Generic Name: misoprostol (mye so PRAH stole)
Brand Names: Cytotec

What is Cytotec (misoprostol)?

Misoprostol reduces stomach acid and replaces protective substances in the stomach that are inhibited by nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin.

Misoprostol is used to prevent the formation of ulcers in the stomach during treatment with aspirin or an NSAID such as ibuprofen (Motrin, Advil, Nuprin, others), ketoprofen (Orudis, Orudis KT, Oruvail), naproxen (Naprosyn, Aleve, Anaprox, Naprelan), oxaprozin (Daypro), indomethacin (Indocin), diclofenac (Voltaren, Cataflam), etodolac (Lodine), piroxicam (Feldene), meloxicam (Mobic), tolmetin (Tolectin), nabumetone (Relafen), and fenoprofen (Nalfon). NSAIDs and aspirin are used to treat pain, fever, arthritis, and inflammatory conditions.

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

What is the most important information I should know about Cytotec (misoprostol)?

Do not take misoprostol for the prevention of stomach ulcers if you are pregnant or if you might become pregnant during treatment. If you do become pregnant during treatment with misoprostol, stop taking the medication and contact your doctor immediately. Misoprostol is in the FDA pregnancy category X. This means that misoprostol is known to be harmful to an unborn baby. Misoprostol can cause miscarriage or spontaneous abortion (sometimes incomplete which could lead to dangerous bleeding and require hospitalization and surgery), premature birth, or birth defects. Misoprostol has also been reported to cause uterine rupture (tearing) when given after the eighth week of pregnancy, which can result in severe bleeding, hysterectomy, and/or maternal or fetal death. A pregnancy test with negative results will be required within 2 weeks of starting treatment with misoprostol, and treatment will begin only on the second or third day of a regular menstrual cycle. Also, appropriate contraception will be needed to prevent pregnancy during treatment and for one menstrual cycle following treatment. In some cases, misoprostol may be used under the supervision of a doctor for the induction of labor and delivery or abortion. Do not share this medication with anyone else. Misoprostol has been prescribed for your specific condition, may not be the correct treatment for another person, and would be dangerous if the other person were pregnant.

What should I discuss with my healthcare provider before taking Cytotec (misoprostol)?

Before taking misoprostol, tell your doctor if you have inflammatory bowel disease, irritable bowel syndrome, or other intestinal problems. You may need a dosage adjustment or special monitoring during treatment with misoprostol.

Do not take misoprostol for the prevention of stomach ulcers if you are pregnant or if you might become pregnant during treatment. If you do become pregnant during treatment with misoprostol, stop taking the medication and contact your doctor immediately. Misoprostol is in the FDA pregnancy category X. This means that misoprostol is known to be harmful to an unborn baby. Misoprostol can cause miscarriage or spontaneous abortion (sometimes incomplete which could lead to dangerous bleeding and require hospitalization and surgery), premature birth, or birth defects. Misoprostol has also been reported to cause uterine rupture (tearing) when given after the eighth week of pregnancy, which can result in severe bleeding, hysterectomy, and/or maternal or fetal death. A pregnancy test with negative results will be required within 2 weeks of starting treatment with misoprostol, and treatment will begin only on the second or third day of a regular menstrual cycle. Also, appropriate contraception will be needed to prevent pregnancy during treatment and for one menstrual cycle following treatment. In some cases, misoprostol may be used under the supervision of a doctor for the induction of labor and delivery or abortion. It is not known whether misoprostol passes into breast milk. Do not take misoprostol without first talking to your doctor if you are breast-feeding a baby.

How should I take Cytotec (misoprostol)?

Take misoprostol 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. Misoprostol is usually taken four times a day, with meals and at bedtime. Follow your doctor’s instructions.

Misoprostol may cause mild to moderate diarrhea, stomach cramps, and/or nausea. These problems usually occur during the first few weeks of treatment and stop after about a week. The occurrence of diarrhea may be minimized by taking misoprostol with food. Contact your doctor if these symptoms persist for longer than 8 days or if they are severe.

Take misoprostol for the full amount of time prescribed by your doctor. Treatment usually continues for as long as aspirin or an NSAID is taken.

Do not share this medication with anyone else. Misoprostol has been prescribed for your specific condition, may not be the correct treatment for another person, and would be dangerous if the other person were pregnant. Store misoprostol at room temperature away from moisture and heat.

See also: Cytotec 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 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.

The symptoms of a misoprostol overdose are not well known but might include stomach upset, stomach pain, diarrhea, drowsiness, tremor, seizures, difficulty breathing, fever, low blood pressure, and an irregular heart beat.

What should I avoid while taking Cytotec (misoprostol)?

Do not share this medication with anyone else. Misoprostol has been prescribed for your specific condition, may not be the correct treatment for another person, and would be dangerous if the other person were pregnant.

The incidence of diarrhea may be reduced by avoiding antacids that contain magnesium. If an antacid is needed, one that contains aluminum or calcium may be a more appropriate choice.

There are no restrictions on food, beverages, or activities during treatment with misoprostol unless otherwise directed by your doctor.

Cytotec (misoprostol) side effects

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

Misoprostol may cause mild to moderate diarrhea, stomach cramps, and/or nausea. These problems usually occur during the first few weeks of treatment and stop after about a week. The occurrence of diarrhea may be minimized by taking misoprostol with food. Contact your doctor if these symptoms persist for longer than 8 days or if they are severe.

Other, less serious side effects may also occur. Continue to take misoprostol and talk to your doctor if you experience

• vomiting;

• flatulence;

• constipation;

• headache; or

• menstrual cramps, spotting, or increased or irregular menstruation.

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.

What other drugs will affect Cytotec (misoprostol)?

The incidence of diarrhea may be reduced by avoiding antacids that contain magnesium. If an antacid is needed, one that contains aluminum or calcium may be a more appropriate choice.

Drugs other than those listed here may also interact with misoprostol. 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 has more information about misoprostol 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.

Copyright 1996-2006 Cerner Multum, Inc. Version: 7.02. Revision Date: 4/12/2009 4:36:56 PM.

Generic Name: ganciclovir (oral and injectable) (gan SYE kloe veer)
Brand Names: Cytovene

What is ganciclovir?

Ganciclovir is an antiviral drug. It slows the growth and spread of the cytomegalovirus.

Ganciclovir is used to treat and prevent infections caused by cytomegalovirus. This infection usually occurs in patients who have suppressed immune systems such as patients with AIDS and organ transplant patients.

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

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

If you are injecting ganciclovir at home, your healthcare provider will give you detailed instructions on how and where to inject the medication. If you do not understand these directions, do not attempt to inject the medication. Contact your healthcare provider for further instructions.

Serious side effects affecting the blood have been reported with the use of ganciclovir. Decreased levels of blood cells (white blood cells, red blood cells, and platelets) have occurred. Your doctor may monitor your blood with blood tests.

Ganciclovir has caused birth defects in animals, and it is generally not recommended for use during pregnancy. Women should use an effective form of birth control during treatment with ganciclovir. Also, men should use a form of barrier contraception (e.g., condom) during and for at least 90 days following treatment with ganciclovir. Take all of the ganciclovir that has been prescribed, even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated. Take oral ganciclovir with food to increase its absorption by the body.

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

Before taking ganciclovir, tell your doctor if you have

• had an allergic reaction to ganciclovir or acyclovir (Zovirax);

• kidney disease; or

• blood problems or low blood counts.

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

Ganciclovir is in the FDA pregnancy category C. This means that it is not known whether ganciclovir will be harmful to an unborn baby. Ganciclovir has caused birth defects in animals, and it is generally not recommended for use during pregnancy. Women should use an effective form of birth control during treatment with ganciclovir. Also, men should use a form of barrier contraception (e.g., condom) during and for at least 90 days following treatment with ganciclovir. It is not known whether ganciclovir passes into breast milk. Generally, breast-feeding should be avoided during treatment with ganciclovir. Do not take ganciclovir without first talking to your doctor if you are breast-feeding a baby.

How should I take ganciclovir?

Take ganciclovir 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 oral dose with a full glass of water. Take each oral dose with food to increase the absorption of the drug in your body.

Your healthcare provider will administer injectable ganciclovir as an intravenous (into a vein) infusion.

If you are injecting ganciclovir at home, your healthcare provider will give you detailed instructions on how and where to inject the medication. If you do not understand these directions, do not attempt to inject the medication. Contact your healthcare provider for further instructions.

Do not use any ganciclovir that is discolored, has particles in it, or looks different from your previous doses. Throw away any unused ganciclovir after the amount of time determined by your pharmacist or doctor.

Take all of the ganciclovir that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.

Your doctor may want you to have blood tests, eye exams, or other evaluations during treatment with ganciclovir to monitor progress and side effects.

Store oral ganciclovir at room temperature away from moisture and heat.

Dispose of used needles and syringes in a puncture resistant container out of the reach of children.

Your healthcare provider will store injectable ganciclovir as directed by the manufacturer or give you detailed storage instructions if you are storing the medication at home.

What happens if I miss a dose?

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

Contact your healthcare provider if you miss a dose of injectable ganciclovir.

What happens if I overdose?

Seek emergency medical attention if an overdose is suspected.

Symptoms of a ganciclovir overdose include seizures, diarrhea, kidney damage (decreased urine production), liver damage (yellowing of the skin or eyes, abdominal pain), and bone marrow damage (paleness, increased chance of infection, fever and chills).

What should I avoid while taking ganciclovir?

There are no restrictions on food, beverages, or activity during treatment with ganciclovir unless otherwise directed by your doctor.

Ganciclovir side effects

Serious side effects affecting the blood have been reported with the use of ganciclovir. Decreased levels of blood cells (white blood cells, red blood cells, and platelets) have occurred. Your doctor may monitor your blood with blood tests.

Stop taking ganciclovir and seek emergency medical attention if you experience any of the following serious side effects:

• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);

• paleness and fatigue that may be signs of anemia (a low level of red blood cells);

• unusual bleeding or bruising;

• fever or signs of infection; or

• numbness or tingling in a part of your body.

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

• nausea, vomiting, diarrhea, or decreased appetite;

• increased sweating;

• itching; or

• decreased sperm production or infertility.

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.

What other drugs will affect ganciclovir?

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

• zidovudine (Retrovir, AZT);

• didanosine (Videx);

• probenecid (Benemid); or

• imipenem-cilastatin (Primaxin).

You may not be able to take ganciclovir, or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with ganciclovir. 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 has additional information about ganciclovir 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.

Copyright 1996-2006 Cerner Multum, Inc. Version: 4.02. Revision Date: 4/12/2009 4:22:37 PM.

Generic Name: Ganciclovir (gan-SYE-kloe-vir)
Brand Name: Cytovene

Cytovene Capsules is used for:

Preventing CMV infection in patients with HIV infection or certain organ transplant patients. It is used as an alternative to the injectable form of Cytovene Capsules for treating CMV eye infection in patients with a weakened immune system. It may also be used for other conditions as determined by your doctor.

Cytovene Capsules is an antiviral agent. It works by blocking reproduction of the CMV virus.

Do NOT use Cytovene Capsules if:

• you are allergic to any ingredient in Cytovene Capsules or to acyclovir
• you have very low white blood cell or platelet levels

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

Before using Cytovene Capsules:

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

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have a history of blood disorders, kidney problems, other eye problems, HIV infection, or bone marrow problems
• if you are on dialysis or do not have a weakened immune system
• if you have low white blood cell or platelet levels, or if you have a history of low white blood cell or platelet levels caused by medicine, chemotherapy, or radiation

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

• Medicines that may harm the kidney (eg, aminoglycoside antibiotics [eg, gentamicin], amphotericin B, cyclosporine, nonsteroidal anti-inflammatory drugs [NSAIDs] [eg, ibuprofen], tacrolimus, vancomycin) because the risk of kidney side effects may be increased. Ask your doctor if you are unsure if any of your medicines might harm the kidney
• Imipenem/cilastin because seizures may occur
• Probenecid because it may increase the risk of Cytovene Capsules’s side effects
• Zidovudine because the risk of blood disorders may be increased
• Adriamycin, amphotericin B, dapsone, didanosine, flucytosine, pentamidine, trimethoprim/sulfamethoxazole, vinblastine, or vincristine because the risk of their side effects may be increased by Cytovene Capsules

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

How to use Cytovene Capsules:

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

• Take Cytovene Capsules by mouth with food.
• Swallow Cytovene Capsules whole. Do not break, crush, or chew before swallowing.
• Drinking extra fluids while you are taking Cytovene Capsules is recommended. Check with your doctor for instructions.
• Continue to use Cytovene Capsules even if you feel well. Do not miss any doses.
• Use caution when handling the capsules. Avoid contact with your skin, eyes, mouth, or nose if a capsule is broken or crushed. If such contact occurs, wash thoroughly with soap and water or rinse your eyes with plain water.
• If you miss a dose of Cytovene Capsules, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

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

Important safety information:

• Cytovene Capsules may cause dizziness and drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Cytovene Capsules with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
• Cytovene Capsules may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.
• Cytovene Capsules may reduce the number of clot-forming cells (platelets) in your blood. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.
• Cytovene Capsules is not a cure for CMV infection and you may continue to experience effects of the infection during or after treatment.
• Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.
• Tell your doctor or dentist that you take Cytovene Capsules before you receive any medical or dental care, emergency care, or surgery.
• Cytovene Capsules has been shown to cause cancer in animals, and may cause cancer in humans. Discuss any questions or concerns with your doctor.
• If you may become pregnant, you must use an effective form of birth control while you take Cytovene Capsules. If you have questions about effective birth control, talk with your doctor.
• Cytovene Capsules may lower sperm production and make you unable to have children. Discuss any questions or concerns with your doctor.
• Men who take Cytovene Capsules should always use a condom when having sex with a woman who may become pregnant. Do this for as long as you take Cytovene Capsules and for at least 90 days after you stop taking it.
• Lab tests, including kidney function tests, eye examinations, and complete blood cell counts, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.
• Use Cytovene Capsules with caution in the ELDERLY; they may be more sensitive to its effects.
• Cytovene Capsules should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.
• PREGNANCY and BREAST-FEEDING: Cytovene Capsules may cause harm to the fetus. Do not become pregnant while you are using it. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Cytovene Capsules while you are pregnant. It is not known if Cytovene Capsules is found in breast milk. Do not breast-feed while using Cytovene Capsules.

Possible side effects of Cytovene Capsules:

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

Diarrhea; loss of appetite; sweating; vomiting.

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); bloody or black, tarry stools; change in the amount of urine produced; confusion; fever, chills, or sore throat; numbness or tingling of hands or feet; pain, swelling, or redness at the injection site; severe or persistent stomach pain; unusual bleeding or bruising; unusual tiredness or weakness; vision changes (eg, blurred vision, flashes of light); vomit that looks like coffee grounds.

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 decreased urination; severe diarrhea or vomiting.

Proper storage of Cytovene Capsules:

Store Cytovene Capsules between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Cytovene Capsules out of the reach of children and away from pets.

General information:

• If you have any questions about Cytovene Capsules, please talk with your doctor, pharmacist, or other health care provider.
• Cytovene Capsules 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 Cytovene Capsules. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Generic Name: ganciclovir (Oral route, Intravenous route)

gan-SYE-kloe-vir

Commonly used brand name(s):

In the U.S.

• Cytovene
• Cytovene IV

Available Dosage Forms:

• Capsule
• Powder for Solution

Therapeutic Class: Antiviral

Pharmacologic Class: Viral DNA Polymerase Inhibitor

Chemical Class: Guanosine Nucleoside Analog

Uses For Cytovene IV

Ganciclovir is an antiviral. It is used to treat infections caused by viruses.

Ganciclovir is used to treat the symptoms of cytomegalovirus (CMV) infection of the eyes in people whose immune system is not working fully. This includes patients with acquired immune deficiency syndrome (AIDS). Ganciclovir will not cure this eye infection, but it may help to keep the symptoms from becoming worse. It is also used to help prevent CMV infection in patients who receive organ or bone marrow transplants, as well as in patients with advanced human immunodeficiency virus (HIV) infection. Ganciclovir may be used for other serious CMV infections as determined by your doctor. However, it does not work in treating certain viruses, such as the common cold or the flu.

This medicine may cause some serious side effects, including anemia and other blood problems. Before you begin treatment with ganciclovir, you and your doctor should talk about the good this medicine will do as well as the risks of using it.

Ganciclovir is to be administered only by or under the supervision of your doctor.

Before Using Cytovene IV

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

Ganciclovir can cause serious side effects in any patient. Therefore, it is especially important that you discuss with the child’s doctor the good that this medicine may do as well as the risks of using it.

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 ganciclovir in the elderly with use in other age groups.

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

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 this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Imipenem
• Zidovudine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Didanosine

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.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Kidney disease—Ganciclovir may build up in the blood in patients with kidney disease, increasing the chance of side effects

• Low platelet count or
• Low white blood cell count—Ganciclovir may make these blood diseases worse

Proper Use of ganciclovir

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

It is important that you take ganciclovir capsules with food. This is to make sure the medicine is fully absorbed into the body and will work properly.

To get the best results, ganciclovir must be given for the full time of treatment. Also, this medicine works best when there is a constant amount in the blood. To help keep the amount constant, ganciclovir must be given on a regular schedule.

Dosing

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

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

• For oral dosage form (capsules):
  • For treatment of CMV retinitis after you have received ganciclovir injection for at least fourteen to twenty-one days:
    • Adults and teenagers—1000 milligrams (mg) three times a day with food; or 500 mg six times a day, every three hours with food, during waking hours.
    • Children—Use and dose must be determined by your doctor.
  • For prevention of CMV disease in transplant patients and patients with advanced HIV infection:
    • Adults and teenagers—1000 mg three times a day with food.
    • Children—Use and dose must be determined by your doctor.
• For injection dosage form:
  • For treatment of CMV retinitis:
    • Adults and teenagers—Dose is based on body weight and must be determined by your doctor. At first, 5 mg per kilogram (2.3 mg per pound) of body weight is injected into a vein every twelve hours for fourteen to twenty-one days. Then, 5 mg per kilogram (2.3 mg per pound) of body weight is injected into a vein once a day for seven days of the week; or 6 mg per kilogram (2.7 mg per pound) of body weight is injected into a vein once a day for five days of the week.
    • Children—Use and dose must be determined by your doctor.
  • For prevention of CMV in transplant patients:
    • Adults and teenagers—Dose is based on body weight and must be determined by your doctor. At first, 5 mg per kilogram (2.3 mg per pound) of body weight is injected into a vein every twelve hours for seven to fourteen days. Then the dose is reduced to 5 mg per kilogram (2.3 mg per pound) of body weight once a day for seven days of the week; or 6 mg per kilogram (2.7 mg per pound) of body weight is injected into a vein once a day for five days of the week.
    • Children—Use and dose must be determined by your doctor.

Precautions While Using Cytovene IV

Ganciclovir can lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take to reduce the risk of infection or bleeding:

• Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.

The use of birth control is recommended for both men and women. Women should use effective birth control methods while receiving this medicine. Men should use a condom during treatment with this medicine and for at least 90 days after treatment has been completed.

It is very important that your doctor check you at regular visits for any blood problems that may be caused by this medicine.

If you have CMV retinitis: It is also very important that your ophthalmologist (eye doctor) check your eyes at regular visits since it is still possible that you may have some loss of eyesight during ganciclovir treatment.

Cytovene IV 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.

Medicines like ganciclovir can sometimes cause serious side effects such as blood problems; these are described below. Discuss these possible effects with your doctor.

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

More commonFor oral capsules and injection into the vein only

• Sore throat and fever
• unusual bleeding or bruising

Less commonFor oral capsules and injection into the vein only

• Mood or other mental changes
• nervousness
• pain at place of injection
• skin rash
• tremor
• unusual tiredness and weakness

For injection into the eye only

• Decreased vision or any change in vision

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

Less common

• Abdominal or stomach pain
• loss of appetite
• nausea and vomiting

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.

Generic Name: cyclophosphamide (oral/injection) (sye kloe FOSS fah mide)
Brand Names: Cytoxan, Cytoxan Lyophilized, Neosar

What is cyclophosphamide?

Cyclophosphamide is a cancer (chemotherapeutic) medication. Cyclophosphamide interferes with the growth of cancer cells and slows their growth and spread in the body.

Cyclophosphamide is used to treat several types of cancer. Cyclophosphamide is also used to treat certain cases of nephrotic syndrome (kidney disease) in children.

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

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

Cyclophosphamide should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.

Serious side effects have been reported with the use of cyclophosphamide including: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); decreased bone marrow function and blood problems (extreme fatigue; easy bruising or bleeding; black, bloody or tarry stools; fever or chills; or signs of infection such as fever; chills, or sore throat); bladder problems; and others. Talk to your doctor about the possible side effects from treatment with cyclophosphamide.

In some cases, secondary cancers have been reported to occur during and following treatment with cyclophosphamide. Talk to your doctor about the risks and benefits of this medication.

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

Before taking cyclophosphamide, tell your doctor if you

• have an infection or have had recent vaccinations;

• have a low level of white blood cells or platelets (detected by blood tests);

• have bone marrow problems;

• have been previously treated with x-ray therapy;

• have been previously treated with other chemotherapy medicines (i.e., Alkeran, CeeNU, Leukeran, Myleran, and others);

• have had your adrenal glands removed;

• need to have surgery;

• have any unhealed wounds;

• have a history of heart disease;

• have liver disease; or
• have kidney disease.

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

Cyclophosphamide is in the FDA pregnancy category D. This means that cyclophosphamide is known to be harmful to an unborn baby. Cyclophosphamide may also affect egg production in women and sperm production in men. Do not take cyclophosphamide without first talking to your doctor if you are pregnant or could become pregnant during treatment. Use of cyclophosphamide by the father prior to conception has also been associated with birth defects. Contraceptive measures are recommended during treatment with cyclophosphamide for both men and women. Cyclophosphamide passes into breast milk and may harm a nursing infant. Do not take cyclophosphamide without first talking to your doctor if you are breast feeding a baby.

How should I take cyclophosphamide?

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

Take each oral dose with a large glass of water.

To avoid urinary bladder irritation during treatment with either oral or injectable cyclophosphamide, drink plenty of fluid during treatment and for 48 hours following treatment, usually 7 to 12 cups (3 quarts) per day, and empty your bladder frequently, every 2 to 3 hours including once during the night.

Taking oral cyclophosphamide on an empty stomach is preferable. If severe stomach upset occurs, take cyclophosphamide with food. Continue to take cyclophosphamide even if nausea and vomiting occurs. Do not stop taking the medicine without first talking to your doctor. Check with your doctor if vomiting occurs shortly after taking a dose of cyclophosphamide. Your doctor may want you to take another dose, but do not do this without checking with your doctor first.

If you are taking a liquid form of cyclophosphamide by mouth, use a dose measuring spoon or cup to ensure that you get the correct dose.

Injectable cyclophosphamide should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.

Your doctor will determine the correct amount and frequency of treatment with cyclophosphamide depending upon the type of cancer being treated and other factors. Talk to your doctor if you have any questions or concerns regarding the treatment schedule.

Your doctor will probably want you to have regularly scheduled blood tests and other medical evaluations during treatment with cyclophosphamide to monitor progress and side effects.

Store cyclophosphamide oral tablets at or below 77 degrees Fahrenheit (25 degrees Celsius). Brief exposures to 86 degrees Fahrenheit (30 degrees Celsius) are permitted but the tablets should be protected from temperatures above 86 degrees Fahrenheit. Your healthcare provider will store cyclophosphamide injection as directed by the manufacturer. If you are storing cyclophosphamide injection at home, follow the directions provided by your healthcare provider. Store cyclophosphamide oral liquid in a glass container in the refrigerator for up to 14 days.

What happens if I miss a dose?

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

Contact your doctor if you miss a dose of cyclophosphamide injection.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a cyclophosphamide overdose may include decreased bone marrow function, infection, and heart problems.

What should I avoid while taking cyclophosphamide?

Cyclophosphamide can lower the activity of the immune system making you more susceptible to infection. Avoid contact with people who have colds, the flu, or other contagious illnesses. In addition, do not receive vaccines that contain a live strain of the virus (e.g., live oral polio vaccine) and avoid contact with individuals who have recently been vaccinated with a live virus.

Cyclophosphamide side effects

If you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:

• an allergic reaction (shortness of breath; closing of your throat; difficulty breathing; swelling of your lips, face, or tongue; or hives);

• blood in the urine;

• black or tarry stools;

• painful or difficult urination;

• signs of infection such as fever; chills, or sore throat;

• jaundice (yellowing of the skin or eyes);

• lower back or side pain;

• chest pain, difficulty breathing, or swelling;

• unusual bleeding or bruising; or

• changes in bone marrow function (detected by blood tests).

Other less serious side effects may be more likely to occur. Talk to your doctor if you experience

• nausea, vomiting, or decreased appetite;

• mouth sores;

• abdominal pain;

• diarrhea;

• temporary hair loss;

• temporary or permanent sterility;

• rash;

• changes in skin color; or

• changes in nails.

In some cases, secondary cancers have been reported to occur during and following treatment with cyclophosphamide. Talk to your doctor about the risks and benefits of this medication.

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.

What other drugs will affect cyclophosphamide?

Before taking cyclophosphamide, tell your doctor if you are taking any other medicines, especially any of the following:

• phenobarbital (Luminal, Solfoton);

• allopurinol (Zyloprim);

• digoxin (Lanoxin);

• warfarin (Coumadin);

• a thiazide diuretic (water pill) such as chlorothiazide (Diuril), hydrochlorothiazide (HCTZ, HydroDiuril, Esidrix, Microzide, Oretic), chlorthalidone (Hygroton, Thalitone), indapamide (Lozol), metolazone (Mykrox, Zaroxolyn), and others; or

• another chemotherapy medicine.

You may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.

Do not receive “live” vaccines during treatment with cyclophosphamide. Administration of a live vaccine may be dangerous during treatment with cyclophosphamide.

Other drugs may interact with cyclophosphamide. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines, including herbal products, during treatment with cyclophosphamide.

Where can I get more information?

• Your pharmacist has additional information about cyclophosphamide 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.

Copyright 1996-2006 Cerner Multum, Inc. Version: 3.06. Revision Date: 4/12/2009 4:22:26 PM.

Generic Name: cytarabine liposomal (sye TAR a been LYE poe SOE mal)
Brand Names: DepoCyt

What is cytarabine liposomal?

Cytarabine liposomal is a cancer medication. Cytarabine liposomal interferes with the growth of cancer cells and slows their growth and spread in the body.

Cytarabine liposomal is used to treat lymphoma associated with meningitis.

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

What is the most important information I should know about cytarabine liposomal?

Do not use cytarabine liposomal if you are pregnant. It could harm the unborn baby. You should not receive this medication if you are allergic to cytarabine or if you have an active meningitis infection.

Before you receive cytarabine liposomal, tell your doctor about all of your medical conditions and any other medications you use. You may need a dose adjustment or special tests to safely use cytarabine liposomal.

Tell your caregivers at once if you have nausea and vomiting with headache and fever. These may be early signs of central nervous system damage. Call your doctor at once if you have a serious side effect such as neck stiffness or pain, extreme drowsiness, confusion, personality changes, seizure, loss of muscle control, problems with vision or hearing, severe numbness or tingling, or loss of bladder or bowel control.

What should I discuss with my healthcare provider before receiving cytarabine liposomal?

You should not receive this medication if you are allergic to cytarabine liposomal or if you have an active meningitis infection.

Before you receive cytarabine liposomal, tell your doctor about all of your medical conditions and any other medications you use. You may need a dose adjustment or special tests to safely use cytarabine liposomal:

FDA pregnancy category D. Do not use cytarabine liposomal if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment. It is not known whether cytarabine liposomal passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are receiving this medication.

How is cytarabine liposomal given?

Cytarabine liposomal is given as an injection through a needle placed into the space around your spinal cord. You will receive this injection in a clinic or hospital setting.

Tell your caregivers at once if you have nausea and vomiting with headache and fever. These may be early signs of central nervous system damage. To be sure cytarabine liposomal is not causing harmful effects, your doctor will need to check your progress on a regular basis. Do not miss any follow-up appointments.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your cytarabine liposomal injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, headache and fever, confusion, and changes in personality or behavior.

What should I avoid while receiving cytarabine liposomal?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Cytarabine liposomal 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:

• nausea and vomiting with headache and fever;

• neck stiffness or pain, seizure (convulsions);

• extreme drowsiness, loss of muscle control;

• confusion, personality changes, problems with memory or concentration, sleep problems, agitation;

• problems with speech, vision, hearing, or balance,

• numbness, tingling, or burning pain that interferes with daily activities;

• loss of bladder or bowel control;

• pale skin, feeling light-headed or short of breath, rapid heart rate;

• easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin; or

• flu symptoms, sores in your mouth and throat.

Less serious side effects may include:

• mild nausea or vomiting;

• diarrhea, constipation, stomach pain;

• swelling in your hands or feet;

• dizziness, tired feeling;

• joint pain, back pain; or

• pain in your arms or legs.

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.

Cytarabine liposomal Dosing Information

Usual Adult Dose for Meningitis — Lymphomatous:

Cytarabine liposomal for the intrathecal treatment of lymphomatous meningitis:

Induction Therapy: cytarabine liposome injection 50 mg, administered intrathecally (intraventricular or lumbar puncture) every 14 days for 2 doses (weeks 1 and 3).

Consolidation Therapy: cytarabine liposome injection 50 mg, administered intrathecally (intraventricular or lumbar puncture) every 14 days for 3 doses (weeks 5, 7 and 9) followed by one additional dose at week 13.

Maintenance: cytarabine liposome injection 50 mg, administered intrathecally (intraventricular or lumbar puncture) every 28 days for 4 doses (weeks 17, 21, 25 and 29).

What other drugs will affect cytarabine liposomal?

There may be other drugs that can interact with cytarabine liposomal. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your doctor or pharmacist can provide more information about cytarabine liposomal.

• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 3.01. Revision Date: 02/22/2010 2:44:06 PM.

sye-TARE-a-been LYE-poh-some

Commonly used brand name(s):

In the U.S.

• Depocyt

Available Dosage Forms:

• Suspension

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Antimetabolite

Uses For cytarabine liposome

Liposomal cytarabine belongs to the group of medicines known as antineoplastics. It is used to treat cancer of the lymph system that has spread to the brain.

Liposomal cytarabine interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal cells may also be affected by the medicine, other effects may also occur. Some of these may be serious and must be reported to your doctor. Some effects may occur after treatment with liposomal cytarabine has been stopped.

Before you begin treatment with liposomal cytarabine, you and your doctor should talk about the good cytarabine liposome will do as well as the risks of using it.

Liposomal cytarabine is to be administered only by or under the immediate supervision of your doctor.

Before Using cytarabine liposome

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 cytarabine liposome, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to cytarabine liposome 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

Studies on cytarabine liposome have been done only in adult patients, and there is no specific information comparing use of liposomal cytarabine 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 liposomal cytarabine in the elderly with use in other age groups.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	D	Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

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

Using cytarabine liposome with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Rotavirus Vaccine, Live

Using cytarabine liposome 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.

• Bacillus of Calmette and Guerin Vaccine, Live
• Influenza Virus Vaccine, Live
• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Poliovirus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Smallpox Vaccine
• Typhoid Vaccine
• Varicella Virus Vaccine
• Yellow Fever Vaccine

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.

Other Medical Problems

The presence of other medical problems may affect the use of cytarabine liposome. Make sure you tell your doctor if you have any other medical problems, especially:

• Active meningitis—Use is not recommended

• Blockage to cerebrospinal fluid flow— Increased risk of neurotoxicity

Proper Use of cytarabine liposome

cytarabine liposome often causes nausea and vomiting. However, it is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your health care professional for ways to lessen these effects.

Dosing

The dose of cytarabine liposome 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 cytarabine liposome. 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.

Precautions While Using cytarabine liposome

It is very important that your doctor check your progress at regular visits to make sure that cytarabine liposome is working properly and to check for unwanted effects.

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

More common

• Back pain
• fever
• headache
• nausea
• neck pain or rigidity
• sleepiness
• vomiting
• weakness

Less common

• Black, tarry stools
• blood in urine or stools
• chills
• cough or hoarseness
• lower back or side pain
• painful or difficult urination
• pinpoint red spots on skin
• sore throat
• swelling of fingers, hands, arms, lower legs, or feet
• unusual bleeding or bruising

Rare

• Fast or irregular breathing
• puffiness or swelling around the face
• shortness of breath
• sudden, severe decrease in blood pressure
• unusual tiredness

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

Less common

• Constipation
• urinary incontinence

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.

Generic Name: cytomegalovirus immune globulin (CMV IG) (injectable) (sye toe MEH gah loe vye rus ih MUNE GLAW byoo lin)
Brand Names: Cytogam

What is CMV IG?

Cytomegalovirus immune globulin (CMV IG) is a sterilized solution obtained from pooled human blood. It contains the immunoglobulins (or antibodies) to protect against infection from cytomegalovirus. Antibodies are substances in the blood that fight infections.

CMV IG is used to help prevent infection by cytomegalovirus in people who receive an organ transplant.

CMV IG may also be used for purposes other than those listed here.

What is the most important information I should know about CMV IG?

CMV IG is made from human plasma (part of the blood) and may contain infectious agents (e.g., viruses) that can cause disease. Although CMV IG is screened, tested, and treated to reduce the possibility that it carries an infectious agent, it can still potentially transmit disease. Discuss with your doctor the risks and benefits of using CMV IG.

Treatment with immune globulin products such as CMV IG has been associated with the development of kidney problems, sometimes resulting in kidney failure and/or death. Notify your doctor immediately if you develop decreased urination, sudden weight gain, fluid retention or swelling, or shortness of breath. These may be signs of kidney problems. Rare cases of aseptic meningitis syndrome (AMS) have been associated with the use of immune globulin products such as CMV IG. Notify your doctor immediately if you experience severe headache, neck stiffness, drowsiness, fever, eye sensitivity to light, painful eye movements, and nausea or vomiting. These may be signs of AMS. Stopping treatment with the immune globulin has resulted in resolution of AMS without any lasting problems.

What should I discuss with my healthcare provider before taking CMV IG?

Do not use CMV IG without first talking to your doctor if you have

• kidney disease;

• diabetes;

• IgA deficiency; or

• a previous allergic reaction to another immune globulin product.

You may not be able to use CMV IG, or you may require a dosage adjustment or special monitoring during treatment.

CMV IG is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby. Do not use CMV IG without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is not known whether CMV IG passes into breast milk. Do not use CMV IG without first talking to your doctor if you are breast-feeding a baby. Individuals over the age of 65 years may have an increased risk of kidney problems with the use of CMV IG. Your doctor may prescribe a lower dose of the medication or special monitoring during treatment.

How should I take CMV IG?

CMV IG will be administered by intravenous (into a vein) injection by a healthcare provider in a hospital or clinic setting.

Your doctor may want you to have blood tests or other forms of monitoring during treatment with CMV IG to monitor progress and side effects.

Your healthcare provider will store CMV IG as directed by the manufacturer. If you are storing CMV IG at home, your healthcare provider will provide storage instructions.

What happens if I miss a dose?

Contact your healthcare provider if a dose of CMV IG is missed.

What happens if I overdose?

Seek emergency medical attention or contact your healthcare provider if an overdose of CMV IG is suspected.

No information is available regarding an overdose of CMV IG.

What should I avoid while taking CMV IG?

Do not receive vaccines that use live strains of the virus (e.g., measles, mumps, and rubella or MMR) during and for approximately three months following treatment with CMV IG. These vaccines may not work properly when CMV IG has been recently administered.

CMV IG side effects

CMV IG is made from human plasma (part of the blood) and may contain infectious agents (e.g., viruses) that can cause disease. Although CMV IG is screened, tested, and treated to reduce the possibility that it carries an infectious agent, it can still potentially transmit disease. Discuss with your doctor the risks and benefits of using CMV IG.

Treatment with immune globulin products such as CMV IG has been associated with the development of kidney problems, sometimes resulting in kidney failure and/or death. Notify your doctor immediately if you develop decreased urination, sudden weight gain, fluid retention or swelling, or shortness of breath. These may be signs of kidney problems. Rare cases of aseptic meningitis syndrome (AMS) have been associated with the use of immune globulin products such as CMV IG. Notify your doctor immediately if you experience severe headache, neck stiffness, drowsiness, fever, eye sensitivity to light, painful eye movements, and nausea or vomiting. These may be signs of AMS. Stopping treatment with the immune globulin has resulted in resolution of AMS without any lasting problems. Notify your doctor immediately if you experience a rare but serious allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives) to CMV IG.

Other less serious side effects may also occur. Upon injection of the medication, some patients experience the following side effects:

• flushing or sweating;

• wheezing;

• muscle cramps;

• joint pain;

• nausea or vomiting; or

• fever or chills.

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.

What other drugs will affect CMV IG?

Do not receive vaccines that use live strains of the virus (e.g., measles, mumps, and rubella or MMR) during and for approximately three months following treatment with CMV IG. These vaccines may not work properly when CMV IG has been recently administered.

It is not known whether other medications will interact with CMV IG. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products during treatment with CMV IG.

Where can I get more information?

• Your pharmacist has additional information about CMV IG 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.

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.05. Revision Date: 4/12/2009 4:39:08 PM.

Generic Name: Cytomegalovirus Immune Globulin (sye-toe-MEG-a-loe-vye-rus)
Brand Name: CytoGam

Cytomegalovirus Immune Globulin is used for:

Reducing the risk of cytomegalovirus (CMV) disease associated with kidney, lung, liver, pancreas, and heart transplants. It may also be used for other conditions as determined by your doctor.

Cytomegalovirus Immune Globulin is an intravenous immune globulin (IGIV) enriched in antibodies against CMV. It works by temporarily increasing the antibody concentration in the body.

Do NOT use Cytomegalovirus Immune Globulin if:

• you are allergic to any ingredient in Cytomegalovirus Immune Globulin
• you have selective immunoglobulin A (IgA) deficiency

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

Before using Cytomegalovirus Immune Globulin:

Some medical conditions may interact with Cytomegalovirus Immune Globulin. 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 kidney problems, diabetes, a blood infection, or low blood volume

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

• Live vaccines (eg, measles, mumps, rubella) because the effectiveness of the vaccine may be decreased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Cytomegalovirus Immune Globulin 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 Cytomegalovirus Immune Globulin:

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

• Cytomegalovirus Immune Globulin is usually administered as an injection at your doctor’s office, hospital, or clinic. If you are using Cytomegalovirus Immune Globulin at home, carefully follow the injection procedures taught to you by your health care provider.
• If Cytomegalovirus Immune Globulin contains particles or is discolored, or if the vial is cracked or damaged in any way, do not use it. Ask your health care provider any questions you may have about the proper use of Cytomegalovirus Immune Globulin.
• The infusion should begin within 6 hours after entering the vial and should be complete within 12 hours of entering the vial. This product does not contain a preservative.
• Keep this product, as well as syringes and needles, out of the reach of children. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor, nurse, or pharmacist to explain local regulations for proper disposal.
• If you miss a dose of Cytomegalovirus Immune Globulin, contact your doctor immediately.

Ask your health care provider any questions you may have about how to use Cytomegalovirus Immune Globulin.

Important safety information:

• Because Cytomegalovirus Immune Globulin is obtained from human plasma, there is a risk that viruses can be passed on to patients who use Cytomegalovirus Immune Globulin.
• Administration of live virus vaccines (eg, measles, mumps, rubella) should be delayed until approximately 3 months after receiving Cytomegalovirus Immune Globulin.
• Contact your health care provider at once if any of the following occur: severe headache, stiff neck, drowsiness, fever, sensitivity to light, painful eye movements, nausea, vomiting.
• Local reactions to the injection site may occur (eg, tenderness, pain, hives, swelling). Apply a warm compress. If the symptoms persist, contact your health care provider.
• LAB TESTS, including liver and kidney function and immune globulin levels, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.
• Use Cytomegalovirus Immune Globulin with caution in the ELDERLY because they may be more sensitive to its effects, such as kidney problems.
• PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Cytomegalovirus Immune Globulin during pregnancy. It is unknown if Cytomegalovirus Immune Globulin is excreted in breast milk. If you are or will be breast-feeding while you are using Cytomegalovirus Immune Globulin, check with your doctor or pharmacist to discuss the risks to your baby.

Possible side effects of Cytomegalovirus Immune Globulin:

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:

Chills; fever; flushing; joint or back pain; muscle pain; nausea; pain, redness, or swelling at injection site; vomiting; wheezing.

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); decreased urine output; drowsiness; eye pain; hoarseness; lightheadedness, especially upon standing; sensitivity to light; severe headache; shortness of breath; stiff neck; sudden weight gain.

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.

Proper storage of Cytomegalovirus Immune Globulin:

Store Cytomegalovirus Immune Globulin in the refrigerator between 36 and 46 degrees F (2 and 8 degrees C). Do not freeze. The product does not contain a preservative. The infusion should begin within 6 hours after entering the vial. Keep Cytomegalovirus Immune Globulin out of the reach of children and away from pets.

General information:

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