Saturday, April 28, 2012

Tranxene T-Tab



clorazepate dipotassium

Dosage Form: tablet
Tranxene* T-TAB® Tablets C-IV/DEA Schedule IV

(clorazepate dipotassium tablets, USP)


Rx only

DESCRIPTION


Chemically, TRANXENE is a benzodiazepine. The empirical formula is C16H11ClK2N2O4; the molecular weight is 408.92; 1H-1, 4-Benzodiazepine-3-carboxylic acid, 7-chloro-2,3-dihydro-2-oxo-5-phenyl-, potassium salt compound with potassium hydroxide (1:1) and the structural formula may be represented as follows:



The compound occurs as a fine, light yellow, practically odorless powder. It is insoluble in the common organic solvents, but very soluble in water. Aqueous solutions are unstable, clear, light yellow, and alkaline.


Tranxene T-Tab tablets contain either 3.75 mg, 7.5 mg or 15 mg of clorazepate dipotassium for oral administration.


Inactive ingredients for Tranxene T-Tab Tablets: Colloidal silicon dioxide, FD&C Blue No. 2 (3.75 mg only), FD&C Yellow No. 6 (7.5 mg only), FD&C Red No. 3 (15 mg only), magnesium oxide, magnesium stearate, microcrystalline cellulose, potassium carbonate, potassium chloride, and talc.



CLINICAL PHARMACOLOGY


Pharmacologically, clorazepate dipotassium has the characteristics of the benzodiazepines. It has depressant effects on the central nervous system. The primary metabolite, nordiazepam, quickly appears in the blood stream. The serum half-life is about 2 days. The drug is metabolized in the liver and excreted primarily in the urine.


Studies in healthy men have shown that clorazepate dipotassium has depressant effects on the central nervous system. Prolonged administration of single daily doses as high as 120 mg was without toxic effects. Abrupt cessation of high doses was followed in some patients by nervousness, insomnia, irritability, diarrhea, muscle aches, or memory impairment.


Since orally administered clorazepate dipotassium is rapidly decarboxylated to form nordiazepam, there is essentially no circulating parent drug. Nordiazepam, the primary metabolite, quickly appears in the blood and is eliminated from the plasma with an apparent half-life of about 40 to 50 hours. Plasma levels of nordiazepam increase proportionally with TRANXENE dose and show moderate accumulation with repeated administration. The protein binding of nordiazepam in plasma is high (97-98%).


Within 10 days after oral administration of a 15 mg (50μCi) dose of 14C-TRANXENE to two volunteers, 62-67% of the radioactivity was excreted in the urine and 15-19% was eliminated in the feces. Both subjects were still excreting measurable amounts of radioactivity in the urine (about 1% of the 14C-dose) on day ten.


Nordiazepam is further metabolized by hydroxylation. The major urinary metabolite is conjugated oxazepam (3-hydroxynordiazepam), and smaller amounts of conjugated p-hydroxynordiazepam and nordiazepam are also found in the urine.



INDICATIONS AND USAGE


TRANXENE is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.


TRANXENE tablets are indicated as adjunctive therapy in the management of partial seizures.


The effectiveness of TRANXENE tablets in long-term management of anxiety, that is, more than 4 months, has not been assessed by systematic clinical studies. Long-term studies in epileptic patients, however, have shown continued therapeutic activity. The physician should reassess periodically the usefulness of the drug for the individual patient.


TRANXENE tablets are indicated for the symptomatic relief of acute alcohol withdrawal.



CONTRAINDICATIONS


TRANXENE tablets are contraindicated in patients with a known hypersensitivity to the drug and in those with acute narrow angle glaucoma.



WARNINGS



Use in Depressive Neuroses or Psychotic Reactions


TRANXENE tablets are not recommended for use in depressive neuroses or in psychotic reactions.



Use in Children


Because of the lack of sufficient clinical experience, TRANXENE tablets are not recommended for use in patients less than 9 years of age.



Interference with Psychomotor Performance


Patients taking TRANXENE tablets should be cautioned against engaging in hazardous occupations requiring mental alertness, such as operating dangerous machinery including motor vehicles.



Concomitant Use with CNS Depressants


Since TRANXENE has a central nervous system depressant effect, patients should be advised against the simultaneous use of other CNS depressant drugs, and cautioned that the effects of alcohol may be increased.



Physical and Psychological Dependence


Withdrawal symptoms (similar in character to those noted with barbiturates and alcohol) have occurred following abrupt discontinuance of clorazepate. Withdrawal symptoms associated with the abrupt discontinuation of benzodiazepines have included convulsions, delirium, tremor, abdominal and muscle cramps, vomiting, sweating, nervousness, insomnia, irritability, diarrhea, and memory impairment. The more severe withdrawal symptoms have usually been limited to those patients who had received excessive doses over an extended period of time. Generally milder withdrawal symptoms have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation of clorazepate should generally be avoided and a gradual dosage tapering schedule followed.


Caution should be observed in patients who are considered to have a psychological potential for drug dependence.


Evidence of drug dependence has been observed in dogs and rabbits which was characterized by convulsive seizures when the drug was abruptly withdrawn or the dose was reduced; the syndrome in dogs could be abolished by administration of clorazepate.



Suicidal Behavior and Ideation


Antiepileptic drugs (AEDs), including TRANXENE, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.


Pooled analyses of 199 placebo-controlled clinical trials (mono- and adjunctive therapy) of 11 different AEDs showed that patients randomized to one of the AEDs had approximately twice the risk (adjusted Relative Risk 1.8, 95% CI:1.2, 2.7) of suicidal thinking or behavior compared to patients randomized to placebo. In these trials, which had a median treatment duration of 12 weeks, the estimated incidence rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one case of suicidal thinking or behavior for every 530 patients treated. There were four suicides in drug-treated patients in the trials and none in placebo-treated patients, but the number is too small to allow any conclusion about drug effect on suicide.


The increased risk of suicidal thoughts or behavior with AEDs was observed as early as one week after starting drug treatment with AEDs and persisted for the duration of treatment assessed. Because most trials included in the analysis did not extend beyond 24 weeks, the risk of suicidal thoughts or behavior beyond 24 weeks could not be assessed.


The risk of suicidal thoughts or behavior was generally consistent among drugs in the data analyzed. The finding of increased risk with AEDs of varying mechanisms of action and across a range of indications suggests that the risk applies to all AEDs used for any indication. The risk did not vary substantially by age (5-100 years) in the clinical trials analyzed. Table 1 shows absolute and relative risk by indication for all evaluated AEDs.




























Table 1: Risk by indication for antiepileptic drugs in the pooled analysis
IndicationPlacebo Patients with Events Per 1000 PatientsDrug Patients with Events Per 1000 PatientsRelative Risk: Incidence of Events in Drug Patients/Incidence in Placebo PatientsRisk Difference: Additional Drug Patients with Events Per 1000 Patients
Epilepsy1.03.43.52.4
Psychiatric5.78.51.52.9
Other1.01.81.90.9
Total2.44.31.81.9

The relative risk for suicidal thoughts or behavior was higher in clinical trials for epilepsy than in clinical trials for psychiatric or other conditions, but the absolute risk differences were similar for the epilepsy and psychiatric indications.


Anyone considering prescribing tranxene or any other AED must balance the risk of suicidal thoughts or behavior with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Should suicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated.


Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Behaviors of concern should be reported immediately to healthcare providers.



Usage in Pregnancy


An increased risk of congenital malformations associated with the use of minor tranquilizers (chlordiazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has been suggested in several studies. Clorazepate dipotassium, a benzodiazepine derivative, has not been studied adequately to determine whether it, too, may be associated with an increased risk of fetal abnormality. Because use of these drugs is rarely a matter of urgency, their use during this period should almost always be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physician about the desirability of discontinuing the drug.


To provide information regarding the effects of in utero exposure to TRANXENE, physicians are advised to recommend that pregnant patients taking TRANXENE enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry. This can be done by calling the toll-free number 1-888-233-2334, and must be done by patients themselves. Information on the registry can also be found at the website http://www.aedpregnancyregistry.org/.



Usage during Lactation


TRANXENE tablets should not be given to nursing mothers since it has been reported that nordiazepam is excreted in human breast milk.



PRECAUTIONS


In those patients in which a degree of depression accompanies the anxiety, suicidal tendencies may be present and protective measures may be required. The least amount of drug that is feasible should be available to the patient.


Patients taking TRANXENE tablets for prolonged periods should have blood counts and liver function tests periodically. The usual precautions in treating patients with impaired renal or hepatic function should also be observed.


In elderly or debilitated patients, the initial dose should be small, and increments should be made gradually, in accordance with the response of the patient, to preclude ataxia or excessive sedation.



Information for Patients


To assure the safe and effective use of benzodiazepines, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is essential that they consult with their physician before either increasing the dose or abruptly discontinuing this drug.


Patients, their caregivers, and families should be counseled that AEDs, including TRANXENE, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Behaviors of concern should be reported immediately to healthcare providers.


Patients should be encouraged to enroll in the NAAED Pregnancy Registry if they become pregnant. This registry is collecting information about the safety of antiepileptic drugs during pregnancy. To enroll, patients can call the toll-free number 1-888-233-2334 (see Usage in Pregnancy).


Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with clorazepate dipotassium and should counsel them in its appropriate use. A patient Medication Guide is available for TRANXENE. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is available at www.lundbeckinc.com.



Pediatric Use


See WARNINGS.



Geriatric Use


Clinical studies of TRANXENE were not adequate to determine whether subjects aged 65 and over respond differently than younger subjects. Elderly or debilitated patients may be especially sensitive to the effects of all benzodiazepines, including TRANXENE. In general, elderly or debilitated patients should be started on lower doses of TRANXENE and observed closely, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant disease or other drug therapy. Dose adjustments should also be made slowly, and with more caution in this patient population (see PRECAUTIONS and DOSAGE AND ADMINISTRATION).



ADVERSE REACTIONS


The side effect most frequently reported was drowsiness. Less commonly reported (in descending order of occurrence) were: dizziness, various gastrointestinal complaints, nervousness, blurred vision, dry mouth, headache, and mental confusion. Other side effects included insomnia, transient skin rashes, fatigue, ataxia, genitourinary complaints, irritability, diplopia, depression, tremor, and slurred speech.


There have been reports of abnormal liver and kidney function tests and of decrease in hematocrit.


Decrease in systolic blood pressure has been observed.


To report SUSPECTED ADVERSE REACTIONS, contact Lundbeck Inc. at 1-800-455-1141 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.



DOSAGE AND ADMINISTRATION



For the symptomatic relief of anxiety


Tranxene T-Tab tablets are administered orally in divided doses. The usual daily dose is 30 mg. The dose should be adjusted gradually within the range of 15 to 60 mg daily in accordance with the response of the patient. In elderly or debilitated patients it is advisable to initiate treatment at a daily dose of 7.5 to 15 mg.


TRANXENE tablets may also be administered in a single dose daily at bedtime; the recommended initial dose is 15 mg. After the initial dose, the response of the patient may require adjustment of subsequent dosage. Lower doses may be indicated in the elderly patient. Drowsiness may occur at the initiation of treatment and with dosage increment.



For the symptomatic relief of acute alcohol withdrawal


The following dosage schedule is recommended:










1st 24 hours (Day 1)30 mg initially; followed by

30 to 60 mg in divided doses
2nd 24 hours (Day 2)45 to 90 mg in divided doses
3rd 24 hours (Day 3)22.5 to 45 mg in divided doses
Day 415 to 30 mg in divided doses

Thereafter, gradually reduce the daily dose to 7.5 to 15 mg. Discontinue drug therapy as soon as patient's condition is stable.


The maximum recommended total daily dose is 90 mg. Avoid excessive reductions in the total amount of drug administered on successive days.



As an Adjunct to Antiepileptic Drugs


In order to minimize drowsiness, the recommended initial dosages and dosage increments should not be exceeded.



Adults


The maximum recommended initial dose in patients over 12 years old is 7.5 mg three times a day. Dosage should be increased by no more than 7.5 mg every week and should not exceed 90 mg/day.



Children (9-12 years)


The maximum recommended initial dose is 7.5 mg two times a day. Dosage should be increased by no more than 7.5 mg every week and should not exceed 60 mg/day.



DRUG INTERACTIONS


If TRANXENE is to be combined with other drugs acting on the central nervous system, careful consideration should be given to the pharmacology of the agents to be employed. Animal experience indicates that clorazepate dipotassium prolongs the sleeping time after hexobarbital or after ethyl alcohol, increases the inhibitory effects of chlorpromazine, but does not exhibit monoamine oxidase inhibition. Clinical studies have shown increased sedation with concurrent hypnotic medications. The actions of the benzodiazepines may be potentiated by barbiturates, narcotics, phenothiazines, monoamine oxidase inhibitors or other antidepressants.


If TRANXENE tablets are used to treat anxiety associated with somatic disease states, careful attention must be paid to possible drug interaction with concomitant medication.


In bioavailability studies with normal subjects, the concurrent administration of antacids at therapeutic levels did not significantly influence the bioavailability of TRANXENE tablets.



OVERDOSAGE


Overdosage is usually manifested by varying degrees of CNS depression ranging from slight sedation to coma. As in the management of overdosage with any drug, it should be borne in mind that multiple agents may have been taken.


The treatment of overdosage should consist of the general measures employed in the management of overdosage of any CNS depressant. Gastric evacuation either by the induction of emesis, lavage, or both, should be performed immediately. General supportive care, including frequent monitoring of the vital signs and close observation of the patient, is indicated. Hypotension, though rarely reported, may occur with large overdoses. In such cases the use of agents such as norepinephrine bitartrate injection, USP or metaraminol bitartrate injection, USP should be considered.


While reports indicate that individuals have survived overdoses of clorazepate dipotassium as high as 450 to 675 mg, these doses are not necessarily an accurate indication of the amount of drug absorbed since the time interval between ingestion and the institution of treatment was not always known. Sedation in varying degrees was the most common physiological manifestation of clorazepate dipotassium overdosage. Deep coma when it occurred was usually associated with the ingestion of other drugs in addition to clorazepate dipotassium.


Flumazenil, a specific benzodiazepine receptor antagonist, is indicated for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with a benzodiazepine is known or suspected. Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation, and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Patients treated with flumazenil should be monitored for resedation, respiratory depression, and other residual benzodiazepine effects for an appropriate period after treatment. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. The complete flumazenil package insert including CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS should be consulted prior to use.



ANIMAL PHARMACOLOGY AND TOXICOLOGY


Studies in rats and monkeys have shown a substantial difference between doses producing tranquilizing, sedative and toxic effects. In rats, conditioned avoidance response was inhibited at an oral dose of 10 mg/kg; sedation was induced at 32 mg/kg; the LD50 was 1320 mg/kg. In monkeys aggressive behavior was reduced at an oral dose of 0.25 mg/kg; sedation (ataxia) was induced at 7.5 mg/kg; the LD50 could not be determined because of the emetic effect of large doses, but the LD50 exceeds 1600 mg/kg.


Twenty-four dogs were given clorazepate dipotassium orally in a 22-month toxicity study; doses up to 75 mg/kg were given. Drug-related changes occurred in the liver; weight was increased and cholestasis with minimal hepatocellular damage was found, but lobular architecture remained well preserved.


Eighteen rhesus monkeys were given oral doses of clorazepate dipotassium from 3 to 36 mg/kg daily for 52 weeks. All treated animals remained similar to control animals. Although total leucocyte count remained within normal limits it tended to fall in the female animals on the highest doses.


Examination of all organs revealed no alterations attributable to clorazepate dipotassium. There was no damage to liver function or structure.



Reproduction Studies


Standard fertility, reproduction, and teratology studies were conducted in rats and rabbits. Oral doses in rats up to 150 mg/kg and in rabbits up to 15 mg/kg produced no abnormalities in the fetuses. TRANXENE did not alter the fertility indices or reproductive capacity of adult animals. As expected, the sedative effect of high doses interfered with care of the young by their mothers (see Usage in Pregnancy).



HOW SUPPLIED


TRANXENE 3.75 mg scored T-TAB tablets are supplied as blue-colored tablets bearing the letters OV, the distinctive T shape and a two-digit designation, 31:


Bottles of 100 (NDC 67386-301-01).



7.5 mg scored T-TAB tablets are supplied as peach-colored tablets bearing the letters OV, the distinctive T shape and a two-digit designation, 32:


Bottles of 100 (NDC 67386-302-01).



15 mg scored T-TAB tablets are supplied as lavender-colored tablets bearing the letters OV, the distinctive T shape and a two-digit designation, 33:


Bottles of 100 (NDC 67386-303-01).



Recommended storage: Protect from moisture. Keep bottle tightly closed. Store at 20-25°C (68-77°F). See USP controlled room temperature. Dispense in a USP tight, light-resistant container.


T-TAB tablet appearance and shape are registered trademarks of Lundbeck Inc.


U.S. Design Pat. No. D-300,879


Manufactured by: Abbott Pharmaceuticals PR Ltd.

Barceloneta, PR 00617


For: Lundbeck Inc., Deerfield IL, 60015, U.S.A.


*Trademark of Sanofi-Aventis

®Trademark of Lundbeck Inc.


Revised: May 2010



MEDICATION GUIDE


Tranxene* (TRAN-zeen) T-TAB®

(clorazepate dipotassium)

tablets

C-IV/DEA Schedule IV


Read this Medication Guide before you start taking TRANXENE and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment.




What is the most important information I should know about TRANXENE?


Do not stop taking TRANXENE without first talking to your healthcare provider.


Stopping TRANXENE suddenly can cause serious problems.


TRANXENE can cause serious side effects, including:


1.  TRANXENE can make you sleepy or dizzy and can slow your thinking and motor skills


  • Do not drive, operate heavy machinery, or do other dangerous activities until you know how TRANXENE affects you.

  • Do not drink alcohol or take other drugs that may make you sleepy or dizzy while taking TRANXENE without first talking to your healthcare provider. When taken with alcohol or drugs that cause sleepiness or dizziness, TRANXENE may make your sleepiness or dizziness much worse.

2.  TRANXENE can cause abuse and dependence.


  • Do not stop taking TRANXENE all of a sudden. Stopping TRANXENE suddenly can cause seizures that do not stop, hearing or seeing things that are not there (hallucinations), shaking, and stomach and muscle cramps.
    • Talk to your doctor about slowly stopping TRANXENE to avoid getting sick with withdrawal symptoms.

    • Physical dependence is not the same as drug addiction. Your healthcare provider can tell you more about the differences between physical dependence and drug addiction.


TRANXENE is a federally controlled substance (C-IV) because it can be abused or lead to dependence. Keep TRANXENE in a safe place to prevent misuse and abuse. Selling or giving away TRANXENE may harm others, and is against the law. Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines or street drugs.


3.  TRANXENE may harm your unborn or developing baby.


Medicines like TRANXENE can cause birth defects. Talk with your healthcare provider if you are pregnant or plan to become pregnant. Tell your healthcare provider right away if you become pregnant while taking TRANXENE. You and your healthcare provider should decide if you will take TRANXENE while you are pregnant. Birth defects may occur even in children born to women who are not taking any medicines and do not have other risk factors.


  • If you become pregnant while taking TRANXENE, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry. You can register by calling 1-888-233-2334. The purpose of this registry is to collect information about the safety of antiepileptic drugs during pregnancy.

  • Tranxene can pass into breast milk. Talk to your healthcare provider about the best way to feed your baby if you take TRANXENE. You and your healthcare provider should decide if you will take TRANXENE or breast feed. You should not do both.

4.  Like other antiepileptic drugs, TRANXENE may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.


Call your healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:


  • thoughts about suicide or dying

  • attempts to commit suicide

  • new or worse depression

  • new or worse anxiety

  • feeling agitated or restless

  • panic attacks

  • trouble sleeping (insomnia)

  • new or worse irritability

  • acting aggressive, being angry, or violent

  • acting on dangerous impulses

  • an extreme increase in activity and talking (mania)

  • other unusual changes in behavior or mood

How can I watch for early symptoms of suicidal thoughts and actions?


  • Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings.

  • Keep all follow-up visits with your healthcare provider as scheduled.

Call your healthcare provider between visits as needed, especially if you are worried about symptoms.


Do not stop TRANXENE without first talking to a healthcare provider.


Stopping TRANXENE suddenly can cause serious problems.


Stopping a seizure medicine suddenly in a patient who has epilepsy can cause seizures that will not stop (status epilepticus).


Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.




What is TRANXENE?


TRANXENE is a prescription medicine used:


  • to treat anxiety disorders

  • with other medicines to treat partial seizures

  • to treat the symptoms of sudden alcohol withdrawal



Who should not take TRANXENE?


Do not take TRANXENE if you:


  • are allergic to clorazepate dipotassium or any of the ingredients in TRANXENE. See the end of this Medication Guide for a complete list of ingredients in TRANXENE.

  • have an eye disease called acute narrow angle glaucoma.



What should I tell my healthcare provider before taking TRANXENE?


Before you take TRANXENE, tell your healthcare provider if you:


  • have liver or kidney problems

  • have or have had depression, mood problems, or suicidal thoughts or behavior

  • have a history of abnormal thinking and behavior (psychotic reactions)

  • have any other medical conditions

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Taking TRANXENE with certain other medicines can cause side effects or affect how well they work. Do not start or stop other medicines without talking to your healthcare provider.


Know the medicines you take. Keep a list of them and show it to your healthcare provider and pharmacist when you get a new medicine.




How should I take TRANXENE?


  • Take TRANXENE exactly as prescribed. Your healthcare provider will tell you how much TRANXENE to take.

  • Your healthcare provider may change your dose. Do not change your dose of TRANXENE without talking to your healthcare provider.

  • Do not stop taking TRANXENE without first talking to your healthcare provider. Stopping TRANXENE suddenly can cause serious problems.

If you take too much TRANXENE, call your healthcare provider or local Poison Control Center right away.




What are the possible side effects of TRANXENE?


See "What is the most important information I should know about TRANXENE?"


The most common side effects of TRANXENE include:


  • drowsiness

  • dizziness

  • upset stomach

  • blurred vision

  • dry mouth

  • confusion

These are not all the possible side effects of TRANXENE. For more information ask your healthcare provider or pharmacist.


Tell your healthcare provider if you have any side effect that bothers you or that does not go away.


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




How should I store TRANXENE?


  • Store TRANXENE between 68°F to 77°F (20°C to 25°C).

  • Keep TRANXENE in a tightly closed container.

  • Keep TRANXENE out of the light.

  • Keep TRANXENE tablets dry.

Keep TRANXENE and all medicines away from children.




General Information about TRANXENE


Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use TRANXENE for a condition for which it was not prescribed. Do not give TRANXENE to other people, even if they have the same symptoms that you have. It may harm them.


This Medication Guide summarizes the most important information about TRANXENE. If you would like more information, talk with your healthcare provider. You can ask your pharmacist or healthcare provider for information about TRANXENE that is written for health professionals.


For more information about TRANXENE, go to www.lundbeckinc.com or call Lundbeck Inc. at 1-888-514-5204.




What are the ingredients in TRANXENE?


Active ingredient: clorazepate dipotassium


Inactive ingredients: colloidal silicon dioxide, magnesium oxide, magnesium stearate, microcrystalline cellulose, potassium carbonate, potassium chloride and talc.


In addition:


  • the 3.75 mg tablets contain FD&C Blue No. 2

  • the 7.5 mg tablets contain FD&C Yellow No. 6

  • the 15 mg tablets contain FD&C Red No. 3

This Medication Guide has been approved by the U.S. Food and Drug Administration.


Manufactured by: Abbott Pharmaceuticals PR Ltd.

Barceloneta, PR 00617


For: Lundbeck Inc.

Deerfield, IL 60015, U.S.A.


* Trademark of Sanofi-Aventis

® Trademark of Lundbeck Inc.


Revised: May 2010



PRINCIPAL DISPLAY PANEL


NDC 67386-301-01 (3.75 mg T-TAB tablets)


Bottle:



NDC 67386-302-01 (7.5 mg T-TAB tablets)


Bottle:



NDC 67386-303-01 (15 mg T-TAB tablets)


Bottle:



  









TRANXENE  T-TAB
clorazepate dipotassium  tablet










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)67386-301
Route of AdministrationORALDEA ScheduleCIV    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
CLORAZEPATE DIPOTASSIUM (CLORAZEPIC ACID)CLORAZEPATE DIPOTASSIUM3.75 mg




















Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE 
FD&C BLUE NO. 2 
MAGNESIUM OXIDE 
MAGNESIUM STEARATE 
CELLULOSE, MICROCRYSTALLINE 
POTASSIUM CARBONATE 
POTASSIUM CHLORIDE 
TALC 


















Product Characteristics
ColorBLUE (BLUE)Score2 pieces
ShapeFREEFORM (FREEFORM)Size9mm
FlavorImprint CodeT;OV;31
Contains      










Packaging
#NDCPackage DescriptionMultilevel Packaging
167386-301-01100 TABLET In 1 BOTTLENone










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDANDA01710506/23/1972







TRANXENE  T-TAB
clorazepate dipotassium  tablet










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)67386-302
Route of AdministrationORALDEA ScheduleCIV    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
CLORAZEPATE DIPOTASSIUM (CLORAZEPIC ACID)CLORAZEPATE DIPOTASSIUM7.5 mg




















Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE 
FD&C YELLOW NO. 6 
MAGNESIUM OXIDE 
MAGNESIUM STEARATE 
CELLULOSE, MICROCRYSTALLINE 
POTASSIUM CARBONATE 
POTASSIUM CHLORIDE 
TALC 


















Product Characteristics
ColorORANGE (ORANGE)Score2 pieces
ShapeFREEFORM (FREEFORM)Size9mm
FlavorImprint CodeT;OV;32
Contains      










Packaging
#NDCPackage DescriptionMultilevel Packaging
167386-302-01100 TABLET In 1 BOTTLENone










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDANDA01710506/23/1972







TRANXENE  T-TAB
clorazepate dipotassium  tablet










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)67386-303
Route of AdministrationORALDEA ScheduleCIV    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
CLORAZEPATE DIPOTASSIUM (CLORAZEPIC ACID)CLORAZEPATE DIPOTASSIUM15 mg




















Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE 
FD&C RED NO. 3 
MAGNESIUM OXIDE 
MAGNESIUM STEARATE 
CELLULOSE, MICROCRYSTALLINE 
POTASSIUM CARBONATE 
POTASSIUM CHLORIDE 
TALC 


















Product Characteristics
ColorPURPLE (PURPLE)Score2 pieces
ShapeFREEFORM (FREEFORM)Size9mm
FlavorImprint CodeT;OV;33
Contains      










Packaging
#NDCPackage DescriptionMultilevel Packaging
167386-303-01100 TABLET In 1 BOTTLENone





Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing E

Sunday, April 22, 2012

Sulfacetamide and fluorometholone ophthalmic


Generic Name: sulfacetamide and fluorometholone ophthalmic (SUL fa SEET a mide and FLOR oh METH oh lone off THAL mik)

Brand Names: FML-S Liquifilm


What is sulfacetamide and fluorometholone ophthalmic?

Sulfacetamide is an antibiotic. It is used to treat bacterial infections.


Fluorometholone is a steroid. It is used to reduce swelling associated with bacterial infections in the eye.


Sulfacetamide and fluorometholone ophthalmic is used to treat bacterial infections of the eyes.

Sulfacetamide and fluorometholone ophthalmic may also be used for purposes other than those listed in this medication guide.


What is the most important information I should know about sulfacetamide and fluorometholone ophthalmic?


Contact your doctor if your symptoms begin to get worse or if you do not see any improvement in your condition after a few days.


Do not touch the dropper to any surface, including your eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in your eye.

Apply light pressure to the inside corner of your eye (near your nose) after each drop to prevent the fluid from draining down your tear duct.


Who should not use sulfacetamide and fluorometholone ophthalmic?


Do not use sulfacetamide and fluorometholone ophthalmic if you have a viral or fungal infection in your eye. It is used to treat infections caused by bacteria only.

Do not use sulfacetamide and fluorometholone ophthalmic if you have ever had an allergic reaction to a sulfa-based drug.


It is not known whether sulfacetamide and fluorometholone ophthalmic will harm an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant. It is also not known whether sulfacetamide and fluorometholone ophthalmic passes into breast milk. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.

How should I use sulfacetamide and fluorometholone ophthalmic?


Use sulfacetamide and fluorometholone ophthalmic eye drops exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.


Wash your hands before using your eyedrops.


To apply the eyedrops:



  • Shake the drops gently to be sure the medicine is well mixed. Tilt your head back slightly and pull down on your lower eyelid. Position the dropper above your eye. Look up and away from the dropper. Squeeze out a drop and close your eye. Apply gentle pressure to the inside corner of your eye (near your nose) for about 1 minute to prevent the liquid from draining down your tear duct. If you are using more than one drop in the same eye or drops in both eyes, repeat the process with about 5 minutes between drops.




Do not touch the dropper to any surface, including your eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in your eye. Do not use any eyedrop that is discolored or has particles in it. Store sulfacetamide and fluorometholone ophthalmic at room temperature away from moisture and heat. Keep the bottle properly capped.

What happens if I miss a dose?


Apply the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and apply the next one as directed. Do not use a double dose of this medication.


What happens if I overdose?


An overdose of this medication is unlikely to occur. If you do suspect an overdose, wash the eye with water and call an emergency room or poison control center near you. If the drops have been ingested, drink plenty of fluid and call an emergency center for advice.


What should I avoid while using sulfacetamide and fluorometholone ophthalmic?


Do not touch the dropper to any surface, including your eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in your eye. Use caution when driving, operating machinery, or performing other hazardous activities. Sulfacetamide and fluorometholone ophthalmic may cause blurred vision. If you experience blurred vision, avoid these activities.

Use caution with contact lenses. Wear them only if your doctor approves. After applying this medication, wait at least 15 minutes before inserting contact lenses.


Avoid other eye medications unless your doctor approves.


Sulfacetamide and fluorometholone ophthalmic side effects


Serious side effects are not expected with this medication.


Some burning, stinging, irritation, itching, redness, blurred vision, eyelid itching, eyelid swelling, or sensitivity to light may occur.


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.


Sulfacetamide and fluorometholone ophthalmic Dosing Information


Usual Adult Dose for Uveitis:

Steroid-responsive inflammatory ocular conditions with superficial bacterial infection or risk of infection:
Instill 1 drop into the conjunctival sac of the affected eye(s) 4 times daily.

Usual Adult Dose for Bacterial Conjunctivitis:

Steroid-responsive inflammatory ocular conditions with superficial bacterial infection or risk of infection:
Instill 1 drop into the conjunctival sac of the affected eye(s) 4 times daily.

Usual Adult Dose for Keratitis:

Steroid-responsive inflammatory ocular conditions with superficial bacterial infection or risk of infection:
Instill 1 drop into the conjunctival sac of the affected eye(s) 4 times daily.

Usual Adult Dose for Keratoconjunctivitis:

Steroid-responsive inflammatory ocular conditions with superficial bacterial infection or risk of infection:
Instill 1 drop into the conjunctival sac of the affected eye(s) 4 times daily.

Usual Adult Dose for Blepharitis:

Steroid-responsive inflammatory ocular conditions with superficial bacterial infection or risk of infection:
Instill 1 drop into the conjunctival sac of the affected eye(s) 4 times daily.


What other drugs will affect sulfacetamide and fluorometholone ophthalmic?


Do not use this medication with other eyedrops that contain nitrates (e.g., silver nitrate).


Avoid other eye medications unless they are approved by your doctor.


Tell your doctor and pharmacist about all other medications that you are taking, especially antidepressants, tranquilizers (anxiety medications), sedatives (sleeping pills), and blood pressure pills.


Before using this medication, tell your doctor if you are taking an oral steroid medication such as prednisone (Deltasone, Orasone, others).


Drugs other than those listed here may also interact with sulfacetamide and fluorometholone ophthalmic. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.



More sulfacetamide and fluorometholone ophthalmic resources


  • Sulfacetamide and fluorometholone ophthalmic Side Effects (in more detail)
  • Sulfacetamide and fluorometholone ophthalmic Dosage
  • Sulfacetamide and fluorometholone ophthalmic Use in Pregnancy & Breastfeeding
  • Sulfacetamide and fluorometholone ophthalmic Drug Interactions
  • Sulfacetamide and fluorometholone ophthalmic Support Group
  • 0 Reviews for Sulfacetamide and fluorometholone - Add your own review/rating


Compare sulfacetamide and fluorometholone ophthalmic with other medications


  • Blepharitis
  • Conjunctivitis, Bacterial
  • Keratitis
  • Keratoconjunctivitis
  • Uveitis


Where can I get more information?


  • Your pharmacist has additional information about sulfacetamide and fluorometholone ophthalmic written for health professionals that you may read.

See also: sulfacetamide and fluorometholone side effects (in more detail)



Sentry AQ Maracide





Dosage Form: FOR ANIMAL USE ONLY
Medication for All Freshwater Fish For Ick, Velvet, & Other External Parasites in Fish.

Indications and Usage for Sentry AQ Maracide


A spot on product that treats the fish not the water.  Biospheres technology transports the medication directly to the skin where it is needed.  Read enclosed brochure carefully before using,  Use of a hospital tank is recommended.  No water changes, pH or temperature adjustments necessary, if readings are in ideal range.  Maintain normal filtration and air.



Sentry AQ Maracide Dosage and Administration


Shake well before use.  Use 2 capfuls (10 mL) per 10 gallons of water.  Treat on days 1, 3 and 5.



KEEP OUT OF REACH OF CHILDREN




Precautions


Do not overdose.  For aquarium use only.  THIS PRODUCT IS INTENDED FOR THE EXCLUSIVE USE WITH ORNAMENTAL FISH AND/OR OTHER ORNAMENTAL ORGANISMS AND IS NOT INTENDED FOR USE WITH HUMANS OR FISH FOR HUMAN CONSUMPTION.



ACTIVE INGREDIENTS


Malachite Green, Chitosan.



How is Sentry AQ Maracide Supplied


Net Contents: 2 fl. oz. (59 mL)



PACKAGING LABEL PRINCIPAL DISPLAY PANEL




Sentry AQ Mardel Biospheres Maracide


Distributed by:


Sergeant's Pet Care Product, Inc., Omaha, NE 68130


www.sentrypetcare.com











Sentry AQ Maracide W/BIOSPHERES 
malachite green  liquid










Product Information
Product TypeOTC ANIMAL DRUGNDC Product Code (Source)21091-315
Route of AdministrationEXTRACORPOREALDEA Schedule    











Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
MALACHITE GREEN (MALACHITE GREEN )MALACHITE GREEN0.101 mg  in 1 mL
GLUCOSAMINE (GLUCOSAMINE)GLUCOSAMINE.0136488 mg  in 1 mL





Inactive Ingredients
Ingredient NameStrength
No Inactive Ingredients Found


















Product Characteristics
ColorblueScore    
ShapeSize
FlavorImprint Code
Contains      










Packaging
#NDCPackage DescriptionMultilevel Packaging
121091-315-0259 mL In 1 BOTTLE, PLASTICNone










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
unapproved drug other01/24/2009


Labeler - Sergeant's Pet Care Products, Inc. (876995171)
Revised: 12/2009Sergeant's Pet Care Products, Inc.




Friday, April 20, 2012

Sulfadiazine


Pronunciation: sul-fa-DYE-a-zeen
Generic Name: Sulfadiazine
Brand Name: Generic only. No brands available.


Sulfadiazine is used for:

Treating and preventing certain bacterial infections.


Sulfadiazine is a sulfonamide antibiotic. It works by inhibiting the growth and replication of bacteria.


Do NOT use Sulfadiazine if:


  • you are allergic to any ingredient in Sulfadiazine or any other sulfonamide medicine (eg, sulfamethoxazole)

  • you are pregnant at term or you are breast-feeding an infant younger than 2 months of age

  • you have blood problems (anemia) due to decreased folic acid in your blood

  • you have severe kidney disease or a blockage of your bladder

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



Before using Sulfadiazine:


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


  • if you are planning to become pregnant

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

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

  • if you have diarrhea, a sore throat, or a stomach or intestinal infection

  • if you have a history of asthma, liver problems, kidney problems, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, the blood disease porphyria, or other blood problems

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


  • Indomethacin, probenecid, or salicylates (eg, aspirin) because the side effects of Sulfadiazine may be increased

  • Anticoagulants (eg, warfarin) because the risk of bleeding may be increased

  • Methotrexate or thiazide diuretics (eg, hydrochlorothiazide) because side effects may be increased by Sulfadiazine

  • Sulfonylureas (eg, glyburide) because the risk of low blood sugar may be increased

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


How to use Sulfadiazine:


Use Sulfadiazine as directed by your doctor. Check the label on the medicine for exact dosing instructions.


  • Sulfadiazine may be taken with or without food.

  • Drinking extra fluids while you are taking Sulfadiazine is recommended. Check with your doctor for instructions.

  • To clear up your infection completely, continue using Sulfadiazine for the full course of treatment even if you feel better in a few days.

  • If you miss a dose of Sulfadiazine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Sulfadiazine.



Important safety information:


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

  • If you have had a severe allergic reaction to Sulfadiazine or any other sulfonamide medicine (eg, sulfisoxazole, sulfamethoxazole, glyburide, probenecid), contact your doctor or pharmacist before taking Sulfadiazine. A severe reaction includes a severe rash, hives, breathing difficulties, or dizziness. If you have a question about whether you are allergic to Sulfadiazine or if a certain medicine is a sulfonamide, contact your doctor or pharmacist.

  • Sulfadiazine is effective only against bacteria. It is not effective for treating viral infections (eg, the common cold).

  • It is important to use Sulfadiazine for the full course of treatment. Failure to do so may decrease the effectiveness of Sulfadiazine and increase the risk that the bacteria will no longer be sensitive to Sulfadiazine and will not be able to be treated by this or certain other antibiotics in the future.

  • Long-term or repeated use of Sulfadiazine may cause a second infection. Your doctor may want to change your medicine to treat the second infection. Contact your doctor if signs of a second infection occur.

  • Sulfadiazine may cause increased sensitivity to the sun. Avoid exposure to the sun, sunlamps, or tanning booths until you know how you react to Sulfadiazine. Use a sunscreen or wear protective clothing if you must be outside for a prolonged period.

  • If severe diarrhea, stomach pain or cramps, or bloody stools occur, contact your doctor immediately. This could be a symptom of a serious side effect requiring immediate medical attention. Do not treat diarrhea without consulting your doctor.

  • Diabetes patients - Sulfadiazine may cause incorrect test results with urine tests for ketones. Check with your doctor before you adjust the dose of your diabetes medicine or change your diet.

  • Diabetes patients - Sulfadiazine may cause low blood sugar (eg, increased heartbeat, headache, chills, sweating, tremor, increased hunger, changes in vision, nervousness, weakness, dizziness, drowsiness, fainting). It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you do not have a reliable source of glucose available, eat a quick source of sugar such as table sugar, honey, or candy, or drink a glass of orange juice or nondiet soda to quickly raise your blood sugar level. Tell your doctor immediately about the reaction. To prevent hypoglycemia, eat meals on a regular schedule and do not skip meals.

  • Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using Sulfadiazine.

  • LAB TESTS, including blood counts, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.

  • Sulfadiazine is not recommended for use in CHILDREN younger than 2 months of age because they may develop yellowing of the skin or eyes (jaundice).

  • PREGNANCY and BREAST-FEEDING: If you become pregnant while taking Sulfadiazine, discuss with your doctor the benefits and risks of using Sulfadiazine during pregnancy. Sulfadiazine is excreted in breast milk. Do not breast-feed while taking Sulfadiazine.


Possible side effects of Sulfadiazine:


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



Dizziness; drowsiness; headache; gas; loss of appetite; nausea; sensitivity to sunlight; vomiting.



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

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody stools; bluish color of skin; dark urine; decreased amount of urine; fainting; fast heartbeat; hallucinations; joint pain; mouth sores or irritation; pale skin; persistent sore throat or fever; pounding in the chest; red, blistered, or swollen skin; red or purple patches under the skin; seizures; severe or persistent diarrhea; severe reaction to the sun; stomach pain or cramps; trouble urinating; unusual tiredness or weakness; vaginal irritation or discharge; yellowing of the eyes or skin.



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


See also: Sulfadiazine side effects (in more detail)


If OVERDOSE is suspected:


Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include dizziness; drowsiness; headache; loss of appetite; loss of consciousness; nausea; stomach cramps; vomiting.


Proper storage of Sulfadiazine:

Store Sulfadiazine at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Sulfadiazine out of the reach of children and away from pets.


General information:


  • If you have any questions about Sulfadiazine, please talk with your doctor, pharmacist, or other health care provider.

  • Sulfadiazine is to be used only by the patient for whom it is prescribed. Do not share it with other people.

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

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

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



Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Sulfadiazine resources


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


  • Sulfadiazine Prescribing Information (FDA)

  • Sulfadiazine Monograph (AHFS DI)

  • Sulfadiazine Professional Patient Advice (Wolters Kluwer)

  • sulfadiazine Concise Consumer Information (Cerner Multum)

  • sulfadiazine Advanced Consumer (Micromedex) - Includes Dosage Information



Compare Sulfadiazine with other medications


  • Rheumatic Fever Prophylaxis
  • Toxoplasmosis
  • Toxoplasmosis, Prophylaxis


Wednesday, April 18, 2012

Theophylline Sustained-Release Capsules



Pronunciation: thee-OF-i-lin
Generic Name: Theophylline
Brand Name: Theo 24


Theophylline Sustained-Release Capsules are used for:

Preventing and treating symptoms and blockage of airway due to asthma or other lung diseases (eg, emphysema, bronchitis). It may also be used for other conditions as determined by your doctor.


Theophylline Sustained-Release Capsules are a xanthine derivative. It works by relaxing the muscle around the airways in the lungs, which allows them to widen and makes breathing easier. It also improves contraction of the diaphragm (the major breathing muscle) and decreases the response of the airways to irritants.


Do NOT use Theophylline Sustained-Release Capsules if:


  • you are allergic to any ingredient in Theophylline Sustained-Release Capsules, similar medicines (eg, aminophylline), or xanthines (eg, caffeine, chocolate)

  • you are using large amounts of other products that contain xanthine (such as chocolate or caffeinated drinks)

  • you are taking dipyridamole intravenously (IV), febuxostat, halothane, or St. John's wort

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



Before using Theophylline Sustained-Release Capsules:


Some medical conditions may interact with Theophylline Sustained-Release Capsules. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:


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

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

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

  • if you have a history of heart problems (eg, congestive heart failure, cor pulmonale), an irregular heartbeat, liver problems (eg, cirrhosis, hepatitis), viral infection, thyroid problems, increased acid levels in the body, brain or nerve problems, or seizures (eg, epilepsy)

  • if you are in shock or have a fever, an ulcer, a severe infection, cystic fibrosis, or fluid in the lungs (pulmonary edema)

  • if you smoke, are stopping or starting smoking, or are exposed to the smoke from cigarettes or marijuana

  • if you are in the last 3 months of pregnancy

Some MEDICINES MAY INTERACT with Theophylline Sustained-Release Capsules. Tell your health care provider if you are taking any other medicines, especially any of the following:


  • Aminoglutethimide, barbiturates (eg, phenobarbital), carbamazepine, hydantoins (eg, phenytoin), isoproterenol, moricizine, rifampin, St. John's wort, or sulfinpyrazone because they may decrease Theophylline Sustained-Release Capsules's effectiveness

  • Allopurinol, beta-blockers (eg, propranolol), cimetidine, disulfiram, enoxacin, estrogen, febuxostat, fluvoxamine, interferon alpha, macrolide antibiotics (eg, clarithromycin, erythromycin), methotrexate, mexiletine, oral contraceptives (birth control pills), pentoxifylline, propafenone, quinolone antibiotics (eg, ciprofloxacin), tacrine, thiabendazole, ticlopidine, troleandomycin, verapamil, viloxazine, or zileuton because they may increase the risk of Theophylline Sustained-Release Capsules's side effects

  • Ephedrine because the risk of side effects, such as nausea, nervousness, and trouble sleeping, may be increased

  • Halothane because the risk of side effects such as irregular heartbeat may be increased

  • Ketamine because the risk of seizures may be increased

  • Adenosine, benzodiazepines (eg, diazepam, flurazepam, lorazepam, midazolam), dipyridamole IV, lithium, or nondepolarizing muscle relaxants (eg, pancuronium) because their effectiveness may be decreased by Theophylline Sustained-Release Capsules

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


How to use Theophylline Sustained-Release Capsules:


Use Theophylline Sustained-Release Capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.


  • Some foods may change the effectiveness or increase the side effects of Theophylline Sustained-Release Capsules. Talk to your doctor about how you should take Theophylline Sustained-Release Capsules with regard to food. Do not suddenly change your diet or eating habits without first checking with your doctor.

  • Swallow Theophylline Sustained-Release Capsules whole. Do not break, crush, or chew before swallowing.

  • Take Theophylline Sustained-Release Capsules at about the same time(s) each day. If you are using more than 1 dose per day, try to take the second dose 10 to 12 hours after your first dose and before the evening meal. Check with your doctor or pharmacist if you have questions about how to take Theophylline Sustained-Release Capsules.

  • If you are using 1 dose per day, take Theophylline Sustained-Release Capsules in the morning unless your doctor tells you otherwise.

  • Continue to take Theophylline Sustained-Release Capsules even if you feel well. Do not miss any doses.

  • If you miss a dose of Theophylline Sustained-Release Capsules, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Theophylline Sustained-Release Capsules.



Important safety information:


  • Drinking alcohol may increase the risk of side effects of Theophylline Sustained-Release Capsules. Talk to your doctor before drinking alcohol while you are taking Theophylline Sustained-Release Capsules.

  • Tell your doctor or dentist that you take Theophylline Sustained-Release Capsules before you receive any medical or dental care, emergency care, or surgery.

  • Do not take more than the recommended dose or use more often than prescribed without checking with your doctor. If your symptoms become worse, contact your doctor.

  • Carry an ID card at all times that says you take Theophylline Sustained-Release Capsules.

  • Avoid large amounts of food or drink that have caffeine (eg, coffee, tea, cocoa, cola, chocolate).

  • Notify your doctor if you develop a new illness, especially if it is accompanied by fever; if a chronic illness becomes worse; or if you start or stop smoking cigarettes or marijuana.

  • Tell your doctor if another doctor prescribes a new medicine or tells you to stop using a medicine that you have already been taking. Tell your doctor if you start or stop any medicine, either prescription or over the counter.

  • Theophylline Sustained-Release Capsules will not stop an asthma attack once one has started. Be sure to always carry appropriate rescue medicine (eg, bronchodilator inhaler) with you in case of an asthma attack.

  • If you have more than one doctor, be sure to tell each of your doctors that you are taking Theophylline Sustained-Release Capsules.

  • Diabetes patients - Theophylline Sustained-Release Capsules may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.

  • Theophylline Sustained-Release Capsules may interfere with certain lab tests. Be sure your doctor and lab personnel know you are taking Theophylline Sustained-Release Capsules.

  • Lab tests, including blood theophylline levels, may be performed while you use Theophylline Sustained-Release Capsules. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

  • Use Theophylline Sustained-Release Capsules with caution in the ELDERLY; they may be more sensitive to its effects.

  • Caution is advised when using Theophylline Sustained-Release Capsules in CHILDREN, especially children younger than 1 year old; they may be more sensitive to its effects. Children may be more likely to experience mild, temporary behavior changes.

  • PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Theophylline Sustained-Release Capsules while you are pregnant. Theophylline Sustained-Release Capsules are found in breast milk. If you are or will be breast-feeding while you use Theophylline Sustained-Release Capsules, check with your doctor. Discuss any possible risks to your baby.


Possible side effects of Theophylline Sustained-Release Capsules:


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



Irritability; mild, temporary caffeine-like effects (eg, headache, nausea, diarrhea, trouble sleeping); mild, temporary changes in behavior; restlessness; temporary increased urination.



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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; dizziness; fast breathing; fast or irregular heartbeat; heart rhythm problems; seizures; severe or persistent nausea, diarrhea, or headache; sleeplessness; tremors; vomiting.



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


See also: Theophylline side effects (in more detail)


If OVERDOSE is suspected:


Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include agitation; chest pain; confusion; decreased urination; fast or irregular heartbeat; headache; increased thirst; irritability; loss of appetite; muscle pain or tenderness; nausea; nervousness; persistent increased urination; restlessness; seizures; severe or persistent diarrhea; stomach pain; tremors or twitching; vomiting, especially of blood.


Proper storage of Theophylline Sustained-Release Capsules:

Store Theophylline Sustained-Release Capsules at room temperature below 77 degrees F (25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Theophylline Sustained-Release Capsules out of the reach of children and away from pets.


General information:


  • If you have any questions about Theophylline Sustained-Release Capsules, please talk with your doctor, pharmacist, or other health care provider.

  • Theophylline Sustained-Release Capsules are to be used only by the patient for whom it is prescribed. Do not share it with other people.

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

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

This information is a summary only. It does not contain all information about Theophylline Sustained-Release Capsules. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.



Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Theophylline resources


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


Compare Theophylline with other medications


  • Apnea of Prematurity
  • Asthma, acute
  • Asthma, Maintenance


Monday, April 16, 2012

Ketoderm Topical



Generic Name: ketoconazole (Topical route)

kee-toe-KON-a-zole

Commonly used brand name(s)

In the U.S.


  • Extina

  • Nizoral

  • Nizoral A-D

  • Xolegel

In Canada


  • Ketoderm

Available Dosage Forms:


  • Shampoo

  • Foam

  • Gel/Jelly

  • Solution

  • Cream

Therapeutic Class: Antifungal


Chemical Class: Imidazole


Uses For Ketoderm


Ketoconazole is used to treat infections caused by a fungus or yeast. It works by killing the fungus or yeast or preventing its growth.


Ketoconazole cream is used to treat:


  • Athlete's foot (tinea pedis; ringworm of the foot);

  • Ringworm of the body (tinea corporis);

  • Ringworm of the groin (tinea cruris; jock itch);

  • Seborrheic dermatitis;

  • "Sun fungus" (tinea versicolor; pityriasis versicolor); and

  • Yeast infection of the skin (cutaneous candidiasis).

Ketoconazole foam or gel is used to treat seborrheic dermatitis (scaly areas on your skin or scalp).


Ketoconazole 1% shampoo is used to treat dandruff.


Ketoconazole 2% shampoo is used to treat "sun fungus" (tinea versicolor; pityriasis versicolor).


This medicine may also be used for other fungus infections of the skin as determined by your doctor.


Most forms of this medicine are available only with your doctor's prescription. Some forms are available without a prescription. However, your doctor may have special instructions on the proper use for your medical condition.


Before Using Ketoderm


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 ketoconazole topical in children younger than 12 years of age. 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 ketoconazole topical in the elderly. However, some elderly patients may be more sensitive to the side effects of this medicine.


Pregnancy








Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding


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


Interactions with Medicines


Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.


Interactions with Food/Tobacco/Alcohol


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


Proper Use of ketoconazole

This section provides information on the proper use of a number of products that contain ketoconazole. It may not be specific to Ketoderm. Please read with care.


It is very important that you use this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may cause unwanted side effects or skin irritation.


This medicine is for use on the skin only. Do not get it in your eyes, nose, mouth, or vagina. Do not use it on skin areas that have cuts, scrapes, or burns. If it does get on these areas, rinse it off right away with water.


For patients using the cream:


  • Apply enough cream to cover the affected and surrounding skin areas, and rub in gently.

  • To help clear up your infection completely, it is very important that you keep using the cream for the full time of treatment, even if your symptoms begin to clear up after a few days. Since fungus or yeast infections may be very slow to clear up, you may have to continue using this medicine every day for up to several weeks. If you stop using this medicine too soon, your symptoms may return. Do not miss any doses.

For patients using the foam:


  • Wash your hands before and after using this medicine.

  • Do not spray the foam directly on your hand because it will begin to melt as soon as it touches your skin. Instead, spray the foam into the cap of the medicine can or other cool surface. Then dip your fingertips into the foam to pick up small amounts of the medicine, and apply to the affected skin areas. Gently massage the foam into your skin until it disappears.

  • If you are treating skin areas with hair, such as your scalp, move any hair away so the foam can be applied directly to the affected skin.

  • This medicine is flammable. Do not use it near heat, an open flame, or while smoking. Do not puncture, break, or burn the medicine can.

For patients using the gel:


  • Wash your hands before and after using this medicine.

  • Apply enough ketoconazole gel to cover the affected and surrounding skin areas, and rub in gently with your fingertips.

  • After applying this medicine, do not wash the affected area for at least 3 hours.

  • Cosmetics (makeup or sunscreens) may be used on the treated skin areas no sooner than 20 minutes after this medicine is applied.

  • This medicine may be flammable. Do not use it near heat, an open flame, or while smoking.

For patients using the 1% shampoo:


  • Wet your hair and scalp well with water.

  • Apply enough shampoo to work up a good lather and gently massage it over your entire scalp.

  • Rinse your hair and scalp with warm water.

  • Repeat application.

  • Rinse your hair and scalp well with warm water, and dry your hair.

For patients using the 2% shampoo:


  • Wet your hair and scalp well with water.

  • Apply the shampoo to the skin of the affected area and a wide margin surrounding this area.

  • Work up a good lather and leave it in place for 5 minutes.

  • Rinse your hair and scalp well with warm water, and dry your hair.

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 cream dosage form:
    • For cutaneous candidiasis, tinea corporis, tinea cruris, tinea pedis, or pityriasis versicolor:
      • Adults—Apply to the affected area of the skin and the surrounding area once a day.

      • Children—Use and dose must be determined by your doctor.


    • For seborrheic dermatitis:
      • Adults—Apply to the affected area of the skin and the surrounding area two times per day.

      • Children—Use and dose must be determined by your doctor.



  • For foam dosage form:
    • For seborrheic dermatitis:
      • Adults—Apply to the affected area of the skin and the surrounding area two times per day for 4 weeks.

      • Children—Use and dose must be determined by your doctor.



  • For gel dosage form:
    • For seborrheic dermatitis:
      • Adults, teenagers, and children 12 years of age and older—Apply to the affected area of the skin and the surrounding area once a day for 2 weeks.

      • Children younger than 12 years of age—Use and dose must be determined by your doctor.



  • For 1% shampoo dosage form:
    • For dandruff:
      • Adults—Use every 3 or 4 days for up to 8 weeks. Then use only as needed to keep dandruff under control.

      • Children—Use and dose must be determined by your doctor.



  • For 2% shampoo dosage form:
    • For pityriasis versicolor:
      • Adults—Use once.

      • Children—Use and dose must be determined by your doctor.



Missed Dose


If you miss a dose of this medicine, apply 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.


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 Ketoderm


It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and check you for any problems or unwanted effects that may be caused by this medicine.


Do not use this medicine for a skin problem that has not been checked by your doctor.


If your skin problem does not improve within 2 weeks for cutaneous candidiasis, pityriasis versicolor, tinea corporis, or tinea cruris; or 4 weeks for seborrheic dermatitis; or 4 to 6 weeks for tinea pedis, or if it becomes worse, check with your doctor.


Good health habits are also required for patients using the cream form of this medicine to help clear up your infection completely and to help make sure it does not return.


For patients using the cream for athlete's foot (tinea pedis; ringworm of the foot), the following instructions will help keep the feet cool and dry:


  • Avoid wearing socks made from wool or synthetic materials (e.g., rayon or nylon). Instead, wear clean, cotton socks and change them daily or more often if your feet sweat a lot.

  • Wear sandals or well-ventilated shoes (e.g., shoes with holes).

  • Use a bland, absorbent powder (e.g., talcum powder) or an antifungal powder between the toes, on the feet, and in socks and shoes one or two times a day. It is best to use the powder between the times you use the cream.

  • If you have any questions about these instructions, check with your doctor.

For patients using the cream for ringworm of the groin (tinea cruris; jock itch), the following instructions will help reduce chafing and irritation and will also help keep the groin area cool and dry:


  • Avoid wearing underwear that is tight-fitting or made from synthetic materials (e.g., rayon or nylon). Instead, wear loose-fitting, cotton underwear.

  • Use a bland, absorbent powder (e.g., talcum powder) or an antifungal powder on the skin. It is best to use the powder between the times you use ketoconazole cream.

  • If you have any questions about these instructions, check with your doctor.

The foam form of this medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.


This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth while you are using this medicine.


Tell your doctor if you have the following symptoms while using the ketoconazole 2% shampoo: hair discoloration, abnormal hair texture, removal of the curl from permanently waved hair, hair loss, itching, burning sensation of the skin, or blistering, peeling, or redness of the skin.


Stop using this medicine and check with your doctor right away if you or your child have a skin rash, burning, stinging, swelling, or irritation on the skin.


Ketoderm 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:


Less common—For cream, shampoo, foam, or gel
  • Itching, stinging, burning, or irritation not present before use of this medicine

Rare—For cream, foam, or gel
  • Acne

  • bleeding from sore in the mouth

  • blistering, crusting, irritation, itching, or reddening of the skin

  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

  • cracked, dry, or scaly skin

  • discoloration of the fingernails or toenails

  • dizziness

  • eye dryness, irritation, or swelling

  • red rash with watery, yellow-colored, or pus filled blisters with or without thick yellow to honey-colored crusts

  • skin dryness, pain, rash, redness, or swelling

  • sore in the mouth or on the gums

  • swelling of the face

Rare—For shampoo
  • Hair loss and irritation

Incidence not known—For gel
  • Pain

Incidence not known—For shampoo
  • Blistering, burning, crusting, dryness, or flaking of the skin

  • burning sensation of the skin

  • burning, itching, redness, skin rash, swelling, or soreness at the application site

  • discoloration of the hair

  • dry skin

  • fast heartbeat

  • fever

  • hives

  • hoarseness

  • irritation

  • itching, scaling, severe redness, or soreness of the skin

  • joint pain, stiffness, or swelling

  • rash

  • shortness of breath

  • swelling of the eyelids, face, lips, hands, or feet

  • thinning of the hair

  • tightness in the chest

  • troubled breathing or swallowing

  • wheezing

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


Less common—For shampoo or gel
  • Dryness or oiliness of the hair and scalp

  • headache

Rare—For shampoo
  • Abnormal hair texture

  • mild dryness of the skin

  • scalp pustules

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.



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Compare Ketoderm Topical with other medications


  • Cutaneous Candidiasis
  • Dandruff
  • Seborrheic Dermatitis
  • Tinea Corporis
  • Tinea Cruris
  • Tinea Pedis
  • Tinea Versicolor