Generic Name: dexbrompheniramine, hydrocodone, and phenylephrine (DEX brom fen IR a meen, HYE dro KOE done, FEN il EFF rin)
Brand Names: Cytuss-HC NR, H-C Tussive-NR, Histussin HC

What is H-C Tussive-NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Brompheniramine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose.

Hydrocodone is a narcotic cough suppressant.

Phenylephrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).

The combination of dexbrompheniramine, hydrocodone, and phenylephrine is used to treat nasal congestion, sneezing, runny nose, itchy or water eyes, and cough caused by allergies or the common cold.

Dexbrompheniramine, hydrocodone, and phenylephrine may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about H-C Tussive-NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Do not use this medication if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take a cough and cold medicine before the MAO inhibitor has cleared from your body.

You should not use dexbrompheniramine, hydrocodone, and phenylephrine if you are allergic to it, or if you have severe or uncontrolled high blood pressure, coronary artery disease, ischemic heart disease (reduced circulation of blood to the heart), narrow-angle glaucoma, peptic ulcer, if you are unable to urinate, or if you are pregnant or breast-feeding.

Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. This medication should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Always ask a doctor before giving cough or cold medicine to a child. Death can occur from the misuse of cough or cold medicine in very young children. Dexbrompheniramine, hydrocodone, and phenylephrine should not be given to a child younger than 6 years old.

What should I discuss with my healthcare provider before taking H-C Tussive-NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Do not use this medication if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take a cough and cold medicine before the MAO inhibitor has cleared from your body. You should not use dexbrompheniramine, hydrocodone, or phenylephrine, if you have ever had an allergic reaction to it, or if you have:

• severe or uncontrolled high blood pressure;

• coronary artery disease;

• an enlarged prostate;

• narrow-angle glaucoma;

• peptic ulcer;

• asthma;

• pheochromocytoma;

• if you are breast-feeding a baby; or

• if you are having an asthma attack.

If you have certain conditions, you may need a dose adjustment or special tests to safely take dexbrompheniramine, hydrocodone, and phenylephrine. Before taking this medication, tell your doctor if you have:

• heart disease or high blood pressure;

• asthma, COPD, or other breathing disorder;

• diabetes;

• glaucoma;

• thyroid disorder;

• a history of head injury or brain tumor;

• enlarged prostate, urination problems.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Hydrocodone can cause breathing problems or addiction/withdrawal symptoms in a newborn. Do not take this medication while you are pregnant. This medication can pass into breast milk and may harm a nursing baby. Do not take this medication if you are breast-feeding a baby. Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. This medication should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Older adults may be more likely to have side effects from this medication.

How should I take H-C Tussive-NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. Cold medicine is usually taken for only a short time until your symptoms clear up.

Always ask a doctor before giving cough or cold medicine to a child. Death can occur from the misuse of cough or cold medicine in very young children. Dexbrompheniramine, hydrocodone, and phenylephrine should not be given to a child younger than 6 years old. Take the medicine with a full glass of water.

Measure liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Talk with your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever with a headache or skin rash. Store dexbrompheniramine, hydrocodone, and phenylephrine at room temperature away from moisture and heat.

Keep track of how much of this medicine has been used from the bottle. Hydrocodone is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

Since cough and cold medicine is usually taken only as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of hydrocodone can be fatal.

Overdose symptoms may include feeling restless or hyperactive, agitation, dizziness, confusion, hallucinations, fast or uneven heart rate, tremor, hallucinations, extreme drowsiness, loss of coordination, warmth or redness in your face, fever, cold or clammy skin, dilated pupils, pinpoint pupils, slow heart rate, blue-colored lips or fingernails, seizure (convulsions), weak or shallow breathing, or breathing that stops.

What should I avoid while taking H-C Tussive-NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol while you are taking this medication.

Tell your doctor if you regularly use other medicines that make you sleepy (such as pain medication, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by dexbrompheniramine, hydrocodone, and phenylephrine.

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Brompheniramine or phenylephrine are contained in many medicines available over the counter. If you take certain products together you may accidentally take too much of a certain drug. Read the label of any other medicine you are using to see if it contains brompheniramine or phenylephrine.

H-C Tussive-NR (dexbrompheniramine, hydrocodone, and phenylephrine) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:

• shallow breathing, slow heartbeat;

• fast or pounding heartbeat;

• slow heart rate, weak pulse, fainting, slow breathing (breathing may stop);

• confusion, hallucinations, unusual thoughts or behavior;

• seizure (convulsions);

• painful or difficult urination;

• urinating less than usual or not at all; or

• severe dizziness, anxiety, fear, or tremors.

Less serious side effects may include:

• dizziness, drowsiness, headache;

• feeling restless or nervous;

• sleep problems (insomnia);

• nausea, vomiting, heartburn, loss of appetite;

• dry mouth;

• increased urination; or

• blurred vision.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect H-C Tussive-NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Before taking this medication, tell your doctor if you regularly use other medicines that make you sleepy (such as narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, anxiety, or mental illness). They can add to sleepiness caused by dexbrompheniramine or hydrocodone.

Also tell your doctor about all other medicines you use, especially:

• medicines to treat high blood pressure;

• indomethacin (Indocin);

• mecamylamine (Inversine);

• methyldopa (Aldomet);

• reserpine;

• a beta-blocker such as atenolol (Tenormin), carteolol (Cartrol), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), timolol (Blocadren), and others; or

• an antidepressant such as amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Janimine, Tofranil), and others.

This list is not complete and there may be other drugs that can interact with dexbrompheniramine, hydrocodone, and phenylephrine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about dexbrompheniramine, hydrocodone, and phenylephrine.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.02. Revision Date: 4/12/2009 4:46:13 PM.

Generic Name: H1N1 influenza virus vaccine (injectable) (IN floo EN za VYE rus VAX een)
Brand Names:

What is H1N1 influenza virus vaccine?

H1N1 influenza is sometimes called “swine flu” because it is usually found in pigs. You cannot become infected with H1N1 influenza from eating pork products.

H1N1 influenza virus can spread from one person to another through small droplets of saliva that are expelled into the air when an infected person coughs or sneezes. The virus can also be passed through contact with objects the infected person has touched, such as a door handle or other surfaces.

H1N1 influenza virus vaccine is used to prevent infection caused by the pandemic 2009 H1N1 influenza virus.

The injectable H1N1 influenza virus vaccine is a “killed virus” vaccine. H1N1 influenza virus vaccine is also available in a nasal spray form, which is a “live virus” vaccine.

H1N1 influenza virus vaccine works by exposing you to a small dose of the virus, which helps your body to develop immunity to the disease. This vaccine will not treat an active infection that has already developed in the body.

H1N1 influenza virus injectable vaccine is for use in adults and children who are at least 6 months old.

Becoming infected with influenza is much more dangerous to your health than receiving the vaccine to protect against it. Most people with H1N1 influenza have recovered, but the virus has caused some deaths. Like any medicine, this vaccine can cause side effects, but the risk of serious side effects is extremely low.

Like any vaccine, H1N1 influenza virus vaccine may not provide protection from disease in every person. This vaccine will not prevent illness caused by avian flu (“bird flu”).

What is the most important information I should know about this vaccine?

The injectable H1N1 influenza virus vaccine is a “killed virus” vaccine. H1N1 influenza virus vaccine is also available in a nasal spray form, which is a “live virus” vaccine. This medication guide addresses only the injectable form of this vaccine. H1N1 influenza is sometimes called “swine flu” because it is usually found in pigs. You cannot become infected with H1N1 influenza from eating pork products.

The injectable form of H1N1 influenza virus vaccine is a “killed virus” vaccine and will not cause you to become ill with the flu virus that it contains. However, you may have flu-like symptoms at any time during flu season that may be caused by other strains of influenza virus.

Do not receive this vaccine if you have ever had an allergic reaction to a flu vaccine, or if you are allergic to eggs.

Before you receive an H1N1 influenza virus vaccine, tell your doctor if you have a weak immune system, or a history of Guillain-Barré syndrome or neurologic disorder affecting the brain (especially if these were caused by a vaccine).

You can still receive an H1N1 influenza vaccine if you have a cold or fever. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine.

Keep track of any and all side effects you have after receiving this vaccine. If you ever have to receive another influenza virus vaccine in the future, you will need to tell the doctor if the first shot caused any side effects.

Like any vaccine, H1N1 influenza virus vaccine may not provide protection from disease in every person. This vaccine will not prevent illness caused by avian flu (“bird flu”).

Becoming infected with influenza is much more dangerous to your health than receiving the vaccine to protect against it. Most people with H1N1 influenza have recovered, but the virus has caused some deaths.

What should I discuss with my healthcare provider before receiving this vaccine?

Do not receive this vaccine if you have ever had an allergic reaction to a flu vaccine, or if you are allergic to eggs.

Before you receive an H1N1 influenza virus vaccine, tell your doctor if you have:

• a history of Guillain-Barré syndrome (especially if you had it within 6 weeks after having a flu vaccine);

• a weak immune system caused by disease, bone marrow transplant, or by using certain medicines or receiving cancer treatments; or

• a neurologic disorder or disease affecting the brain (or if this was a reaction to a previous vaccine).

You can still receive a vaccine if you have a cold or fever. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine.

Vaccines may be harmful to an unborn baby and generally should not be given to a pregnant woman. However, not vaccinating the mother could be more harmful to the baby if the mother becomes infected with a disease that this vaccine could prevent. Your doctor will decide whether you should receive this vaccine. It is not known whether H1N1 influenza virus vaccine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. This vaccine should not be given to a child younger than 6 months old.

How is this vaccine given?

This vaccine is given as an injection (shot) into a muscle. You will receive this injection in a doctor’s office or other clinic setting.

Children younger than 10 years old should receive two H1N1 influenza virus vaccine shots spaced one month apart. Older children and adults are usually given only one shot without a booster dose.

Your doctor may recommend treating fever and pain with an aspirin-free pain reliever such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil, and others) after the shot is given. Follow the label directions or your doctor’s instructions about how much of this medicine to take.

It is especially important to prevent fever from occurring if you have a seizure disorder such as epilepsy.

What happens if I miss a dose?

If your child misses a booster dose of this vaccine, call your doctor for instructions.

Be sure to receive all doses of this vaccine recommended by your healthcare provider or by the health department of the state where you live. If you do not receive the full series of vaccines, you may not be fully protected against the disease.

What happens if I overdose?

An overdose of this vaccine is unlikely to occur.

What should I avoid before or after receiving this vaccine?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity after you receive this vaccine.

H1N1 influenza virus injectable vaccine side effects

The injectable form of H1N1 influenza virus vaccine is a “killed virus” vaccine and will not cause you to become ill with the flu virus that it contains. However, you may have flu-like symptoms at any time during flu season that may be caused by other strains of influenza virus.

You should not receive a booster vaccine if you had a life-threatening allergic reaction after the first shot. Keep track of any and all side effects you have after receiving this vaccine. If you ever have to receive another H1N1 influenza virus vaccine in the future, you will need to tell the doctor if the first shot caused any side effects. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• weakness, numbness or tingly feeling in your feet and spreading upward;

• problems with vision, speech, swallowing, or bladder and bowel functions;

• severe lower back pain;

• slow heart rate, trouble breathing, feeling like you might pass out;

• high fever; or

• unusual bruising or bleeding.

Less serious side effects can last a day or two after you receive this vaccine and may include:

• runny or stuffy nose;

• low fever;

• sore throat;

• loss of appetite;

• headache, tired feeling; or

• muscle pain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report vaccine side effects to the US Department of Health and Human Services at 1-800-822-7967.

H1N1 influenza virus vaccine Dosing Information

Usual Adult Dose for Influenza Prophylaxis:

0.5 mL intramuscularly once.

Usual Pediatric Dose for Influenza Prophylaxis:

Sanofi Pasteur and CSL:
6 months to 35 months: Two 0.25 mL intramuscular injections approximately 1 month apart.
36 months to 9 years: Two 0.5 mL intramuscular injections approximately 1 month apart.
10 years or older: A single 0.5 mL intramuscular injection.

Novartis:
4 years to 9 years of age: Two 0.5 mL intramuscular injections approximately 1 month apart.
10 years or older through 17 years of age: A single 0.5 mL intramuscular injection.

What other drugs will affect H1N1 influenza virus injectable vaccine?

Before receiving this vaccine, tell the doctor if you have recently received drugs or treatments that can weaken the immune system, including:

• cancer medicines;

• an oral, nasal, inhaled, or injectable steroid medicine;

• medications to treat psoriasis, rheumatoid arthritis, or other autoimmune disorders, such as azathioprine (Imuran), efalizumab (Raptiva), etanercept (Enbrel), leflunomide (Arava), and others; or

• medicines to treat or prevent organ transplant rejection, such as basiliximab (Simulect), cyclosporine (Sandimmune, Neoral, Gengraf), muromonab-CD3 (Orthoclone), mycophenolate mofetil (CellCept), sirolimus (Rapamune), or tacrolimus (Prograf).

This list is not complete and there may be other drugs that can interact with this vaccine. Tell your doctor about all the prescription and over-the-counter medications you have received. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your doctor or pharmacist may have information about H1N1 influenza virus vaccine written for health professionals that you may read. You may also find additional information from your local health department or the Centers for Disease Control and Prevention.

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

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.01. Revision Date: 09/25/2009 11:40:16 AM.

Generic Name: nicotine (oral/patches/nasal) (NIK oh teen)
Brand Names: Commit, Commit Cappuccino, Commit Cherry, Habitrol, Leader Nicotine Polacrilex, Nicoderm C-Q, Nicoderm C-Q Clear, Nicorelief, Nicorette, Nicorette Cinnamon Surge, Nicorette Fruit Chill, Nicorette Mint, Nicotrol Inhaler, Nicotrol NS

What is nicotine?

Nicotine is the primary ingredient in tobacco products.

Nicotine in medical products is used to aid in smoking cessation. Using a controlled amount of nicotine helps reduce nicotine withdrawal symptoms when you quit smoking.

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

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

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

You may not be able to use certain forms of this medicine if you have medical conditions that could interfere with use. Nasal or sinus problems (allergies, nasal polyps, sinusitis) could affect safe use of the nasal spray form of nicotine. Mouth or dental problems may affect safe use of nicotine gum or lozenges. A skin condition may affect safe use of nicotine transdermal patches. Talk with your doctor about the best form of nicotine for you to use.

Do not smoke while you are using nicotine. Stop smoking as soon as your treatment begins. Smoking while using this medication can be dangerous. The nicotine transdermal patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.

What should I discuss with my healthcare provider before using nicotine?

You may not be able to use certain forms of this medicine if you have medical conditions that could interfere with use. Nasal or sinus problems (allergies, nasal polyps, sinusitis) could affect safe use of the nasal spray form of nicotine. Mouth or dental problems may affect safe use of nicotine gum or lozenges. A skin condition may affect safe use of nicotine transdermal patches. Talk with your doctor about the best form of nicotine for you to use.

Before using this medication, tell your doctor if you have:

• heart disease, an irregular heartbeat, high blood pressure or chest pain;

• a jaw condition called TMJ (temporomandibular joint) disease;

• an overactive thyroid;

• diabetes;

• pheochromocytoma (tumor of the adrenal gland);

• liver or kidney disease;

• a stomach ulcer; or

• asthma or chronic pulmonary disease.

Nicotine oral lozenges may contain phenylalanine. Tell your doctor if you have phenylketonuria (PKU).

Nicotine can cause harm to an unborn baby. Do not use nicotine if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Nicotine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. The nicotine transdermal patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.

How should I take nicotine?

Use nicotine exactly as it was prescribed for you. Do not use the medication in larger amounts or for longer than recommended by your doctor.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

To use the patches:

• Choose a different place on your body to wear the patch each time you put on a new one. Do not use the same skin area twice within 7 days.

• Apply the patch to clean, dry, and hairless skin on the outer part of your upper arm or on your chest. Remove the patch after 24 hours and replace it with a new one.

• If you are using Nicotrol patches, apply a new patch each morning and remove it at bedtime. Do not wear the patch while you are sleeping. If you are using Nicoderm CQ, you may wear the patch for 16 or 24 hours. If you crave cigarettes when you wake up, you may wear the patch for 24 hours. Do not wear the patch at night if you have vivid dreams or trouble sleeping.

To use the chewing gum or oral lozenges:

• Place a piece of gum or a lozenge in your mouth.

• Chew the gum slowly several times and stop chewing when you notice a tingling sensation or a peppery taste in the mouth. “Park” the gum between your cheek and gum and leave it there until the taste or tinging sensation is almost gone. Then slowly chew a few more times until the taste or sensation returns. Park the gum again in a different place in your mouth. Chewing too much or too quickly can cause too much nicotine to be released from the gum and you may have side effects such as nausea, hiccups, or stomach problems. Remove the gum after 30 minutes, or when the taste or tingle no longer return when you chew the gum.

• Allow the lozenge to dissolve slowly without chewing or swallowing. You may notice a warm or tingling sensation in your mouth. Move the lozenge from one side of your mouth to the other while it is dissolving.

• Do not eat or drink for 15 minutes before using the gum or lozenge and while the medicine is in your mouth.

To use the nasal spray:

• Blow nose if it is not clear. Tilt head back slightly. Insert the tip of bottle into your nostril as far as comfortable. Spray once in each nostril. Do not sniff, swallow, or inhale while spraying. If your nose runs, gently sniff to keep the medicine in. Wait 2 or 3 minutes before blowing your nose. Do not use more of the medication than is directed.

• Recap the bottle after each use. If you don’t use the nasal spray for 24 hours, prime the pump by spraying several sprays into a tissue 1, then throw the tissue away.

• Do not get nicotine spray into your eyes or mouth or on your skin. If this does occur, rinse the area with water.

To use the inhaler:

• Inhale deeply or puff in short breaths. As you inhale through the mouthpiece, nicotine turns into a vapor and is absorbed into the mouth and throat. Nicotine in cartridges is used up after about 20 minutes of active puffing.

Keep used and unused nicotine patches or gum out of the reach of children and pets to prevent poisoning. Used bottles of nasal spray should be thrown away with their child-resistant caps in place.

Store nicotine products at room temperature away from moisture, heat, and direct sunlight.

What happens if I miss a dose?

Since nicotine is used as needed, you may not be on a dosing schedule. If you are using the medication regularly, use the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine, or if anyone has accidentally swallowed it.

Overdose symptoms may include nausea; vomiting; diarrhea; stomach pain; cold sweat; headache; dizziness; problems with hearing or vision; confusion; uneven heartbeats; chest pain; seizures; and death.

What should I avoid while taking nicotine?

Do not smoke while you are using nicotine. Stop smoking as soon as your treatment begins. Smoking while using this medication can be dangerous.

Nicotine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using nicotine and call your doctor at once if you have any of these serious side effects:

• seizures; or

• chest pain or uneven heartbeats.

Less serious side effects may include:

• dizziness;

• belching or hiccups;

• stomach upset or nausea;

• mouth or throat soreness;

• dry or watering mouth;

• watering eyes;

• headache;

• runny or stuffy nose (when using the nasal spray);

• white patches or sores inside your mouth or on your lips (when using the inhaler);

• constipation;

• sneezing and coughing;

• changes in taste; or

• redness, itching, or burning where the patch is worn.

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

What other drugs will affect nicotine?

Before using nicotine, tell your doctor if you are using any of the following drugs:

• imipramine (Tofranil);

• oxazepam (Serax);

• propranolol (Inderal), labetalol (Normodyne, Trandate), or prazosin (Minipress);

• theophylline (Theo-Dur, Theochron, Theolair);

• pentazocine (Talwin), or

• insulin.

This list is not complete and there may be other drugs that can interact with nicotine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about nicotine.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 6.03. Revision Date: 11/18/2009 11:08:09 AM.