Generic Name: pancrelipase (oral) (pan kre LYE pace)
Brand Names: Cotazym, Creon, Dygase, Ku-Zyme, Ku-Zyme HP, Kutrase, Lapase, Palcaps 10, Pancrease MT 10, Pancrease MT 16, Pancrease MT 20, Pancrease MT 4, Pancrecarb MS-16, Pancrecarb MS-4, Pancrecarb MS-8, Panocaps, Panocaps MT 16, Ultrase, Ultrase MT 12, Ultrase MT 18, Ultrase MT 20, Viokase, Viokase 16, Zenpep

What is pancrelipase?

Pancrelipase is a combination of three enzymes (proteins): lipase, protease, and amylase. These enzymes are normally produced by the pancreas and are important in the digestion of fats, proteins, and sugars.

Pancrelipase is used to replace these enzymes when the body does not have enough of its own. Certain medical conditions can cause this lack of enzymes, including cystic fibrosis, chronic inflammation of the pancreas, or blockage of the pancreatic ducts.

Pancrelipase may also be used following surgical removal of the pancreas.

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

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

You should not take pancrelipase if you are allergic to pork proteins.

Before taking pancrelipase, tell your doctor if you have gout, kidney disease, a history of intestinal blockage, a sudden onset of pancreatitis, or worsening of chronic pancreatic disease.

Use pancrelipase regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Do not hold the tablets or capsule contents in your mouth. The medication may irritate the inside of your mouth.

Do not inhale the powder from a pancrelipase capsule, or allow it to touch your skin. It may cause irritation, especially to your nose and lungs.

If you miss a dose of this medicine, skip the missed dose and wait until your next scheduled dose to take the medicine. Do not take extra medicine to make up the missed dose.

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

You should not take pancrelipase if you are allergic to pork proteins.

If you have any of these other conditions, you may need a pancrelipase dose adjustment or special tests:

• kidney disease;

• gout;

• a history of blockage in your intestines;

• a sudden onset of pancreatitis; or

• worsening of chronic pancreatic disease.

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

How should I take pancrelipase?

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

Pancrelipase should be taken with a meal or snack. Take the medicine with a full glass of water or juice.

Do not hold the tablets or capsule contents in your mouth. The medication may irritate the inside of your mouth.

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

You may open the pancrelipase capsule and sprinkle the medicine into a spoonful of pudding or applesauce to make swallowing easier. Swallow right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

Do not inhale the powder from a pancrelipase capsule, or allow it to touch your skin. It may cause irritation, especially to your nose and lungs.

Use pancrelipase regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store in the original container at room temperature (below 78 degrees F) for up to 12 weeks. Protect from moisture or high heat. Keep the bottle tightly closed when not in use. If the medication is exposed to temperatures between 78 and 104 degrees F, throw it away after 30 days. Do not use any pancrelipase that has been exposed to temperatures above 104 degrees F.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

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

Overdose symptoms may include diarrhea or stomach upset.

What should I avoid while taking pancrelipase?

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

Pancrelipase 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 severe or unusual stomach pain. This could be a symptom of a rare but serious bowel disorder.

Less serious side effects may include:

• nausea or vomiting;

• mild stomach pain or upset;

• diarrhea or constipation;

• bloating or gas.

• greasy stools;

• rectal irritation;

• headache, dizziness;

• cough; or

• weight loss.

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 pancrelipase?

There may be other drugs that can interact with pancrelipase. 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 pharmacist can provide more information about pancrelipase.

• 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: 02/05/2010 8:53:06 AM.

Generic Name: vinorelbine (vin OR el been)
Brand Names: Navelbine

What is vinorelbine?

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

Vinorelbine is used to treat non-small cell lung cancer.

Vinorelbine is sometimes used in combination with other cancer medications.

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

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

You should not use this medication if you are allergic to it, or if you have severely low white blood cell counts. Do not use vinorelbine 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 you receive vinorelbine, tell your doctor if you have liver disease, bone marrow suppression, a nerve disorder, or if you have received radiation therapy or other cancer treatments.

Vinorelbine is sometimes used in combination with other cancer medications.

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

Vinorelbine can lower blood cells that help your body fight infections. Avoid being near people who have colds, the flu, or other contagious illnesses. Your blood will need to be tested on a regular basis. Do not miss any scheduled appointments. Contact your doctor at once if you develop signs of infection.

Do not receive a “live” vaccine while you are being treated with vinorelbine, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you.

What should I discuss with my healthcare provider before receiving vinorelbine?

You should not use this medication if you are allergic to it, or if you have severely low white blood cell counts.

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

• liver disease;

• bone marrow suppression;

• a nerve disorder; or

• if you have received radiation therapy or other cancer treatments.

FDA pregnancy category D. Vinorelbine can cause harm to an unborn baby or cause birth defects. Before you receive vinorelbine, tell 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 vinorelbine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are being treated with vinorelbine.

How is vinorelbine given?

Vinorelbine is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. The medicine must be given slowly through an IV infusion.

Vinorelbine is usually given once every 7 days. You may also receive the medication once every 6 weeks. Follow your doctor’s instructions.

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

Vinorelbine can lower the 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. Your cancer treatments may be delayed based on the results of these tests. Do not miss any scheduled visits to your doctor.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your vinorelbine 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 white patches or sores in your mouth or throat, painful swallowing, heartburn, severe constipation, and stomach pain.

What should I avoid while receiving vinorelbine?

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 vinorelbine, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you. Live vaccines include measles, mumps, rubella (MMR), oral polio, chickenpox (varicella), BCG (Bacillus Calmette and Guérin), and nasal flu vaccine.

Talk to your doctor about ways to avoid constipation while being treated with vinorelbine.

Vinorelbine side effects

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

• signs of infection such as fever, chills, flu symptoms, mouth and throat ulcers, rapid heart rate, rapid and shallow breathing, fainting;

• cough, bronchospasm (wheezing, chest tightness, trouble breathing);

• severe constipation, stomach pain, bloody or black stools;

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

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

• numbness, burning, pain, or tingly feeling;

• problems with vision, hearing, speech, balance, or daily activities;

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; or

• pain, burning, redness, swelling, or skin changes where the IV needle was placed.

Less serious side effects may include:

• temporary hair loss;

• jaw pain, joint or muscle pain;

• tumor pain;

• weight loss;

• nausea, vomiting, diarrhea, loss of appetite; or

• feeling dizzy, weak, or tired.

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.

Vinorelbine Dosing Information

Usual Adult Dose for Non-Small Cell Lung Cancer:

vinorelbine 30 mg/m2 administered weekly as a single agent. The recommended method of administration is an intravenous injection over 6 to 10 minutes. In controlled trials, single-agent vinorelbine was given weekly until progression or dose-limiting toxicity.

or

vinorelbine 25 mg/m2 weekly in combination with cisplatin. Blood counts should be checked weekly to determine whether dose reductions of vinorelbine and/or cisplatin are necessary. (In the SWOG study, most patients required a 50% dose reduction of vinorelbine at day 15 of each cycle and a 50% dose reduction of cisplatin by cycle 3.)

or

vinorelbine 30 mg/m2 weekly in combination with cisplatin.

What other drugs will affect vinorelbine?

Tell your doctor about all other medications you use, especially:

• conivaptan (Vaprisol);

• diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);

• imatinib (Gleevec);

• isoniazid (for treating tuberculosis);

• an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), or telithromycin (Ketek);

• antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend);

• an antidepressant such as nefazodone;

• heart or blood pressure medication such as diltiazem (Cartia, Cardizem), felodipine (Plendil), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan), and others;

• cancer medicines such as cisplatin (Platinol), carboplatin (Paraplatin), mitomycin (Mutamycin), or oxaliplatin (Elixatin);

• HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase), or ritonavir (Norvir).

This list is not complete and there may be other drugs that can interact with vinorelbine. 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 doctor or pharmacist can provide more information about vinorelbine.

• 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: 01/05/2010 1:06:36 PM.

Generic Name: vincristine (vin KRIS teen)
Brand Names: Oncovin, Vincasar PFS

What is vincristine?

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

Vincristine is used to treat leukemia, Hodgkin’s disease, non-Hodgkin’s lymphoma, rhabdomyosarcoma (soft tissue tumors), neuroblastoma (cancer that forms in nerve tissue), and Wilms’ tumor.

Vincristine is sometimes used in combination with other cancer medications.

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

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

You should not use this medication if you are allergic to it, or if you have Charcot-Marie-Tooth syndrome. Do not use vincristine 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 you receive vincristine, tell your doctor if you have liver disease, coronary artery disease, or a nerve-muscle disorder such as myasthenia gravis, Lou Gehrig’s disease, multiple sclerosis, or muscular dystrophy.

Vincristine is sometimes used in combination with other cancer medications.

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

Your blood will need to be tested on a regular basis. Do not miss any scheduled appointments. Contact your doctor at once if you develop signs of infection.

What should I discuss with my healthcare provider before receiving vincristine?

You should not use this medication if you are allergic to it, or if you have Charcot-Marie-Tooth syndrome.

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

• liver disease;

• a nerve-muscle disorder such as myasthenia gravis, ALS (Lou Gehrig’s disease), multiple sclerosis), or muscular dystrophy; or

• coronary artery disease.

FDA pregnancy category D. Vincristine can cause harm to an unborn baby or cause birth defects. Before you receive vincristine, tell 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 vincristine passes into breast milk or if it could harm a nursing baby. Before you receive this medication, tell your doctor if you are breast-feeding a baby.

How is vincristine given?

Vincristine is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. The medicine must be given slowly through an IV infusion.

Vincristine is usually given once per week. Follow your doctor’s instructions.

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

To be sure this medication is helping your condition and not causing harmful effects, your blood will need to be tested often. Your cancer treatments may be delayed based on the results of these tests. Do not miss any scheduled visits to your doctor.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your vincristine 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 thirst with headache, nausea, vomiting, and weakness, or severe forms of the serious side effects listed in this medication guide.

What should I avoid while receiving vincristine?

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

Talk to your doctor about ways to avoid constipation while being treated with vincristine.

Vincristine side effects

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

• signs of infection such as fever, chills, sore throat, mouth pain, white patches or sores inside your mouth or on your lips;

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

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

• numbness, burning, pain, or tingly feeling;

• bronchospasm (wheezing, chest tightness, trouble breathing);

• stomach pain and tenderness, jaundice (yellowing of the skin or eyes);

• severe constipation;

• painful or difficult urination, urinating more or less than usual or not at all;

• spinning sensation, feeling like you might pass out;

• seizure (convulsions);

• problems with vision, hearing, speech, swallowing, balance, or daily activities;

• sudden numbness or weakness on one side of the body, sudden headache or confusion;

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; or

• pain, burning, redness, swelling, or skin changes where the IV needle was placed.

Less serious side effects may include:

• temporary hair loss;

• decreased weight with loss of muscle tissue;

• jaw pain;

• tumor pain, bone pain;

• missed menstrual periods;

• nausea, vomiting, diarrhea, loss of appetite; or

• feeling weak or tired.

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.

Vincristine Dosing Information

Usual Adult Dose for Neuroblastoma:

Standard Dose: 1.4 mg/m2 IV over one minute, once. The drug is generally administered once a week.

However, doses from 0.4 to 1.4 mg/m2 IV have been used. Dosages of vincristine may depend upon the specific indication for its use, and whether other cytotoxic agents are coadministered. Subsequent doses may be determined by the clinical and hematologic response of the patient.

Maximum Dose = 2 mg

Usual Adult Dose for non-Hodgkin’s Lymphoma:

Standard Dose: 1.4 mg/m2 IV over one minute, once. The drug is generally administered once a week.

However, doses from 0.4 to 1.4 mg/m2 IV have been used. Dosages of vincristine may depend upon the specific indication for its use, and whether other cytotoxic agents are coadministered. Subsequent doses may be determined by the clinical and hematologic response of the patient.

Maximum Dose = 2 mg

Usual Adult Dose for Hodgkin’s Disease:

Standard Dose: 1.4 mg/m2 IV over one minute, once. The drug is generally administered once a week.

However, doses from 0.4 to 1.4 mg/m2 IV have been used. Dosages of vincristine may depend upon the specific indication for its use, and whether other cytotoxic agents are coadministered. Subsequent doses may be determined by the clinical and hematologic response of the patient.

Maximum Dose = 2 mg

Usual Adult Dose for Acute Myeloid Leukemia:

Standard Dose: 1.4 mg/m2 IV over one minute, once. The drug is generally administered once a week.

However, doses from 0.4 to 1.4 mg/m2 IV have been used. Dosages of vincristine may depend upon the specific indication for its use, and whether other cytotoxic agents are coadministered. Subsequent doses may be determined by the clinical and hematologic response of the patient.

Maximum Dose = 2 mg

Usual Adult Dose for Wilms’ Tumor:

Standard Dose: 1.4 mg/m2 IV over one minute, once. The drug is generally administered once a week.

However, doses from 0.4 to 1.4 mg/m2 IV have been used. Dosages of vincristine may depend upon the specific indication for its use, and whether other cytotoxic agents are coadministered. Subsequent doses may be determined by the clinical and hematologic response of the patient.

Maximum Dose = 2 mg

Usual Adult Dose for Acute Lymphocytic Leukemia:

Standard Dose: 1.4 mg/m2 IV over one minute, once. The drug is generally administered once a week.

However, doses from 0.4 to 1.4 mg/m2 IV have been used. Dosages of vincristine may depend upon the specific indication for its use, and whether other cytotoxic agents are coadministered. Subsequent doses may be determined by the clinical and hematologic response of the patient.

Maximum Dose = 2 mg

Usual Adult Dose for Rhabdomyosarcoma:

Standard Dose: 1.4 mg/m2 IV over one minute, once. The drug is generally administered once a week.

However, doses from 0.4 to 1.4 mg/m2 IV have been used. Dosages of vincristine may depend upon the specific indication for its use, and whether other cytotoxic agents are coadministered. Subsequent doses may be determined by the clinical and hematologic response of the patient.

Maximum Dose = 2 mg

Usual Adult Dose for Multiple Myeloma:

(In combination with other chemotherapeutic agents as a part of the VAD regimen)
0.4 mg/day IV continuous infusion on days 1 through 4

(In combination with other chemotherapeutic agents as a part of the M2 protocol)
0.03 mg/day IV on day 1

Usual Pediatric Dose for Malignant Disease:

less than 18 years and less than or equal to 10 kg or BSA less than 1 m2: 0.05 mg/kg once a week

less than 18 years and greater than 10 kg or BSA greater than or equal to 1 m2: 1 to 2 mg/m2 once a week

Subsequent doses may be determined by the clinical and hematologic response of the patient.

Maximum Dose = 2 mg.

Usual Pediatric Dose for Neuroblastoma:

1 mg/m2/day by continuous infusion for 72 hours with doxorubicin

What other drugs will affect vincristine?

Tell your doctor about all other medications you use, especially:

• conivaptan (Vaprisol);

• diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);

• imatinib (Gleevec);

• isoniazid (for treating tuberculosis);

• phenytoin (Dilantin);

• an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), or telithromycin (Ketek);

• antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend);

• an antidepressant such as nefazodone;

• heart or blood pressure medication such as diltiazem (Cartia, Cardizem), felodipine (Plendil), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan), and others;

• cancer medicines such as cisplatin (Platinol), carboplatin (Paraplatin), mitomycin (Mutamycin), or oxaliplatin (Elixatin); or

• HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase), or ritonavir (Norvir).

This list is not complete and there may be other drugs that can interact with vincristine. 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 doctor or pharmacist can provide more information about vincristine.

• 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: 2.01. Revision Date: 11/02/2009 1:52:38 PM.

Generic Name: vincristine (vin KRIS teen)
Brand Names: Oncovin, Vincasar PFS

What is Vincasar PFS (vincristine)?

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

Vincristine is used to treat leukemia, Hodgkin’s disease, non-Hodgkin’s lymphoma, rhabdomyosarcoma (soft tissue tumors), neuroblastoma (cancer that forms in nerve tissue), and Wilms’ tumor.

Vincristine is sometimes used in combination with other cancer medications.

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

What is the most important information I should know about Vincasar PFS (vincristine)?

You should not use this medication if you are allergic to it, or if you have Charcot-Marie-Tooth syndrome. Do not use vincristine 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 you receive vincristine, tell your doctor if you have liver disease, coronary artery disease, or a nerve-muscle disorder such as myasthenia gravis, Lou Gehrig’s disease, multiple sclerosis, or muscular dystrophy.

Vincristine is sometimes used in combination with other cancer medications.

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

Your blood will need to be tested on a regular basis. Do not miss any scheduled appointments. Contact your doctor at once if you develop signs of infection.

What should I discuss with my healthcare provider before receiving Vincasar PFS (vincristine)?

You should not use this medication if you are allergic to it, or if you have Charcot-Marie-Tooth syndrome.

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

• liver disease;

• a nerve-muscle disorder such as myasthenia gravis, ALS (Lou Gehrig’s disease), multiple sclerosis), or muscular dystrophy; or

• coronary artery disease.

FDA pregnancy category D. Vincristine can cause harm to an unborn baby or cause birth defects. Before you receive vincristine, tell 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 vincristine passes into breast milk or if it could harm a nursing baby. Before you receive this medication, tell your doctor if you are breast-feeding a baby.

How is vincristine given?

Vincristine is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. The medicine must be given slowly through an IV infusion.

Vincristine is usually given once per week. Follow your doctor’s instructions.

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

To be sure this medication is helping your condition and not causing harmful effects, your blood will need to be tested often. Your cancer treatments may be delayed based on the results of these tests. Do not miss any scheduled visits to your doctor.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your vincristine 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 thirst with headache, nausea, vomiting, and weakness, or severe forms of the serious side effects listed in this medication guide.

What should I avoid while receiving Vincasar PFS (vincristine)?

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

Talk to your doctor about ways to avoid constipation while being treated with vincristine.

Vincasar PFS (vincristine) side effects

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

• signs of infection such as fever, chills, sore throat, mouth pain, white patches or sores inside your mouth or on your lips;

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

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

• numbness, burning, pain, or tingly feeling;

• bronchospasm (wheezing, chest tightness, trouble breathing);

• stomach pain and tenderness, jaundice (yellowing of the skin or eyes);

• severe constipation;

• painful or difficult urination, urinating more or less than usual or not at all;

• spinning sensation, feeling like you might pass out;

• seizure (convulsions);

• problems with vision, hearing, speech, swallowing, balance, or daily activities;

• sudden numbness or weakness on one side of the body, sudden headache or confusion;

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; or

• pain, burning, redness, swelling, or skin changes where the IV needle was placed.

Less serious side effects may include:

• temporary hair loss;

• decreased weight with loss of muscle tissue;

• jaw pain;

• tumor pain, bone pain;

• missed menstrual periods;

• nausea, vomiting, diarrhea, loss of appetite; or

• feeling weak or tired.

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 Vincasar PFS (vincristine)?

Tell your doctor about all other medications you use, especially:

• conivaptan (Vaprisol);

• diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);

• imatinib (Gleevec);

• isoniazid (for treating tuberculosis);

• phenytoin (Dilantin);

• an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), or telithromycin (Ketek);

• antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend);

• an antidepressant such as nefazodone;

• heart or blood pressure medication such as diltiazem (Cartia, Cardizem), felodipine (Plendil), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan), and others;

• cancer medicines such as cisplatin (Platinol), carboplatin (Paraplatin), mitomycin (Mutamycin), or oxaliplatin (Elixatin); or

• HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase), or ritonavir (Norvir).

This list is not complete and there may be other drugs that can interact with vincristine. 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 doctor or pharmacist can provide more information about vincristine.

• 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: 2.01. Revision Date: 11/02/2009 1:52:38 PM.

Generic Name: prenatal multivitamins (PRE nay tal VYE ta mins)
Brand Names: Advance Care Plus, Bright Beginnings, Cenogen Ultra, CitraNatal 90 DHA, CitraNatal Assure, CitraNatal DHA, CitraNatal Rx, Complete Natal, Complete-RF, CompleteNate, Concept DHA, Concept OB, Dualvit OB, Duet, Duet Chewable, Duet DHA, Duet DHA EC, Edge OB, Folbecal, Foltabs, Foltabs 90 plus DHA, Foltabs plus DHA, Gesticare, Gesticare DHA, Icar Prenatal, Icare Prenatal Rx, Inatal Advance, Inatal Ultra, Lactocal-F, Marnatal-F Plus, Maternity, Maxinate, Mission Prenatal, Mission Prenatal HP, Multinatal Plus, Nata 29 OB, Nata 29 Prenatal, Natachew, Natafort, Natelle, Natelle C, Natelle Plus with DHA, Natelle Prefer, Natelle-ez, Neevo, Neevo DHA, Nestabs CBF, Novanatal, NovaStart, O-Cal Prenatal, OB Complete, OB Complete with DHA, OB Natal One, Ob-20, OptiNate, Pre-H-Cal, Precare, Precare Conceive, Precare Premier, PreferaOB, Premesis Rx, PrenaCare, PrenaFirst, PrenaPlus, Prenatabs CBF, Prenatabs FA, Prenatabs OBN, Prenatabs Rx, Prenatal 1 Plus 1, Prenatal 19, Prenatal AD, Prenatal Elite, Prenatal H, Prenatal Low Iron, Prenatal Multivitamins, Prenatal Plus, Prenatal Plus Iron, Prenatal S, Prenatal-U, Prenate Advanced Formula, Prenate DHA, Prenate Elite, Prenate Elite Plus Iron, Prenavite FC, Prenavite PC, PreNexa, Previte Rx, PrimaCare, PrimaCare Advantage, PrimaCare One, Pruet DHA, Pruet DHA EC, RE OB 90 Plus DHA, RE OB Plus DHA, Renate, Renate DHA, Renate DHA Extra, RightStep, Se-Care, Se-Care Conceive, Se-Natal 90, Se-Natal One, Select-OB, Select-OB+DHA, Strongstart, Stuart Prenatal with Beta Carotene, Tandem DHA, Tandem OB, Tri Rx, TriAdvance, TriCare, Trinatal Rx, Trinate, UltimateCare Advance, UltimateCare One, Ultra-Natal, Verotin-BY, Verotin-GR, Vinatal 600, Vinatal Forte, Vinate 90, Vinate Advanced (New Formula), Vinate AZ, Vinate AZ Extra, Vinate C, Vinate Calcium, Vinate Care, Vinate Good Start, Vinate GT, Vinate IC, Vinate II (New Formula), Vinate III, Vinate M, Vinate One, Vinate PN Care, Vinate Ultra, Vitafol PN, Vitafol-OB, Vitafol-OB+DHA, Vitaphil, Vitaphil Aide, Vitaphil Plus DHA, Vitaphil Plus DHA 90, Vitaspire, Viva DHA, Vynatal F.A.

What are Vinate Ultra (prenatal multivitamins)?

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

Prenatal vitamins are used to provide the additional vitamins needed during pregnancy. Minerals may also be contained in prenatal multivitamins.

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

What is the most important information I should know about prenatal vitamins?

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

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

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

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

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

What should I discuss with my healthcare provider before taking prenatal vitamins?

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

Before taking prenatal vitamins, tell your doctor about all of your medical conditions.

You may need to continue taking prenatal vitamins if you breast-feed your baby. Ask your doctor about taking this medication while-breast-feeding.

How should I take prenatal vitamins?

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

Never take more than the recommended dose of prenatal vitamins.

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

Take your prenatal vitamin with a full glass of water.

Swallow the regular tablet or capsule whole. Do not break, chew, crush, or open it.

The chewable tablet must be chewed or allowed to dissolve in your mouth before swallowing. You may also allow the chewable tablet to dissolve in drinking water, fruit juice, or infant formula (but not milk or other dairy products). Drink this mixture right away.

It is important to take prenatal vitamins regularly to get the most benefit.

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

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

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

What should I avoid while taking prenatal vitamins?

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

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

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

Prenatal vitamins 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.

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

• upset stomach;

• headache; or

• unusual or unpleasant taste in your mouth.

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

What other drugs will affect prenatal vitamins?

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

• diuretics (water pills);

• heart or blood pressure medications;

• tretinoin (Vesanoid);

• isotretinoin (Accutane, Amnesteen, Clavaris, Sotret);

• trimethoprim and sulfamethoxazole (Cotrim, Bactrim, Gantanol, Gantrisin, Septra, TMP/SMX); or

• an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), and others.

This list is not complete and there may be other medications that can interact with or be affected by prenatal vitamins. 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 prenatal vitamins.

• 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: 09/23/2009 11:57:32 AM.

Generic Name: vinblastine (vin BLAS teen)
Brand Names: Velban

What is vinblastine?

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

Vinblastine is used to treat Hodgkin’s disease, certain types of lymphoma, testicular cancer, breast cancer, choriocarcinoma (a type of uterine cancer), Kaposi’s sarcoma, and Letterer-Siwe disease.

Vinblastine is often used in combination with other cancer medications.

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

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

You should not use this medication if you are allergic to it, or if you have severely low white blood cell counts, or an untreated or uncontrolled bacterial infection. Do not use vinblastine 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 you receive vinblastine, tell your doctor if you have liver disease, wasting syndrome, skin ulcers, coronary artery disease, a history of blood clot or stroke, or cancer that has spread to your bone marrow.

Vinblastine is often used in combination with other cancer medications.

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

Vinblastine can lower blood cells that help your body fight infections. Avoid being near people who have colds, the flu, or other contagious illnesses. Your blood will need to be tested on a regular basis. Do not miss any scheduled appointments. Contact your doctor at once if you develop signs of infection.

Do not receive a “live” vaccine while you are being treated with vinblastine, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you.

What should I discuss with my healthcare provider before receiving vinblastine?

You should not use this medication if you are allergic to it, or if you have:

• severely low white blood cell counts; or

• an untreated or uncontrolled bacterial infection.

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

• liver disease;

• wasting syndrome (decreased weight with loss of muscle tissue);

• skin ulcers, bed sores;

• coronary artery disease, a history of blood clot or stroke (including “mini-stroke”); or

• cancer than has spread to your bone marrow.

FDA pregnancy category D. Vinblastine can cause harm to an unborn baby or cause birth defects. Before you receive vinblastine, tell 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 vinblastine passes into breast milk or if it could harm a nursing baby. Before you receive this medication, tell your doctor if you are breast-feeding a baby.

How is vinblastine given?

Vinblastine is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. The medicine must be given slowly through an IV infusion.

Vinblastine is usually given once every 7 days. Follow your doctor’s instructions.

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

Vinblastine can lower the 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. Your cancer treatments may be delayed based on the results of these tests. Do not miss any scheduled visits to your doctor.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your vinblastine 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 severe forms of the serious side effects listed in this medication guide.

What should I avoid while receiving vinblastine?

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 vinblastine, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you. Live vaccines include measles, mumps, rubella (MMR), oral polio, chickenpox (varicella), BCG (Bacillus Calmette and Guérin), and nasal flu vaccine.

Talk to your doctor about ways to avoid constipation while being treated with vinblastine.

Vinblastine side effects

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

• signs of infection such as fever, chills, sore throat, mouth pain, white patches or sores inside your mouth or on your lips;

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

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

• numbness, burning, pain, or tingly feeling;

• bronchospasm (wheezing, chest tightness, trouble breathing);

• severe constipation;

• problems with vision, hearing, speech, balance, or daily activities;

• sudden numbness or weakness on one side of the body, sudden headache or confusion;

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; or

• pain, burning, redness, swelling, or skin changes where the IV needle was placed.

Less serious side effects may include:

• temporary hair loss;

• jaw pain;

• tumor pain, bone pain;

• missed menstrual periods;

• nausea, vomiting, loss of appetite; or

• feeling weak or tired.

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.

Vinblastine Dosing Information

Usual Adult Dose for Breast Cancer:

Initial Dose: 3.7 mg/m2 intravenously over approximately one minute, once.

Because of the variation in the depth of the leukopenic response following therapy, the manufacturer recommends that vinblastine not be given more frequently than once every 7 days. However, there are several multiple day regimens where the dose is split into several consecutive days.

The manufacturer outlines the following conservative incremental approach to dosage at weekly intervals for adults. Therapy may be continued at 5.5 mg/m2 for the second dose, 7.4 mg/m2 for the third dose, 9.25 mg/m2 for the fourth dose, and 11.1 mg/m2 for the fifth dose. This progression may be followed up to a maximum dosage of 18.5 mg/m2. Dosage regimens may vary in clinical practice according to the disease being treated and the combination of antineoplastic agents being used.

White blood cell counts should be obtained just prior to dosage administration. The nadir in the white blood cell count is generally observed from 5 to 10 days following the dosage. Recovery to pretreatment levels is usually observed from 7 to 14 days after treatment. If a dose reduces the white cell count to approximately 3,000 cells/mm3, the next dose should not be given until the white cell count has returned to at least 4,000/mm3. The previous dosage increment may then be administered at weekly intervals for maintenance. In some cases, oncolytic activity may be encountered before leukopenic effect. When this occurs, there is no need to increase subsequent doses.

The manufacturer states that the use of small amounts of vinblastine daily for long periods of time is not advisable and that strict adherence to the recommended dosage schedule is very important.

The duration of maintenance therapy varies according to the disease being treated and the combination of antineoplastic agents being used. Prolonged chemotherapy for maintaining remissions involves several risks, including life-threatening infectious diseases, sterility and the appearance of other cancers through suppression of immune surveillance. These risks must be balanced with potential benefits of therapy.

Usual Adult Dose for Kaposi’s Sarcoma:

Initial Dose: 3.7 mg/m2 intravenously over approximately one minute, once.

Because of the variation in the depth of the leukopenic response following therapy, the manufacturer recommends that vinblastine not be given more frequently than once every 7 days. However, there are several multiple day regimens where the dose is split into several consecutive days.

The manufacturer outlines the following conservative incremental approach to dosage at weekly intervals for adults. Therapy may be continued at 5.5 mg/m2 for the second dose, 7.4 mg/m2 for the third dose, 9.25 mg/m2 for the fourth dose, and 11.1 mg/m2 for the fifth dose. This progression may be followed up to a maximum dosage of 18.5 mg/m2. Dosage regimens may vary in clinical practice according to the disease being treated and the combination of antineoplastic agents being used.

White blood cell counts should be obtained just prior to dosage administration. The nadir in the white blood cell count is generally observed from 5 to 10 days following the dosage. Recovery to pretreatment levels is usually observed from 7 to 14 days after treatment. If a dose reduces the white cell count to approximately 3,000 cells/mm3, the next dose should not be given until the white cell count has returned to at least 4,000/mm3. The previous dosage increment may then be administered at weekly intervals for maintenance. In some cases, oncolytic activity may be encountered before leukopenic effect. When this occurs, there is no need to increase subsequent doses.

The manufacturer states that the use of small amounts of vinblastine daily for long periods of time is not advisable and that strict adherence to the recommended dosage schedule is very important.

The duration of maintenance therapy varies according to the disease being treated and the combination of antineoplastic agents being used. Prolonged chemotherapy for maintaining remissions involves several risks, including life-threatening infectious diseases, sterility and the appearance of other cancers through suppression of immune surveillance. These risks must be balanced with potential benefits of therapy.

Usual Adult Dose for Testicular Cancer:

Initial Dose: 3.7 mg/m2 intravenously over approximately one minute, once.

Because of the variation in the depth of the leukopenic response following therapy, the manufacturer recommends that vinblastine not be given more frequently than once every 7 days. However, there are several multiple day regimens where the dose is split into several consecutive days.

The manufacturer outlines the following conservative incremental approach to dosage at weekly intervals for adults. Therapy may be continued at 5.5 mg/m2 for the second dose, 7.4 mg/m2 for the third dose, 9.25 mg/m2 for the fourth dose, and 11.1 mg/m2 for the fifth dose. This progression may be followed up to a maximum dosage of 18.5 mg/m2. Dosage regimens may vary in clinical practice according to the disease being treated and the combination of antineoplastic agents being used.

White blood cell counts should be obtained just prior to dosage administration. The nadir in the white blood cell count is generally observed from 5 to 10 days following the dosage. Recovery to pretreatment levels is usually observed from 7 to 14 days after treatment. If a dose reduces the white cell count to approximately 3,000 cells/mm3, the next dose should not be given until the white cell count has returned to at least 4,000/mm3. The previous dosage increment may then be administered at weekly intervals for maintenance. In some cases, oncolytic activity may be encountered before leukopenic effect. When this occurs, there is no need to increase subsequent doses.

The manufacturer states that the use of small amounts of vinblastine daily for long periods of time is not advisable and that strict adherence to the recommended dosage schedule is very important.

The duration of maintenance therapy varies according to the disease being treated and the combination of antineoplastic agents being used. Prolonged chemotherapy for maintaining remissions involves several risks, including life-threatening infectious diseases, sterility and the appearance of other cancers through suppression of immune surveillance. These risks must be balanced with potential benefits of therapy.

Usual Adult Dose for Hodgkin’s Disease:

Initial Dose: 3.7 mg/m2 intravenously over approximately one minute, once.

Because of the variation in the depth of the leukopenic response following therapy, the manufacturer recommends that vinblastine not be given more frequently than once every 7 days. However, there are several multiple day regimens where the dose is split into several consecutive days.

The manufacturer outlines the following conservative incremental approach to dosage at weekly intervals for adults. Therapy may be continued at 5.5 mg/m2 for the second dose, 7.4 mg/m2 for the third dose, 9.25 mg/m2 for the fourth dose, and 11.1 mg/m2 for the fifth dose. This progression may be followed up to a maximum dosage of 18.5 mg/m2. Dosage regimens may vary in clinical practice according to the disease being treated and the combination of antineoplastic agents being used.

White blood cell counts should be obtained just prior to dosage administration. The nadir in the white blood cell count is generally observed from 5 to 10 days following the dosage. Recovery to pretreatment levels is usually observed from 7 to 14 days after treatment. If a dose reduces the white cell count to approximately 3,000 cells/mm3, the next dose should not be given until the white cell count has returned to at least 4,000/mm3. The previous dosage increment
may then be administered at weekly intervals for maintenance. In some cases, oncolytic activity may be encountered before leukopenic effect. When this occurs, there is no need to increase subsequent doses.

The manufacturer states that the use of small amounts of vinblastine daily for long periods of time is not advisable and that strict adherence to the recommended dosage schedule is very important.

The duration of maintenance therapy varies according to the disease being treated and the combination of antineoplastic agents being used. Prolonged chemotherapy for maintaining remissions involves several risks, including life-threatening infectious diseases, sterility and the appearance of other cancers through suppression of immune surveillance. These risks must be balanced with potential benefits of therapy.

Usual Adult Dose for Mycosis Fungoides:

Initial Dose: 3.7 mg/m2 intravenously over approximately one minute, once.

Because of the variation in the depth of the leukopenic response following therapy, the manufacturer recommends that vinblastine not be given more frequently than once every 7 days. However, there are several multiple day regimens where the dose is split into several consecutive days.

The manufacturer outlines the following conservative incremental approach to dosage at weekly intervals for adults. Therapy may be continued at 5.5 mg/m2 for the second dose, 7.4 mg/m2 for the third dose, 9.25 mg/m2 for the fourth dose, and 11.1 mg/m2 for the fifth dose. This progression may be followed up to a maximum dosage of 18.5 mg/m2. Dosage regimens may vary in clinical practice according to the disease being treated and the combination of antineoplastic agents being used.

White blood cell counts should be obtained just prior to dosage administration. The nadir in the white blood cell count is generally observed from 5 to 10 days following the dosage. Recovery to pretreatment levels is usually observed from 7 to 14 days after treatment. If a dose reduces the white cell count to approximately 3,000 cells/mm3, the next dose should not be given until the white cell count has returned to at least 4,000/mm3. The previous dosage increment may then be administered at weekly intervals for maintenance. In some cases, oncolytic activity may be encountered before leukopenic effect. When this occurs, there is no need to increase subsequent doses.

The manufacturer states that the use of small amounts of vinblastine daily for long periods of time is not advisable and that strict adherence to the recommended dosage schedule is very important.

The duration of maintenance therapy varies according to the disease being treated and the combination of antineoplastic agents being used. Prolonged chemotherapy for maintaining remissions involves several risks, including life-threatening infectious diseases, sterility and the appearance of other cancers through suppression of immune surveillance. These risks must be balanced with potential benefits of therapy.

Usual Adult Dose for Choriocarcinoma:

Initial Dose: 3.7 mg/m2 intravenously over approximately one minute, once.

Because of the variation in the depth of the leukopenic response following therapy, the manufacturer recommends that vinblastine not be given more frequently than once every 7 days. However, there are several multiple day regimens where the dose is split into several consecutive days.

The manufacturer outlines the following conservative incremental approach to dosage at weekly intervals for adults. Therapy may be continued at 5.5 mg/m2 for the second dose, 7.4 mg/m2 for the third dose, 9.25 mg/m2 for the fourth dose, and 11.1 mg/m2 for the fifth dose. This progression may be followed up to a maximum dosage of 18.5 mg/m2. Dosage regimens may vary in clinical practice according to the disease being treated and the combination of antineoplastic agents being used.

White blood cell counts should be obtained just prior to dosage administration. The nadir in the white blood cell count is generally observed from 5 to 10 days following the dosage. Recovery to pretreatment levels is usually observed from 7 to 14 days after treatment. If a dose reduces the white cell count to approximately 3,000 cells/mm3, the next dose should not be given until the white cell count has returned to at least 4,000/mm3. The previous dosage increment may then be administered at weekly intervals for maintenance. In some cases, oncolytic activity may be encountered before leukopenic effect. When this occurs, there is no need to increase subsequent doses.

The manufacturer states that the use of small amounts of vinblastine daily for long periods of time is not advisable and that strict adherence to the recommended dosage schedule is very important.

The duration of maintenance therapy varies according to the disease being treated and the combination of antineoplastic agents being used. Prolonged chemotherapy for maintaining remissions involves several risks, including life-threatening infectious diseases, sterility and the appearance of other cancers through suppression of immune surveillance. These risks must be balanced with potential benefits of therapy.

Usual Adult Dose for Lymphoma:

Initial Dose: 3.7 mg/m2 intravenously over approximately one minute, once.

Because of the variation in the depth of the leukopenic response following therapy, the manufacturer recommends that vinblastine not be given more frequently than once every 7 days. However, there are several multiple day regimens where the dose is split into several consecutive days.

The manufacturer outlines the following conservative incremental approach to dosage at weekly intervals for adults. Therapy may be continued at 5.5 mg/m2 for the second dose, 7.4 mg/m2 for the third dose, 9.25 mg/m2 for the fourth dose, and 11.1 mg/m2 for the fifth dose. This progression may be followed up to a maximum dosage of 18.5 mg/m2. Dosage regimens may vary in clinical practice according to the disease being treated and the combination of antineoplastic agents being used.

White blood cell counts should be obtained just prior to dosage administration. The nadir in the white blood cell count is generally observed from 5 to 10 days following the dosage. Recovery to pretreatment levels is usually observed from 7 to 14 days after treatment. If a dose reduces the white cell count to approximately 3,000 cells/mm3, the next dose should not be given until the white cell count has returned to at least 4,000/mm3. The previous dosage increment may then be administered at weekly intervals for maintenance. In some cases, oncolytic activity may be encountered before leukopenic effect. When this occurs, there is no need to increase subsequent doses.

The manufacturer states that the use of small amounts of vinblastine daily for long periods of time is not advisable and that strict adherence to the recommended dosage schedule is very important.

The duration of maintenance therapy varies according to the disease being treated and the combination of antineoplastic agents being used. Prolonged chemotherapy for maintaining remissions involves several risks, including life-threatening infectious diseases, sterility and the appearance of other cancers through suppression of immune surveillance. These risks must be balanced with potential benefits of therapy.

Usual Adult Dose for Histiocytosis:

Initial Dose: 3.7 mg/m2 intravenously over approximately one minute, once.

Because of the variation in the depth of the leukopenic response following therapy, the manufacturer recommends that vinblastine not be given more frequently than once every 7 days. However, there are several multiple day regimens where the dose is split into several consecutive days.

The manufacturer outlines the following conservative incremental approach to dosage at weekly intervals for adults. Therapy may be co
ntinued at 5.5 mg/m2 for the second dose, 7.4 mg/m2 for the third dose, 9.25 mg/m2 for the fourth dose, and 11.1 mg/m2 for the fifth dose. This progression may be followed up to a maximum dosage of 18.5 mg/m2. Dosage regimens may vary in clinical practice according to the disease being treated and the combination of antineoplastic agents being used.

White blood cell counts should be obtained just prior to dosage administration. The nadir in the white blood cell count is generally observed from 5 to 10 days following the dosage. Recovery to pretreatment levels is usually observed from 7 to 14 days after treatment. If a dose reduces the white cell count to approximately 3,000 cells/mm3, the next dose should not be given until the white cell count has returned to at least 4,000/mm3. The previous dosage increment may then be administered at weekly intervals for maintenance. In some cases, oncolytic activity may be encountered before leukopenic effect. When this occurs, there is no need to increase subsequent doses.

The manufacturer states that the use of small amounts of vinblastine daily for long periods of time is not advisable and that strict adherence to the recommended dosage schedule is very important.

The duration of maintenance therapy varies according to the disease being treated and the combination of antineoplastic agents being used. Prolonged chemotherapy for maintaining remissions involves several risks, including life-threatening infectious diseases, sterility and the appearance of other cancers through suppression of immune surveillance. These risks must be balanced with potential benefits of therapy.

Usual Pediatric Dose for Malignant Disease:

Hodgkin’s disease: 2.5 to 6 mg/m2/day once every one to two weeks for three to six weeks. The maximum weekly dose is 12.5 mg/m2.

Histiocytosis: 0.4 mg/kg once every seven to ten days.

Germ cell tumor: 0.2 mg/kg on days one and two of the cycle every three weeks for four cycles.

What other drugs will affect vinblastine?

Tell your doctor about all other medications you use, especially:

• conivaptan (Vaprisol);

• diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);

• imatinib (Gleevec);

• isoniazid (for treating tuberculosis);

• phenytoin (Dilantin);

• an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), or telithromycin (Ketek);

• antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend);

• an antidepressant such as nefazodone;

• heart or blood pressure medication such as diltiazem (Cartia, Cardizem), felodipine (Plendil), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan), and others;

• cancer medicines such as cisplatin (Platinol), carboplatin (Paraplatin), mitomycin (Mutamycin), or oxaliplatin (Elixatin);

• HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase), or ritonavir (Norvir).

This list is not complete and there may be other drugs that can interact with vinblastine. 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 doctor or pharmacist can provide more information about vinblastine.

• 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: 2.01. Revision Date: 11/02/2009 12:51:01 PM.

Generic Name: prenatal multivitamins (PRE nay tal VYE ta mins)
Brand Names: Advance Care Plus, Bright Beginnings, Cenogen Ultra, CitraNatal 90 DHA, CitraNatal Assure, CitraNatal DHA, CitraNatal Rx, Complete Natal, Complete-RF, CompleteNate, Concept DHA, Concept OB, Dualvit OB, Duet, Duet Chewable, Duet DHA, Duet DHA EC, Edge OB, Folbecal, Foltabs, Foltabs 90 plus DHA, Foltabs plus DHA, Gesticare, Gesticare DHA, Icar Prenatal, Icare Prenatal Rx, Inatal Advance, Inatal Ultra, Lactocal-F, Marnatal-F Plus, Maternity, Maxinate, Mission Prenatal, Mission Prenatal HP, Multinatal Plus, Nata 29 OB, Nata 29 Prenatal, Natachew, Natafort, Natelle, Natelle C, Natelle Plus with DHA, Natelle Prefer, Natelle-ez, Neevo, Neevo DHA, Nestabs CBF, Novanatal, NovaStart, O-Cal Prenatal, OB Complete, OB Complete with DHA, OB Natal One, Ob-20, OptiNate, Pre-H-Cal, Precare, Precare Conceive, Precare Premier, PreferaOB, Premesis Rx, PrenaCare, PrenaFirst, PrenaPlus, Prenatabs CBF, Prenatabs FA, Prenatabs OBN, Prenatabs Rx, Prenatal 1 Plus 1, Prenatal 19, Prenatal AD, Prenatal Elite, Prenatal H, Prenatal Low Iron, Prenatal Multivitamins, Prenatal Plus, Prenatal Plus Iron, Prenatal S, Prenatal-U, Prenate Advanced Formula, Prenate DHA, Prenate Elite, Prenate Elite Plus Iron, Prenavite FC, Prenavite PC, PreNexa, Previte Rx, PrimaCare, PrimaCare Advantage, PrimaCare One, Pruet DHA, Pruet DHA EC, RE OB 90 Plus DHA, RE OB Plus DHA, Renate, Renate DHA, Renate DHA Extra, RightStep, Se-Care, Se-Care Conceive, Se-Natal 90, Se-Natal One, Select-OB, Select-OB+DHA, Strongstart, Stuart Prenatal with Beta Carotene, Tandem DHA, Tandem OB, Tri Rx, TriAdvance, TriCare, Trinatal Rx, Trinate, UltimateCare Advance, UltimateCare One, Ultra-Natal, Verotin-BY, Verotin-GR, Vinatal 600, Vinatal Forte, Vinate 90, Vinate Advanced (New Formula), Vinate AZ, Vinate AZ Extra, Vinate C, Vinate Calcium, Vinate Care, Vinate Good Start, Vinate GT, Vinate IC, Vinate II (New Formula), Vinate III, Vinate M, Vinate One, Vinate PN Care, Vinate Ultra, Vitafol PN, Vitafol-OB, Vitafol-OB+DHA, Vitaphil, Vitaphil Aide, Vitaphil Plus DHA, Vitaphil Plus DHA 90, Vitaspire, Viva DHA, Vynatal F.A.

What are Vinate M (prenatal multivitamins)?

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

Prenatal vitamins are used to provide the additional vitamins needed during pregnancy. Minerals may also be contained in prenatal multivitamins.

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

What is the most important information I should know about prenatal vitamins?

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

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

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

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

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

What should I discuss with my healthcare provider before taking prenatal vitamins?

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

Before taking prenatal vitamins, tell your doctor about all of your medical conditions.

You may need to continue taking prenatal vitamins if you breast-feed your baby. Ask your doctor about taking this medication while-breast-feeding.

How should I take prenatal vitamins?

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

Never take more than the recommended dose of prenatal vitamins.

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

Take your prenatal vitamin with a full glass of water.

Swallow the regular tablet or capsule whole. Do not break, chew, crush, or open it.

The chewable tablet must be chewed or allowed to dissolve in your mouth before swallowing. You may also allow the chewable tablet to dissolve in drinking water, fruit juice, or infant formula (but not milk or other dairy products). Drink this mixture right away.

It is important to take prenatal vitamins regularly to get the most benefit.

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

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

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

What should I avoid while taking prenatal vitamins?

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

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

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

Prenatal vitamins 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.

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

• upset stomach;

• headache; or

• unusual or unpleasant taste in your mouth.

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

What other drugs will affect prenatal vitamins?

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

• diuretics (water pills);

• heart or blood pressure medications;

• tretinoin (Vesanoid);

• isotretinoin (Accutane, Amnesteen, Clavaris, Sotret);

• trimethoprim and sulfamethoxazole (Cotrim, Bactrim, Gantanol, Gantrisin, Septra, TMP/SMX); or

• an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), and others.

This list is not complete and there may be other medications that can interact with or be affected by prenatal vitamins. 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 prenatal vitamins.

• 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: 09/23/2009 11:57:32 AM.

Generic Name: prenatal multivitamins (PRE nay tal VYE ta mins)
Brand Names: Advance Care Plus, Bright Beginnings, Cenogen Ultra, CitraNatal 90 DHA, CitraNatal Assure, CitraNatal DHA, CitraNatal Rx, Complete Natal, Complete-RF, CompleteNate, Concept DHA, Concept OB, Dualvit OB, Duet, Duet Chewable, Duet DHA, Duet DHA EC, Edge OB, Folbecal, Foltabs, Foltabs 90 plus DHA, Foltabs plus DHA, Gesticare, Gesticare DHA, Icar Prenatal, Icare Prenatal Rx, Inatal Advance, Inatal Ultra, Lactocal-F, Marnatal-F Plus, Maternity, Maxinate, Mission Prenatal, Mission Prenatal HP, Multinatal Plus, Nata 29 OB, Nata 29 Prenatal, Natachew, Natafort, Natelle, Natelle C, Natelle Plus with DHA, Natelle Prefer, Natelle-ez, Neevo, Neevo DHA, Nestabs CBF, Novanatal, NovaStart, O-Cal Prenatal, OB Complete, OB Complete with DHA, OB Natal One, Ob-20, OptiNate, Pre-H-Cal, Precare, Precare Conceive, Precare Premier, PreferaOB, Premesis Rx, PrenaCare, PrenaFirst, PrenaPlus, Prenatabs CBF, Prenatabs FA, Prenatabs OBN, Prenatabs Rx, Prenatal 1 Plus 1, Prenatal 19, Prenatal AD, Prenatal Elite, Prenatal H, Prenatal Low Iron, Prenatal Multivitamins, Prenatal Plus, Prenatal Plus Iron, Prenatal S, Prenatal-U, Prenate Advanced Formula, Prenate DHA, Prenate Elite, Prenate Elite Plus Iron, Prenavite FC, Prenavite PC, PreNexa, Previte Rx, PrimaCare, PrimaCare Advantage, PrimaCare One, Pruet DHA, Pruet DHA EC, RE OB 90 Plus DHA, RE OB Plus DHA, Renate, Renate DHA, Renate DHA Extra, RightStep, Se-Care, Se-Care Conceive, Se-Natal 90, Se-Natal One, Select-OB, Select-OB+DHA, Strongstart, Stuart Prenatal with Beta Carotene, Tandem DHA, Tandem OB, Tri Rx, TriAdvance, TriCare, Trinatal Rx, Trinate, UltimateCare Advance, UltimateCare One, Ultra-Natal, Verotin-BY, Verotin-GR, Vinatal 600, Vinatal Forte, Vinate 90, Vinate Advanced (New Formula), Vinate AZ, Vinate AZ Extra, Vinate C, Vinate Calcium, Vinate Care, Vinate Good Start, Vinate GT, Vinate IC, Vinate II (New Formula), Vinate III, Vinate M, Vinate One, Vinate PN Care, Vinate Ultra, Vitafol PN, Vitafol-OB, Vitafol-OB+DHA, Vitaphil, Vitaphil Aide, Vitaphil Plus DHA, Vitaphil Plus DHA 90, Vitaspire, Viva DHA, Vynatal F.A.

What are Vinate One (prenatal multivitamins)?

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

Prenatal vitamins are used to provide the additional vitamins needed during pregnancy. Minerals may also be contained in prenatal multivitamins.

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

What is the most important information I should know about prenatal vitamins?

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

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

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

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

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

What should I discuss with my healthcare provider before taking prenatal vitamins?

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

Before taking prenatal vitamins, tell your doctor about all of your medical conditions.

You may need to continue taking prenatal vitamins if you breast-feed your baby. Ask your doctor about taking this medication while-breast-feeding.

How should I take prenatal vitamins?

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

Never take more than the recommended dose of prenatal vitamins.

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

Take your prenatal vitamin with a full glass of water.

Swallow the regular tablet or capsule whole. Do not break, chew, crush, or open it.

The chewable tablet must be chewed or allowed to dissolve in your mouth before swallowing. You may also allow the chewable tablet to dissolve in drinking water, fruit juice, or infant formula (but not milk or other dairy products). Drink this mixture right away.

It is important to take prenatal vitamins regularly to get the most benefit.

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

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

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

What should I avoid while taking prenatal vitamins?

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

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

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

Prenatal vitamins 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.

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

• upset stomach;

• headache; or

• unusual or unpleasant taste in your mouth.

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

What other drugs will affect prenatal vitamins?

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

• diuretics (water pills);

• heart or blood pressure medications;

• tretinoin (Vesanoid);

• isotretinoin (Accutane, Amnesteen, Clavaris, Sotret);

• trimethoprim and sulfamethoxazole (Cotrim, Bactrim, Gantanol, Gantrisin, Septra, TMP/SMX); or

• an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), and others.

This list is not complete and there may be other medications that can interact with or be affected by prenatal vitamins. 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 prenatal vitamins.

• 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: 09/23/2009 11:57:32 AM.

Generic Name: prenatal multivitamins (PRE nay tal VYE ta mins)
Brand Names: Advance Care Plus, Bright Beginnings, Cenogen Ultra, CitraNatal 90 DHA, CitraNatal Assure, CitraNatal DHA, CitraNatal Rx, Complete Natal, Complete-RF, CompleteNate, Concept DHA, Concept OB, Dualvit OB, Duet, Duet Chewable, Duet DHA, Duet DHA EC, Edge OB, Folbecal, Foltabs, Foltabs 90 plus DHA, Foltabs plus DHA, Gesticare, Gesticare DHA, Icar Prenatal, Icare Prenatal Rx, Inatal Advance, Inatal Ultra, Lactocal-F, Marnatal-F Plus, Maternity, Maxinate, Mission Prenatal, Mission Prenatal HP, Multinatal Plus, Nata 29 OB, Nata 29 Prenatal, Natachew, Natafort, Natelle, Natelle C, Natelle Plus with DHA, Natelle Prefer, Natelle-ez, Neevo, Neevo DHA, Nestabs CBF, Novanatal, NovaStart, O-Cal Prenatal, OB Complete, OB Complete with DHA, OB Natal One, Ob-20, OptiNate, Pre-H-Cal, Precare, Precare Conceive, Precare Premier, PreferaOB, Premesis Rx, PrenaCare, PrenaFirst, PrenaPlus, Prenatabs CBF, Prenatabs FA, Prenatabs OBN, Prenatabs Rx, Prenatal 1 Plus 1, Prenatal 19, Prenatal AD, Prenatal Elite, Prenatal H, Prenatal Low Iron, Prenatal Multivitamins, Prenatal Plus, Prenatal Plus Iron, Prenatal S, Prenatal-U, Prenate Advanced Formula, Prenate DHA, Prenate Elite, Prenate Elite Plus Iron, Prenavite FC, Prenavite PC, PreNexa, Previte Rx, PrimaCare, PrimaCare Advantage, PrimaCare One, Pruet DHA, Pruet DHA EC, RE OB 90 Plus DHA, RE OB Plus DHA, Renate, Renate DHA, Renate DHA Extra, RightStep, Se-Care, Se-Care Conceive, Se-Natal 90, Se-Natal One, Select-OB, Select-OB+DHA, Strongstart, Stuart Prenatal with Beta Carotene, Tandem DHA, Tandem OB, Tri Rx, TriAdvance, TriCare, Trinatal Rx, Trinate, UltimateCare Advance, UltimateCare One, Ultra-Natal, Verotin-BY, Verotin-GR, Vinatal 600, Vinatal Forte, Vinate 90, Vinate Advanced (New Formula), Vinate AZ, Vinate AZ Extra, Vinate C, Vinate Calcium, Vinate Care, Vinate Good Start, Vinate GT, Vinate IC, Vinate II (New Formula), Vinate III, Vinate M, Vinate One, Vinate PN Care, Vinate Ultra, Vitafol PN, Vitafol-OB, Vitafol-OB+DHA, Vitaphil, Vitaphil Aide, Vitaphil Plus DHA, Vitaphil Plus DHA 90, Vitaspire, Viva DHA, Vynatal F.A.

What are Vinate PN Care (prenatal multivitamins)?

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

Prenatal vitamins are used to provide the additional vitamins needed during pregnancy. Minerals may also be contained in prenatal multivitamins.

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

What is the most important information I should know about prenatal vitamins?

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

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

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

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

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

What should I discuss with my healthcare provider before taking prenatal vitamins?

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

Before taking prenatal vitamins, tell your doctor about all of your medical conditions.

You may need to continue taking prenatal vitamins if you breast-feed your baby. Ask your doctor about taking this medication while-breast-feeding.

How should I take prenatal vitamins?

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

Never take more than the recommended dose of prenatal vitamins.

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

Take your prenatal vitamin with a full glass of water.

Swallow the regular tablet or capsule whole. Do not break, chew, crush, or open it.

The chewable tablet must be chewed or allowed to dissolve in your mouth before swallowing. You may also allow the chewable tablet to dissolve in drinking water, fruit juice, or infant formula (but not milk or other dairy products). Drink this mixture right away.

It is important to take prenatal vitamins regularly to get the most benefit.

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

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

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

What should I avoid while taking prenatal vitamins?

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

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

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

Prenatal vitamins 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.

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

• upset stomach;

• headache; or

• unusual or unpleasant taste in your mouth.

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

What other drugs will affect prenatal vitamins?

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

• diuretics (water pills);

• heart or blood pressure medications;

• tretinoin (Vesanoid);

• isotretinoin (Accutane, Amnesteen, Clavaris, Sotret);

• trimethoprim and sulfamethoxazole (Cotrim, Bactrim, Gantanol, Gantrisin, Septra, TMP/SMX); or

• an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), and others.

This list is not complete and there may be other medications that can interact with or be affected by prenatal vitamins. 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 prenatal vitamins.

• 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: 09/23/2009 11:57:32 AM.

Generic Name: prenatal multivitamins (PRE nay tal VYE ta mins)
Brand Names: Advance Care Plus, Bright Beginnings, Cenogen Ultra, CitraNatal 90 DHA, CitraNatal Assure, CitraNatal DHA, CitraNatal Rx, Complete Natal, Complete-RF, CompleteNate, Concept DHA, Concept OB, Dualvit OB, Duet, Duet Chewable, Duet DHA, Duet DHA EC, Edge OB, Folbecal, Foltabs, Foltabs 90 plus DHA, Foltabs plus DHA, Gesticare, Gesticare DHA, Icar Prenatal, Icare Prenatal Rx, Inatal Advance, Inatal Ultra, Lactocal-F, Marnatal-F Plus, Maternity, Maxinate, Mission Prenatal, Mission Prenatal HP, Multinatal Plus, Nata 29 OB, Nata 29 Prenatal, Natachew, Natafort, Natelle, Natelle C, Natelle Plus with DHA, Natelle Prefer, Natelle-ez, Neevo, Neevo DHA, Nestabs CBF, Novanatal, NovaStart, O-Cal Prenatal, OB Complete, OB Complete with DHA, OB Natal One, Ob-20, OptiNate, Pre-H-Cal, Precare, Precare Conceive, Precare Premier, PreferaOB, Premesis Rx, PrenaCare, PrenaFirst, PrenaPlus, Prenatabs CBF, Prenatabs FA, Prenatabs OBN, Prenatabs Rx, Prenatal 1 Plus 1, Prenatal 19, Prenatal AD, Prenatal Elite, Prenatal H, Prenatal Low Iron, Prenatal Multivitamins, Prenatal Plus, Prenatal Plus Iron, Prenatal S, Prenatal-U, Prenate Advanced Formula, Prenate DHA, Prenate Elite, Prenate Elite Plus Iron, Prenavite FC, Prenavite PC, PreNexa, Previte Rx, PrimaCare, PrimaCare Advantage, PrimaCare One, Pruet DHA, Pruet DHA EC, RE OB 90 Plus DHA, RE OB Plus DHA, Renate, Renate DHA, Renate DHA Extra, RightStep, Se-Care, Se-Care Conceive, Se-Natal 90, Se-Natal One, Select-OB, Select-OB+DHA, Strongstart, Stuart Prenatal with Beta Carotene, Tandem DHA, Tandem OB, Tri Rx, TriAdvance, TriCare, Trinatal Rx, Trinate, UltimateCare Advance, UltimateCare One, Ultra-Natal, Verotin-BY, Verotin-GR, Vinatal 600, Vinatal Forte, Vinate 90, Vinate Advanced (New Formula), Vinate AZ, Vinate AZ Extra, Vinate C, Vinate Calcium, Vinate Care, Vinate Good Start, Vinate GT, Vinate IC, Vinate II (New Formula), Vinate III, Vinate M, Vinate One, Vinate PN Care, Vinate Ultra, Vitafol PN, Vitafol-OB, Vitafol-OB+DHA, Vitaphil, Vitaphil Aide, Vitaphil Plus DHA, Vitaphil Plus DHA 90, Vitaspire, Viva DHA, Vynatal F.A.

What are Vinate IC (prenatal multivitamins)?

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

Prenatal vitamins are used to provide the additional vitamins needed during pregnancy. Minerals may also be contained in prenatal multivitamins.

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

What is the most important information I should know about prenatal vitamins?

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

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

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

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

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

What should I discuss with my healthcare provider before taking prenatal vitamins?

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

Before taking prenatal vitamins, tell your doctor about all of your medical conditions.

You may need to continue taking prenatal vitamins if you breast-feed your baby. Ask your doctor about taking this medication while-breast-feeding.

How should I take prenatal vitamins?

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

Never take more than the recommended dose of prenatal vitamins.

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

Take your prenatal vitamin with a full glass of water.

Swallow the regular tablet or capsule whole. Do not break, chew, crush, or open it.

The chewable tablet must be chewed or allowed to dissolve in your mouth before swallowing. You may also allow the chewable tablet to dissolve in drinking water, fruit juice, or infant formula (but not milk or other dairy products). Drink this mixture right away.

It is important to take prenatal vitamins regularly to get the most benefit.

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

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

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects and can also harm your unborn baby. Certain minerals contained in a prenatal multivitamin may also cause serious overdose symptoms or harm to the baby if you take too much.

Overdose symptoms may include stomach pain, vomiting, diarrhea, constipation, loss of appetite, hair loss, peeling skin, tingly feeling in or around your mouth, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine, pale skin, and easy bruising or bleeding.

What should I avoid while taking prenatal vitamins?

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

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

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

Prenatal vitamins 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.

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

• upset stomach;

• headache; or

• unusual or unpleasant taste in your mouth.

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

What other drugs will affect prenatal vitamins?

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

• diuretics (water pills);

• heart or blood pressure medications;

• tretinoin (Vesanoid);

• isotretinoin (Accutane, Amnesteen, Clavaris, Sotret);

• trimethoprim and sulfamethoxazole (Cotrim, Bactrim, Gantanol, Gantrisin, Septra, TMP/SMX); or

• an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), and others.

This list is not complete and there may be other medications that can interact with or be affected by prenatal vitamins. 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 prenatal vitamins.

• 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: 09/23/2009 11:57:32 AM.