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buprenorphine

30/06/10

Generic Name: buprenorphine (oral) (byoo pre NOR feen)
Brand Names: Subutex

What is buprenorphine?

Buprenorphine is an opioid (narcotic) medication that is similar to morphine, codeine, and heroin.

Buprenorphine is used to treat narcotic addiction.

Buprenorphine may also be used for purposes other than those listed in this medication guide.

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

Using buprenorphine improperly will increase your risk of serious side effects or death. Even if you have used other narcotic medications, you may still have serious side effects from buprenorphine. Follow all dosing instructions carefully.

Like other narcotic medicines, buprenorphine can slow your breathing. Death may occur if breathing becomes too weak.

Never crush a tablet or other pill to mix into a liquid for injecting the drug into your vein. This practice has resulted in death with the misuse of buprenorphine and similar prescription drugs. Carry an ID card or wear a medical alert bracelet stating that you are using buprenorphine, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are being treated for narcotic addiction.

Taking buprenorphine together with other drugs that cause drowsiness can slow the functions of your breathing and central nervous system to dangerous levels. These effects could result in a fatal overdose.

Avoid drinking alcohol, which can increase some of the side effects of buprenorphine. Using too much of this medicine in addition to drinking alcohol can cause death. You may have withdrawal symptoms when you stop using buprenorphine after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely. Buprenorphine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What should I discuss with my healthcare provider before taking buprenorphine?

Do not use this medication if you are allergic to buprenorphine or naloxone (Narcan), or if you have used another narcotic drug within the past 4 hours.

Before using buprenorphine, tell your doctor if you are allergic to any drugs, or if you have:

asthma, COPD, sleep apnea, or other breathing disorders;
liver or kidney disease;
mental illness or a history of suicide attempt;
a history of alcoholism or IV drug use; or
a history of seizures, head injury, or brain tumor.

If you have any of these conditions, you may not be able to use buprenorphine, or you may need a dosage adjustment or special tests during treatment.

Buprenorphine should be used only by the person it was prescribed for. Buprenorphine should never be given to another person, especially someone who has a history of drug abuse or addiction. Buprenorphine can cause withdrawal effects in a person who is addicted to narcotics. Keep the medication in a secure place where others cannot get to it. FDA pregnancy category C. This medication may be harmful to an unborn baby. It could also cause addiction or withdrawal symptoms in a newborn if the mother takes buprenorphine during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Buprenorphine passes into breast milk and may be harmful to a nursing baby. It may also decrease breast milk production. Do not use buprenorphine if you are breast-feeding a baby. Do not give this medication to a child.

How should I take buprenorphine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

The buprenorphine sublingual tablet should be placed under the tongue and allowed to dissolve. Do not chew the tablet or swallow it whole. If your doctor has prescribed more than 2 tablets per dose, place the correct number of tablets under your tongue at the same time and allow them to dissolve completely.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using buprenorphine. You may need to stop using the medicine for a short time. You may have withdrawal symptoms when you stop using buprenorphine after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely. Store buprenorphine at room temperature away from moisture and heat. Keep track of how many pills have been used from each new bottle of this medicine. Buprenorphine is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

Throw away any unused buprenorphine tablets down the toilet after your treatment has ended.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of buprenorphine can be fatal.

Symptoms of a buprenorphine overdose may include slowed breathing, extreme weakness, cold or clammy skin, small pupils, fainting, and coma.

What should I avoid while taking buprenorphine?

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by buprenorphine.

Avoid drinking alcohol, which can increase some of the side effects of buprenorphine. Using too much of this medicine in addition to drinking alcohol can cause death. Buprenorphine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Buprenorphine side effects

Like other narcotic medicines, buprenorphine can slow your breathing. Death may occur if breathing becomes too weak.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

slow or shallow breathing;
feeling light-headed, fainting;
confusion, unusual thoughts or behavior; or
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may be more likely to occur, such as:

headache;
stomach pain, nausea, vomiting, constipation;
warmth or tingly feeling;
increased sweating;
weakness;
back pain;
anxiety, depression;
sleep problems (insomnia); or
runny nose.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

Buprenorphine Dosing Information

Usual Adult Dose for Opiate Dependence:

Initial dose: 8 mg sublingually on day 1.
Maintenance dose: Rapidly titrate to the recommended target dose of 16 mg/day. In clinical trials, patients received 8 mg on day 1 and 16 mg on day 2 and thereafter. Further dose adjustments may be made in 2 mg to 4 mg increments up to a level that suppresses opioid withdrawal symptoms and holds the patient in treatment. The usual daily range is 4 mg to 24 mg sublingually.

The tablets should be placed under the tongue at the same time and allowed to dissolve. If patients are taking more than 2 tablets per dose and cannot hold more than 2 under the tongue comfortably, they should use 2 tablets at a time, allowing them to dissolve completely before taking more tablets.

For patients taking heroin or short-acting opioids, the first dose should be administered at least 4 hours after the patient last used opioids or preferably when early withdrawal symptoms appear.

Withdrawal symptoms may occur during buprenorphine induction treatment of patients taking methadone or long-acting opioids, especially high opioid doses or when buprenorphine is administered shortly after the last opioid dose. The optimal time for the first dose has not been reported.

The optimal method of tapering to discontinuation has not been reported.

Usual Adult Dose for Pain:

0.3 mg slow IM or IV every 6 hours as needed. May repeat once 30-60 minutes after the initial dose.
Maximum single dose: 0.6 mg (IM only).

Usual Pediatric Dose for Pain:

<2 years: Safety and effectiveness have not been established.
2-12 years: 2-6 mcg/kg IM or slow IV every 4-6 hours.
13-18 years: 0.3 mg IM or slow IV every 6 hours; may repeat dose in 30-60 minutes.

What other drugs will affect buprenorphine?

Before using buprenorphine, tell your doctor if you use any of the following drugs:

an antifungal antibiotic such as fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox), or voriconazole (Vfend);
an antibacterial antibiotic such as azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E-Mycin, E.E.S., Ery-Tab, Erythrocin), or telithromycin (Ketek);
HIV medication such as nevirapine (Viramune), delavirdine (Rescriptor), efavirenz (Sustiva), indinavir (Crixivan), ritonavir (Norvir), saquinavir (Invirase), or nelfinavir (Viracept);
rifampin (Rifadin, Rifater, Rifamate, Rimactane);
a sedative such as diazepam (Valium), midazolam (Versed), alprazolam (Xanax) lorazepam (Ativan), clorazepate (Tranxene), triazolam (Halcion), flurazepam (Dalmane), or temazepam (Restoril); or
seizure medication such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), phenobarbital (Luminal, Solfoton), and others.

If you are using any of these drugs, you may not be able to use buprenorphine, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect buprenorphine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about buprenorphine written for health professionals that you may read.

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.
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.

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buprenorphine (Injection route)

30/06/10

bue-pre-NOR-feen

Commonly used brand name(s):

In the U.S.

Buprenex

Available Dosage Forms:

Solution

Therapeutic Class: Analgesic

Pharmacologic Class: Opioid Agonist/Antagonist

Chemical Class: Opioid

Uses For buprenorphine

Buprenorphine injection is used to relieve moderate to severe pain.

Buprenorphine belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain.

When a narcotic medicine is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped. completely.

buprenorphine is available only with your doctor’s prescription.

Before Using buprenorphine

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 buprenorphine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to buprenorphine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of buprenorphine injection in children 2 to 12 years of age. However, safety and efficacy have not been established in children younger than 2 years of age.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of buprenorphine injection in the elderly. However, elderly patients may be more sensitive to the effects of buprenorphine than younger adults, and are more likely to have age-related kidney or liver problems, which may require caution and an adjustment in the dose for patients receiving buprenorphine injection.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using buprenorphine.

Interactions with Medicines

Using buprenorphine 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.

Alfentanil
Alphaprodine
Atazanavir
Codeine
Diazepam
Dihydrocodeine
Fentanyl
Hydrocodone
Hydromorphone
Levorphanol
Meperidine
Methadone
Morphine
Morphine Sulfate Liposome
Oxycodone
Oxymorphone
Propoxyphene
Sufentanil
Tapentadol

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 buprenorphine

A nurse or other trained health professional will give you or your child buprenorphine. buprenorphine is given as a shot into a muscle or through a needle placed in one of your veins.

Your doctor will give you a few doses of buprenorphine until your condition improves, and then switch you or your child to an oral medicine that works the same way. If you have any concerns about this, talk to your doctor.

Precautions While Using buprenorphine

It is very important that your doctor check the progress of you or your child while using buprenorphine. This will allow your doctor to see if the medicine is working properly and to decide if you or your child should continue to take it.

buprenorphine may be habit-forming. If you or your child feels that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you or your child to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

buprenorphine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicine or narcotics; medicine for seizures or barbiturates; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the other medicines listed above while you or your child is using buprenorphine.

buprenorphine may make you dizzy, drowsy, confused, or disoriented. Make sure you know how you react to buprenorphine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

If you or your child has been using buprenorphine regularly for several days, do not suddenly stop using it without first checking with your doctor. You or your child may be directed to gradually reduce the amount you are using before stopping treatment completely to lessen the chance of withdrawal side effects (e.g., abdominal or stomach cramps, fever, runny nose, anxiety, or restlessness).

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.

buprenorphine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Drowsiness
relaxed and calm
sleepiness

Rare

Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the site
bluish color of the fingernails, lips, skin, palms, or nail beds
blurred vision
burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
chest pain or discomfort
confusion
difficult or labored breathing
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
headache
severe mood or mental changes
shortness of breath
slurred speech
tightness of the chest
unusual behavior
wheezing

Incidence not known

Anxiety
cough
diarrhea
difficulty breathing
dry mouth
hyperventilation
irregular heartbeats
irritability
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of muscle coordination
nervousness
noisy breathing
restlessness
seizures
shaking
trouble sleeping
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:

More common

Nausea

Less common

Constricted, pinpoint, or small pupils (black part of the eye)
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
extremely shallow or slow breathing
sweating
vomiting

Rare

Burning, dry, or itching eyes
chills
continuing ringing or buzzing or other unexplained noise in the ears
decrease in frequency of urination
decrease in urine volume
depression
difficulty in passing urine (dribbling)
discharge, excessive tearing
dreaming
dry mouth
false or unusual sense of well-being
fast, pounding, or irregular heartbeat or pulse
feeling of warmth
hearing loss
itching of the skin
painful urination
pounding in the ears
redness of the face, neck, arms and occasionally, upper chest
redness, pain, or swelling of the eye, eyelid, or inner lining of eyelid
unusual tiredness or weakness

Incidence not known

Acid or sour stomach
belching
bloated
bluish lips or skin
change in vision
excess air or gas in the stomach or intestines
feeling of unreality
full feeling
general feeling of discomfort or illness
heartburn
hives or welts
impaired vision
indigestion
loss of appetite
not breathing
paleness of the skin
passing gas
redness of the skin
sense of detachment from self or body
skin rash
stomach discomfort, upset, or pain

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.

The information contained in the Thomson Reuters 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 Thomson Reuters Healthcare 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. Thomson Reuters Healthcare 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, THOMSON REUTERS HEALTHCARE 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. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

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buprenorphine (Sublingual route)

30/06/10

bue-pre-NOR-feen

Commonly used brand name(s):

In the U.S.

Subutex

Available Dosage Forms:

Tablet

Therapeutic Class: Opioid Dependency

Pharmacologic Class: Opioid Agonist/Antagonist

Chemical Class: Opioid

Uses For buprenorphine

Buprenorphine is used to treat opioid (narcotic) dependence or addiction. When a narcotic medicine is used for a long time, it may become habit-forming, causing mental or physical dependence. Physical dependence may lead to withdrawal side effects if the narcotic is stopped suddenly. Severe withdrawal side effects can usually be prevented when a person is switched to buprenorphine. It acts on the central nervous system (CNS) to help prevent the withdrawal side effects.

buprenorphine is available only with your doctor’s prescription.

Before Using buprenorphine

Allergies

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of buprenorphine in children younger than 16 years of age. Safety and efficacy have not been established.

Geriatric

No information is available on the relationship of age to the effects of buprenorphine in geriatric patients.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using buprenorphine.

Interactions with Medicines

Alfentanil
Alphaprodine
Atazanavir
Codeine
Diazepam
Dihydrocodeine
Fentanyl
Hydrocodone
Hydromorphone
Levorphanol
Meperidine
Methadone
Morphine
Morphine Sulfate Liposome
Oxycodone
Oxymorphone
Propoxyphene
Sufentanil
Tapentadol

Interactions with Food/Tobacco/Alcohol

Proper Use of buprenorphine

Take buprenorphine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

Do not crush or swallow the sublingual tablet. Place the tablet under the tongue until it is dissolved. If you take 2 or more tablets at a time, place all of the tablets under the tongue together. If this is uncomfortable, place 2 tablets at a time under the tongue and repeat the process until all tablets have been taken.

Dosing

The dose of buprenorphine 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 buprenorphine. 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 sublingual dosage form (tablets):
- For treatment of opioid dependence:
  - Adults and teenagers—12 to 16 milligrams (mg) as a single dose once a day.
  - Children younger than 16 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of buprenorphine, 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 buprenorphine

It is very important that your doctor check your progress while you are using buprenorphine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.

Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are using buprenorphine. Serious unwanted effects can occur if certain medicines are given together with buprenorphine.

buprenorphine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicine or narcotics; medicine for seizures or barbiturates; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the medicines listed above while you are using buprenorphine.

Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve the dizziness or lightheadedness.

buprenorphine may make you dizzy, drowsy, or lightheaded. Make sure you know how you react to buprenorphine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

buprenorphine may cause serious allergic reactions, including 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 buprenorphine.

If you have been using buprenorphine regularly for several weeks or longer, do not suddenly stop using it without checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help reduce the possibility of withdrawal symptoms, such as abdominal or stomach cramps, anxiety, fever, nausea, runny nose, sweating, tremors, or trouble with sleeping.

Using buprenorphine while you are pregnant may cause serious unwanted effects in your newborn baby. Tell your doctor right away if you think you are pregnant or if you plan to become pregnant while using buprenorphine.

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.

buprenorphine 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

Blurred vision
confusion
difficult or troubled breathing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
irregular, fast, slow, or shallow breathing
pale or blue lips, fingernails, or skin
pinpoint pupils
relaxed and calm feeling
shortness of breath
sleepiness
unusual tiredness or weakness

More common

Back pain
cough or hoarseness
difficulty having a bowel movement (stool)
fever or chills
headache
lower back or side pain
nausea
painful or difficult urination
runny nose
sleeplessness
sneezing
stomach pain
stuffy nose
trouble sleeping
unable to sleep
vomiting

Less common

Diarrhea
feeling faint, dizzy, or lightheaded
feeling of warmth or heat
flushing or redness of the skin, especially on the face and neck
lack or loss of strength
sweating

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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buprenorphine and naloxone

30/06/10

Generic Name: buprenorphine and naloxone (byoo PREH nor feen and NAH lox own)
Brand Names: Suboxone

What is buprenorphine and naloxone?

Buprenorphine is an opioid medication. Buprenorphine is similar to other opioids such as morphine, codeine, and heroin however, it produces less euphoric (“high”) effects and therefore may be easier to stop taking.

Naloxone blocks the effects of opioids such as morphine, codeine, and heroin. If buprenorphine and naloxone is injected, naloxone will block the effects of buprenorphine and lead to withdrawal symptoms in a person with an opioid addiction. When administered under the tongue as directed, naloxone will not affect the actions of buprenorphine.

Buprenorphine and naloxone is used to treat opiate addiction.

Buprenorphine and naloxone may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about buprenorphine and naloxone?

Buprenorphine and naloxone can cause death from overdose, especially if it is injected with a tranquilizer. Use buprenorphine and naloxone exactly as directed by your doctor.

Buprenorphine and naloxone can cause drug dependence. This means that withdrawal symptoms may occur if you stop using the medicine too quickly. Withdrawal symptoms may also occur at the start of treatment due to dependence on another drug. Buprenorphine and naloxone is not for occasional (“as needed”) use. Do not stop taking buprenorphine and naloxone without first talking to your doctor. Your doctor may want to gradually reduce the dose to avoid or minimize withdrawal symptoms.

In an emergency, have family members tell emergency room staff that you are taking buprenorphine and naloxone and that you are dependent on opioids.

Use caution when driving, operating machinery, or performing other hazardous activities. Buprenorphine and naloxone may cause drowsiness, dizziness, or impaired thinking. If you experience drowsiness, dizziness, or impaired thinking, avoid these activities. Avoid alcohol while taking buprenorphine and naloxone. Alcohol may dangerously increase drowsiness and dizziness caused by the medication.

Buprenorphine and naloxone may dangerously increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), other pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any other prescription or over-the-counter medicine, including herbal products, without first talking to your doctor.

What should I discuss with my healthcare provider before taking buprenorphine and naloxone?

Do not take buprenorphine and naloxone if:

the medication was not prescribed for you; or
you are allergic to buprenorphine, naloxone, or any components of the tablets.

Before taking buprenorphine and naloxone, tell your doctor if you have:

lung problems or difficulty breathing;
a head injury or brain problem;
liver problems;
kidney problems;
gallbladder problems;
adrenal gland problems, such as Addison’s disease;
low thyroid (hypothyroidism);
enlarged prostate gland;
problems urinating;
a curve in the spine that affects breathing;
severe mental problems or hallucinations (seeing or hearing thing that are not really there); or
alcoholism.

You may not be able to take buprenorphine and naloxone, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Buprenorphine and naloxone is in the FDA pregnancy category C. This means that it is not known whether buprenorphine and naloxone will be harmful to an unborn baby. Use of buprenorphine and naloxone during pregnancy may cause withdrawal symptoms in a newborn baby. Do not take buprenorphine and naloxone if you are pregnant or could become pregnant during treatment. Buprenorphine and naloxone passes into breast milk and may be harmful to a nursing baby. Do not take buprenorphine and naloxone if you are breast-feeding a baby.

How should I take buprenorphine and naloxone?

Take buprenorphine and naloxone exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

The buprenorphine and naloxone tablets should be placed under the tongue and allowed to dissolve. This will take 2 to 10 minutes. If more than one tablet is prescribed per dose, your doctor may tell you to put all of the tablets under your tongue at the same time, or put 2 tablets under your tongue and allow them to dissolve completely, then put the next tablet or tablets under the tongue right away.

Do not chew or swallow the tablets. The medicine will not work this way and you may get withdrawal symptoms. Do not change the dose of buprenorphine and naloxone or take it more often than prescribed without first talking to your doctor. Do not inject (“shoot-up”) buprenorphine and naloxone. Shooting-up is dangerous and may cause bad withdrawal symptoms.

Buprenorphine and naloxone may cause withdrawal symptoms if taken too soon after a dose of heroin, morphine, or methadone.

When treatment with buprenorphine and naloxone is completed, flush any unused tablets down the toilet.

Buprenorphine and naloxone can cause constipation. Drink plenty of water (six to eight full glasses a day) to lessen this side effect. Increasing the amount of fiber in your diet can also help to alleviate constipation.

Your doctor may want to perform blood tests or other forms of monitoring during treatment with buprenorphine and naloxone.

Store buprenorphine and naloxone at room temperature away from moisture and heat. Buprenorphine and naloxone may be a target for people who abuse prescription or street drugs. Therefore, keep the tablets in a safe place to protect them from theft. Never give them to anyone else. Sell or giving away this medicine is against the law.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a buprenorphine and naloxone overdose may include slow breathing, seizures, dizziness, weakness, loss of consciousness, coma, confusion, tiredness, cold and clammy skin, and small pupils.

What should I avoid while taking buprenorphine and naloxone?

In an emergency, have family members tell emergency room staff that you are taking buprenorphine and naloxone and that you are dependent on opioids.

Dizziness may be more likely to occur when rising from a sitting or lying position. Rise slowly to minimize dizziness and prevent a fall.

Avoid alcohol while taking buprenorphine and naloxone. Alcohol may dangerously increase drowsiness and dizziness caused by the medication.

Buprenorphine and naloxone side effects

an allergic reaction (difficulty breathing; closing of the throat, swelling of the lips, tongue, or face; or hives);
slow breathing;
dizziness or confusion; or
liver problems such as yellowing of the skin or eyes, dark colored urine, light colored stools (bowel movements), decreased appetite for several days or longer, nausea, or lower stomach pain.

Other less serious side effects may be more likely to occur. Continue to take buprenorphine and naloxone and talk to your doctor if you experience

headache;
pain;
problems sleeping;
nausea;
sweating;
stomach pain; or
constipation.

Buprenorphine and naloxone Dosing Information

Usual Adult Dose for Opiate Dependence:

Initial dose: 8 mg on day 1.
Maintenance dose: Rapidly titrate to the recommended target dose of 16 mg/day. In clinical trials, patients received 8 mg on day 1 and 16 mg on day 2 and thereafter. Further dose adjustments may be made in 2 mg to 4 mg increments up to a level that suppresses opioid withdrawal symptoms and holds the patient in treatment. The usual daily range is 4 mg to 24 mg.

For patients taking heroin or short-acting opioids, the first dose should be administered at least 4 hours after the patient last used opioids or preferably when early withdrawal symptoms appear.

The optimal method of tapering to discontinuation has not been reported.

What other drugs will affect buprenorphine and naloxone?

Buprenorphine and naloxone can cause death from overdose, especially if it is injected with a tranquilizer. Use buprenorphine and naloxone exactly as directed by your doctor.

Do not take buprenorphine and naloxone without first talking to your doctor if you are taking:

a benzodiazepine such as alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), clorazepate (Tranxene), lorazepam (Ativan), chlordiazepoxide (Librium), oxazepam (Serax), triazolam (Halcion), temazepam (Restoril), estazolam (Prosom), quazepam (Doral), or flurazepam (Dalmane);
erythromycin (Ery-Tab, E.E.S., E-Mycin, others) or clarithromycin (Biaxin);
itraconazole (Sporanox) or ketoconazole (Nizoral);
an HIV protease inhibitor such as indinavir (Crixivan), ritonavir (Norvir) or saquinavir (Fortovase, Invirase);
rifampin (Rifadin, Rimactane), rifapentine (Priftin), or rifabutin (Mycobutin);
phenytoin (Dilantin);
carbamazepine (Tegretol);
a barbiturate such as phenobarbital, mephobarbital (Mebaral), and others.

You may not be able to take buprenorphine and naloxone, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medications listed above.

Drugs other than those listed here may also interact with buprenorphine and naloxone. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

Where can I get more information?

Your pharmacist may have additional information about buprenorphine and naloxone written for health professionals that you may read.

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.
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.

B,Concise

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buprenorphine and naloxone (Sublingual route)

30/06/10

bue-pre-NOR-feen hye-droe-KLOR-ide, Naloxone Hydrochloride

Commonly used brand name(s):

In the U.S.

Suboxone

Available Dosage Forms:

Tablet

Therapeutic Class: Opioid Dependency

Pharmacologic Class: Buprenorphine

Chemical Class: Buprenorphine

Uses For buprenorphine and naloxone

Buprenorphine and naloxone combination is used to treat opioid (narcotic) dependence or addiction. When a narcotic medicine is used for a long time, it may become habit-forming, causing mental or physical dependence. Physical dependence may lead to withdrawal side effects if the narcotic is stopped suddenly. Severe withdrawal side effects can usually be prevented when a person is switched to buprenorphine and naloxone combination. It acts on the central nervous system (CNS) to help prevent the withdrawal side effects.

buprenorphine and naloxone is available only with your doctor’s prescription.

Before Using buprenorphine and naloxone

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 buprenorphine and naloxone, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to buprenorphine and naloxone 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 buprenorphine and naloxone combination in children younger than 16 years of age. Safety and efficacy have not been established.

Geriatric

No information is available on the relationship of age to the effects of buprenorphine and naloxone combination in geriatric patients.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Buprenorphine

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using buprenorphine and naloxone.

Naloxone

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

Using buprenorphine and naloxone 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.

Alfentanil
Alphaprodine
Atazanavir
Codeine
Diazepam
Dihydrocodeine
Fentanyl
Hydrocodone
Hydromorphone
Levorphanol
Meperidine
Methadone
Morphine
Morphine Sulfate Liposome
Oxycodone
Oxymorphone
Propoxyphene
Sufentanil
Tapentadol

Using buprenorphine and naloxone 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.

Clonidine
Yohimbine

Interactions with Food/Tobacco/Alcohol

Proper Use of buprenorphine and naloxone

Take buprenorphine and naloxone exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

Dosing

The dose of buprenorphine and naloxone 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 buprenorphine and naloxone. If your dose is different, do not change it unless your doctor tells you to do so.

For sublingual dosage form (tablets):
- For treatment of opioid dependence:
  - Adults and teenagers—12 to 16 milligrams (mg) as a single dose once a day.
  - Children younger than 16 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of buprenorphine and naloxone, 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 buprenorphine and naloxone

It is very important that your doctor check your progress while you are using buprenorphine and naloxone. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.

Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are using buprenorphine and naloxone. Serious unwanted effects can occur if certain medicines are given together with buprenorphine and naloxone combination.

buprenorphine and naloxone will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicine or narcotics; medicine for seizures or barbiturates; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the medicines listed above while you are using buprenorphine and naloxone.

buprenorphine and naloxone may make you dizzy, drowsy, or lightheaded. Make sure you know how you react to buprenorphine and naloxone before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

buprenorphine and naloxone may cause serious allergic reactions, including 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 buprenorphine and naloxone.

If you have been using buprenorphine and naloxone regularly for several weeks or longer, do not suddenly stop using it without checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help reduce the possibility of withdrawal symptoms, such as abdominal or stomach cramps, anxiety, fever, nausea, runny nose, sweating, tremors, or trouble with sleeping.

Using buprenorphine and naloxone while you are pregnant may cause serious unwanted effects in your newborn baby. Tell your doctor right away if you think you are pregnant or if you plan to become pregnant while using buprenorphine and naloxone.

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.

buprenorphine and naloxone 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:

More common

Cough or hoarseness
feeling faint, dizzy, or lightheaded
feeling of warmth or heat
fever or chills
flushing or redness of the skin, especially on the face and neck
headache
lower back or side pain
painful or difficult urination
sweating

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Blurred vision
confusion
difficult or troubled breathing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
irregular, fast, slow, or shallow breathing
pale or blue lips, fingernails, or skin
pinpoint pupils
relaxed and calm feeling
shortness of breath
sleepiness
unusual tiredness or weakness

More common

Abdominal or stomach pain
difficulty having a bowel movement (stool)
lack or loss of strength
nausea
pain
sleeplessness
trouble sleeping
unable to sleep
vomiting

Less common

Back pain
diarrhea
runny nose
sneezing
stuffy nose

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.

Advanced,B

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Bufferin Arthritis Strength

30/06/10

Generic Name: aspirin (oral) (AS pir in)
Brand Names: Arthritis Pain, Aspergum Cherry, Aspergum Orginal, Aspir 81, Aspir-Low, Aspirin Lite Coat, Aspirin Litecoat, Aspirin Low Dose, Aspirin Low Strength, Bayer Aspirin, Bayer Aspirin Regimen, Bayer Aspirin Sugar Free, Bayer Aspirin with Calcium, Bayer Childrens Aspirin, Bayer Low Strength, Bayer Plus, Buffered Aspirin, Bufferin, Bufferin Arthritis Strength, Bufferin Extra Strength, Easprin, Ecotrin, Ecotrin Adult Low Strength, Ecotrin Maximum Strength, Fasprin, Genacote, Halfprin, Litecoat Aspirin, Norwich Aspirin, St. Joseph Aspirin, St. Joseph Aspirin Adult Chewable, St. Joseph Aspirin Adult EC, Stanback Analgesic, Tri-Buffered Aspirin, YSP Aspirin, Zorprin

What is aspirin?

Aspirin is in a group of drugs called salicylates (sa-LIS-il-ates). It works by reducing substances in the body that cause pain, fever, and inflammation.

Aspirin is used to treat mild to moderate pain, and also to reduce fever or inflammation. Aspirin is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina). Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.

Aspirin may also be used for other purposes not listed in this medication guide.

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

There are many brands and forms of aspirin available and not all brands are listed on this leaflet.

Aspirin should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Aspirin can cause a serious and sometimes fatal condition called Reye’s syndrome in children.

Stop using this medication and call your doctor at once if you have any symptoms of bleeding in your stomach or intestines. Symptoms include black, bloody, or tarry stools, and coughing up blood or vomit that looks like coffee grounds.

Avoid drinking alcohol while you are taking aspirin. Alcohol may increase your risk of stomach bleeding.

Aspirin is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina). Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.

What should I discuss with my healthcare provider before taking aspirin?

a recent history of stomach or intestinal bleeding;
a bleeding disorder such as hemophilia; or
an allergy to an NSAID (non-steroidal anti-inflammatory drug) such as Advil, Motrin, Aleve, Orudis, Indocin, Lodine, Voltaren, Toradol, Mobic, Relafen, Feldene, and others.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely take aspirin:

asthma or seasonal allergies;
stomach ulcers;
liver disease;
kidney disease;
a bleeding or blood clotting disorder;
heart disease, high blood pressure, or congestive heart failure;
gout; or
nasal polyps.

If you are taking aspirin to prevent heart attack or stroke, avoid also taking ibuprofen (Advil, Motrin). Ibuprofen may make aspirin less effective in protecting your heart and blood vessels. If you must use both medications, take the ibuprofen at least 8 hours before or 30 minutes after you take the aspirin (non-enteric coated form). This medication may be harmful to an unborn baby’s heart, and may also reduce birth weight or have other dangerous effects. Tell your doctor if you are pregnant or plan to become pregnant while you are taking aspirin. Aspirin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take aspirin?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger or smaller amounts, or use it for longer than recommended.

Take this medication with a full glass of water. Taking aspirin with food or milk can lessen stomach upset. Enteric-coated aspirin is specially formulated to be gentle on your stomach, but you may take it with food or milk if desired. Do not crush, chew, break, or open an enteric-coated or extended-release pill. Swallow the pill whole. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating. The extended-release tablet is specially made to release medicine slowly in the body. Breaking this pill would cause too much of the drug to be released at one time.

The chewable tablet form of aspirin must be chewed before swallowing.

Keep the orally disintegrating tablet in its package until you are ready to take the medicine. Open the package and peel the back cover from the tablet. Using dry hands, place the tablet into your mouth. It will begin to dissolve right away, without water. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking aspirin. You may need to stop using the medicine for a short time.

Do not take this medication if you smell a strong vinegar odor in the aspirin bottle. The medicine may no longer be effective. Store aspirin at room temperature away from moisture and heat.

What happens if I miss a dose?

Since aspirin is often used as needed, you may not be on a dosing schedule. If you are using the medication regularly, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include ringing in your ears, headache, nausea, vomiting, dizziness, confusion, hallucinations, rapid breathing, fever, seizure (convulsions), or coma.

What should I avoid while taking aspirin?

Do not use any other over-the-counter medication without first asking your doctor or pharmacist. Aspirin is contained in many medicines available over the counter. If you take certain products together you may accidentally take too much aspirin. Read the label of any other medicine you are using to see if it contains aspirin.

Avoid taking an NSAID (non-steroidal anti-inflammatory drug) while you are taking aspirin. NSAIDs include ibuprofen (Motrin, Advil), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.

Avoid drinking alcohol while you are taking aspirin. Alcohol may increase your risk of stomach bleeding. Avoid taking ibuprofen (Advil, Motrin) if you are taking aspirin to prevent stroke or heart attack. Ibuprofen can make aspirin less effective in protecting your heart and blood vessels. If you must use both medications, take the ibuprofen at least 8 hours before or 30 minutes after you take the aspirin (non-enteric coated form).

Aspirin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:

black, bloody, or tarry stools;
coughing up blood or vomit that looks like coffee grounds;
severe nausea, vomiting, or stomach pain;
fever lasting longer than 3 days;
swelling, or pain lasting longer than 10 days; or
hearing problems, ringing in your ears.

Less serious side effects may include:

upset stomach, heartburn;
drowsiness; or
headache.

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.

What other drugs will affect aspirin?

Tell your doctor if you are taking an antidepressant such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor). Taking any of these drugs with aspirin may cause you to bruise or bleed easily.

Before taking aspirin, tell your doctor if you are using any of the following drugs:

a blood thinner such as warfarin (Coumadin); or
another salicylate such as choline salicylate and/or magnesium salicylate (Magan, Doan’s, Bayer Select Backache Pain Formula, Mobidin, Arthropan, Trilisate, Tricosal), or salsalate (Disalcid).

This list is not complete and there may be other drugs that can interact with aspirin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about aspirin.

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.
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.

B,Concise

Comments (0)

Bufferin Extra Strength

30/06/10

What is aspirin?

Aspirin is in a group of drugs called salicylates (sa-LIS-il-ates). It works by reducing substances in the body that cause pain, fever, and inflammation.

Aspirin may also be used for other purposes not listed in this medication guide.

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

There are many brands and forms of aspirin available and not all brands are listed on this leaflet.

Avoid drinking alcohol while you are taking aspirin. Alcohol may increase your risk of stomach bleeding.

Aspirin is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina). Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.

What should I discuss with my healthcare provider before taking aspirin?

a recent history of stomach or intestinal bleeding;
a bleeding disorder such as hemophilia; or
an allergy to an NSAID (non-steroidal anti-inflammatory drug) such as Advil, Motrin, Aleve, Orudis, Indocin, Lodine, Voltaren, Toradol, Mobic, Relafen, Feldene, and others.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely take aspirin:

asthma or seasonal allergies;
stomach ulcers;
liver disease;
kidney disease;
a bleeding or blood clotting disorder;
heart disease, high blood pressure, or congestive heart failure;
gout; or
nasal polyps.

How should I take aspirin?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger or smaller amounts, or use it for longer than recommended.

The chewable tablet form of aspirin must be chewed before swallowing.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking aspirin. You may need to stop using the medicine for a short time.

Do not take this medication if you smell a strong vinegar odor in the aspirin bottle. The medicine may no longer be effective. Store aspirin at room temperature away from moisture and heat.

What happens if I miss a dose?

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include ringing in your ears, headache, nausea, vomiting, dizziness, confusion, hallucinations, rapid breathing, fever, seizure (convulsions), or coma.

What should I avoid while taking aspirin?

Aspirin side effects

black, bloody, or tarry stools;
coughing up blood or vomit that looks like coffee grounds;
severe nausea, vomiting, or stomach pain;
fever lasting longer than 3 days;
swelling, or pain lasting longer than 10 days; or
hearing problems, ringing in your ears.

Less serious side effects may include:

upset stomach, heartburn;
drowsiness; or
headache.

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.

What other drugs will affect aspirin?

Before taking aspirin, tell your doctor if you are using any of the following drugs:

a blood thinner such as warfarin (Coumadin); or
another salicylate such as choline salicylate and/or magnesium salicylate (Magan, Doan’s, Bayer Select Backache Pain Formula, Mobidin, Arthropan, Trilisate, Tricosal), or salsalate (Disalcid).

Where can I get more information?

Your pharmacist can provide more information about aspirin.

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.
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.

B,Concise

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Bugs Bunny with Iron Chewable

30/06/10

Generic Name: multivitamin with iron (MUL tee VYE ta mins with i ron)
Brand Names:

What is Bugs Bunny with Iron Chewable (multivitamin with iron)?

Multivitamin are a combination of many different vitamins that are normally found in foods and other natural sources.

Iron is normally found in foods like red meat. In the body, iron becomes a part of your hemoglobin (HEEM o glo bin) and myoglobin (MY o glo bin). Hemoglobin carries oxygen through your blood to tissues and organs. Myoglobin helps your muscle cells store oxygen.

Multivitamin and iron are used to provide vitamins and iron that are not taken in through the diet. They are also used to treat iron or vitamin deficiencies caused by illness, pregnancy, poor nutrition, digestive disorders, and many other conditions.

Multivitamin and iron may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Bugs Bunny with Iron Chewable (multivitamin with iron)?

Never take more than the recommended dose of a multivitamin. Avoid taking any other multivitamin product within 2 hours before or after you take multivitamin with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects. Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects. Iron and other minerals contained in a multivitamin can also cause serious overdose symptoms if you take too much.

Overdose symptoms may include severe stomach pain, vomiting, bloody diarrhea, coughing up blood, constipation, loss of appetite, hair loss, peeling skin, warmth or tingly feeling, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine or stools, black and tarry stools, pale skin, easy bruising or bleeding, weakness, shallow breathing, weak and rapid pulse, pale skin, blue lips, and seizure (convulsions).

Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin with iron.

What should I discuss with my healthcare provider before taking Bugs Bunny with Iron Chewable (multivitamin with iron)?

Iron and certain vitamins can cause serious or life-threatening side effects if taken in large doses. Do not take more of this medication than directed on the label or prescribed by your doctor.

If you have any medical conditions, ask your doctor before taking a multivitamin with iron. If you have certain conditions, you may need a certain vitamin formulation or special tests while taking this product.

Do not take multivitamin with iron without telling your doctor if you are pregnant or plan to become pregnant. Some vitamins and minerals can harm an unborn baby if taken in large doses. You may need to use a prenatal vitamin specially formulated for pregnant women. Multivitamin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Bugs Bunny with Iron Chewable (multivitamin with iron)?

Use this medication as directed on the label, or as your doctor has prescribed. Do not use the medication in larger amounts or for longer than recommended.

Never take more than the recommended dose of multivitamin with iron. Avoid taking any other multivitamin product within 2 hours before or after you take multivitamin with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.

Many multivitamin products also contain minerals such as calcium, magnesium, potassium, and zinc. Minerals (especially taken in large doses) can cause side effects such as tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, and muscle weakness or limp feeling. Read the label of any multivitamin product you take to make sure you are aware of what it contains.

Take your multivitamin with a full glass of water. You may take the multivitamin with food if it upsets your stomach.

The chewable tablet must be chewed or allowed to dissolve in the mouth before swallowing.

Measure the liquid form of this multivitamin using a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

Liquid multivitamin may sometimes be mixed with water, fruit juice, or infant formula (but not milk or other dairy products). Follow the directions on the medicine label.

Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

It is important to take multivitamin with iron regularly to get the most benefit.

Store this medication at room temperature away from moisture and heat. Keep the liquid medicine from freezing.

Store multivitamin in their original container. Storing multivitamin in a glass container can ruin the medication.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects. Iron and other minerals contained in a multivitamin can also cause serious overdose symptoms.

What should I avoid while taking Bugs Bunny with Iron Chewable (multivitamin with iron)?

Avoid taking any other multivitamin product within 2 hours before or after you take multivitamin with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.

Avoid the regular use of salt substitutes in your diet if your multivitamin contains potassium. If you are on a low-salt diet, ask your doctor before taking a vitamin or mineral supplement.

Avoid taking an antibiotic medicine within 2 hours before or after you take multivitamin with iron. This is especially important if you are taking an antibiotic such as ciprofloxacin (Cipro), demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), levofloxacin (Levaquin), lomefloxacin (Maxaquin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), norfloxacin (Noroxin), ofloxacin (Floxin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

Certain foods can also make it harder for your body to absorb iron. Avoid taking this multivitamin within 1 hour before or 2 hours after eating fish, meat, liver, and whole grain or “fortified” breads or cereals.

Bugs Bunny with Iron Chewable (multivitamin with iron) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor if you have serious side effects such as:

bright red blood in your stools; or
pain in your chest or throat when swallowing a ferrous fumarate tablet.

When taken as directed, multivitamin are not expected to cause serious side effects. Less serious side effects may include:

constipation, diarrhea;
nausea, vomiting, heartburn;
stomach pain, upset stomach;
black or dark-colored stools or urine;
temporary staining of the teeth;
headache; or
unusual or unpleasant taste in your mouth.

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.

What other drugs will affect Bugs Bunny with Iron Chewable (multivitamin with iron)?

Vitamin and mineral supplements can interact with certain medications, or affect how medications work in your body. Before taking multivitamin with iron, tell your doctor if you also use:

acetohydroxamic acid (Lithostat);
cimetidine (Tagamet);
deferoxamine (Desferal);
etidronate (Didronel);
diuretics (water pills);
heart or blood pressure medications;
tretinoin (Vesanoid);
isotretinoin (Accutane, Amnesteen, Clavaris, Sotret);
dimercaprol (an injection used to treat poisoning by arsenic, lead, or mercury);
penicillamine (Cuprimine);
pancrelipase (Cotazym, Creon, Ilozyme, Pancrease, Ultrase);
trimethoprim and sulfamethoxazole (Cotrim, Bactrim, Septra, TMP/SMX); or
an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), and others.

This list is not complete and there may be other medications that can interact with or be affected by multivitamin with iron. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about multivitamin with iron.

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.
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.

B,Concise

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bumetanide

30/06/10

Generic Name: bumetanide (byoo MET a nide)
Brand Names: Bumex

What is bumetanide?

Bumetanide is a loop diuretic (water pill) that prevents your body from absorbing too much salt, allowing the salt to instead be passed in your urine.

Bumetanide treats fluid retention (edema) in people with congestive heart failure, liver disease, or a kidney disorder such as nephrotic syndrome.

Bumetanide may also be used for other purposes not listed in this medication guide.

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

Do not use this medication if you are unable to urinate, if you have severe liver disease, or if you are severely dehydrated.

Before using this medication, tell your doctor if you have kidney disease, liver disease, gout, lupus, diabetes, or an allergy to sulfa drugs.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled appointments.

Bumetanide will make you urinate more often and you may get dehydrated easily. Follow your doctor’s instructions about using potassium supplements or getting enough salt and potassium in your diet.

Avoid becoming dehydrated. Follow your doctor’s instructions about the type and amount of liquids you should drink while you are taking bumetanide.

There are many other medicines that can interact with bumetanide. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

What should I discuss with my healthcare provider before taking bumetanide?

Do not use this medication if you have:

severe kidney disease or are unable to urinate;
severe liver disease; or
if you are severely dehydrated.

Before using bumetanide, tell your doctor if you have:

kidney disease;
liver disease;
gout;
lupus;
diabetes; or
an allergy to sulfa drugs.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take bumetanide.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether bumetanide passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take bumetanide?

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Bumetanide will make you urinate more often and you may get dehydrated easily. Follow your doctor’s instructions about using potassium supplements or getting enough salt and potassium in your diet.

Store this medication at room temperature away from heat, light, and moisture.

See also: Bumetanide dosage in more detail

What happens if I miss a dose?

Bumetanide is sometimes used only once, so you may not be on a dosing schedule. If you are using the medication regularly, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include ringing in your ears, loss of appetite, weakness, dizziness, or confusion.

What should I avoid while taking bumetanide?

Avoid becoming dehydrated. Follow your doctor’s instructions about the type and amount of liquids you should drink while you are taking bumetanide.

What are the possible side effects of bumetanide

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using bumetanide and call your doctor at once if you have any of these serious side effects:

dry mouth, thirst, nausea, vomiting;
feeling weak, drowsy, restless, or light-headed;
fast or uneven heartbeat;
muscle pain or weakness;
easy bruising or bleeding, unusual weakness; or
hearing loss.

Less serious side effects may include:

mild nausea or stomach pain;
headache;
dizziness; or
mild itching or skin rash.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect bumetanide?

Before taking this medication, tell your doctor if you are using any of the following drugs:

lithium;
digoxin (Lanoxin);
cyclosporine (Neoral, Sandimmune, Gengraf);
pentamidine (Nebupent, Pentam);
probenecid (Benemid);
tacrolimus (Prograf);
other diuretics;
blood pressure medications;
amphotericin B (Fungizone, AmBisome, Amphotec, Abelcet);
antibiotics such as capreomycin (Capastat), rifampin (Rifadin, Rimactane, Rifater), vancomycin (Vancocin, Vancoled);
antiviral medicines such as acyclovir (Zovirax), adefovir (Hepsera), cidofovir (Vistide), or foscarnet (Foscavir);
amikacin (Amikin), gentamicin (Garamycin), netilmicin (Netromycin), streptomycin, tobramycin (Nebcin, Tobi);
indomethacin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Motrin, Advil), diclofenac (Voltaren), naproxen (Aleve, Naprosyn), piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others; or
cancer medicine such as aldesleukin (Proleukin), carmustine (BiCNU, Gliadel), cisplatin (Platinol), ifosfamide (Ifex), oxaliplatin (Eloxatin), plicamycin (Mithracin), streptozocin (Zanosar), or tretinoin (Vesanoid).

This list is not complete and there may be other drugs that can interact with bumetanide. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about bumetanide.

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.
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.

B,Concise

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bumetanide (Injection route)

30/06/10

bue-MET-a-nide

Injection routeSolution

Bumetanide is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose and dosage schedule have to be adjusted to the individual patient’s needs .

Oral routeTablet

Commonly used brand name(s):

In the U.S.

Bumex

Available Dosage Forms:

Solution

Therapeutic Class: Cardiovascular Agent

Pharmacologic Class: Diuretic, Loop

Uses For bumetanide

Bumetanide belongs to a group of medicines called loop diuretics or “water pills.” Bumetanide is given to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease, kidney disease, or other medical conditions. It works by acting on the kidneys to increase the flow of urine .

bumetanide is available only with your doctor’s prescription .

Before Using bumetanide

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 bumetanide, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to bumetanide 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 bumetanide injection in the pediatric population. Safety and efficacy have not been established .

Geriatric

Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of bumetanide injection in the elderly. However, elderly patients are more likely to have age-related liver, kidney or heart problems, which may require an adjustment of dosage in patients receiving bumetanide injection .

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Interactions with Medicines

Using bumetanide 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.

Arsenic Trioxide
Bepridil
Digitoxin
Dofetilide
Droperidol
Ketanserin
Levomethadyl
Lithium
Metolazone
Sotalol

Using bumetanide 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.

Aceclofenac
Acemetacin
Alacepril
Alclofenac
Apazone
Benazepril
Benoxaprofen
Bromfenac
Bufexamac
Captopril
Carprofen
Celecoxib
Cilazapril
Clometacin
Clonixin
Delapril
Dexketoprofen
Dibekacin
Diclofenac
Diflunisal
Dipyrone
Droxicam
Enalaprilat
Enalapril Maleate
Etodolac
Etofenamate
Felbinac
Fenbufen
Fenoprofen
Fentiazac
Floctafenine
Flufenamic Acid
Flurbiprofen
Fosinopril
Germanium
Ginseng
Gossypol
Ibuprofen
Imidapril
Indomethacin
Indoprofen
Isoxicam
Kanamycin
Ketoprofen
Ketorolac
Licorice
Lisinopril
Lornoxicam
Meclofenamate
Mefenamic Acid
Meloxicam
Moexipril
Nabumetone
Naproxen
Neomycin
Niflumic Acid
Nimesulide
Oxaprozin
Oxyphenbutazone
Pentopril
Perindopril
Phenylbutazone
Pirazolac
Piroxicam
Pirprofen
Propyphenazone
Proquazone
Quinapril
Ramipril
Rofecoxib
Spirapril
Streptomycin
Sulindac
Suprofen
Temocapril
Tenidap
Tenoxicam
Tiaprofenic Acid
Tolmetin
Trandolapril
Valdecoxib
Zofenopril
Zomepirac

Interactions with Food/Tobacco/Alcohol

Proper Use of bumetanide

A nurse or other trained health professional will give you bumetanide. bumetanide is given through a needle placed into one of your veins .

Precautions While Using bumetanide

Your doctor will only give you a few doses of bumetanide until your condition improves, and then you will be switched to another medicine that works the same way. If you have any concerns about this, talk to your doctor .

bumetanide Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Abdominal pain
blurred vision
confusion
decreased urine output
dizziness
drowsiness
dry mouth
fast or irregular heartbeat
flushed, dry skin
fruit-like breath odor
headache
increased hunger
increased thirst
increased urination
irritability
joint pain, stiffness, or swelling
loss of appetite
loss of mental alertness
lower back, side, or stomach pain
mood or mental changes
muscle pain or cramps
nausea or vomiting
numbness or tingling in the hands, feet, or lips
shortness of breath
sweating
swelling of face, hands, feet, ankles, or lower legs
troubled breathing
unexplained weight loss
unusual tiredness or weakness
weak pulse

Rare

Agitation
back pain
black, tarry stools
bleeding gums
blood in the urine or stools
chest pain
convulsions (seizures)
deep or fast breathing with dizziness
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
fever
hallucinations
hives
increase in heart rate
increased blood pressure
numbness of feet, hands, and around the mouth
pinpoint red spots on the skin
rapid breathing
stiff neck
sunken eyes
trembling, jerking of hands
unusual bleeding or bruising
weight gain
wrinkled skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Difficulty breathing
pain in chest, groin, or legs, especially the calves
severe, sudden headache
slurred speech
sudden loss of coordination
sudden, severe weakness or numbness in the arm or leg
sudden, unexplained shortness of breath
tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over affected area
unusual drowsiness, dullness, or feeling of sluggishness
vision changes

Rare

Decreased interest in sexual intercourse
diarrhea
difficulty with moving
ear discomfort
feeling of constant movement of self or surroundings
inability to have or keep an erection
itching skin
loss in sexual ability, desire, drive, or performance
muscle or bone pain
muscle stiffness
nipple tenderness
pain, swelling, or redness in joints
rash
sensation of spinning
shorter than usual time to ejaculation of semen
trouble with hearing
upset stomach

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.

Advanced,B

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Drugs & Medications:A-Z

Recent Posts

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30/06/10

What is buprenorphine?

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

What should I discuss with my healthcare provider before taking buprenorphine?

How should I take buprenorphine?

What happens if I miss a dose?

What happens if I overdose?

What should I avoid while taking buprenorphine?

Buprenorphine side effects

Buprenorphine Dosing Information

What other drugs will affect buprenorphine?

Where can I get more information?

30/06/10

Uses For buprenorphine

Before Using buprenorphine

Allergies

Pediatric

Geriatric

Pregnancy

Breast Feeding

Interactions with Medicines

Interactions with Food/Tobacco/Alcohol

Other Medical Problems

Proper Use of buprenorphine

Precautions While Using buprenorphine

buprenorphine Side Effects

30/06/10

Uses For buprenorphine

Before Using buprenorphine

Allergies

Pediatric

Geriatric

Pregnancy

Breast Feeding

Interactions with Medicines

Interactions with Food/Tobacco/Alcohol

Other Medical Problems

Proper Use of buprenorphine

Dosing

Missed Dose

Storage

Precautions While Using buprenorphine

buprenorphine Side Effects

30/06/10

What is buprenorphine and naloxone?

What is the most important information I should know about buprenorphine and naloxone?

What should I discuss with my healthcare provider before taking buprenorphine and naloxone?

How should I take buprenorphine and naloxone?

What happens if I miss a dose?

What happens if I overdose?

What should I avoid while taking buprenorphine and naloxone?

Buprenorphine and naloxone side effects

Buprenorphine and naloxone Dosing Information

What other drugs will affect buprenorphine and naloxone?

Where can I get more information?

30/06/10

Uses For buprenorphine and naloxone

Before Using buprenorphine and naloxone

Allergies

Pediatric

Geriatric

Pregnancy

Breast Feeding

Interactions with Medicines

Interactions with Food/Tobacco/Alcohol

Other Medical Problems

Proper Use of buprenorphine and naloxone

Dosing

Missed Dose

Storage

Precautions While Using buprenorphine and naloxone

buprenorphine and naloxone Side Effects

30/06/10

What is aspirin?

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

What should I discuss with my healthcare provider before taking aspirin?

How should I take aspirin?