Brand names: Parnate

Why is Tranylcypromine sulfate prescribed?

Parnate is prescribed for the treatment of major depression—that is, a depressed mood that lasts for at least 2 weeks and interferes with daily functioning. Major depression is marked by at least 4 of the following 8 symptoms: changes in appetite, changes in sleep patterns, agitation or listlessness, loss of interest in usual activities or a decrease in sex drive, fatigue, feelings of guilt or worthlessness, slowed thinking or difficulty concentrating, and thoughts of suicide.

Parnate is a member of the class of drugs known as monoamine oxidase (MAO) inhibitors. It works by increasing concentrations of the brain chemicals epinephrine, norepinephrine, and serotonin.

Most important fact about Tranylcypromine sulfate

Parnate is a potent drug with the capability of producing serious side effects. It is typically prescribed only if other antidepressants fail, and then only for adults who are under close medical supervision. It is considered especially risky because it can interact with a long list of drugs and foods to produce life-threatening side effects (see “Possible food and drug interactions when taking Tranylcypromine sulfate”).

How should you take Tranylcypromine sulfate?

Your doctor will adjust the dosage of Parnate according to your individual needs and response. The drug usually produces improvement within 48 hours to 3 weeks after starting therapy.

• If you miss a dose…
  Take it as soon as you remember. If it is within 2 hours of your next dose, skip the one you missed and go back to your regular schedule. Never 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 Parnate.

• Side effects may include:
  Blood disorders, diarrhea, dizziness, drowsiness, dry mouth, insomnia, muscle spasm, nausea, overstimulation, rapid or irregular heartbeat, restlessness, ringing in the ears, water retention, weakness, weight loss

Why should Tranylcypromine sulfate not be prescribed?

Do not take Parnate if you are in danger of a stroke, if you have heart or liver disease, high blood pressure, or a history of headaches, if you have a type of tumor known as pheochromocytoma, or if you will be undergoing elective surgery requiring general anesthesia.

Special warnings about Tranylcypromine sulfate

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Parnate or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Parnate is not approved for use in children.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Parnate and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly—especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior—and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

The most dangerous reaction to Parnate is a surge in blood pressure, which has sometimes been fatal. For this reason, report promptly to your doctor any of the following symptoms: constriction or pain in the throat or chest, dizziness, fever, headache, irregular heartbeat, light sensitivity, nausea, neck stiffness or soreness, palpitations, pupil dilation, sweating, or vomiting.

A number of people who take Parnate experience low blood pressure, faintness, or drowsiness, so exercise great care when performing potentially hazardous tasks, such as driving a car or operating machinery.

Some people become physically dependent on Parnate and experience withdrawal symptoms when the drug is stopped, including restlessness, anxiety, depression, confusion, hallucinations, headache, weakness, and diarrhea.

If you have kidney problems, make sure the doctor is aware of this. The doctor may need to reduce your dosage of Parnate to avoid a buildup of the drug. Parnate should also be used with caution if you have an overactive thyroid gland.

MAO inhibitors can suppress heart pain that would otherwise serve as a warning sign of a heart attack. For this reason and others, it should be used with caution by older adults. Also, it should be used with caution by diabetics and people with epilepsy or other convulsive disorders because it can alter the level of drugs used to treat these conditions. Tell every doctor or dentist who you see that you are taking Parnate.

Possible food and drug interactions when taking Tranylcypromine sulfate

Never take Parnate with the following drugs; the combination can trigger seizures or a dangerous spike in blood pressure:

Other MAO inhibitors such as phenelzine
Antidepressant drugs classified as tricyclics, such as amitriptyline, clomipramine, and imipramine
Carbamazepine
Cyclobenzaprine

When switching from one of these drugs to Parnate, or vice versa, allow an interval of at least 1 week between medications.

Also avoid combining Parnate with any of the following:

Antidepressant drugs classified as selective serotonin reuptake inhibitors, such as fluoxetine, paroxetine, and sertraline
Amphetamines such as dextroamphetamine
Anesthetics
Antihistamines such as desloratadine, diphenhydramine, and fexofenadine
Blood pressure medications such as benazepril, lisinopril, and quinapril
Bupropion
Buspirone
Cold and hay fever remedies that constrict blood vessels
Cough remedies containing dextromethorphan
Demerol and other narcotic painkillers such as hydrocodone and oxycodone
Disulfiram
Guanethidine
Methyldopa
Over-the-counter weight reduction aids
Parkinson’s disease medications such as bromocriptine, ropinirole, and levodopa
Reserpine
Sedatives such as pentobarbital, secobarbital, and triazolam
Tryptophan
Water pills such as hydrochlorothiazide

While taking Parnate, you should also avoid foods that contain a high amount of a substance called tyramine, including:

Anchovies
Avocados
Bananas
Beer (including nonalcoholic beer)
Caviar
Cheese (especially strong and aged varieties)
Chianti wine
Chocolate
Dried fruits (including raisins, prunes, and figs)
Liqueurs
Liver
Meat extracts or meat prepared with tenderizers
Overripe fruit
Pickled herring
Pods of broad beans like fava beans
Raspberries
Sauerkraut
Sherry
Sour cream
Soy sauce
Yeast extracts
Yogurt

Likewise, avoid alcohol and large amounts of caffeine.

Special information if you are pregnant or breastfeeding

If you are pregnant or plan to become pregnant, inform your doctor immediately. Parnate should be used during pregnancy only if its benefits outweigh potential risks.

Parnate makes its way into breast milk. If the drug is essential to your health, your doctor may advise you to stop nursing until your treatment is finished.

Recommended dosage for Tranylcypromine sulfate

ADULTS

The usual dosage is 30 milligrams per day, divided into smaller doses. If ineffective, the dosage may be slowly increased under your doctor’s supervision to a maximum of 60 milligrams per day.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose of Parnate, seek medical help immediately.

• Symptoms of Parnate overdose may include:
  Agitation, confusion, coma, dizziness, drowsiness, high fever, incoherence, rigid muscles, severe headache, twitching, weakness

Generic name: Clorazepate dipotassium
Brand names: Tranxene-SD Half Strength, Tranxene-SD, Tranxene

Why is Tranxene-SD Half Strength prescribed?

Tranxene belongs to a class of drugs known as benzodiazepines. It is used in the treatment of anxiety disorders and for short-term relief of the symptoms of anxiety.

It is also used to relieve the symptoms of acute alcohol withdrawal and to help in treating certain convulsive disorders such as epilepsy.

Most important fact about Tranxene-SD Half Strength

Tranxene can be habit-forming if taken regularly over a long period. You may experience withdrawal symptoms if you stop using Tranxene-SD Half Strength abruptly. Consult your doctor before discontinuing Tranxene or making any change in your dose.

How should you take Tranxene-SD Half Strength?

Tranxene should be taken exactly as prescribed by your doctor.

• If you miss a dose…
  Take it as soon as you remember if it is within an hour or so of your scheduled time. If you do not remember until later, skip the dose you missed and go back to your regular schedule. Do not take 2 doses at once.

• Storage instructions…
  Store at room temperature. Protect from excessive 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 Tranxene.

• Side effects may include:
  Blurred vision, depression, difficulty in sleeping or falling asleep, dizziness, drowsiness, dry mouth, double vision, fatigue, genital and urinary tract disorders, headache, irritability, lack of muscle coordination, mental confusion, nervousness, tremors, skin rashes, slurred speech, stomach and intestinal disorders, tremor

• Side effects due to a rapid decrease in dose or abrupt withdrawal from Tranxene may include:
  Abdominal cramps, convulsions, diarrhea, difficulty in sleeping or falling asleep, hallucinations, impaired memory, irritability, muscle aches, nervousness, tremors, vomiting

Why should Tranxene-SD Half Strength not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Tranxene, you should not take Tranxene-SD Half Strength. Make sure your doctor is aware of any drug reactions you have experienced.

Do not take Tranxene-SD Half Strength if you have the eye condition known as acute narrow-angle glaucoma.

Anxiety or tension related to everyday stress usually does not require treatment with such a strong drug. Discuss your symptoms thoroughly with your doctor.

Tranxene is not recommended for use in more serious conditions such as depression or severe psychological disorders.

Special warnings about Tranxene-SD Half Strength

Tranxene may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how Tranxene-SD Half Strength affects you.

If you are being treated for anxiety associated with depression, your doctor will prescribe the lowest dose possible to avoid the risk of overdose. Do not increase your dose without consulting the doctor.

The elderly and people in a weakened condition are more apt to become unsteady or oversedated when taking Tranxene.

If you have to take Tranxene for a long period of time, the doctor will need to monitor your blood counts and liver function.

Possible food and drug interactions when taking Tranxene-SD Half Strength

Tranxene slows down the central nervous system and may intensify the effects of alcohol. Do not drink alcohol while taking Tranxene-SD Half Strength.

If Tranxene 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 Tranxene with the following:

Antidepressant drugs known as MAO inhibitors (Nardil, Parnate) and other antidepressants such as Elavil and Prozac
Antipsychotic drugs such as Mellaril and chlorpromazine
Barbiturates such as Nembutal and Seconal
Narcotic pain relievers such as Demerol and Percodan
Any other drugs that slow down the central nervous system

Special information if you are pregnant or breastfeeding

The effects of Tranxene during pregnancy have not been adequately studied. However, because there is an increased risk of birth defects associated with this class of drug, its use during pregnancy should be avoided. Tranxene may appear in breast milk and could affect a nursing infant. If Tranxene-SD Half Strength is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with Tranxene-SD Half Strength is finished.

Recommended dosage for Tranxene-SD Half Strength

ANXIETY

Adults

The usual daily dosage is 30 milligrams divided into several smaller doses. A normal daily dose can be as little as 15 milligrams. Your doctor may increase the dosage gradually to as much as 60 milligrams, according to your individual needs.

Tranxene can also be taken in a single bedtime dose. The initial dose is 15 milligrams, but your doctor will adjust the dosage to suit your individual needs.

Tranxene-SD, a 22.5-milligram tablet, and Tranxene-SD Half Strength, an 11.25-milligram tablet, can be taken once every 24 hours. Your doctor may switch you to this form of the drug after you have been taking Tranxene for several weeks.

Older Adults

The usual starting dose is 7.5 to 15 milligrams per day.

ACUTE ALCOHOL WITHDRAWAL

Tranxene can be used in a multi-day program for relief of the symptoms of acute alcohol withdrawal.

Dosages are usually increased in the first 2 days from 30 to 90 milligrams and then reduced over the next 2 days to lower levels. After that, your doctor will gradually lower the dose still further, and will take you off the drug when you are ready.

WHEN USED WITH ANTIEPILEPTIC DRUGS

Tranxene can be used in conjunction with antiepileptic drugs. Follow the recommended dosages carefully to avoid drowsiness.

Adults and Children over 12 Years Old

The starting dose is 7.5 milligrams 3 times a day. Your doctor may increase the dosage by 7.5 milligrams per week to a maximum of 90 milligrams a day.

Children 9 to 12 Years Old

The starting dose is 7.5 milligrams twice a day. Your doctor may increase the dosage by 7.5 milligrams a week to a maximum of 60 milligrams a day.

Safety and effectiveness in children under 9 years of age have not been established.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical treatment immediately.

• Symptoms of Tranxene overdose may include:
  Coma, low blood pressure, sedation

Generic name: Clorazepate dipotassium
Brand names: Tranxene-SD Half Strength, Tranxene-SD, Tranxene

Why is Tranxene-SD prescribed?

Tranxene belongs to a class of drugs known as benzodiazepines. It is used in the treatment of anxiety disorders and for short-term relief of the symptoms of anxiety.

It is also used to relieve the symptoms of acute alcohol withdrawal and to help in treating certain convulsive disorders such as epilepsy.

Most important fact about Tranxene-SD

Tranxene can be habit-forming if taken regularly over a long period. You may experience withdrawal symptoms if you stop using Tranxene-SD abruptly. Consult your doctor before discontinuing Tranxene or making any change in your dose.

How should you take Tranxene-SD?

Tranxene should be taken exactly as prescribed by your doctor.

• If you miss a dose…
  Take it as soon as you remember if it is within an hour or so of your scheduled time. If you do not remember until later, skip the dose you missed and go back to your regular schedule. Do not take 2 doses at once.

• Storage instructions…
  Store at room temperature. Protect from excessive 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 Tranxene.

• Side effects may include:
  Blurred vision, depression, difficulty in sleeping or falling asleep, dizziness, drowsiness, dry mouth, double vision, fatigue, genital and urinary tract disorders, headache, irritability, lack of muscle coordination, mental confusion, nervousness, tremors, skin rashes, slurred speech, stomach and intestinal disorders, tremor

• Side effects due to a rapid decrease in dose or abrupt withdrawal from Tranxene may include:
  Abdominal cramps, convulsions, diarrhea, difficulty in sleeping or falling asleep, hallucinations, impaired memory, irritability, muscle aches, nervousness, tremors, vomiting

Why should Tranxene-SD not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Tranxene, you should not take Tranxene-SD. Make sure your doctor is aware of any drug reactions you have experienced.

Do not take Tranxene-SD if you have the eye condition known as acute narrow-angle glaucoma.

Anxiety or tension related to everyday stress usually does not require treatment with such a strong drug. Discuss your symptoms thoroughly with your doctor.

Tranxene is not recommended for use in more serious conditions such as depression or severe psychological disorders.

Special warnings about Tranxene-SD

Tranxene may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how Tranxene-SD affects you.

If you are being treated for anxiety associated with depression, your doctor will prescribe the lowest dose possible to avoid the risk of overdose. Do not increase your dose without consulting the doctor.

The elderly and people in a weakened condition are more apt to become unsteady or oversedated when taking Tranxene.

If you have to take Tranxene for a long period of time, the doctor will need to monitor your blood counts and liver function.

Possible food and drug interactions when taking Tranxene-SD

Tranxene slows down the central nervous system and may intensify the effects of alcohol. Do not drink alcohol while taking Tranxene-SD.

If Tranxene 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 Tranxene with the following:

Antidepressant drugs known as MAO inhibitors (Nardil, Parnate) and other antidepressants such as Elavil and Prozac
Antipsychotic drugs such as Mellaril and chlorpromazine
Barbiturates such as Nembutal and Seconal
Narcotic pain relievers such as Demerol and Percodan
Any other drugs that slow down the central nervous system

Special information if you are pregnant or breastfeeding

The effects of Tranxene during pregnancy have not been adequately studied. However, because there is an increased risk of birth defects associated with this class of drug, its use during pregnancy should be avoided. Tranxene may appear in breast milk and could affect a nursing infant. If Tranxene-SD is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with Tranxene-SD is finished.

Recommended dosage for Tranxene-SD

ANXIETY

Adults

The usual daily dosage is 30 milligrams divided into several smaller doses. A normal daily dose can be as little as 15 milligrams. Your doctor may increase the dosage gradually to as much as 60 milligrams, according to your individual needs.

Tranxene can also be taken in a single bedtime dose. The initial dose is 15 milligrams, but your doctor will adjust the dosage to suit your individual needs.

Tranxene-SD, a 22.5-milligram tablet, and Tranxene-SD Half Strength, an 11.25-milligram tablet, can be taken once every 24 hours. Your doctor may switch you to this form of the drug after you have been taking Tranxene for several weeks.

Older Adults

The usual starting dose is 7.5 to 15 milligrams per day.

ACUTE ALCOHOL WITHDRAWAL

Tranxene can be used in a multi-day program for relief of the symptoms of acute alcohol withdrawal.

Dosages are usually increased in the first 2 days from 30 to 90 milligrams and then reduced over the next 2 days to lower levels. After that, your doctor will gradually lower the dose still further, and will take you off the drug when you are ready.

WHEN USED WITH ANTIEPILEPTIC DRUGS

Tranxene can be used in conjunction with antiepileptic drugs. Follow the recommended dosages carefully to avoid drowsiness.

Adults and Children over 12 Years Old

The starting dose is 7.5 milligrams 3 times a day. Your doctor may increase the dosage by 7.5 milligrams per week to a maximum of 90 milligrams a day.

Children 9 to 12 Years Old

The starting dose is 7.5 milligrams twice a day. Your doctor may increase the dosage by 7.5 milligrams a week to a maximum of 60 milligrams a day.

Safety and effectiveness in children under 9 years of age have not been established.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical treatment immediately.

• Symptoms of Tranxene overdose may include:
  Coma, low blood pressure, sedation

Generic name: Clorazepate dipotassium
Brand names: Tranxene-SD Half Strength, Tranxene-SD, Tranxene

Why is Tranxene prescribed?

Tranxene belongs to a class of drugs known as benzodiazepines. It is used in the treatment of anxiety disorders and for short-term relief of the symptoms of anxiety.

It is also used to relieve the symptoms of acute alcohol withdrawal and to help in treating certain convulsive disorders such as epilepsy.

Most important fact about Tranxene

Tranxene can be habit-forming if taken regularly over a long period. You may experience withdrawal symptoms if you stop using Tranxene abruptly. Consult your doctor before discontinuing Tranxene or making any change in your dose.

How should you take Tranxene?

Tranxene should be taken exactly as prescribed by your doctor.

• If you miss a dose…
  Take it as soon as you remember if it is within an hour or so of your scheduled time. If you do not remember until later, skip the dose you missed and go back to your regular schedule. Do not take 2 doses at once.

• Storage instructions…
  Store at room temperature. Protect from excessive 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 Tranxene.

• Side effects may include:
  Blurred vision, depression, difficulty in sleeping or falling asleep, dizziness, drowsiness, dry mouth, double vision, fatigue, genital and urinary tract disorders, headache, irritability, lack of muscle coordination, mental confusion, nervousness, tremors, skin rashes, slurred speech, stomach and intestinal disorders, tremor

• Side effects due to a rapid decrease in dose or abrupt withdrawal from Tranxene may include:
  Abdominal cramps, convulsions, diarrhea, difficulty in sleeping or falling asleep, hallucinations, impaired memory, irritability, muscle aches, nervousness, tremors, vomiting

Why should Tranxene not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Tranxene, you should not take Tranxene. Make sure your doctor is aware of any drug reactions you have experienced.

Do not take Tranxene if you have the eye condition known as acute narrow-angle glaucoma.

Anxiety or tension related to everyday stress usually does not require treatment with such a strong drug. Discuss your symptoms thoroughly with your doctor.

Tranxene is not recommended for use in more serious conditions such as depression or severe psychological disorders.

Special warnings about Tranxene

Tranxene may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how Tranxene affects you.

If you are being treated for anxiety associated with depression, your doctor will prescribe the lowest dose possible to avoid the risk of overdose. Do not increase your dose without consulting the doctor.

The elderly and people in a weakened condition are more apt to become unsteady or oversedated when taking Tranxene.

If you have to take Tranxene for a long period of time, the doctor will need to monitor your blood counts and liver function.

Possible food and drug interactions when taking Tranxene

Tranxene slows down the central nervous system and may intensify the effects of alcohol. Do not drink alcohol while taking Tranxene.

If Tranxene 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 Tranxene with the following:

Antidepressant drugs known as MAO inhibitors (Nardil, Parnate) and other antidepressants such as Elavil and Prozac
Antipsychotic drugs such as Mellaril and chlorpromazine
Barbiturates such as Nembutal and Seconal
Narcotic pain relievers such as Demerol and Percodan
Any other drugs that slow down the central nervous system

Special information if you are pregnant or breastfeeding

The effects of Tranxene during pregnancy have not been adequately studied. However, because there is an increased risk of birth defects associated with this class of drug, its use during pregnancy should be avoided. Tranxene may appear in breast milk and could affect a nursing infant. If Tranxene is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with Tranxene is finished.

Recommended dosage for Tranxene

ANXIETY

Adults

The usual daily dosage is 30 milligrams divided into several smaller doses. A normal daily dose can be as little as 15 milligrams. Your doctor may increase the dosage gradually to as much as 60 milligrams, according to your individual needs.

Tranxene can also be taken in a single bedtime dose. The initial dose is 15 milligrams, but your doctor will adjust the dosage to suit your individual needs.

Tranxene-SD, a 22.5-milligram tablet, and Tranxene-SD Half Strength, an 11.25-milligram tablet, can be taken once every 24 hours. Your doctor may switch you to this form of the drug after you have been taking Tranxene for several weeks.

Older Adults

The usual starting dose is 7.5 to 15 milligrams per day.

ACUTE ALCOHOL WITHDRAWAL

Tranxene can be used in a multi-day program for relief of the symptoms of acute alcohol withdrawal.

Dosages are usually increased in the first 2 days from 30 to 90 milligrams and then reduced over the next 2 days to lower levels. After that, your doctor will gradually lower the dose still further, and will take you off the drug when you are ready.

WHEN USED WITH ANTIEPILEPTIC DRUGS

Tranxene can be used in conjunction with antiepileptic drugs. Follow the recommended dosages carefully to avoid drowsiness.

Adults and Children over 12 Years Old

The starting dose is 7.5 milligrams 3 times a day. Your doctor may increase the dosage by 7.5 milligrams per week to a maximum of 90 milligrams a day.

Children 9 to 12 Years Old

The starting dose is 7.5 milligrams twice a day. Your doctor may increase the dosage by 7.5 milligrams a week to a maximum of 60 milligrams a day.

Safety and effectiveness in children under 9 years of age have not been established.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical treatment immediately.

• Symptoms of Tranxene overdose may include:
  Coma, low blood pressure, sedation

Brand names: Nitro-Bid, Nitro-Dur, Nitrolingual Spray, Nitrostat Tablets, Transderm-Nitro, Nitroglycerin

Why is Transderm-Nitro prescribed?

Nitroglycerin is prescribed to prevent and treat angina pectoris (suffocating chest pain). This condition occurs when the coronary arteries become constricted and are not able to carry sufficient oxygen to the heart muscle. Nitroglycerin is thought to improve oxygen flow by relaxing the walls of arteries and veins, thus allowing them to dilate.

Nitroglycerin is used in different forms. As a patch or ointment, nitroglycerin may be applied to the skin. The patch and the ointment are for prevention of chest pain.

Swallowing nitroglycerin in capsule or tablet form also helps to prevent chest pain from occurring.

In the form of sublingual (held under the tongue) or buccal (held in the cheek) tablets, or in oral spray (sprayed on or under the tongue), nitroglycerin helps relieve chest pain that has already occurred. The spray can also prevent anginal pain. The type of nitroglycerin you use will depend on your condition.

Most important fact about Transderm-Nitro

Nitroglycerin may cause severe low blood pressure (possibly marked by dizziness or light-headedness), especially if you are in an upright position or have just gotten up from sitting or lying down. You may also find your heart rate slowing and your chest pain increasing. People taking diuretic medication, or who have low systolic blood pressure (less than 90 mm Hg) should use nitroglycerin with caution.

How should you take Transderm-Nitro?

Since nitroglycerin is available in many forms, it is crucial for you to follow your doctor’s directions for taking the type of nitroglycerin prescribed for you. Never interchange brands.

Ideally, you should take nitroglycerin while sitting down—especially if you feel dizzy or light-headed—so as to avoid a fall.

• If you miss a dose…
  If you are using a skin patch or ointment:
  Apply it as soon as you remember. If it is almost time for your regular dose, skip the one you missed and go back to your regular schedule. Never apply 2 skin patches at the same time. If you are taking oral tablets or capsules:
  Take the forgotten dose as soon as you remember. However, if it is within 2 hours of 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…
  Keep Transderm-Nitro in the container it came in, tightly closed. Store it at room temperature. Do not refrigerate.

Avoid puncturing the spray container and keep it away from excess heat.

Do not open the container of sublingual tablets until you need a dose. Close the container tightly immediately after each use. Do not put other medications, a cotton plug, or anything else in the container. Keep the sublingual tablets handy at all times. Keep the patches in the protective pouches they come in until use.

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 nitroglycerin.

• Side effects may include:
  Dizziness, flushed skin (neck and face), headache, light-headedness, worsened angina pain

Why should Transderm-Nitro not be prescribed?

You should not be using nitroglycerin if you are allergic to it or to the adhesive in the patch, if you have a head injury, or if you have any condition caused by increased fluid pressure in your head. Nitroglycerin should not be taken if you have severe anemia or if you recently had a heart attack. The capsule form should not be used if you have closed-angle glaucoma (pressure in the eye) or suffer from postural hypotension (dizziness upon standing up). Do not take the tablets if you are using the impotence drug sildenafil.

Special warnings about Transderm-Nitro

If your vision becomes blurry or your mouth becomes dry while taking nitroglycerin, it should be discontinued. Contact your doctor immediately if these symptoms develop.

You may develop acute headaches if you take nitroglycerin excessively. Also, some people may develop a tolerance to nitroglycerin, and it may become less beneficial over time, especially if used in excess.

Nitroglycerin tablets lose their effectiveness when exposed to air. If you are taking sublingual nitroglycerin, you may notice a burning or tingling sensation. This does not necessarily mean that tablets which have been exposed to air for a long period of time are still good.

Take no more than the smallest possible amount needed to relieve pain.

Daily headaches may be an indicator of the drug’s activity. Do not change your dose to avoid the headache, because you may reduce the drug’s effectiveness at the same time.

Before taking nitroglycerin, tell your doctor if you have had a recent heart attack, head injury, or stroke; or if you have anemia, glaucoma (pressure in the eye), or heart, kidney, liver, or thyroid disease.

If you use a patch, dispose of it carefully. There is enough drug left in a used patch to be harmful to children and pets.

Since nitroglycerin can cause dizziness, you should observe caution while driving, operating machinery, or performing other tasks that demand concentration.

The benefits of applying nitroglycerin to the skin of people experiencing heart attacks or congestive heart failure have not been established. If you are using the medication for these conditions, your doctor will monitor you to prevent low blood pressure and pounding heartbeat.

Possible food and drug interactions when taking Transderm-Nitro

If nitroglycerin is taken with certain other drugs, the effects of either could be increased, decreased, or altered.

Taken with many high blood pressure drugs, nitroglycerin may cause extreme low blood pressure (dizziness, fainting, numbness). Take particular care with calcium channel blockers such as nifedipine and verapamil, as well as isosorbide dinitrate, isosorbide mononitrate, blood vessel dilators such as minoxidil, and beta-blocker medications such as atenolol. Nitroglycerin may also cause a severe drop in blood pressure when taken with the impotence drug sildenafil.

Aspirin can increase the effects of nitroglycerin.

Alcohol may interact with nitroglycerin and cause a swift decrease in blood pressure, possibly causing dizziness and fainting.

Also be alert for an interaction with dihydroergotamine. Check with your doctor if you are uncertain about any combination you plan to take.

Special information if you are pregnant or breastfeeding

It has not been determined whether nitroglycerin might harm a fetus or a pregnant woman. As a result, nitroglycerin should be used only when the benefits of therapy clearly outweigh the potential risks to the fetus and woman. It is not known if nitroglycerin appears in breast milk; therefore, a nursing mother should use nitroglycerin only on advice of her doctor.

Recommended dosage for Transderm-Nitro

The following section is intended to provide guidelines for taking nitroglycerin. Follow your doctor’s instructions carefully for using nitroglycerin in the form prescribed for you.

ADULTS

Sublingual or Buccal Tablets

At the first sign of chest pain, 1 tablet should be dissolved under the tongue or inside the cheek. You may repeat the dose every 5 minutes until the pain is relieved. If your pain continues after you have taken 3 tablets in a 15-minute period, notify your doctor or seek medical attention immediately.

You may take sublingual or buccal nitroglycerin from 5 to 10 minutes before starting activities that may cause chest pain.

Patch Form

A patch is applied to the skin for 12 to 14 hours. After this time, the patch is removed; it is not applied again for 10 to 12 hours (a “patch-off” period). Apply the patch as soon as you remove it from its protective pouch.

Spray Form

At the first sign of chest pain, spray 1 or 2 pre-measured doses onto or under the tongue. You should not use more than 3 doses within a 15-minute period. If your chest pain continues, you should contact your doctor or seek medical attention immediately.

The spray can be used 5 to 10 minutes before activity that might precipitate an attack.

Ointment Form

Your initial dose may be a daily total of 1 inch of ointment. Apply one-half inch on rising in the morning, and the remaining one-half inch 6 hours later. If needed, follow your doctor’s instructions for increasing your dosage. Apply in a thin, uniform layer, regardless of the amount of your dosage. There should be a daily period where no ointment is applied. Usually, the “ointment-off” period will last from 10 to 12 hours.

Absorption varies with site of application—more is absorbed through the chest.

Sustained-Release Capsules or Tablets

The smallest effective amount should be taken 2 or 3 times a day at 8- to 12-hour intervals.

CHILDREN

The safety and effectiveness of nitroglycerin have not been established for children.

OLDER ADULTS

In general, dosages less than the above adult dosages are recommended, since the elderly may be more susceptible to low blood pressure and headaches.

Overdosage

Any medication taken in excess can have serious consequences. Severe overdosage of nitroglycerin may result in death. If you suspect an overdose, seek medical attention immediately.

• Symptoms of overdose may include:
  Bluish skin, clammy skin, colic, coma, confusion, diarrhea (may be bloody), difficult and/or slow breathing, dizziness, fainting, fever, flushed skin, headache (persistent, throbbing), increased pressure within the skull, irregular pulse, loss of appetite, nausea, palpitations (an abnormally rapid throbbing or fluttering of the heart), paralysis, rapid decrease in blood pressure, seizures, slow or fast pulse/heartbeat, sweating, vertigo, visual disturbances, vomiting

Brand names: Tarka

Why is Trandolapril, Verapamil hydrochloride prescribed?

Tarka is used to treat high blood pressure. It combines two blood pressure drugs: an ACE inhibitor and a calcium channel blocker. The ACE inhibitor (trandolapril) lowers blood pressure by preventing a chemical in your blood called angiotensin I from converting to a more potent form that narrows the blood vessels and increases salt and water retention. The calcium channel blocker (verapamil hydrochloride) also works to keep the blood vessels open, and eases the heart’s workload by reducing the force and rate of your heartbeat.

Most important fact about Trandolapril, Verapamil hydrochloride

Doctors usually prescribe Tarka for patients who have been taking one of its components-trandolapril (Mavik) or sustained-release verapamil (Calan SR, Isoptin SR)-without showing improvement. Like other blood pressure medications, Tarka must be taken regularly for it to be effective. Since blood pressure declines gradually, it may take a few weeks before you get the full benefit of Tarka; and you must continue taking it even if you are feeling well. Tarka does not cure high blood pressure; it merely keeps it under control.

How should you take Trandolapril, Verapamil hydrochloride?

Take each dose with food, exactly as prescribed.

• 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…
  Keep the container tightly closed. 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 Tarka.

• Side effects may include:
  Constipation, cough, dizziness, headache, heartbeat irregularities, upper respiratory tract infection

Why should Trandolapril, Verapamil hydrochloride not be prescribed?

Avoid Tarka if you have ever had an allergic reaction to it, or to verapamil or any of the ACE inhibitors, including Capoten, Vasotec, and Zestril.

You should also avoid Tarka if you have low blood pressure or certain types of heart disease or irregular heartbeat. Make sure your doctor is aware of any cardiac problems you may have.

In addition, Tarka is not for you if you have ever developed a swollen throat and difficulty swallowing (angioedema) while taking an ACE inhibitor. Make sure your doctor is aware of the incident.

Special warnings about Trandolapril, Verapamil hydrochloride

Call your doctor immediately if you begin to suffer angioedema while taking Tarka. Warning signs include swelling of the face, lips, tongue, or throat; swelling of the arms and legs; and difficulty swallowing or breathing.

Bee or wasp venom given to prevent an allergic reaction to stings may cause a severe allergic reaction to Tarka. Kidney dialysis can also prompt an allergic reaction to the drug.

Tarka sometimes causes a severe drop in blood pressure. The danger is especially great if you have been taking water pills (diuretics), or if you have heart disease, kidney disease, or a potassium or salt imbalance. Excessive sweating, severe diarrhea, and vomiting are also a threat. They can rob the body of water, causing a dangerous drop in blood pressure. If you feel light-headed or faint, you should lie down and contact your doctor immediately.

Because another of the ACE inhibitors, Capoten, has been known to cause serious blood disorders, your doctor will check your blood regularly while you are taking Tarka. If you develop signs of infection such as a sore throat or a fever, you should contact your doctor at once-an infection could be a signal of blood abnormalities.

Tarka may also affect the liver, so your doctor will perform liver function tests periodically. Report these symptoms of liver problems to your doctor immediately: a generally run-down feeling, fever, pain in the upper right abdomen, or yellowing of the skin or the whites of your eyes.

If you have a heart condition, heart failure, cardiac irregularities, kidney disease, liver disease, diabetes, or Duchenne’s dystrophy (the most common type of muscular dystrophy), make certain that your doctor knows about it. Tarka should be used with caution under these circumstances.

Possible food and drug interactions when taking Trandolapril, Verapamil hydrochloride

If Tarka 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 Tarka with the following:

Drugs classified as “beta blockers,” such as Inderal, Lopressor, and Tenormin
Carbamazepine (Tegretol)
Cimetidine (Tagamet)
Cyclosporine (Sandimmune, Neoral)
Digoxin (Lanoxin)
Disopyramide (Norpace)
Diuretics such as Lasix and HydroDIURIL
Flecainide (Tambocor)
Lithium (Lithonate, Lithobid)
Phenobarbital
Potassium-sparing diuretics such as Aldactone, Midamor, Dyrenium
Potassium supplements such as K-Lyte, K-Tabs, and Slow-K
Quinidine (Quinidex)
Rifampin (Rifadin)
Theophylline (Theo-Dur)

Because Tarka can increase the potassium level in your blood, you should avoid salt substitutes that contain potassium unless your doctor approves.

Special information if you are pregnant or breastfeeding

Because of its ACE-inhibitor component (trandolapril), Tarka should not be used during pregnancy. When taken during the last 6 months of pregnancy, ACE inhibitors can cause birth defects, premature birth, and death of the developing or newborn baby. If you become pregnant, inform your doctor immediately.

The verapamil component of Tarka does appear in breast milk and could affect a nursing infant. Do not breastfeed while taking Tarka.

Recommended dosage for Trandolapril, Verapamil hydrochloride

ADULTS

Tarka comes in four strengths of trandolapril and sustained-release verapamil. Your doctor will prescribe a dose of Tarka that is comparable to the doses you were taking separately. Doses range from 1 to 4 milligrams of trandolapril and 180 to 240 milligrams of verapamil. Tarka is taken once a day with food.

If you have impaired liver or kidney function, your doctor will adjust your dosage accordingly.

CHILDREN

The safety and effectiveness of Tarka in children under 18 have not been established.

OLDER ADULTS

If you are over 65 years old, you may be more sensitive to Tarka. Your doctor will monitor your blood pressure more closely and adjust your medication dose accordingly.

Overdosage

An overdose of Tarka can cause dangerously low blood pressure and life-threatening heart problems. If you suspect an overdose, seek medical treatment immediately.

Brand names: Ultram

Why is Tramadol hydrochloride prescribed?

Ultram is prescribed to relieve moderate to moderately severe pain.

Most important fact about Tramadol hydrochloride

You should not drive a car, operate machinery, or perform any other potentially hazardous activities until you know how Tramadol hydrochloride affects you.

How should you take Tramadol hydrochloride?

It’s important to take Ultram exactly as prescribed. Do not increase the dosage or length of time you take Tramadol hydrochloride without your doctor’s approval.

• If you miss a dose…
  Take it as soon as you remember. However, 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 once.

• Storage instructions…
  Store in a tightly closed container 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 for you to continue taking Ultram.

• Side effects may include:
  Agitation, anxiety, bloating and gas, constipation, convulsive movements, diarrhea, dizziness, drowsiness, dry mouth, feeling of elation, hallucinations, headache, indigestion, itching, nausea, nervousness, sweating, tremor, vomiting, weakness

Why should Tramadol hydrochloride not be prescribed?

Avoid Ultram if it has ever given you an allergic reaction. Also avoid Ultram after taking large doses of sleeping pills such as Halcion, Dalmane, and Restoril; narcotic pain relievers such as Demerol, morphine, Darvon, and Percocet; or psychotherapeutic drugs such as antidepressants and tranquilizers. And do not take Ultram after drinking excessive amounts of alcohol.

Special warnings about Tramadol hydrochloride

If you have stomach problems such as an ulcer, make sure your doctor is aware of them. Ultram may hide the symptoms, making them difficult to diagnose and treat.

Ultram can cause mental and physical addiction. If you’ve ever had a problem with narcotic painkillers such as Percocet, Demerol, or morphine, you should avoid Tramadol hydrochloride. Withdrawal symptoms may occur if you stop taking Ultram abruptly. Such symptoms include anxiety, sweating, insomnia, pain, nausea, tremor, diarrhea, and respiratory problems. A gradual decrease in dosage will help prevent these symptoms.

Do not take more than the recommended dose of Ultram, since larger doses have been known to cause seizures, especially if you have epilepsy or are taking medications that also increase the risk of seizures. Among such medications are almost all antidepressant drugs, plus narcotics and major tranquilizers such as Loxitane and Stelazine.

If you have liver or kidney disease, be sure your doctor knows about it. Your dosage may have to be reduced.

Before you have any kind of surgery, make sure the doctor knows you are taking Ultram.

If you have any kind of breathing problem, use Ultram with caution or take a different kind of painkiller. Ultram can impair respiration, especially if taken with alcohol.

If you have experienced a head injury, consult your doctor before taking Ultram. The medication’s effects may be stronger and could hide warning signs of serious trouble.

Possible food and drug interactions when taking Tramadol hydrochloride

Ultram may increase the drowsiness caused by alcohol. Do not drink alcohol while taking Tramadol hydrochloride.

Avoid Ultram, too, if you are taking the seizure medication Tegretol.

If Ultram 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 Ultram with the following:

Cyclobenzaprine (Flexeril)
Drugs known as MAO inhibitors, including the antidepressants Nardil and Parnate
Serotonin-boosting antidepressants such as Paxil, Prozac, and Zoloft
“Tricyclic” antidepressants such as Elavil, Norpramin, and Tofranil
Major tranquilizers such as Thorazine and Stelazine
Narcotic pain relievers (Demerol, morphine, Darvon, Percocet)
Promethazine (Mepergan, Phenergan)
Quinidine (Quinidex)
Sleeping pills (Halcion, Dalmane, Restoril)
Tranquilizers (Valium, Xanax)

Special information if you are pregnant or breastfeeding

There have been reports of serious harm to developing babies when Ultram was used during pregnancy. If you are pregnant or plan to become pregnant, tell your doctor immediately.

Ultram appears in breast milk and may affect a nursing infant. If Tramadol hydrochloride is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.

Recommended dosage for Tramadol hydrochloride

ADULTS

The usual starting dose for chronic pain is 25 milligrams once a day in the morning. The daily dosage is then increased every 3 days until it reaches 200 milligrams taken in four doses of 50 milligrams each. After the phase-in period, Ultram may be taken in doses of 50 to 100 milligrams every 4 to 6 hours, depending on the severity of pain. If rapid pain relief is needed, the phase-in steps can be skipped, though side effects will be more likely. The maximum dosage under any circumstances is 400 milligrams a day (300 milligrams for those over age 75).

For people with kidney problems, the usual starting dose is 50 to 100 milligrams every 12 hours; and the maximum per day is 200 milligrams. For those with cirrhosis, the usual dose is 50 milligrams every 12 hours.

CHILDREN

Safety and effectiveness in children under 16 years of age have not been established.

Overdosage

An overdose of Ultram can be fatal. If you suspect an overdose, seek emergency medical treatment immediately.

• Symptoms of Ultram overdose include:
  Difficult or slowed breathing, drowsiness, coma, seizures, cardiac arrest

Brand names: Ultracet

Why is Tramadol hydrochloride, Acetaminophen prescribed?

Ultracet is used to treat moderate to severe pain for a period of five days or less. It contains two pain-relieving agents. Tramadol, known technically as an opioid analgesic, is a narcotic pain reliever. Acetaminophen is the active ingredient in the over-the-counter pain remedy Tylenol.

Most important fact about Tramadol hydrochloride, Acetaminophen

Take only the amount and number of doses prescribed. Exceeding the recommended dosage can lead to reduced breathing, liver damage, seizures, and death.

How should you take Tramadol hydrochloride, Acetaminophen?

Follow dosage recommendations strictly, and stop taking the drug as soon as possible.

• If you miss a dose…
  Take Tramadol hydrochloride, Acetaminophen only as needed. Never take two doses at once.

• Storage instructions…
  Store Ultracet in a tight container at room temperature.

What side effects may occur?

• Side effects may include:
  Constipation, increased sweating, sleepiness

Why should Tramadol hydrochloride, Acetaminophen not be prescribed?

Avoid Ultracet if you have had an allergic reaction to either of its active ingredients, or to any other narcotic pain reliever. Do not take Tramadol hydrochloride, Acetaminophen if you have been drinking, or have taken any other narcotic drug, sleep aid, tranquilizer, or antidepressant; your consciousness or breathing could be compromised. Avoid Tramadol hydrochloride, Acetaminophen if you’ve ever been dependent on other narcotic pain relievers.

Special warnings about Tramadol hydrochloride, Acetaminophen

Ultracet has caused serious and even fatal allergic reactions in some people, typically after the first dose. Seek medical help immediately if you begin to have trouble breathing or break out in hives or blisters.

Ultracet may cause seizures, particularly in those with epilepsy, a history of seizures, or in those at special risk for seizures, such as people with head trauma, metabolic disorders, or central nervous system infections, and those going through alcohol or drug withdrawal.

Inform your doctor if you have had a head injury, as Ultracet can increase pressure around the brain. Also let the doctor know if you have liver disease, since Ultracet can affect the liver.

Do not take Tramadol hydrochloride, Acetaminophen if you will be driving a car or operating dangerous machinery. Ultracet may impair the mental and physical abilities needed for driving

Ultracet poses a danger of mental and physical addiction. Never exceed the prescribed dosage. If you experience withdrawal symptoms—which can occur if you stop taking the drug abruptly—consult your doctor for a tapering regimen. Withdrawal symptoms include anxiety, chills, diarrhea, hallucinations, insomnia, nausea, pain, erection of hair, sweating, tremors, and upper respiratory symptoms.

The safety and effectiveness of Ultracet have not been established in children under the age of 16 years.

Possible food and drug interactions when taking Tramadol hydrochloride, Acetaminophen

If Ultracet is taken with certain other drugs, the effects of either may be increased, decreased, or altered. It is especially important to check with your doctor before combining Ultracet with the following:

Acetaminophen-containing products such as Tylenol
Antidepressant drugs classified as MAO inhibitors, including Nardil and Parnate
Antipsychotic drugs such as Thorazine and Haldol
Carbamazepine (Tegretol)
Cyclobenzaprine (Flexeril)
Digoxin (Lanoxin)
Other narcotic pain relievers such as Percodan and Vicodin
Promethazine (Phenergan)
Serotonin-boosting antidepressants such as Paxil and Prozac
Sleep aids such as Halcion and Restoril
Tranquilizers such as Valium and Xanax
Tricyclic antidepressants such as Elavil and Tofranil
Warfarin (Coumadin)

Special information if you are pregnant or breastfeeding

Taken during pregnancy, Ultracet can be fatal to the developing baby, or lead to seizures and withdrawal symptoms in the newborn. If you are pregnant, inform your doctor immediately.

Ultracet appears in breast milk and is not recommended for nursing mothers.

Recommended dosage for Tramadol hydrochloride, Acetaminophen

ADULTS

The usual dose of Ultracet is two tablets every 4 to 6 hours as needed for pain relief up to a maximum of 8 tablets per day for no more than 5 days.

If you have kidney problems, the doctor may reduce the dose to 2 tablets every 12 hours. Older adults may also receive a low dose.

Overdosage

An Ultracet overdose can be fatal. If you suspect an overdose, seek emergency treatment immediately.

• Symptoms of Ultracet overdose may include:
  Cardiac arrest, coma, depressed breathing, a generally ill feeling, lethargy, loss of appetite, nausea, pallor, profuse perspiration, seizures, and vomiting

Generic name: Ketorolac tromethamine
Brand names: Toradol

Why is Toradol prescribed?

Toradol, a nonsteroidal anti-inflammatory drug, is used to relieve moderately severe, acute pain. It is prescribed for a limited amount of time (no more than 5 days for adults and as a single dose for children), not for long-term therapy.

Most important fact about Toradol

Toradol can cause serious side effects, including ulcers and internal bleeding. Never take it for more than 5 days.

How should you take Toradol?

Toradol works fastest when taken on an empty stomach, but an antacid can be taken if it causes upset. Take Toradol exactly as prescribed.

Take Toradol with a full glass of water. Also, do not lie down for about 20 minutes after taking it. This will help to prevent irritation of your upper digestive tract.

• If you miss a dose…
  If you take Toradol on a regular schedule, 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, 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 using Toradol.

• Side effects may include:
  Diarrhea, dizziness, drowsiness, headache, indigestion, nausea, stomach and intestinal pain, swelling due to fluid retention

Why should Toradol not be prescribed?

Do not take Toradol if it has ever given you an allergic reaction. Also avoid Toradol if you have ever had an allergic reaction—such as nasal polyps (tumors), swelling of the face, limbs, and throat, hives, wheezing, light-headedness—to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin.

Do not take Toradol if you have ever had a peptic ulcer or stomach or intestinal bleeding. Avoid it if you have severe kidney disease or bleeding problems.

Never combine Toradol with aspirin, NSAIDs, or probenecid. Make sure your doctor is aware of any drug reactions you have experienced.

Special warnings about Toradol

Remember that Toradol has been known to cause peptic ulcers and bleeding. Contact your doctor immediately if you suspect a problem.

This drug should be used with caution if you have kidney or liver disease. It may cause liver inflammation or kidney problems in some people.

Toradol is not recommended for long-term use, since side effects increase over time. This medication should be taken for no more than 5 days.

If you are an older adult, use Toradol cautiously.

Toradol can increase water retention. If you have heart disease or high blood pressure, use Toradol with care.

This medication can prolong bleeding time. If you are taking blood-thinning medication, take Toradol with caution.

Possible food and drug interactions when taking Toradol

If Toradol 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 Toradol with the following:

ACE inhibitor drugs such as the blood pressure medications Vasotec and Capoten
Antidepressants such as Prozac
Antiepileptic drugs (Dilantin, Tegretol)
Aspirin and other nonsteroidal anti-inflammatory drugs such as Motrin
Blood thinners such as Coumadin
Lithium (Eskalith, Lithobid)
Major tranquilizers such as Navane
Methotrexate (Rheumatrex)
Probenecid
Tranquilizers such as Xanax
Water pills such as Lasix and Dyazide

Special information if you are pregnant or breastfeeding

Toradol should not be taken late in pregnancy; during this period, it can harm the developing baby. If you are pregnant or plan to become pregnant, inform your doctor immediately. Toradol appears in breast milk and could affect a nursing infant. This medication should not be used while you are breastfeeding.

Recommended dosage for Toradol

ADULTS

Your doctor will give you Toradol intravenously or intramuscularly to start, then have you switch to the tablets. Most patients take 2 tablets for the first dose (20 milligrams) and then 1 tablet (10 milligrams) every 4 to 6 hours. You should not take more than 40 milligrams per day and should not take Toradol for more than 5 days in all.

CHILDREN

For children under 16, the doctor may prescribe a single dose of Toradol, by intravenous or intramuscular injection, after an operation. Toradol is not recommended for children under 2.

OLDER ADULTS

Doses are usually lower for people over 65, those with kidney problems, and those who weigh less than 110 pounds. Your doctor will tailor the best dosage for you.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Toradol overdose may include:
  Drowsiness, stomach pain, nausea, vomiting

In rare cases, the victim may develop stomach bleeding, high blood pressure, kidney failure, impaired breathing, or coma. Severe allergic reactions are also possible.

Brand names: Topamax

Why is Topiramate 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 Topiramate

Do not abruptly stop taking Topamax. If the drug isn’t withdrawn gradually, the frequency of your seizures could increase.

How should you take Topiramate?

It is important to take Topiramate 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 Topiramate 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 Topiramate not be prescribed?

If Topamax gives you an allergic reaction, you’ll be unable to use the drug.

Special warnings about Topiramate

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 Topiramate 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 Topiramate

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 Topiramate

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 Topiramate”).