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Cyclessa

30/06/10

Generic Name: ethinyl estradiol and desogestrel (EH thih nill ess tra DYE ole and des oh JESS trel)
Brand Names: Apri, Cesia, Cyclessa, Desogen, Kariva, Mircette, Ortho-Cept, Reclipsen, Solia, Velivet

What is Cyclessa (ethinyl estradiol and desogestrel)?

Ethinyl estradiol and desogestrel contains a combination of female hormones that prevent ovulation (the release of an egg from an ovary). This medication also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Ethinyl estradiol and desogestrel are used as contraception to prevent pregnancy.

Ethinyl estradiol and desogestrel may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Cyclessa (ethinyl estradiol and desogestrel)?

Do not use birth control pills if you are pregnant or if you have recently had a baby. Do not use this medication if you have any of the following conditions: a history of stroke or blood clot, circulation problems (especially if caused by diabetes), a hormone-related cancer such as breast or uterine cancer, abnormal vaginal bleeding, liver disease or liver cancer, severe high blood pressure, migraine headaches, a heart valve disorder, or a history of jaundice caused by birth control pills.

You may need to use back-up birth control, such as condoms or a spermicide, when you first start using this medication. Follow your doctor’s instructions.

Taking hormones can increase your risk of blood clots, stroke, or heart attack, especially if you smoke and are older than 35.

Some drugs can make birth control pills less effective, which may result in pregnancy. Tell your doctor about all the prescription and over-the-counter medications you use, including vitamins, minerals and herbal products. Do not start using a new medication without telling your doctor.

What should I discuss with my healthcare provider before taking Cyclessa (ethinyl estradiol and desogestrel)?

This medication can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant, or if you miss two menstrual periods in a row. If you have recently had a baby, wait at least 4 weeks before taking birth control pills (6 weeks if you are breast-feeding). Do not use this medication if you have:

a history of a stroke or blood clot;
circulation problems (especially if caused by diabetes);
a hormone-related cancer such as breast or uterine cancer;
abnormal vaginal bleeding;
liver disease or liver cancer;
severe high blood pressure;
severe migraine headaches;
a heart valve disorder; or
a history of jaundice caused by birth control pills.

Before using this medication, tell your doctor if you have any of the following conditions. You may need a dosage adjustment or special tests to safely take birth control pills.

high blood pressure, heart disease, congestive heart failure, angina (chest pain), or a history of heart attack;
high cholesterol or if you are overweight;
a history of depression;
gallbladder disease;
diabetes;
seizures or epilepsy;
a history of irregular menstrual cycles; or
a history of fibrocystic breast disease, lumps, nodules, or an abnormal mammogram.

The hormones in birth control pills can pass into breast milk and may harm a nursing baby. This medication may also slow breast milk production. Do not use if you are breast-feeding a baby.

How should I take Cyclessa (ethinyl estradiol and desogestrel)?

Take this medication exactly as it was prescribed for you. Do not take larger amounts, or take it for longer than recommended by your doctor. You will take your first pill on the first day of your period or on the first Sunday after your period begins (follow your doctor’s instructions).

You may need to use back-up birth control, such as condoms or a spermicide, when you first start using this medication. Follow your doctor’s instructions.

The 28-day birth control pack contains seven “reminder” pills to keep you on your regular cycle. Your period will usually begin while you are using these reminder pills.

You may have breakthrough bleeding, especially during the first 3 months. Tell your doctor if this bleeding continues or is very heavy.

Take one pill every day, no more than 24 hours apart. When the pills run out, start a new pack the following day. You may get pregnant if you do not use this medication regularly. Get your prescription refilled before you run out of pills completely.

If you need to have any type of medical tests or surgery, or if you will be on bed rest, you may need to stop using this medication for a short time. Any doctor or surgeon who treats you should know that you are using birth control pills.

Your doctor will need to see you on a regular basis while you are using this medication. Do not miss any appointments.

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

What happens if I miss a dose?

Missing a pill increases your risk of becoming pregnant. Follow the directions on the patient information sheet provided with your medicine. If you do not have an information sheet, call your doctor for instructions if you miss a dose.

If you miss one “active” pill, take two pills on the day that you remember. Then take one pill per day for the rest of the pack.

If you miss two “active” pills in a row in week one or two, take two pills per day for two days in a row. Then take one pill per day for the rest of the pack. Use back-up birth control for at least 7 days following the missed pills.

If you miss two “active” pills in a row in week 3, or if you miss three pills in a row during any of the first 3 weeks, throw out the rest of the pack and start a new one the same day if you are a Day 1 starter. If you are a Sunday starter, keep taking a pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new one that day.

If you miss three “active” tablets in a row during any of the first 3 weeks, throw out the rest of the pack and start a new pack on the same day if you are a Day 1 starter. If you are a Sunday starter, keep taking a pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new one that day.

If you miss two or more pills, you may not have a period during the month. If you miss a period for two months in a row, call your doctor because you might be pregnant.

If you miss any reminder pills, throw them away and keep taking one pill per day until the pack is empty. You do not need back-up birth control if you miss a reminder pill.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include nausea, vomiting, and vaginal bleeding.

What should I avoid while taking Cyclessa (ethinyl estradiol and desogestrel)?

Do not smoke while using this medication, especially if you are older than 35. Smoking can increase your risk of blood clots, stroke, or heart attack caused by birth control pills.

This medication will not protect you from sexually transmitted diseases–including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

Cyclessa (ethinyl estradiol and desogestrel) 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:

sudden numbness or weakness, especially on one side of the body;
sudden headache, confusion, problems with vision, speech, or balance;
chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
a change in the pattern or severity of migraine headaches;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
swelling in your hands, ankles, or feet;
a breast lump; or
symptoms of depression (sleep problems, weakness, mood changes).

Less serious side effects may include:

mild nausea, vomiting, bloating, stomach cramps;
breast pain, tenderness, or swelling;
freckles or darkening of facial skin;
increased hair growth, loss of scalp hair;
changes in weight or appetite;
problems with contact lenses;
vaginal itching or discharge;
changes in your menstrual periods, decreased sex drive; or
headache, nervousness, dizziness, tired feeling.

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 Cyclessa (ethinyl estradiol and desogestrel)?

Some drugs can make birth control pills less effective, which may result in pregnancy. Before using this medication, tell your doctor if you are using any of the following drugs:

acetaminophen (Tylenol) or ascorbic acid (vitamin C);
an antibiotic;
phenylbutazone (Azolid, Butazolidin);
St. John’s wort;
seizure medicines such as phenytoin (Dilantin), carbamazepine (Tegretol), topiramate (Topamax), and others;
a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton); or
HIV medicines such as amprenavir (Agenerase), atazanavir (Reyataz), indinavir (Crixivan), saquinavir (Invirase), fosamprenavir (Lexiva), ritonavir (Norvir), and others.

This list is not complete and there may be other drugs that can affect birth control pills. 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 ethinyl estradiol and desogestrel.

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.

C,Concise

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cyclizine

30/06/10

Generic Name: cyclizine (SYE kli zeen)
Brand names: Marezine, Bonine For Kids

What is cyclizine?

Cyclizine is used to relieve nausea, vomiting, and dizziness associated with motion sickness.

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

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

Use caution when driving, operating machinery, or performing other hazardous activities. Cyclizine may cause dizziness, drowsiness, or blurred vision. If you experience dizziness, drowsiness, or blurred vision, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking cyclizine.

Who should not take cyclizine?

Before taking this medication, tell your doctor if you have

kidney or liver disease,
an enlarged prostate,
difficulty urinating,
bladder problems, or
glaucoma.

You may not be able to take cyclizine, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.

Cyclizine is in the FDA pregnancy category B. This means that it is unlikely to harm an unborn baby. Do not take cyclizine without first talking to your doctor if you are pregnant. It is not known whether cyclizine passes into breast milk. Do not take cyclizine without first talking to your doctor if you are breast-feeding a baby. Cyclizine is not recommended for use by children younger than 12 years of age.

How should I take cyclizine?

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

Take each dose with a full glass of water.

Cyclizine usually is taken approximately 30 minutes before travel and then every 4 to 6 hours as needed. Do not take more than 200 mg of this medication in 1 day.

Store cyclizine at room temperature away from moisture and heat.

See also: Cyclizine dosage in more detail

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your 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 cyclizine overdose include drowsiness, agitation, excitability, seizures or convulsions, hallucinations, and death.

What should I avoid while taking cyclizine?

Cyclizine side effects

Stop taking cyclizine and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives).

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

drowsiness;
restlessness, excitation, nervousness, or insomnia;
blurred vision;
dry mouth, nose, or throat;
decreased appetite, nausea, or vomiting;
difficulty urinating; or
an irregular or fast heartbeat.

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.

Cyclizine Dosing Information

Usual Adult Dose for Motion Sickness:

50 mg orally 30 minutes prior to departure. The dosage may be repeated every 4 to 6 hours, not to exceed 200 mg/24 hours.

Usual Adult Dose for Nausea/Vomiting:

50 mg orally or intramuscularly every 4 to 6 hours as needed.
The daily dose should not exceed 200 mg.

Usual Pediatric Dose for Motion Sickness:

13 to 18 years: 50 mg orally up to 4 times a day.
6 to 12 years: 25 mg orally up to 3 times a day.

What other drugs will affect cyclizine?

Cyclizine may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.

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

Where can I get more information?

Your pharmacist has more information about cyclizine 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.

C,Concise

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Cutar

30/06/10

Generic Name: coal tar topical (KOL TAR TOP ik al)
Brand Names: Balnetar, Betatar Gel, Coal Tar, Cutar, Denorex, Denorex Dry Scalp, Denorex Extra Strength, Denorex Medicated Shampoo and Conditioner, DHS Tar Shampoo, Doak Tar, Doak Tar Oil, Elta Tar, Fototar, G-TAR, Ionil T, Ionil T Plus, MG 217 Psoriasis, MG217 Medicated Tar, Neutrogena T/Derm, Neutrogena T/Gel, Neutrogena T/Gel Extra Strength, Oxipor VHC, PC Tar, Pentrax, Pentrax Gold, Polytar, Psoriasin, Psorigel, T/Gel Conditioner, Tegrin Medicated, Tegrin Medicated Soap, Therapeutic, Theraplex T, Zetar

What is coal tar?

Coal tar is a by-product of coal processing.

Coal tar topical (for the skin) is used to treat the skin symptoms of psoriasis, including dryness, redness, flaking, scaling, and itching. Coal tar is not a cure for psoriasis, and it will provide only temporary relief of skin symptoms.

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

What is the most important information I should know about coal tar?

You should not use this medication if you are allergic to coal tar.

Before using coal tar, tell your doctor if you are allergic to any drugs, or if you are receiving ultraviolet radiation treatment for your psoriasis.

Do not use coal tar to treat the skin of your groin or rectal area.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Coal tar can make your skin more sensitive to sunlight and sunburn may result. Stop using coal tar and call your doctor at once if you have severe stinging, burning, swelling, or other irritation of the treated skin. Do not use coal tar to treat large skin areas. Do not use coal tar over long periods of time without your doctor’s advice.

Call your doctor if your symptoms do not improve, or if they get worse after using coal tar.

Coal tar is not a cure for psoriasis, and it will provide only temporary relief of skin symptoms.

What should I discuss with my health care provider before using coal tar?

You should not use this medication if you are allergic to coal tar.

Before using coal tar, tell your doctor if you are allergic to any drugs, or if you are receiving ultraviolet radiation treatment for your psoriasis.

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 coal tar 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.

Coal tar products may contain lanolin, mineral oil, or other emulsifiers. Check the label of any coal tar product you are using. Talk with your doctor before using coal tar if you are allergic to any of the ingredients.

How should I use coal tar?

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.

Apply coal tar cream, lotion, ointment, or solution according the directions on the medication label. Some forms of coal tar may be applied 1 to 4 times per day.

To use coal tar bath oil, pour 1 to 3 capfuls into a warm bath before bathing. The oil can make the bathtub slippery. Take care to avoid a fall.

Shake the coal tar shampoo well just before each use. Use enough shampoo to create a rich lather. Massage the shampoo into your scalp and rinse thoroughly. Apply the shampoo a second time and leave it on your scalp for 5 minutes. Rinse thoroughly. Do not use coal tar to treat large skin areas. Do not use coal tar over long periods of time without your doctor’s advice.

Call your doctor if your symptoms do not improve, or if they get worse after using coal tar.

Coal tar shampoo may discolor blond or colored hair. This effect is usually temporarily.

Some forms of coal tar can stain fabric or other surfaces.

Store coal tar at room temperature away from moisture and heat. Keep the medicine tightly closed with not in use.

What happens if I miss a dose?

Use the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to use the medicine and skip the missed 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.

Symptoms of a coal tar overdose are not known.

What should I avoid while using coal tar?

Avoid getting this medication in your eyes. If this does occur, rinse with water.

Do not use coal tar to treat the skin of your groin or rectal area.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Coal tar can make your skin more sensitive to sunlight and sunburn may result.

Coal tar 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 coal tar and call your doctor at once if you have severe stinging, burning, swelling, or other irritation of the treated skin.

Less serious side effects may include mild skin irritation 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 coal tar?

Do not use coal tar together with other psoriasis medications unless your doctor tells you to.

There may be other drugs that can interact with coal tar. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about coal tar.

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.

C,Concise

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Cutar Emulsion

30/06/10

Generic Name: coal tar (Topical route)

kole tar

Commonly used brand name(s):

In the U.S.

Betatar Gel
Cutar Emulsion
Denorex
DHS Tar
Doak Tar
Duplex T
Fototar
Ionil-T Plus
Medotar
MG 217
Neutrogena T/Derm
Neutrogena T/Gel

In Canada

Estar
Liquor Carbonis Detergens
Psorigel
Spectro Tar Skin Wash
Tar Distillate

Available Dosage Forms:

Liquid
Shampoo
Lotion
Solution
Cream
Gel/Jelly
Soap
Kit
Ointment
Bar
Foam
Emulsion

Therapeutic Class: Keratolytic

Uses For Cutar Emulsion

Coal tar is used to treat eczema, psoriasis, seborrheic dermatitis, and other skin disorders.

Some of these preparations are available only with your doctor’s prescription.

Before Using Cutar Emulsion

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

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

Pediatric

Coal tar products should not be used on infants, unless otherwise directed by your doctor. Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of this medicine in children with use in other age groups.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of this medicine in the elderly with use in other age groups.

Breast Feeding

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

Interactions with Medicines

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

Interactions with Food/Tobacco/Alcohol

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

Proper Use of coal tar

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

Use this medicine only as directed. Do not use more of it and do not use it more often than recommended on the label, unless otherwise directed by your doctor. To do so may increase the chance of side effects.

After applying coal tar, protect the treated area from direct sunlight and do not use a sunlamp for 72 hours, unless otherwise directed by your doctor, since a severe reaction may occur. Also, make sure you have removed all the coal tar medicine from your skin before you go back into direct sunlight or use a sunlamp.

Do not apply this medicine to infected, blistered, raw, or oozing areas of the skin.

Keep this medicine away from the eyes. If you should accidentally get some in your eyes, flush them thoroughly with water at once.

To use the cream or ointment form of this medicine:

Apply enough medicine to cover the affected area, and rub in gently.

To use the gel form of this medicine:

Apply enough gel to cover the affected area, and rub in gently. Allow the gel to remain on the affected area for 5 minutes, then remove excess gel by patting with a clean tissue.

To use the shampoo form of this medicine:

Wet the scalp and hair with lukewarm water. Apply a generous amount of shampoo and rub into the scalp, then rinse. Apply the shampoo again, working up a rich lather, and allow to remain on the scalp for 5 minutes. Then rinse thoroughly.

To use the nonshampoo liquid form of this medicine:

Some of these preparations are to be applied directly to dry or wet skin, some are to be added to lukewarm bath water, and some may be applied directly to dry or wet skin or added to lukewarm bath water. Make sure you know exactly how you should use this medicine. If you have any questions about this, check with your health care professional.
If this medicine is to be applied directly to the skin, apply enough to cover the affected area, and rub in gently.
Some of these preparations contain alcohol and are flammable. Do not use near heat, near open flame, or while smoking.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For eczema, psoriasis, seborrheic dermatitis, and other skin disorders:
- For cleansing bar dosage form:
  - Adults—Use one or two times a day, or as directed by your doctor.
  - Children—Use and dose must be determined by your doctor.
- For cream dosage form:
  - Adults—Apply to the affected area(s) of the skin up to four times a day.
  - Children—Use and dose must be determined by your doctor.
- For gel dosage form:
  - Adults—Apply to the affected area(s) of the skin one or two times a day.
  - Children—Use and dose must be determined by your doctor.
- For lotion dosage form:
  - Adults—Apply directly to the affected area(s) of the skin or use as a bath, hand or foot soak, or as a hair rinse, depending on the product.
  - Children—Use and dose must be determined by your doctor.
- For ointment dosage form:
  - Adults—Apply to the affected area(s) of the skin two or three times a day.
  - Children—Use and dose must be determined by your doctor.
- For shampoo dosage form:
  - Adults—Use once a day to once a week or as directed by your doctor.
  - Children—Use and dose must be determined by your doctor.
- For topical solution dosage form:
  - Adults—Apply to wet the skin or scalp, or use as a bath, depending on the product.
  - Children—Use and dose must be determined by your doctor.
- For topical suspension dosage form:
  - Adults—Use as a bath.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using Cutar Emulsion

If this medicine is used on the scalp, it may temporarily discolor blond, bleached, or tinted hair.

Coal tar may stain the skin or clothing. Avoid getting it on your clothing. The stain on the skin will wear off after you stop using the medicine.

Cutar Emulsion Side Effects

In animal studies, coal tar has been shown to increase the chance of skin cancer.

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 as soon as possible if any of the following side effects occur:

Rare

Skin irritation not present before use of this medicine
skin rash

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

Stinging (mild)—especially for gel and solution dosage forms

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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Cutivate

30/06/10

Generic Name: fluticasone topical (floo TIK a sone)
Brand Names: Cutivate

What is Cutivate (fluticasone topical)?

Fluticasone is a topical (for the skin) steroid. It reduces the actions of chemicals in the body that cause inflammation, redness, and swelling.

Fluticasone topical is used to treat the inflammation and itching caused by a number of skin conditions such as allergic reactions, eczema, and psoriasis.

Fluticasone topical should not be used to treat rosacea, severe acne, or viral skin infections such as chickenpox or herpes. Fluticasone should not be used on a child younger than 12 years old.

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

What is the most important information I should know about Cutivate (fluticasone topical)?

Use this medication exactly as it has been prescribed by your doctor. Do not use the medication in larger amounts or for longer than recommended. Topical steroid medicine can be absorbed through the skin, which may cause steroid side effects throughout the body.

Do not cover treated skin areas with a bandage or other covering. Covering the skin that is treated with fluticasone topical can increase the amount of medicine your skin absorbs, which may lead to unwanted side effects. Do not use this medication on a child younger than 12 years old without the advice of a doctor. Children are more likely to absorb large amounts of a topical steroid through the skin. Steroid absorption in children may cause unwanted side effects, or a delay in growth with long-term use. Talk with your doctor if you think your child is not growing at a normal rate while using this medication over a long treatment period. Contact your doctor if your condition does not improve after 2 weeks of using this medicine, or if you develop signs of a bacterial, fungal, or viral skin infection.

What should I discuss with my healthcare provider before using Cutivate (fluticasone topical)?

Do not use this medication if you are allergic to fluticasone.

Before using fluticasone topical, tell your doctor if you are allergic to any drugs, or if you have any type of skin infection.

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 fluticasone topical 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. Do not use this medication on a child younger than 12 years old without the advice of a doctor. Children are more likely to absorb large amounts of a topical steroid through the skin. Steroid absorption in children may cause unwanted side effects, or a delay in growth with long-term use. Talk with your doctor if you think your child is not growing at a normal rate while using this medication over a long treatment period.

How should I use Cutivate (fluticasone topical)?

Wash your hands before and after using fluticasone topical, unless you are using the medication to treat the skin on your hands.

Apply a small amount to the affected area and rub it gently into the skin. Do not apply the medication over a large area of skin, or use it long-term on the face.

If you are treating your scalp, part the hair and apply the medicine directly to the scalp, rubbing in gently. Avoid washing or rubbing the treated scalp area right away. Wait until the medicine has dried thoroughly.

Do not cover treated skin areas with a bandage or other covering. Covering the skin that is treated with fluticasone topical can increase the amount of medicine your skin absorbs, which may lead to unwanted side effects. Contact your doctor if your condition does not improve after 2 weeks of using this medicine, or if you develop signs of a bacterial, fungal, or viral skin infection. It is important to use fluticasone topical regularly to get the most benefit.

To be sure this medication is not causing harmful effects with long-term use, you may need blood tests. Do not miss any scheduled appointments.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using fluticasone topical. Store fluticasone topical at room temperature away from moisture and heat. Keep from freezing.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. 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.

An overdose of fluticasone is not expected to produce life-threatening symptoms. However, long-term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using Cutivate (fluticasone topical)?

Fluticasone topical should not be used to treat any skin condition your doctor has not prescribed it for.

Do not use this medication to treat skin conditions around your mouth, rectum, or genital areas. When using fluticasone to treat the skin around your eyes, avoid getting the medication directly into your eyes. If contact does occur, rinse with water. Do not use fluticasone topical on broken or infected skin. Also avoid using this medication in open wounds.

Cutivate (fluticasone topical) side effects

blurred vision, or seeing halos around lights;
mood changes;
sleep problems (insomnia);
weight gain, puffiness in your face; or
muscle weakness, feeling tired.

Less serious side effects may include:

mild skin itching, burning, peeling, or dryness;
changes in color of treated skin;
headache;
thinning or softening of your skin;
skin rash or irritation around your mouth;
swollen hair follicles;
blisters, pimples, or crusting of treated skin; or
stretch marks.

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 Cutivate (fluticasone topical)?

It is not likely that other drugs you take orally or inject will have an effect on topically applied fluticasone topical. But many drugs can interact with each other. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about fluticasone topical.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
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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Cutivate Cream

30/06/10

Generic Name: Fluticasone (floo-TIK-a-sone)
Brand Name: Cutivate

Cutivate Cream is used for:

Treating inflammation and itching caused by certain skin conditions. It may also be used for other conditions as determined by your doctor.

Cutivate Cream is a topical corticosteroid. It works by reducing skin inflammation (redness, swelling, itching, and irritation).

Do NOT use Cutivate Cream if:

you are allergic to any ingredient in Cutivate Cream

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

Before using Cutivate Cream:

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

if you are pregnant, plan to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines or other substances
if you have an acne-like rash, rosacea, inflammation around the mouth, skin thinning, a skin infection, measles, tuberculosis (TB), chickenpox, shingles, or a positive TB skin test
if you are taking an oral corticosteroid (eg, prednisone) or similar medicines

Some MEDICINES MAY INTERACT with Cutivate Cream. However, no specific interactions with Cutivate Cream are known at this time.

Ask your health care provider if Cutivate Cream may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Cutivate Cream:

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

Apply a small amount of medicine to the affected area. Gently rub it in until it is evenly distributed.
Wash your hands after you apply Cutivate Cream, unless your hands are part of the treated area.
Do not bandage or cover the treated skin area unless directed by your doctor.
If you miss a dose of Cutivate Cream, apply it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not apply 2 doses at once.

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

Important safety information:

Cutivate Cream is for external use only. Do not get it in your eyes, nose, vagina, or mouth. If you get it in any of these areas, rinse right away with cool water.
Do not use Cutivate Cream on the face, in the groin area, or under the armpits unless your doctor tells you otherwise.
Do not apply Cutivate Cream in the diaper area unless your doctor tells you otherwise. If Cutivate Cream is applied to the diaper area, apply a very small amount and do not use tight-fitting undergarments or plastic pants.
Do not use more than the recommended dose or use for longer than prescribed without checking with you doctor.
If your symptoms do not get better within 2 weeks or if they get worse, check with your doctor.
Contact your doctor if you have a cut or sore that does not heal.
Check with your doctor before you have any vaccines while you are using Cutivate Cream.
Do not apply Cutivate Cream over large areas of the body without first checking with your doctor.
Do not use Cutivate Cream for other skin conditions at a later time.
Do not use other medicines or products on your skin without first checking with your doctor.
Overuse of topical products may worsen your condition.
Cutivate Cream is a corticosteroid. Before you begin too use any new prescription or nonprescription medicine, check the label to see if it has a corticosteroid in it too. If it does or if you are not sure, check with your doctor or pharmacist.
Tell your doctor or dentist that you take Cutivate Cream before you receive any medical or dental care, emergency care, or surgery.
Serious side effects may occur if too much of Cutivate Cream is absorbed through the skin. This may be more likely to occur if you use Cutivate Cream over a large area of the body. It may also be more likely if you wrap or bandage the area after you apply Cutivate Cream. The risk is greater in children. Do not use more than the prescribed dose. Contact your doctor right away if you develop unusual weight gain (especially in the face), muscle weakness, increased thirst or urination, confusion, unusual drowsiness, severe or persistent headache, or vision changes. Discuss any questions or concerns with your doctor.
Corticosteroids may affect growth rate in CHILDREN and teenagers in some cases. They may need regular growth checks while using a corticosteroid.
Cutivate Cream should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Cutivate Cream while you are pregnant. It is not known if Cutivate Cream is found in breast milk after topical use. If you are or will be breast-feeding while you use Cutivate Cream, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Cutivate Cream:

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

Dryness; mild stinging, burning, or itching.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); acne-like rash; burning, cracking, irritation, or peeling not present before you began using Cutivate Cream; excessive hair growth; inflamed hair follicles; inflammation around the mouth; thinning, softening, or discoloration of the skin.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include blurred vision or other vision changes; muscle weakness; severe or persistent headache; symptoms of high blood sugar (eg, increased thirst or urination, confusion, unusual drowsiness); unusual weight gain, especially in the face.

Proper storage of Cutivate Cream:

Store Cutivate Cream between 36 and 86 degrees F (2 and 30 degrees C). Store away from heat and light. Keep Cutivate Cream out of the reach of children and away from pets.

General information:

If you have any questions about Cutivate Cream, please talk with your doctor, pharmacist, or other health care provider.
Cutivate Cream is to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

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

Issue Date: May 5, 2010

Database Edition 10.2.1.002

C,Med-facts

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Cutivate Lotion

30/06/10

Generic Name: Fluticasone (floo-TIK-a-sone)
Brand Name: Cutivate

Cutivate Lotion is used for:

Treating inflammation and itching caused by certain skin conditions. It may also be used for other conditions as determined by your doctor.

Cutivate Lotion is a topical corticosteroid. It works by reducing skin inflammation (redness, swelling, itching, and irritation).

Do NOT use Cutivate Lotion if:

you are allergic to any ingredient in Cutivate Lotion

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

Before using Cutivate Lotion:

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

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines or other substances
if you have an acne-like rash, rosacea, inflammation around the mouth, skin thinning, a skin infection, measles, tuberculosis (TB), chickenpox, shingles, or a positive TB skin test, or if you have been vaccinated recently
if you are taking an oral corticosteroid (eg, prednisone) or similar medicines

Some MEDICINES MAY INTERACT with Cutivate Lotion. However, no specific interactions with Cutivate Lotion are known at this time.

Ask your health care provider if Cutivate Lotion may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Cutivate Lotion:

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

Apply a small amount of medicine to the affected area. Gently rub it in until it is evenly distributed.
Wash your hands after you apply Cutivate Lotion, unless your hands are part of the treated area.
Do not bandage or cover the treated skin area unless directed by your doctor.
If you miss a dose of Cutivate Lotion, apply it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not apply 2 doses at once.

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

Important safety information:

Cutivate Lotion is for external use only. Do not get Cutivate Lotion in your eyes, nose, vagina, or mouth. If you get it in any of these areas, rinse right away with cool water.
Do not use Cutivate Lotion on the face, in the groin area, or under the armpits unless your doctor tells you otherwise.
Do not use Cutivate Lotion to treat diaper rash unless your doctor tells you otherwise. If Cutivate Lotion is applied to the diaper area, apply a very small amount and o not use tight-fitting diapers or plastic pants.
Do not use more than the recommended dose or use for longer than 4 weeks without checking with you doctor.
If your symptoms do not get better within 2 weeks or if they get worse, check with your doctor.
Contact your doctor if you have a cut or sore that does not heal.
Check with your doctor before you have any vaccines while you are using Cutivate Lotion.
Do not apply Cutivate Lotion over large areas of the body without first checking with your doctor.
Do not use Cutivate Lotion for other skin conditions at a later time.
Do not use other medicines or products on your skin without first checking with your doctor.
Overuse of topical products may worsen your condition.
Cutivate Lotion is a corticosteroid. Before you begin too use any new prescription or nonprescription medicine, check the label to see if it has a corticosteroid in it too. If it does or if you are not sure, check with your doctor or pharmacist.
Tell your doctor or dentist that you take Cutivate Lotion before you receive any medical or dental care, emergency care, or surgery.
Serious side effects may occur if too much of Cutivate Lotion is absorbed through the skin. This may be more likely to occur if you use Cutivate Lotion over a large area of the body. It may also be more likely if you wrap or bandage the area after you apply Cutivate Lotion. The risk is greater in children. Do not use more than the prescribed dose. Contact your doctor right away if you develop unusual weight gain (especially in the face), muscle weakness, increased thirst or urination, confusion, unusual drowsiness, severe or persistent headache, or vision changes. Discuss any questions or concerns with your doctor.
Corticosteroids may affect growth rate in CHILDREN and teenagers in some cases. They may need regular growth checks while they use Cutivate Lotion.
Cutivate Lotion should be used with extreme caution in CHILDREN younger than 1 year old; safety and effectiveness in these children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Cutivate Lotion while you are pregnant. It is not known if Cutivate Lotion is found in breast milk after topical use. If you are or will be breast-feeding while you use Cutivate Lotion, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Cutivate Lotion:

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

Dryness; mild stinging, burning, or itching.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); acne-like rash; burning, cracking, irritation, or peeling not present before you began using Cutivate Lotion; excessive hair growth; inflamed hair follicles; inflammation around the mouth; thinning, softening, or discoloration of the skin.

If OVERDOSE is suspected:

Proper storage of Cutivate Lotion:

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

General information:

If you have any questions about Cutivate Lotion, please talk with your doctor, pharmacist, or other health care provider.
Cutivate Lotion is to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

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

Issue Date: May 5, 2010

Database Edition 10.2.1.002

C,Med-facts

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cyanocobalamin

30/06/10

Generic Name: cyanocobalamin (oral) (sye AN oh koe BAL a min)
Brand Names: B-12 Resin, Vitamin B-12, Vitamin B12

What is oral cyanocobalamin?

Cyanocobalamin is a man-made form of vitamin B12. Vitamin B12 is important for growth, cell reproduction, blood formation, and protein and tissue synthesis.

Cyanocobalamin is used to treat vitamin B12 deficiency in people with pernicious anemia and other conditions.

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

What is the most important information I should know about oral cyanocobalamin?

You should not use this medication if you are allergic to cobalt, or if you have Leber’s disease. Cyanocobalamin can lead to optic nerve damage (and possibly blindness) in people with Leber’s disease.

To treat pernicious anemia, you will have to use this medication on a regular basis for the rest of your life. Not using the medication can lead to irreversible nerve damage in your spinal cord.

Pernicious anemia is also treated with folic acid to help maintain red blood cells. However, folic acid will not treat Vitamin B12 deficiency and will not prevent possible damage to the spinal cord. Take all of your medications as directed.

Your dose needs may change if you become pregnant, if you breast-feed, or if you eat a vegetarian diet. Tell your doctor about any changes in your diet or medical condition.

What should I discuss with my healthcare provider before taking oral cyanocobalamin?

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

any type of infection;
iron or folic acid deficiency;
kidney or liver disease; or
if you are receiving any medication or treatment that affects bone marrow.

FDA pregnancy category C. It is not known whether cyanocobalamin is harmful to an unborn baby. Before using this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Cyanocobalamin passes into breast milk, but it is not known whether cyanocobalamin 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 oral cyanocobalamin?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Your dose needs may change if you become pregnant, if you breast-feed, or if you eat a vegetarian diet. Tell your doctor about any changes in your diet or medical condition. Take oral cyanocobalamin with a full glass of water.

The sublingual tablet should be placed under your tongue where it will dissolve.

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

To be sure this medication is helping your condition, your blood will need to be tested every 3 to 6 months. This will help your doctor determine the correct dose and how long to treat you with cyanocobalamin. Do not miss any scheduled appointments.

To treat pernicious anemia, you will have to use this medication on a regular basis for the rest of your life. Not using the medication can lead to irreversible nerve damage in your spinal cord.

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

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, wait until then to take the medicine and skip the missed 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. An overdose of cyanocobalamin is not likely to cause life-threatening symptoms.

What should I avoid while taking oral cyanocobalamin?

Avoid drinking large amounts of alcohol while you are being treated with cyanocobalamin.

Oral cyanocobalamin 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 at once if you have a serious side effect such as:

chest pain;
feeling short of breath, even with mild exertion;
swelling, rapid weight gain; or
unusual warmth, redness, or pain in an arm or leg.

Less serious side effects may include:

headache, dizziness, weakness;
nausea, upset stomach, diarrhea;
numbness or tingling;
fever;
joint pain;
swollen tongue;
swelling; or
itching or rash.

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.

Cyanocobalamin Dosing Information

Usual Adult Dose for Pernicious Anemia:

Parenteral:
Initial dose: 100 mcg intramuscularly once a day for 7 days. If there is clinical improvement and a reticulocyte response, 100 mcg intramuscularly once every other day for 7 days, then once every 3 to 4 days for another 2 to 3 weeks is recommended. Most patients require monthly injections of 100 to 1000 mcg intramuscularly for life.

Nasal Spray or Gel:
Alternatively, cyanocobalamin (Nascobal) nasal spray or nasal gel 500 mcg intranasally to one nostril once a week may be administered to patients with pernicious anemia who require maintenance of normal hematologic status following intramuscular vitamin B12 and who have no nervous system involvement. However, if the patient is not adequately maintained with cyanocobalamin nasal, intramuscular vitamin B12 administration must be resumed.

Usual Adult Dose for B12 Nutritional Deficiency:

Oral: 25 to 250 mcg once a day.
Nasal Spray or Gel:
(Nascobal) 500 mcg intranasally in one nostril once a week
(CaloMist) 25 mcg in each nostril once a day (total dose 50 mcg). May be increased to 50 mcg in each nostril once a day.

Usual Adult Dose for Schilling Test:

1 mcg radiolabeled cyanocobalamin orally once after urinary voiding. A 24-hour urinary collection is immediately begun. At 2 hours an injection of cyanocobalamin 1,000 mcg intramuscularly is given to “flush” the patient of absorbed radiolabeled drug. The percentage of radiolabeled B12 excreted in the urine is a measure of how much labeled drug was absorbed. Normally 7% or more of a dose is excreted in 24 hours (< 7% may be considered a positive Schilling test).

Usual Pediatric Dose for Pernicious Anemia:

30 to 50 mcg/day for 2 or more weeks (to a total dose of 1000 to 5000 mcg), then follow with 100 mcg/month.

Usual Pediatric Dose for B12 Nutritional Deficiency:

100 mcg/day for 10 to 15 days (total dose of 1 to 1.5 mg), then once or twice weekly for several months. May taper to 60 mcg every month.

What other drugs will affect oral cyanocobalamin?

Before taking cyanocobalamin, tell your doctor if you are taking any of the following medications:

antibiotics;
methotrexate (Rheumatrex);
pyrimethamine (Daraprim);
colchicine; or
if you drank a lot of alcohol within the past 2 weeks.

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

Where can I get more information?

Your pharmacist can provide more information about oral cyanocobalamin.

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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cyanocobalamin nasal

30/06/10

Generic Name: cyanocobalamin nasal (sigh ah no ko BALL ah min)
Brand Names: Nascobal

What is cyanocobalamin nasal?

Cyanocobalamin nasal is a synthetic (man-made) form of vitamin B12. Vitamin B12 is important for growth, cell reproduction, blood formation, and protein and tissue synthesis.

Cyanocobalamin nasal is used to maintain vitamin B12 levels in patients with pernicious anemia, nutritional vitamin B12 deficiency, malabsorption of vitamin B12, and other cases of vitamin B12 deficiency.

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

What is the most important information I should know about cyanocobalamin nasal?

To treat pernicious anemia, you will have to use this medication on a regular basis for the rest of your life. Failure to do this will result in irreversible damage to the nerves of your spinal cord. Also, treatment with cyanocobalamin nasal cannot be substituted with folic acid therapy. Folic acid may prevent anemia but it will allow progressive damage to the spinal cord.

Use the nasal spray one hour before or after eating or drinking hot foods or liquids.

Who should not use cyanocobalamin nasal?

Before using this medication, tell your doctor if you have Leber’s disease. Cyanocobalamin nasal may lead to optic nerve damage and possibly blindness when used by people with this condition.

When using the nasal spray, tell your doctor if you develop nasal congestion, a cold, or allergies. The nasal spray may not work as well if you are congested.

Cyanocobalamin nasal is in the FDA pregnancy category C. This means that it is not known whether cyanocobalamin nasal will harm an unborn baby. Vitamin B12 is important to the proper development of a baby. Talk to your doctor about using this medication if you are pregnant. Cyanocobalamin nasal passes into breast milk. Vitamin B12 is necessary for both mother and child during breast-feeding. Talk to your doctor about using this medication during breast-feeding.

How should I use cyanocobalamin nasal?

Use cyanocobalamin nasal exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.

To use the nasal gel:

Gently blow your nose to clear any mucous.
Uncap the pump. Prime the unit (on first use and after 48 hours without use) by pumping it seven to eight times until a gel droplet appears at the tip. Then prime the unit with an additional two sprays.
Insert the tip about 1 centimeter (one-third inch) into your nostril, pointing it towards the back of the nose.
Block your other nostril and tilt your head forward.
Pump and sniff gently at the same time.
Remove the pump from your nose. Rub your nostril gently for a few seconds.
Clean the pump nozzle with a tissue and recap.

Use only one dose in one nostril unless otherwise directed. The nasal gel is usually used once a week to treat pernicious anemia.

Use the nasal spray 1 hour before or after eating or drinking hot foods or liquids.

To treat pernicious anemia, you will have to use this medication on a regular basis for the rest of your life. Failure to do so will result in irreversible damage to the nerves of your spinal cord. Also, treatment with cyanocobalamin nasal cannot be replaced with folic acid therapy. Folic acid may prevent anemia, but it will allow progressive damage to the spinal cord.

Store this medication at room temperature away from moisture, heat, and light. Keep the nasal gel in the prescription vial when it is not in use.

What happens if I miss a dose?

Use the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and use only your next regularly scheduled dose. Do not use a double dose of this medication unless otherwise directed by your doctor.

What happens if I overdose?

An overdose of cyanocobalamin nasal is unlikely to threaten life. If you suspect an overdose, call your doctor, an emergency room, or a poison control center for advice.

Symptoms of a cyanocobalamin nasal overdose are not known.

What should I avoid while using cyanocobalamin nasal?

Use the nasal spray 1 hour before or after eating or drinking hot foods or liquids.

Do not use any other nasal medications while using cyanocobalamin nasal unless they are approved by your doctor.

Cyanocobalamin nasal side effects

If you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives), stop using cyanocobalamin nasal and seek emergency medical attention:

Other, less serious side effects may be more likely to occur. Continue to use cyanocobalamin nasal and talk to your doctor if you experience

headache;
runny nose;
upset stomach; or
numbness or tingling.

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.

What other drugs will affect cyanocobalamin nasal?

Do not use any other nasal medications while using cyanocobalamin nasal unless they are approved by your doctor.

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

antibiotics, methotrexate (Rheumatrex), or pyrimethamine (Daraprim). These medicines may interfere with diagnostic tests for vitamin B12 and folic acid.
colchicine, or alcohol used heavily for 2 weeks or longer. These drugs can decrease the absorption of cyanocobalamin nasal.

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

Where can I get more information?

Your pharmacist has additional information about cyanocobalamin nasal written for health professionals that you may read.

What does my medication look like?

Cyanocobalamin nasalis available with a prescription under the brand name Nascobal in a 500 mcg/spray nasal gel. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

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.

C,Concise

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Cyanocobalamin (B12) Spray

30/06/10

Generic Name: Cyanocobalamin (B12) (SYE-an-oh-koe-BAL-a-min)
Brand Name: Nascobal

Cyanocobalamin (B12) Spray is used for:

Maintaining normal vitamin B₁₂ blood levels in certain patients with pernicious anemia. It is also used to treat or prevent low blood levels of vitamin B₁₂ that may be caused by other conditions.

Cyanocobalamin (B12) Spray is a form of vitamin B₁₂. It works by replacing vitamin B₁₂ in the body.

Do NOT use Cyanocobalamin (B12) Spray if:

you are allergic to any ingredient in Cyanocobalamin (B12) Spray, including cobalt

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

Before using Cyanocobalamin (B12) Spray:

Some medical conditions may interact with Cyanocobalamin (B12) Spray. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have a runny or stuffy nose, or an upper respiratory tract infection
if you have any type of anemia, bone marrow problems, certain eye nerve problems (Leber disease), an infection, a buildup of waste in the blood (uremia), or low blood iron or folic acid levels
if you are a vegetarian
if you drink alcohol on a regular basis

Some MEDICINES MAY INTERACT with Cyanocobalamin (B12) Spray. Tell your health care provider if you are taking any other medicines, especially any of the following:

Chloramphenicol, colchicine, or para-aminosalicylic acid because they may decrease Cyanocobalamin (B12) Spray’s effectiveness

This may not be a complete list of all interactions that may occur. Ask your health care provider if Cyanocobalamin (B12) Spray may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Cyanocobalamin (B12) Spray:

Use Cyanocobalamin (B12) Spray as directed by your doctor. Check the label on the medicine for exact dosing instructions.

An extra patient leaflet is available with Cyanocobalamin (B12) Spray. Talk to your pharmacist if you have questions about this information.
Cyanocobalamin (B12) Spray is used in the nose.
Follow the directions provided by your doctor or other health care provider. If you are unsure how to use Cyanocobalamin (B12) Spray, contact your doctor or other health care provider.
Do not use Cyanocobalamin (B12) Spray within 1 hour before or after eating or drinking hot foods or liquids.
Prime the pump before the first use. Place the nozzle between the first and second finger with the thumb on the bottom. Point the nozzle away from yourself and others. Pump the unit firmly and quickly until the medicine sprays out, then spray two more times.
Re-prime the pump before each dose. Point the nozzle away from yourself and others, then spray once.
Use Cyanocobalamin (B12) Spray in only 1 nostril each week.
To use Cyanocobalamin (B12) Spray, sit down and tilt your head back slightly. Place the tip of the spray container into the nose. Using a finger from your other hand, press against the opposite nostril to close it off. Breath gently through the open nostril and spray a dose of medicine from the container. After using the medicine, rinse the tip of the spray unit in hot water and dry with a clean tissue to prevent contamination.
Cyanocobalamin (B12) Spray is usually used 1 time per week. Do not use it more often than 1 time per week without checking with your doctor.
This bottle contains 8 doses. Do not continue to use this bottle after 8 doses have been used. It may not give the correct amount of medicine.
Continue to use Cyanocobalamin (B12) Spray even if you feel well. Do not miss any doses.
If you miss a dose of Cyanocobalamin (B12) Spray, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Cyanocobalamin (B12) Spray.

Important safety information:

Heavy alcohol intake for more than 2 weeks may decrease the effectiveness of Cyanocobalamin (B12) Spray. Check with your doctor if you drink alcohol on a regular basis.
Do not substitute folic acid for Cyanocobalamin (B12) Spray without first checking with your doctor. Folic acid may prevent anemia but may not prevent other serious effects such as spinal cord problems.
Certain medicines, including antibiotics, methotrexate, or pyrimethamine, may interfere with lab tests for vitamin B₁₂ and folic acid. Be sure your doctor and lab personnel know all the medicines that you are taking.
Do not take large doses of vitamins while taking Cyanocobalamin (B12) Spray unless your doctor tells you to.
Lab tests, including complete blood cell counts; platelet counts; blood potassium; and blood vitamin B₁₂, iron, and folic acid levels, may be performed while you use Cyanocobalamin (B12) Spray. These tests may be used to monitor your condition or check for side effects. They may be performed every 3 to 6 months. Be sure to keep all doctor and lab appointments.
PREGNANCY and BREAST-FEEDING: If you become pregnant while taking Cyanocobalamin (B12) Spray, check with your doctor. You will need to discuss the benefits and risks of using Cyanocobalamin (B12) Spray while you are pregnant. Cyanocobalamin (B12) Spray is found in breast milk. If you are or will be breast-feeding while you are using Cyanocobalamin (B12) Spray, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Cyanocobalamin (B12) Spray:

All medicines may cause side effects, but many people have no, or minor, side effects. When used in small doses, no COMMON side effects have been reported with this product. Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); calf swelling or tenderness; chest pain; irregular heartbeat; muscle weakness or cramping; shortness of breath; swelling of the hands, ankles, or feet; unusual bruising.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately.

Proper storage of Cyanocobalamin (B12) Spray:

Store Cyanocobalamin (B12) Spray at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Store upright. Do not freeze. Do not store in the bathroom. Keep Cyanocobalamin (B12) Spray out of the reach of children and away from pets.

General information:

If you have any questions about Cyanocobalamin (B12) Spray, please talk with your doctor, pharmacist, or other health care provider.
Cyanocobalamin (B12) Spray is to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Cyanocobalamin (B12) Spray. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: May 5, 2010

Database Edition 10.2.1.002

C,Med-facts

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Drugs & Medications:A-Z

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