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.

See also: Cytomegalovirus immune globulin (CMV IG) dosage in more detail

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.

Cytomegalovirus immune globulin (CMV IG) Dosing Information

Usual Adult Dose for CMV Prophylaxis:

Kidney transplant:
Within 72 hours of transplant: 150 mg/kg
2 to 8 weeks post transplant: 100 mg/kg
12 to 16 weeks post transplant: 50 mg/kg

Liver, pancreas, lung, heart transplant:
Within 72 hours of transplant: 150 mg/kg
2 to 8 weeks post transplant: 150 mg/kg
12 to 16 weeks post transplant: 100 mg/kg

Administer IV at 15 mg/kg/hour. If no adverse reactions occur after 30 minutes, the rate may be increased to 30 mg/kg/hour for 15 minutes before increasing to a maximum rate of 60 mg/kg/hour. Maximum volume not to exceed 75 mL/hr.

The maximum recommended total dosage per infusion is 150 mg/kg.

Usual Pediatric Dose for CMV Prophylaxis:

Kidney transplant:
Within 72 hours of transplant: 150 mg/kg
2 to 8 weeks post transplant: 100 mg/kg
12 to 16 weeks post transplant: 50 mg/kg

Liver, pancreas, lung, heart transplant:
Within 72 hours of transplant: 150 mg/kg
2 to 8 weeks post transplant: 150 mg/kg
12 to 16 weeks post transplant: 100 mg/kg

Administer IV at 15 mg/kg/hour. If no adverse reactions occur after 30 minutes, the rate may be increased to 30 mg/kg/hour for 15 minutes before increasing to a maximum rate of 60 mg/kg/hour.

The maximum recommended total dosage per infusion is 150 mg/kg.

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: liothyronine (LYE oh THYE roe neen)
Brand Names: Cytomel

What is Cytomel (liothyronine)?

Liothyronine is a man-made form of a hormone that is normally produced by your thyroid gland to regulate the body’s energy and metabolism. Liothyronine is given when the thyroid does not produce enough of this hormone on its own.

Liothyronine treats hypothyroidism (low thyroid hormone). Liothyronine is also used to treat or prevent goiter (enlarged thyroid gland), and is also given as part of a medical tests for thyroid disorders.

Liothyronine should not be used to treat obesity or weight problems.

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

What is the most important information I should know about Cytomel (liothyronine)?

Since thyroid hormone occurs naturally in the body, almost anyone can take liothyronine. You should not use this medication if you have a thyroid disorder called thyrotoxicosis, or an adrenal gland problem that is not controlled by treatment.

Before taking liothyronine, tell your doctor if you have heart disease, angina (chest pain), coronary artery disease, congestive heart failure, diabetes, or problems with your pituitary or adrenal glands.

Tell your doctor if you are pregnant or breast-feeding.

To be sure this medication is helping your condition, your blood may need to be tested on a regular basis. Do not miss any follow-up visits to your doctor.

Keep using this medicine as directed, even if you feel well. You may need to use this medication for the rest of your life.

Call your doctor if you notice any signs of thyroid toxicity, such as chest pain, fast or pounding heartbeats, feeling hot or nervous, or sweating more than usual.

What should I discuss with my healthcare provider before taking Cytomel (liothyronine)?

Since thyroid hormone occurs naturally in the body, almost anyone can take liothyronine. You should not use this medication if you have a thyroid disorder called thyrotoxicosis, or an adrenal gland problem that is not controlled by treatment.

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

• heart disease, angina (chest pain);

• coronary artery disease;

• congestive heart failure;

• diabetes; or

• problems with your pituitary or adrenal gland.

FDA pregnancy category A. Liothyronine is not expected to be harmful to an unborn baby. However, tell your doctor if you become pregnant, since your dose needs may change. Small amounts of liothyronine can pass into breast milk, but this is not expected to harm a nursing baby. However, do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Cytomel (liothyronine)?

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

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

To be sure this medication is helping your condition, your blood may need to be tested on a regular basis. Do not miss any follow-up visits to your doctor.

Keep using this medicine as directed, even if you feel well. You may need to use this medication for the rest of your life.

Call your doctor if you notice any signs of thyroid toxicity, such as chest pain, fast or pounding heartbeats, feeling hot or nervous, or sweating more than usual.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using liothyronine.

Store liothyronine at room temperature away from moisture and heat.

See also: Cytomel dosage in more detail

What happens if I miss a dose?

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

What happens if I overdose?

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

Overdose symptoms may include headache, sweating, diarrhea, irregular menstrual periods, feeling restless or irritable, confusion, weakness, swelling in your hands or feet, fast heart rate, chest pain, feeling short of breath, or fainting.

What should I avoid while taking Cytomel (liothyronine)?

If you also take cholestyramine (Prevalite, Questran) or colestipol (Colestid), avoid taking these medications within 4 hours before or after you take liothyronine.

Cytomel (liothyronine) side effects

Stop using liothyronine and 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.

Less serious side effects may include temporary hair loss (especially in children).

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 Cytomel (liothyronine)?

The following drugs can interact with liothyronine. Tell your doctor if you are using any of these:

• birth control pills or hormone replacement therapy;

• a blood thinner such as warfarin (Coumadin);

• digoxin (digitalis, Lanoxin);

• insulin or diabetes medication you take by mouth;

• medications that contain iodine (such as I-131);

• an antidepressant such as amitriptyline (Elavil, Etrafon), doxepin (Sinequan), desipramine (Norpramin), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), and others;

• salicylates such as aspirin, Backache Relief Extra Strength, Novasal, Nuprin Backache Caplet, Doan’s Pills Extra Strength, Tricosal, and others; or

• steroids such as prednisone and others.

This list is not complete and there may be other drugs that can interact with liothyronine. 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 liothyronine.

• 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: 5.01. Revision Date: 08/31/2009 4:18:29 PM.

Generic Name: cytarabine (sye TAR a been)
Brand Names: Cytosar-U, Tarabine PFS

What is Cytosar-U (cytarabine)?

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

Cytarabine is used to treat certain types of leukemia (blood cancers). Cytarabine is also used to treat leukemia associated with meningitis.

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

What is the most important information I should know about Cytosar-U (cytarabine)?

Do not receive this medication without telling your doctor if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

Before receiving cytarabine, tell your doctor if you are allergic to any drugs, or if you have a breathing disorder such as asthma, or a history of stomach ulcer or bleeding.

Cytarabine can lower blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Avoid being near people who have colds, the flu, or other contagious illnesses. Contact your doctor at once if you develop signs of infection.

Do not receive a “live” vaccine while you are being treated with cytarabine. The live vaccine may not work as well during this time, and may not fully protect you from disease.

What should I discuss with my healthcare provider before receiving Cytosar-U (cytarabine)?

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

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

• asthma or other breathing disorder; or

• a history of stomach ulcer or bleeding.

FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not receive cytarabine without telling your doctor if you are pregnant. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. It is not known whether cytarabine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How is cytarabine given?

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

Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when the medicine is injected.

Cytarabine can lower blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Do not miss any scheduled appointments.

What happens if I miss a dose?

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

What happens if I overdose?

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

Overdose symptoms may include extreme drowsiness, or changes in personality or behavior.

What should I avoid while receiving Cytosar-U (cytarabine)?

Avoid being near people who have colds, the flu, or other contagious illnesses. Contact your doctor at once if you develop signs of infection.

Do not receive a “live” vaccine while you are being treated with cytarabine. The live vaccine may not work as well during this time, and may not fully protect you from disease.

Cytosar-U (cytarabine) 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:

• easy bruising or bleeding, unusual weakness;

• eye pain or redness, problems with your vision;

• sudden shortness of breath, dry cough;

• unusual thoughts or behavior;

• problems with urination;

• black, bloody, or tarry stools;

• coughing up blood or vomit that looks like coffee grounds;

• nausea, stomach pain, loss of appetite, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

• fever, chest pain, muscle or bone pain, skin rash, tired feeling, and redness of the eyes (may occur 6 to 12 hours after your injection).

Less serious side effects may include:

• nausea, vomiting, diarrhea, stomach pain;

• mouth sores;

• drowsiness, dizziness;

• loss of appetite;

• sores or swelling around your mouth or rectum;

• sore throat;

• hair loss; or

• headache.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Cytosar-U (cytarabine)?

Tell your doctor if you take digoxin (Lanoxin).

This list is not complete and there may be other drugs that can interact with cytarabine. 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 cytarabine.

• 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: 2.02. Revision Date: 06/23/2009 11:24:38 AM.