Topamax
30/06/10
Generic name: Topiramate
Brand names: Topamax
Why is Topamax prescribed?
Topamax is an antiepileptic drug, prescribed to control both the mild attacks known as partial seizures and the severe tonic-clonic convulsions known as grand mal seizures. It is typically added to the treatment regimen when other drugs fail to fully control a patient’s attacks.
Topamax is also prescribed for the prevention of migraine headaches (also known as prophylactic treatment). However, due to a lack of studies, it’s not known whether the drug can treat acute migraine attacks.
Most important fact about Topamax
Do not abruptly stop taking Topamax. If the drug isn’t withdrawn gradually, the frequency of your seizures could increase.
How should you take Topamax?
It is important to take Topamax exactly as prescribed. It can be taken with or without food. Avoid breaking the tablets; the medication has a bitter taste.
Topamax capsules may be swallowed whole, or the capsule may be opened and its contents sprinkled on a teaspoonful of soft food. To open the capsule, hold it so you can read the word “top” and carefully twist off the clear portion of the capsule. The drug and food mixture should be swallowed whole and not chewed. Do not store the mixture for future use.
Topamax increases your risk of developing kidney stones. To prevent this problem, be sure to take Topamax with plenty of fluids.
- If you miss a dose…
Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take two doses at once.
- Storage instructions…
Store Topamax at room temperature in a tightly closed container. Protect the tablets from moisture.
What side effects may occur?
Some side effects, such as fatigue, are more likely to surface with high doses of Topamax. Others occur regardless of dosage. While many tend to disappear after the first 8 weeks of therapy, it’s still important to report them to your doctor. Only your doctor can determine if it is safe for you to continue taking Topamax.
- Side effects may include:
Abdominal pain, abnormal coordination, abnormal vision, agitation, anorexia, anxiety, appetite loss, back pain, breast pain, chest pain, confusion, constipation, depression, difficulty with concentration, difficulty with memory, dizziness, double vision, drowsiness, fatigue, flu-like symptoms, indigestion, language problems, leg pain, loss of coordination, menstrual problems, mood problems, nausea, nervousness, nose inflammation, rash, sinusitis, slowing of movements, sore throat, speech problems, tingling or burning sensations, tremors, weakness, weight loss
In children, the more common side effects are abnormal gait, aggressiveness, behavior problems, confusion, constipation, difficulty concentrating, difficulty with memory, difficulty sleeping, dizziness, drowsiness, fatigue, increased muscle movement, increased saliva, injury, loss of appetite, loss of coordination, nausea, nervousness, nosebleed, pneumonia, rash, speech problems, urinary incontinence, viral infection, and weight loss.
Other, less common side effects in children include allergic reaction, digestive inflammation, increased thirst, skin disorders, slowing of movement, vaginal discharge, vision disorders, and weakened reflexes.
Topamax has also been known to cause a number of very rare side effects in adults and children (typically striking less than one person in a hundred). If you develop any unfamiliar problems while taking Topamax, report them to your doctor.
Why should Topamax not be prescribed?
If Topamax gives you an allergic reaction, you’ll be unable to use the drug.
Special warnings about Topamax
Because Topamax sometimes causes confusion, dizziness, fatigue, and problems with coordination and concentration, you should not drive, operate machinery, or participate in any hazardous activity that requires full mental alertness until you are certain how the drug affects you.
Topamax has been known to cause a potentially serious condition known as metabolic acidosis (an increase of acid in the blood). In children, chronic metabolic acidosis may affect growth or cause rickets (a softening or weakness of the bones that can lead to bone deformities). Contact your doctor immediately if you experience symptoms of metabolic acidosis such as rapid breathing, an irregular heartbeat, confusion, lethargy, fatigue, or loss of appetite. Your doctor will decide if you should discontinue taking Topamax. Do not abruptly stop taking Topamax on your own; your doctor will gradually taper the dosage to avoid an increase in seizures.
Topamax has been known to trigger severe nearsightedness along with increased pressure inside the eye. The problem usually occurs within 1 month of starting treatment. If you develop blurred vision or eye pain, call your doctor immediately. Discontinuation of the drug may be necessary to prevent permanent vision loss.
In children with chronic diarrhea or untreated kidney disorders, use of Topamax may lead to rickets and reduced growth rates.
Tell your doctor if you have kidney problems or if you are on hemodialysis; your dosage of Topamax may need adjustment. Elderly patients in particular may experience reduced kidney function when taking Topamax. Also make sure the doctor is aware of any liver disorder you may have. Topamax must be used cautiously by individuals with impaired liver function.
Anyone using Topamax, particularly children, should be carefully monitored by their doctor for signs of increased body temperature or decreased sweating, especially during hot weather.
In rare instances, suicide attempts have been reported in people taking Topamax.
Possible food and drug interactions when taking Topamax
If Topamax is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Topamax with:
Acetazolamide (Diamox)
Carbamazepine (Tegretol)
Dichlorphenamide (Daranide)
Digoxin (Lanoxin)
Metformin (Glucophage)
Phenytoin (Dilantin)
Pioglitazone (Actos)
Oral contraceptives
Valproic acid (Depakene)
Topamax can depress the central nervous system. Be extremely cautious about combining it with alcohol, sedatives, tranquilizers, and other central nervous system depressants.
Special information if you are pregnant or breastfeeding
In animal studies, Topamax has caused harm to the developing fetus, and its safety has not been verified in pregnant humans. It is recommended for use during pregnancy only if the doctor feels that its potential benefit outweighs the potential risk to the infant.
This medication may appear in breast milk, and its possible effect on the nursing infant remains unknown. Check with your doctor if you plan to breastfeed your baby.
Recommended dosage for Topamax
ADULTS
For Seizures
The usual total daily dose is 200 milligrams twice a day. Your doctor will increase the dose slowly over 6 weeks. The usual regimen is as follows: Week 1: Take 25 milligrams in the morning and again at night. Week 2: Take 50 milligrams in the morning and again at night. Your doctor will continue to raise the dose until Week 6, when the maximum of 200 milligrams twice a day is reached.
If you are also taking Dilantin or Tegretol, the dosage of Topamax may need adjustment.
For Prevention of Migraine Headaches
The recommended total daily dose is 100 milligrams a day, taken in two divided doses. Your doctor will increase the dose slowly over 4 weeks. The usual regimen is as follows: Week 1: No morning dose; take 25 milligrams at night. Week 2: Take 25 milligrams in the morning and again at night. Week 3: Take 25 milligrams in the morning and 50 milligrams at night. Week 4: Take 50 milligrams in the morning and again at night.
CHILDREN
For Seizures
Monotherapy for Children 10 Years and Older
The usual total daily dose is 200 milligrams twice a day. The doctor will increase the dose slowly over 6 weeks. The usual regimen is as follows: Week 1: Take 25 milligrams in the morning and again at night. Week 2: Take 50 milligrams in the morning and again at night. The doctor will continue to raise the dose until Week 6, when the maximum of 200 milligrams twice a day is reached.
Adjunct Therapy for Children 2 to 16 Years Old
The usual daily dose for children 2 to 16 years of age is 5 to 9 milligrams for every 2.2 pounds of body weight, divided into 2 doses. Topamax therapy usually begins with a dose of 25 milligrams (or less) once daily during the first week. The daily dosage is then increased each week until the doctor is satisfied with the patient’s response. It may take 8 weeks to reach the ideal dose.
DOSAGE ADJUSTMENT
For people with poor kidney function, the dosage is usually cut in half. On the other hand, those undergoing hemodialysis may need a supplemental dose. Likewise, the doctor may adjust your dosage if you have liver problems.
Overdosage
Any medication taken in excess can have serious consequences. If you suspect an overdose of Topamax, seek medical attention immediately.
- Symptoms of Topamax overdose may include:
Abdominal pain, agitation, blurred vision, convulsions, depression, dizziness, double vision, drowsiness, impaired coordination, impaired mental activity, low blood pressure, reduced consciousness, severe diarrhea, sluggishness, speech problems
A Topamax overdose may result in metabolic acidosis (see “Special warnings about Topamax”).
Tolterodine tartrate
30/06/10
Brand names: Detrol LA, Detrol
Why is Tolterodine tartrate prescribed?
Detrol combats symptoms of overactive bladder, including frequent urination, urgency (increased need to urinate), and urge incontinence (inability to control urination). The drug works by blocking the nerve impulses that prompt the bladder to contract.
Most important fact about Tolterodine tartrate
In a limited number of people, Detrol causes blurred vision. Take care when driving or operating machinery until you know how the drug affects you.
How should you take Tolterodine tartrate?
Detrol can be taken with or without food. Swallow Detrol LA capsules whole.
- If you miss a dose…
Take the forgotten dose as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.
- Storage instructions…
Store at room temperature.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Detrol.
- Side effects may include:
Abdominal pain, blurred vision, constipation, diarrhea, dizziness, drowsiness, dry eyes, dry mouth, fatigue, flu-like symptoms, headache, indigestion, vertigo
Why should Tolterodine tartrate not be prescribed?
If you suffer from urinary retention (inability to urinate normally), gastric retention (a blockage in the digestive system), or uncontrolled narrow-angle glaucoma (high pressure in the eyes), you should not take Detrol. You should also avoid Tolterodine tartrate if it gives you an allergic reaction.
Special warnings about Tolterodine tartrate
Use Detrol with caution if you have a bladder obstruction or digestive disorder that could lead to a complete blockage. Use caution, too, if you are being successfully treated for glaucoma, or have a liver or kidney problem.
Possible food and drug interactions when taking Tolterodine tartrate
If you take Detrol with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Detrol with any of the following:
Clarithromycin
Cyclosporine
Erythromycin antibiotics
Ketoconazole
Itraconazole
Miconazole
Vinblastine
Special information if you are pregnant or breastfeeding
The use of Detrol during pregnancy has not been adequately studied. If you are pregnant or plan to become pregnant while taking Detrol, tell your doctor immediately.
Researchers are not sure whether Detrol appears in breast milk. Use of the drug is not recommended while breastfeeding.
Recommended dosage for Tolterodine tartrate
ADULTS
Detrol
The usual starting dosage is 2 milligrams twice a day. Your doctor may decrease the dose to 1 milligram twice a day if the higher dose causes problems. The 1-milligram dose is also recommended if you have liver problems or must take any of the drugs listed in the “Possible food and drug interactions” section above.
Detrol LA
The usual starting dosage is 4 milligrams taken once a day. Your doctor may cut the dose in half if it causes problems. A dose of 2 milligrams once daily is recommended for people with liver problems and those taking drugs that might interact.
Overdosage
Any medication taken in excess can have serious consequences. If you suspect symptoms of an overdose with Detrol, seek medical attention immediately.
- Symptoms of Detrol overdose may include:
Blurred vision, constipation, drowsiness, dry eyes, dry mouth
Tolmetin sodium
30/06/10
Brand names: Tolectin
Why is Tolmetin sodium prescribed?
Tolectin is a nonsteroidal anti-inflammatory drug used to relieve the inflammation, swelling, stiffness, and joint pain associated with rheumatoid arthritis and osteoarthritis (the most common form of arthritis). It is used for both acute episodes and long-term treatment. It is also used to treat juvenile rheumatoid arthritis.
Most important fact about Tolmetin sodium
You should have frequent checkups with your doctor if you take Tolectin regularly. Ulcers or internal bleeding can occur without warning.
How should you take Tolmetin sodium?
If Tolectin upsets your stomach, it may be taken with food or an antacid, and with a full glass of water. It may also help to prevent upset if you avoid lying down for 20 to 30 minutes after taking the drug.
Take Tolmetin sodium exactly as prescribed by your doctor.
- If you miss a dose…
Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.
- Storage instructions…
Store at room temperature in a tightly closed container, away from light.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Tolectin.
- Side effects may include:
Abdominal pain, change in weight, diarrhea, dizziness, gas, headache, heartburn, high blood pressure, indigestion, nausea, stomach and intestinal upset, swelling due to fluid retention, vomiting, weakness
Why should Tolmetin sodium not be prescribed?
If you are sensitive to or have ever had an allergic reaction to Tolectin, aspirin, or other nonsteroidal anti-inflammatory drugs, or if you have had asthma, hives, or nasal inflammation caused by aspirin or other nonsteroidal anti-inflammatory drugs, you should not take Tolmetin sodium. Make sure your doctor is aware of any drug reactions you have experienced.
Special warnings about Tolmetin sodium
Tolectin can cause kidney problems, especially if you are elderly, suffer from heart failure or liver disease, or take diuretics.
This drug can also affect the liver. If you develop symptoms such as yellow skin and eyes, notify your doctor. You should be taken off Tolectin.
Do not take aspirin or any other anti-inflammatory medications while taking Tolectin unless your doctor tells you to do so.
Tolectin can cause visual disturbances. If you experience a change in your vision, inform your doctor.
Tolectin prolongs bleeding time. If you are taking blood-thinning medication, Tolmetin sodium should be taken with caution.
This drug can increase water retention. Use with caution if you have heart disease or high blood pressure.
Tolectin causes some people to become drowsy or less alert. If it has this effect on you, driving or operating dangerous machinery or participating in any hazardous activity that requires full mental alertness is not recommended.
Possible food and drug interactions when taking Tolmetin sodium
If Tolectin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Tolectin with the following:
Aspirin
Blood thinners such as Coumadin
Carteolol (Cartrol)
Diuretics such as Lasix
Glyburide (Micronase)
Lithium (Lithonate)
Methotrexate
Special information if you are pregnant or breastfeeding
The effects of Tolectin during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Tolectin appears in breast milk and could affect a nursing infant. If Tolmetin sodium is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.
Recommended dosage for Tolmetin sodium
ADULTS
Rheumatoid Arthritis or Osteoarthritis
The starting dosage is usually 1,200 milligrams a day divided into 3 doses of 400 milligrams each. Take 1 dose when you wake up and 1 at bedtime, and 1 sometime in between. Your doctor may adjust the dosage after 1 to 2 weeks. Most people will take a total daily dosage of 600 to 1,800 milligrams usually divided into 3 doses.
You should see the benefits of Tolectin in a few days to a week.
CHILDREN
The starting dose for children 2 years and older is usually a total of 20 milligrams per 2.2 pounds of body weight per day, divided into 3 or 4 smaller doses. Your doctor will advise you on use in children. The usual dose ranges from 15 to 30 milligrams per 2.2 pounds per day.
The safety and effectiveness of Tolectin have not been established in children under 2 years of age.
Overdosage
Although no specific information is available, any medication taken in excess can have serious consequences. If you suspect an overdose of Tolectin, seek medical attention immediately.
Tocainide hydrochloride
30/06/10
Brand names: Tonocard
Why is Tocainide hydrochloride prescribed?
Tonocard is used to treat severe irregular heartbeat (arrhythmias). Arrhythmias are generally divided into two main types: heartbeats that are faster than normal (tachycardia), or heartbeats that are slower than normal (bradycardia). Irregular heartbeats are often caused by drugs or disease but can occur in otherwise healthy people with no history of heart disease or other illness. Tonocard works differently from other antiarrhythmic drugs, such as quinidine (Quinidex), procainamide (Procan SR), and disopyramide (Norpace). It is similar to lidocaine (Xylocaine) and is effective in treating severe ventricular arrhythmias (irregular heartbeats that occur in the main chambers of the heart).
Most important fact about Tocainide hydrochloride
Tonocard can cause serious blood and lung disorders in some patients, especially in the first 3 months of treatment. Be sure to notify your doctor if any of the following occurs: painful or difficult breathing, wheezing, cough, easy bruising or bleeding, tremors, palpitations, rash, soreness or ulcers in the mouth, sore throat, fever, and chills.
How should you take Tocainide hydrochloride?
It is important to take Tonocard on a regular schedule, exactly as prescribed by your doctor. Try not to miss any doses. If Tocainide hydrochloride is not taken regularly, your condition can worsen.
- If you miss a dose…
If less than 2 hours have passed, take the forgotten dose as soon as you remember. If you are more than 2 hours late, skip the dose. Never try to “catch up” by taking a double dose.
- Storage instructions…
Keep the container tightly closed, and store it at room temperature. Protect from extreme heat.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Tonocard.
- Side effects may include:
Confusion/disorientation, dizziness/vertigo, diarrhea/loose stools, excessive sweating, hallucinations, increased irregular heartbeat, lack of coordination, loss of appetite, nausea, nervousness, rash/skin eruptions, tingling or pins and needles, tremor, vision disturbances, vomiting
Why should Tocainide hydrochloride not be prescribed?
If you have heart block (conduction disorder) and do not have a pacemaker, or if you are sensitive to or have ever had an allergic reaction to Tonocard or certain local anesthetics such as Xylocaine, do not take Tocainide hydrochloride.
Special warnings about Tocainide hydrochloride
Be alert for signs of the blood and lung disorders that can occur early in your treatment. (See “Most important fact about Tocainide hydrochloride.”)
If you have congestive heart failure, make sure the doctor is aware of it. Tonocard could worsen this condition.
Also make certain that the doctor is aware of any kidney or liver problems that you have. You will need to be monitored more carefully.
Before any kind of surgery, including dental surgery and emergency treatment, make sure the surgeon knows that you are taking Tonocard.
Possible food and drug interactions when taking Tocainide hydrochloride
If Tonocard is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Tonocard with any of the following:
The anesthetic Lidocaine (Xylocaine)
The blood pressure medicine Metoprolol (Lopressor)
Other antiarrhythmics such as Quinidex, Procan, Mexitil
Special information if you are pregnant or breastfeeding
The effects of Tonocard during pregnancy have not been adequately studied. However, animal studies have shown an increase in stillbirths and spontaneous abortions. If you are pregnant or plan to become pregnant, inform your doctor immediately. Tonocard may appear in breast milk and could affect a nursing infant. If Tocainide hydrochloride is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.
Recommended dosage for Tocainide hydrochloride
ADULTS
Dosages of Tonocard must be adjusted according to its effects on each individual. Your doctor should monitor you carefully to determine if the dosage you are taking is working properly. He may divide your doses further or make other changes, such as shortening the time between doses, if side effects occur.
The usual starting dose is 400 milligrams every 8 hours.
The usual dose range is between 1,200 and 1,800 milligrams total per day divided into 3 doses. This medication can be taken in 2 doses a day with careful monitoring by your doctor.
Doses beyond 2,400 milligrams per day are rarely used.
Some people, particularly those with reduced kidney or liver function, may be treated successfully with less than 1,200 milligrams per day.
CHILDREN
The safety and effectiveness of Tocainide hydrochloride in children have not been established.
Overdosage
Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.
There are no specific reports of Tonocard overdose. However, the first and most important signs of overdose would be expected to appear in the central nervous system. Disorders of the stomach and intestines might follow. Convulsions and heart and lung slowing or stopping might occur.
Tizanidine
30/06/10
Brand names: Zanaflex
Why is Tizanidine prescribed?
Zanaflex relaxes the tense, rigid muscles caused by spasticity. It is prescribed for people with multiple sclerosis, spinal cord injuries, and other disorders that produce protracted muscles spasms. The effect of the drug peaks 1 to 2 hours after each dose and is gone within 3 to 6 hours, so it’s best to schedule doses for shortly before the daily activities when relief of spasticity is most important.
Most important fact about Tizanidine
Zanaflex causes drowsiness in almost half the people who use it. It also tends to reduce blood pressure in many people, frequently leading to dizziness and light-headedness. The likelihood of significant drowsiness increases when Zanaflex is combined with other spasticity drugs. When taking Zanaflex, always be cautious about driving or operating dangerous machinery.
How should you take Tizanidine?
Take Zanaflex exactly as directed. The danger of side effects increases with the size of the dose.
- If you miss a dose…
Doses should be taken only as needed. Allow 6 to 8 hours between doses. Take no more than 3 a day. Never double the dose.
- Storage instructions…
Store at room temperature.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe to continue using Zanaflex.
- Side effects may include:
Abnormal movements, blurred vision, constipation, dizziness, drowsiness, dry mouth, flu-like symptoms, frequent urination, low blood pressure, nervousness, runny nose, slow heartbeat, sore throat, speech disorders, urinary and other infections, vomiting, weakness or fatigue
Why should Tizanidine not be prescribed?
You’ll need to avoid Zanaflex if it gives you an allergic reaction.
Special warnings about Tizanidine
Researchers have little information on the long-term consequences of using Zanaflex in single doses of more than 8 milligrams, or in total amounts of more than 24 milligrams a day. If you require a higher dosage, previously unrecognized side effects could possibly appear.
Remember that Zanaflex can cause low blood pressure and should be used with caution if you are taking blood pressure medication. Be cautious, too, when first standing up. Dizziness and light-headedness are especially likely at that time.
Zanaflex has been known to cause liver injury in a few patients. If you have a liver condition, make sure the doctor knows about it. Alert your doctor immediately if you develop warning signs of a liver problem such as loss of appetite, nausea, vomiting, or yellow skin or eyes.
You’ll need a reduced dose of Zanaflex if you have a kidney problem. Be sure to inform the doctor about your condition, and be quick to report side effects such as dry mouth, drowsiness, dizziness, and weakness. They could be signs that your dose is too high.
Use Zanaflex with caution if spasticity helps you maintain your posture and balance while walking, or helps to increase other functions.
Although there are no reports of eye damage from Zanaflex, it has occurred in animal tests. Be sure to report any vision problems to your doctor.
Zanaflex has not been tested in children.
Possible food and drug interactions when taking Tizanidine
Oral contraceptives tend to boost the amount of Zanaflex in the system. If you are using an oral contraceptive, you’ll probably need a smaller dose of Tizanidine.
Alcohol, or any drug that slows the nervous system (including other drugs taken for spasticity), increases the likelihood of drowsiness when taken with Zanaflex.
Special information if you are pregnant or breastfeeding
The effects of Zanaflex during pregnancy have not been adequately studied. It should be used during pregnancy only if clearly needed.
It’s likely that Zanaflex makes its way into breast milk, although this has not been confirmed. Check with your doctor before using Zanaflex while nursing.
Recommended dosage for Tizanidine
ADULTS
To minimize side effects, the doctor is likely to begin with a dosage of 4 milligrams, then increase the dose gradually. Doses of 8 milligrams provide relief for most people. No more than 3 doses should be taken each 24 hours. The maximum dose per day is 36 milligrams.
Overdosage
An overdose of Zanaflex can impair breathing and lead to coma. If you suspect an overdose, seek emergency treatment immediately.
Tiotropium bromide
30/06/10
Brand names: Spiriva HandiHaler
Why is Tiotropium bromide prescribed?
Spiriva is used for the long-term, once-a-day treatment of bronchial spasms (wheezing) associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema. It comes as a capsule containing dry powder, which is inhaled through the mouth using the HandiHaler device. When inhaled, Spiriva opens up narrow air passages, allowing more oxygen to reach the lungs.
Most important fact about Tiotropium bromide
Spiriva is not for initial use in sudden attacks of wheezing when fast action is needed—that is, Spiriva is not for rescue therapy.
How should you take Tiotropium bromide?
Spiriva capsules are designed to be used only with the HandiHaler inhalation device. The capsules should not be swallowed. You should try to use the inhaler about the same time every day.
Spiriva capsules are packaged as a blister card containing two strips. Each strip has three capsules. When removing a capsule from the blister card, peel back only the foil that is covering the capsule you are about to use. The capsule’s effectiveness may be reduced if it is not used immediately after the foil is opened. If you accidentally remove the foil covering any of the other capsules, you must throw them away.
When you’re ready to take Spiriva HandiHaler, use the HandiHaler device as follows:
1. Open the dust cap, and then open the mouthpiece.
2. Place the capsule in the center chamber. Close the mouthpiece until you hear a click. Leave the dust cap open.
3. Hold the HandiHaler device with the mouthpiece upward and press the piercing button that will make holes in the capsule to allow the powder to come out.
4. Before inhaling the powder, breathe out completely, but not into the mouthpiece.
5. Place the inhaler’s mouthpiece in your mouth, make a seal with your lips, keep your head upright, and breathe in slowly and deeply with your mouth. Breathe in quickly enough that you hear the capsule vibrate.
6. Hold your breath for as long as is comfortable; at the same time, remove the HandiHaler from your mouth.
7. When you’re done, breathe out completely, seal your lips around the mouthpiece again, and inhale a second time as before.
8. Remove the capsule from the inhaler and discard. You may notice a tiny amount of powder is still left in the capsule; this is normal.
Avoid getting the Spiriva powder into your eyes. It can cause blurred vision.
- If you miss a dose…
Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take two doses at once.
- Storage instructions…
Store at room temperature. Do not store capsules in the Handihaler. Keep capsules away from moisture and extreme temperatures, such as in the refrigerator or in direct sunlight.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe to continue using Spiriva.
- Side effects may include:
Abdominal pain, constipation, dry mouth, chest pain, common cold, indigestion, infection, muscle pain, nose bleeds, rash, runny nose or nasal inflammation, sinus infection, sore throat, urinary tract infection, vomiting, yeast infection
Why should Tiotropium bromide not be prescribed?
You should not take Spiriva if you have an allergic reaction to it, or if you are allergic to atropine or any of its derivatives, including ipratropium.
Special warnings about Tiotropium bromide
An immediate allergic reaction (hives, swelling, or rash) is possible when you first use Spiriva HandiHaler. Inhaled medications such as Spiriva can also cause wheezing in some people. If you have an allergic reaction or you start wheezing, stop using Spiriva and contact your doctor.
Spiriva could worsen certain medical conditions. Use Spiriva HandiHaler cautiously if you have narrow-angle glaucoma (high pressure inside the eye), an enlarged prostate, or obstruction in the neck of the bladder. Also tell your doctor if you have kidney problems.
Possible food and drug interactions when taking Tiotropium bromide
The use of Spiriva together with other anticholinergic drugs, such as ipratropium, has not been studied and is not recommended.
Always tell your doctor about any medication you’re taking, including over-the-counter products and dietary supplements.
Special information if you are pregnant or breastfeeding
Spiriva has not been studied in pregnant women. This drug should be used during pregnancy only if the benefits outweigh the potential risks. Notify your doctor immediately if you are pregnant or plan to become pregnant.
It is not known whether Spiriva appears in breast milk. If using Spiriva is essential to your health, you doctor may recommend that you discontinue breastfeeding while using Spiriva HandiHaler.
Recommended dosage for Tiotropium bromide
ADULTS
The recommended dose is the inhalation of the contents of one capsule, taken once a day, with the HandiHaler device.
Spiriva has not been studied in children.
Overdosage
Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical treatment immediately.
- Symptoms of overdose may include:
Abdominal pain, blurred vision, confusion or memory problems, dry mouth, glaucoma, inability to concentrate, increased heart rate, severe constipation, urinary difficulty, urinary retention, trembling
Timoptic
30/06/10
Brand names: Timoptic-XE, Timoptic, Betimol, Timolol maleate (ophthalmic)
Why is Timoptic prescribed?
This form of timolol is an ophthalmic (applied directly in the eye) medication that effectively reduces internal pressure in the eye. Timolol is used in the treatment of glaucoma to lower elevated eye pressure that could damage vision and, with other glaucoma medications, to further reduce pressure in the eye.
Most important fact about Timoptic
Although timolol drops are applied only to the eye, the medication is absorbed and may have effects in other parts of the body. If you have diabetes, asthma, or other respiratory disease, or decreased heart function, make sure your doctor is aware of the problem.
How should you take Timoptic?
Timolol should be used exactly as prescribed by your doctor. If you need to use other eye medications along with timolol, use them at least 10 minutes before you instill timolol eyedrops. If you wear contact lenses, remove them before using timolol eyedrops and wait 15 minutes before reinserting them.
Handle the timolol solution carefully to avoid contamination. Do not let the tip of the dispenser actually touch the eye. Do not enlarge the hole in the dispenser tip; it is designed to provide just 1 drop. Do not wash the dispenser tip with water, soap, or any other cleaner.
To administer timolol eyedrops, follow these steps:
- Wash your hands thoroughly.
- Tilt your head back and gently pull your lower eyelid down to form a pocket.
- Turn the bottle upside down, holding it with your thumb or index finger over the finger push area.
- Press the bottle lightly until a single drop falls into the eye.
- Repeat steps 3 and 4 with the other eye if necessary.
- Replace the cap firmly.
- If you miss a dose…
If you use timolol eyedrops once a day, apply it as soon as you remember. If you do not remember until the next day, skip the dose you missed and go back to your regular schedule. Do not take 2 doses at once. If you use timolol eyedrops 2 or more times a day, apply it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.
- Storage instructions…
Store at room temperature, protected from light. Keep from freezing.
What side effects may occur?
Side effects cannot be anticipated. If any side effects develop or change in intensity, tell your doctor immediately. Only your doctor can determine whether it is safe to continue using Timoptic. If timolol is absorbed into the bloodstream, it can cause additional side effects.
- Side effects may include:
Burning and stinging on instillation of the drug
Why should Timoptic not be prescribed?
Do not use timolol if you have bronchial asthma, a history of bronchial asthma, or other serious breathing disorders such as emphysema, slow heartbeat, heart block (conduction disorder), active heart failure, or inadequate blood supply to the circulatory system (cardiogenic shock), or if you have ever had an allergic reaction or are sensitive to timolol or any of its ingredients.
Special warnings about Timoptic
Use timolol cautiously if you have a history of heart failure or poor circulation to the brain.
Tell your doctor if you have any type of allergy. The frequency and severity of allergic reactions may increase while you are using timolol.
Timolol may mask the symptoms of low blood sugar. If you are diabetic, discuss this possibility with your doctor.
Tell your doctor or dentist that you are using timolol if you have a medical emergency or before you have surgery or dental treatment.
Timolol may mask symptoms of an overactive thyroid. If your doctor suspects you have excessive thyroid function, he or she will manage your case carefully to avoid such symptoms as rapid heartbeat, which can occur when the drug is withdrawn too abruptly.
The antiglaucoma effects of this timolol may decrease if you use the medication for a long time.
Some older individuals may be more sensitive to this product than younger people. If you develop an eye infection, suffer an eye injury, or have eye surgery, check with your doctor. You may need to stop using timolol.
Possible food and drug interactions when taking Timoptic
If timolol is used with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining timolol with the following:
Epinephrine
Catecholamine-depleting drugs, such as blood pressure drugs that contain reserpine
Clonidine
Digitalis
Heart and blood pressure medications known as calcium channel blockers
Quinidine
Timolol eyedrops should not be used with other topical beta-blockers and should be used with caution if you are taking oral beta-blockers.
Special information if you are pregnant or breastfeeding
If you are pregnant or plan to become pregnant, inform your doctor immediately. No information is available about the safety of using timolol during pregnancy.
Timolol appears in breast milk and may harm a nursing infant. If using timolol is essential to your health, your doctor may advise you to stop breastfeeding until your treatment is finished.
Recommended dosage for Timoptic
ADULTS
Your doctor will tailor an individual timolol dosage depending on your medical condition and how you responded to any previous glaucoma treatment.
The usual recommended starting dose of the regular solution is to place 1 drop of 0.25 percent timolol in the affected eye(s) twice a day. If you do not respond satisfactorily to this dosage, your doctor may tell you to place 1 drop of 0.5 percent timolol in the affected eye(s) twice a day.
The usual dose of the gel-forming solution is 1 drop of either 0.25 percent or 0.5 percent in the affected eye(s) once a day. Invert the closed container and shake it once before you use it.
Overdosage
Seek medical treatment immediately if you think you might have used too much timolol. Call your local poison control center or your doctor for assistance.
- Symptoms of timolol overdose inlcude:
Dizziness, headache, heart failure, shortness of breath, slow heartbeat, wheezing
Timolol maleate (ophthalmic)
30/06/10
Brand names: Timoptic-XE, Timoptic, Betimol, Timolol maleate (ophthalmic)
Why is Timolol maleate (ophthalmic) prescribed?
This form of timolol is an ophthalmic (applied directly in the eye) medication that effectively reduces internal pressure in the eye. Timolol is used in the treatment of glaucoma to lower elevated eye pressure that could damage vision and, with other glaucoma medications, to further reduce pressure in the eye.
Most important fact about Timolol maleate (ophthalmic)
Although timolol drops are applied only to the eye, the medication is absorbed and may have effects in other parts of the body. If you have diabetes, asthma, or other respiratory disease, or decreased heart function, make sure your doctor is aware of the problem.
How should you take Timolol maleate (ophthalmic)?
Timolol should be used exactly as prescribed by your doctor. If you need to use other eye medications along with timolol, use them at least 10 minutes before you instill timolol eyedrops. If you wear contact lenses, remove them before using timolol eyedrops and wait 15 minutes before reinserting them.
Handle the timolol solution carefully to avoid contamination. Do not let the tip of the dispenser actually touch the eye. Do not enlarge the hole in the dispenser tip; it is designed to provide just 1 drop. Do not wash the dispenser tip with water, soap, or any other cleaner.
To administer timolol eyedrops, follow these steps:
- Wash your hands thoroughly.
- Tilt your head back and gently pull your lower eyelid down to form a pocket.
- Turn the bottle upside down, holding it with your thumb or index finger over the finger push area.
- Press the bottle lightly until a single drop falls into the eye.
- Repeat steps 3 and 4 with the other eye if necessary.
- Replace the cap firmly.
- If you miss a dose…
If you use timolol eyedrops once a day, apply it as soon as you remember. If you do not remember until the next day, skip the dose you missed and go back to your regular schedule. Do not take 2 doses at once. If you use timolol eyedrops 2 or more times a day, apply it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.
- Storage instructions…
Store at room temperature, protected from light. Keep from freezing.
What side effects may occur?
Side effects cannot be anticipated. If any side effects develop or change in intensity, tell your doctor immediately. Only your doctor can determine whether it is safe to continue using Timolol maleate (ophthalmic). If timolol is absorbed into the bloodstream, it can cause additional side effects.
- Side effects may include:
Burning and stinging on instillation of the drug
Why should Timolol maleate (ophthalmic) not be prescribed?
Do not use timolol if you have bronchial asthma, a history of bronchial asthma, or other serious breathing disorders such as emphysema, slow heartbeat, heart block (conduction disorder), active heart failure, or inadequate blood supply to the circulatory system (cardiogenic shock), or if you have ever had an allergic reaction or are sensitive to timolol or any of its ingredients.
Special warnings about Timolol maleate (ophthalmic)
Use timolol cautiously if you have a history of heart failure or poor circulation to the brain.
Tell your doctor if you have any type of allergy. The frequency and severity of allergic reactions may increase while you are using timolol.
Timolol may mask the symptoms of low blood sugar. If you are diabetic, discuss this possibility with your doctor.
Tell your doctor or dentist that you are using timolol if you have a medical emergency or before you have surgery or dental treatment.
Timolol may mask symptoms of an overactive thyroid. If your doctor suspects you have excessive thyroid function, he or she will manage your case carefully to avoid such symptoms as rapid heartbeat, which can occur when the drug is withdrawn too abruptly.
The antiglaucoma effects of this timolol may decrease if you use the medication for a long time.
Some older individuals may be more sensitive to this product than younger people. If you develop an eye infection, suffer an eye injury, or have eye surgery, check with your doctor. You may need to stop using timolol.
Possible food and drug interactions when taking Timolol maleate (ophthalmic)
If timolol is used with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining timolol with the following:
Epinephrine
Catecholamine-depleting drugs, such as blood pressure drugs that contain reserpine
Clonidine
Digitalis
Heart and blood pressure medications known as calcium channel blockers
Quinidine
Timolol eyedrops should not be used with other topical beta-blockers and should be used with caution if you are taking oral beta-blockers.
Special information if you are pregnant or breastfeeding
If you are pregnant or plan to become pregnant, inform your doctor immediately. No information is available about the safety of using timolol during pregnancy.
Timolol appears in breast milk and may harm a nursing infant. If using timolol is essential to your health, your doctor may advise you to stop breastfeeding until your treatment is finished.
Recommended dosage for Timolol maleate (ophthalmic)
ADULTS
Your doctor will tailor an individual timolol dosage depending on your medical condition and how you responded to any previous glaucoma treatment.
The usual recommended starting dose of the regular solution is to place 1 drop of 0.25 percent timolol in the affected eye(s) twice a day. If you do not respond satisfactorily to this dosage, your doctor may tell you to place 1 drop of 0.5 percent timolol in the affected eye(s) twice a day.
The usual dose of the gel-forming solution is 1 drop of either 0.25 percent or 0.5 percent in the affected eye(s) once a day. Invert the closed container and shake it once before you use it.
Overdosage
Seek medical treatment immediately if you think you might have used too much timolol. Call your local poison control center or your doctor for assistance.
- Symptoms of timolol overdose inlcude:
Dizziness, headache, heart failure, shortness of breath, slow heartbeat, wheezing
Thioridazine hydrochloride
30/06/10
Brand names: Mellaril
Why is Thioridazine hydrochloride prescribed?
Mellaril combats the crippling mental disorder known as schizophrenia (a severe loss of contact with reality). Because Mellaril has been known to cause dangerous heartbeat irregularities, it is usually prescribed only when at least two other medications have failed.
Most important fact about Thioridazine hydrochloride
The danger of potentially fatal cardiac irregularities increases when Mellaril is combined with any medication that prolongs a part of the heartbeat known as the QTc interval. Many of the drugs prescribed for heartbeat irregularities (including amiodarone, propafenone, propranolol, and quinidine) prolong the QTc interval and should never be combined with Mellaril. Other drugs to avoid when taking Mellaril include cimetidine, delavirdine,fluoxetine, fluvoxamine, paroxetine, pindolol, and ritonavir. Make sure the doctor knows you are taking Mellaril whenever a new drug is prescribed.
How should you take Thioridazine hydrochloride?
If you are taking Mellaril in a liquid concentrate form, you can dilute it with a liquid such as distilled water, soft tap water, or juice just before taking it.
Do not change from one brand of thioridazine to another without consulting your doctor.
- If you miss a dose…
If you take 1 dose a day and remember later in the day, take the dose immediately. If you don’t remember until the next day, skip the dose and go back to your regular schedule.
If you take more than 1 dose a day and remember the forgotten dose within an hour or so after its scheduled time, take it immediately. If you don’t remember until later, skip the dose and go back to your regular schedule.
Never try to “catch up” by doubling a dose.
- Storage instructions…
Store at room temperature, tightly closed, in the container the medication came in.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Mellaril.
- Side effects may include:
Blurred vision, breast development in men, breast milk secretion, constipation, diarrhea, drowsiness, dry mouth, impotence, nausea, swelling in the arms and legs (edema), tardive dyskinesia (see “Special warnings about Thioridazine hydrochloride), vomiting
Why should Thioridazine hydrochloride not be prescribed?
Due to the danger of cardiac irregularities, Mellaril must never be combined with drugs that increase its effects or prolong the part of the heartbeat known as the QTc interval. (See “Most important fact about Thioridazine hydrochloride.”) It is also important to avoid combining Mellaril with excessive amounts of central nervous system depressants such as alcohol, barbiturates, or narcotics. Do not take Mellaril if you have heart disease accompanied by severe high or low blood pressure.
Special warnings about Thioridazine hydrochloride
Mellaril may cause tardive dyskinesia—a condition marked by involuntary muscle spasms and twitches in the face and body. This condition may be permanent, and appears to be most common among the elderly, especially women. Ask your doctor for information about this possible risk.
Drugs such as Mellaril are also known to cause a potentially fatal condition known as Neuroleptic Malignant Syndrome. Symptoms of this problem include high fever, rigid muscles, altered mental status, sweating, fast or irregular heartbeat, and changes in blood pressure. If you develop these symptoms, see your doctor immediately. Mellaril therapy may have to be permanently discontinued.
Animal studies suggest that antipsychotics such as Mellaril may increase the risk of breast cancer, although human studies have not confirmed such a risk. If you have a history of breast cancer, be sure to see your doctor regularly for checkups.
In rare cases, Mellaril has been known to trigger blood disorders and seizures. It can cause dizziness or faintness when you first stand up. High doses can also cause vision problems, including blurring, brownish coloring of vision, and poor night vision.
This drug may impair your ability to drive a car or operate potentially dangerous machinery. Do not participate in any activities that require full alertness until you are certain the drug will not interfere.
Possible food and drug interactions when taking Thioridazine hydrochloride
Remember that combining Mellaril with certain drugs can increase the danger of potentially fatal heartbeat irregularities. Among the drugs to avoid are the following:
Amiodarone
Cimetidine
Delavirdine
Fluoxetine
FluvoxamineParoxetine
Pindolol
Propafenone
Propranolol
Quinidine
Ritonavir
Check with your doctor before adding any new drug to your regimen. Remember, too, that extreme drowsiness and other potentially serious effects can result if Mellaril is combined with alcohol or other central nervous system depressants such as narcotics, painkillers, and sleeping medications.
Special information if you are pregnant or breastfeeding
Pregnant women should use Mellaril only if clearly needed. If you are pregnant or plan to become pregnant, inform your doctor immediately.
There is no information on the effects of Mellaril during breastfeeding. The doctor may advise you to stop nursing until your treatment with Thioridazine hydrochloride is finished.
Recommended dosage for Thioridazine hydrochloride
Your doctor will tailor your dose to your needs, using the smallest effective amount.
ADULTS
The starting dose ranges from 50 to 100 milligrams 3 times a day. Your doctor may gradually increase your dosage to as much as 800 milligrams a day, taken in 2 to 4 small doses. Once your symptoms improve, your doctor will decrease the dosage to the lowest effective amount.
CHILDREN
The usual starting dose for schizophrenic children is 0.5 milligrams per 2.2 pounds of body weight per day, divided into smaller doses. The dose may be gradually increased to a maximum of 3 milligrams per 2.2 pounds per day.
Overdosage
Any medication taken in excess can have serious consequences. An overdose of Mellaril can be fatal. If you suspect an overdose, seek medical help immediately.
- Symptoms of Mellaril overdose may include:
Agitation, blurred vision, coma, confusion, constipation, difficulty breathing, dilated or constricted pupils, diminished flow of urine, dry mouth, dry skin, excessively high or low body temperature, extremely low blood pressure, fluid in the lungs, heart abnormalities, inability to urinate, intestinal blockage, nasal congestion, restlessness, sedation, seizures, shock
Theragran
30/06/10