Truven Health and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. Copyright 2017 Truven Health Analytics, Inc. All Rights Reserved. Next Side Effects Print this page Add to My Med List More about Aventyl Hydrochloride (nortriptyline) Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Interactions Support Group 2 Reviews Add your own review/rating Drug class: tricyclic antidepressants Consumer resources Aventyl Other brands: Pamelor Professional resources Nortriptyline Hydrochloride (AHFS Monograph) Nortriptyline Oral Solution (FDA) Related treatment guides Vulvodynia Depression Primary Nocturnal Enuresis} Drug Status Rx Availability Prescription only N Pregnancy Category Not classified N/A CSA Schedule Not a controlled drug 10 + years Approval History FDA approved 1964 Drug Class Tricyclic antidepressants Related Drugs Depression trazodone , sertraline , Xanax , citalopram , Zoloft , Lexapro , Cymbalta , Celexa , More... Vulvodynia amitriptyline , venlafaxine , nortriptyline , Elavil , Effexor XR , Pamelor , More... Primary Nocturnal Enuresis nortriptyline , imipramine , Pamelor , desmopressin , Tofranil , DDAVP , Tofranil-PM , More... Aventyl Hydrochloride Rating 2 User Reviews 4.2 /10 2 User Reviews 4.2 Rate it! Help and Support Looking for answers? Ask a question or go join the Aventyl Hydrochloride support group to connect with others who have similar interests.} } earn a living from home


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bowled over Home Pregnancy Discomfort Backaches During Pregnancy Backache During Pregnancy What is it? Backache is very common in pregnancy. Half of all pregnant women can expect some back pain. Your ligaments will become softer and stretch to prepare you for labor. As the baby grows, the hollow in your back may increase and this may cause you backache. Also, due to the increased weight, the muscles in your back may have to work harder to support your balance, resulting in increased lower back pain. About half of all pregnant women complain of backaches. Fortunately, there are lots of simple strategies you can use to ease the pain. Tips to Prevent and Treat Backache During Pregnancy 1. Exercise. Sticking to an exercise program can solve a lot of your worries. Find out from your doctor what abdominal and back strengthening exercises are safe for you. Also, find out how long you can maintain your regular exercise program. Swimming, for example, may be an excellent way to keep fit and relieve the stress on your back from the extra pregnancy weight. Water exercises also invariably work out the trunk muscles, as you use them to balance yourself while floating weightlessly. 2. Proper Picking up Posture, Girls! You re walking down the hall when you spot your husband s toolbox laying on the floor. Stop! Remember, when picking something up from the floor, bend your knees and keep your back straight. Always lift with your legs, never your back, keeping the heavy object close to your body at all times. You can also try kneeling down on one knee with the other foot flat on the floor. Get as close to the renegade object as you can. 3. Don t Be A Sitting Duck. Improper sitting positions will make you an easy target for back pain. Be sure to sit with your back straight and well supported. When you are seated, tuck a small, firm cushion in the small of your back. It will give you support and help relieve the aches you experience after you have been sitting for a while. Make sure that your chair has a straight back, arms and firm cushions. When sitting, try not to cross your legs. This can aggravate your back pain and compromise the circulation in your extremities. 4. Showing Style. High-heeled shoes are so before-you-were-pregnant. Word to the fashionista: because of the extra weight you re carrying, you ll want to pack away uncomfortable footwear. Think flat, simple and comfortable. 5. Sleeping Arrangements. A firm mattress will help relieve your back pain. If you don t have a firm mattress, put a piece of hardboard under your current mattress. Lying on your back puts 55 lbs. of pressure on your back. Placing a pillow under your knees cuts the pressure in half. Lying on your side with a pillow between your knees also reduces the pressure. 6. A Pillow is the Answer. Try a pregnancy pillow (see photos below). These popular full-body pillows provide great support for your head, shoulders, abdomen and legs. They promote healthier circulation and can reduce head, neck and back pain. These special pillows soothe aching muscles and also ensure proper spinal alignment. After the arrival of your baby, lie back and use it as a nursing pillow. 7. Wear a Support Belt. A pregnancy support belt gently lifts the abdomen without squeezing and encourages a more erect posture. Proven to be safe, these popular belts can dramatically reduce or even eliminate lower back pain caused by the strains of pregnancy. These belts are comfortable and fully adjustable. 8. Pamper Yourself. While a birthday lets you be "Queen of the Day," pregnancy means people will tolerate you lavishing yourself with tender loving care for a whole nine months. Pampering yourself, even if it s just getting more rest, can mean reduced back pain. Ask your partner or a friend to massage your back remember though that some aromatherapy oils can be dangerous for the baby. Instead, use baby oil to rub your aches away. Also, make sure you get enough rest, especially later on in your pregnancy. Lastly, try not to stand for long periods of time. If you have to, keep one foot up on a stool with your knee bent to prevent strain on your lower back. 9. About Weight Gain. Don t gain more than the recommended amount of weight. Nine months of carrying extra weight gain will take its toll on your back. If you re already a bit over the suggested gain, be sure to make up for it with added rest. Recommended products: Recommended Link As you progress through your pregnancy, how do you deal with your backaches and other discomforts? At Pregnancy Stories , you can share your wisdom and knowledge about getting comfortable during pregnancy with other women. Back to top Back pain got you down? Get tips on how to deal with your discomfort from other women in the forum Login to comment Log in or sign up Forgot Password? Username: Password: CANCEL (1 Comments) Login to add a comment Post a comment You must be logged in to comment. louann my lower back is killing me. i sit at a computer all day and my back can barely take it. i had to buy a special pillow to support my back and i am trying out all the chairs in the office looking for the best one. so far they are all pretty flimsy. i am trying to take more frequent breaks and stand up now and then but i just don't have time to stand up and stretch every 30 minutes. i will try to do so every hour though. 6 years ago is legendary


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