Street drugs, or, in other words, street narcotics, are narcotic substances that are available in legal or illegal sale in the streets.
They contain opiates that drug addicted people consume in order to obtain euphoria effect (a rush of pleasure), or to become impassible for pain. They create a strong addiction (physical or psychological dependence), and force drug abusers to spend increasing money, time and other resources striving to obtain a portion of drug. All types of narcotics provoke severe withdrawal symptoms for addicted people.

Street narcotics may be iilegal, like marijuana, heroin, cocaine, Ecstasy, also called MDMA – or legal (these are medications that can be purchased legally in a drugstore and then abused), like codeine, Darvon, Demerol, methadone, morphine, and others.
Marijuana is a herb with narcotic effect. A person who drinks its decoction or inhales its smoke, feels himself relaxed, merry and talkative, he usually laughs a lot.

Heroin is a very addictive opiate drug that needs to be injected. It is very powerful, one of the most harmful drugs that have ever been known.

Cocaine is a strong and addictive drug, it is a very popular thing on the streets. It makes the abuser feel alert, confident, strong, communicative, and “cool”. It is consumed by means of smelling. A vapor, concentrated form of cocaine is called crack. It is very powerful and addictive, and it can be smoked.

Amphetamines and methamphetamines are stimulating pills swallowed by young people at night clubs in order to maintain high energy level for prolonged dancing. A derivative of amphetamines with a similar stimulating effect is called Ecstasy.

Hallucinogens (also known as psychedelic drugs) are substances which give an abuser different vivid, fantastic perceptual distortions. Lsd is the most widely known psychedelic substance.

Generic Name: hylan polymers a and b (Injection route)

HYE-lan POL-a-mers A and B

Commonly used brand name(s):

In the U.S.

• Synvisc
• Synvisc Hylan G-F
• Synvisc One

Available Dosage Forms:

• Injectable
• Solution

Therapeutic Class: Cartilaginous Defect Repair Agent

Uses For Synvisc One

Hyaluronate sodium derivative is similar to a substance that occurs naturally in joints that helps joints work properly by acting like a lubricant and shock absorber. This medicine is injected into the knee to relieve pain caused by osteoarthritis.

This medicine is to be administered only by or under the immediate supervision of your doctor. It is available only with your doctor’s prescription.

Before Using Synvisc One

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies on this medicine have been done only in adult patients, and there is no specific information comparing the use of hyaluronate sodium derivative in children with use in other age groups.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of hyaluronate sodium derivative in the elderly with use in other age groups.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Skin or knee joint infections or other problems at the place where the injection is to be given—This medicine should not be injected there

Proper Use of hylan polymers a and b

This section provides information on the proper use of a number of products that contain hylan polymers a and b. It may not be specific to Synvisc One. Please read with care.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For parenteral dosage form (injection):
  • For knee pain caused by osteoarthritis:
    • Adults—By injection into the knee, 16 milligrams (mg) once a week (one week apart) for a total of three injections.
    • Children—Use and dose must be determined by your doctor.

Precautions While Using Synvisc One

For the first 48 hours after you receive this medicine, avoid strenuous activities or prolonged (more than 1 hour) activities that put a lot of weight on your legs, such as jogging, heavy lifting, playing tennis, or standing on your feet for a long period of time.

Synvisc One Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Rare

• Difficulty breathing
• hives
• shortness of breath

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Knee pain
• pain at the injection site
• swelling of the knee

Rare

• Calf cramps
• dizziness
• facial flushing with swelling of the lips
• headache
• infection of the joint
• itching of the skin
• muscle pain
• nausea
• pain on one side of the body with anxiety, nausea, and tiredness
• rapid heartbeat
• skin rash

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided “AS IS” and “as available” for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

Generic Name: trientine (TRYE en teen)
Brand Names: Syprine

What is Syprine (trientine)?

Trientine is a chelating (KEE-late-ing) agent. A chelating agent is capable of removing a heavy metal, such as lead, mercury, or copper, from the blood.

Trientine is used to treat Wilson’s disease in people who cannot take penicillamine (Cuprimine, Depen).

Wilson’s disease is a genetic metabolic defect that causes excess copper to build up in the body.

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

What is the most important information I should know about Syprine (trientine)?

Before using trientine, tell your doctor if you are allergic to any drugs, or if you have rheumatoid arthritis, a kidney or bladder condition called cystinuria, or a liver condition called biliary cirrhosis.

Take the trientine capsule with water. Do not take trientine with milk. Take trientine on an empty stomach, at least 1 hour before or 2 hours after eating a meal or snack or taking any other medicines. Do not chew or open a trientine capsule. Swallow the pill whole.

Do not use a capsule that has been accidentally broken. The medicine from a broken capsule can be dangerous if it gets on your skin. If skin contact occurs, rinse the area thoroughly with plain water. Watch for signs of skin irritation and call your doctor if you develop a rash.

You may need to take your temperature every night for at least the first month of treatment with trientine. Call your doctor if you have a fever.

What should I discuss with my health care provider before taking Syprine (trientine)?

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

Before using trientine, tell your doctor if you are allergic to any drugs, or if you have:

• rheumatoid arthritis;

• a kidney or bladder condition called cystinuria; or

• a liver condition called biliary cirrhosis.

If you have any of these conditions, you may need dose adjustments or special tests during treatment.

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

How should I take Syprine (trientine)?

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

Take the trientine capsule with water. Do not take trientine with milk. Take trientine on an empty stomach, at least 1 hour before or 2 hours after eating a meal or snack or taking any other medicines.

Trientine is usually taken 2 to 4 times each day. Follow your doctor’s instructions.

Do not chew or open a trientine capsule. Swallow the pill whole.

Do not use a capsule that has been accidentally broken. The medicine from a broken capsule can be dangerous if it gets on your skin. If skin contact occurs, rinse the area thoroughly with plain water. Watch for signs of skin irritation and call your doctor if you develop a rash.

You may need to take your temperature every night for at least the first month of treatment with trientine. Call your doctor if you have a fever.

To be sure this medication is helping your condition, your blood will need to be tested often. Your iron levels will also be checked to make sure they don’t get too low. Do not miss any scheduled appointments.

Store this medication in the refrigerator and do not allow it to freeze.

See also: Syprine dosage in more detail

What happens if I miss a dose?

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

What happens if I overdose?

A trientine overdose is not expected to produce life-threatening symptoms.

What should I avoid while taking Syprine (trientine)?

Avoid eating, drinking milk, or taking other medications within 1 hour before or after taking trientine.

Do not take any vitamins or mineral supplements unless your doctor tells you to. You may occasionally need to take an iron supplement, but follow your doctor’s instructions.

Syprine (trientine) 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:

• cough, trouble breathing;

• pale skin, easy bruising or bleeding, weakness;

• tired feeling, muscle or joint pain, swollen glands;

• seizure (convulsions);

• muscle weakness, dropping eyelids, double vision; or

• problems with speech, balance, walking, lifting, chewing, or swallowing;

Less serious side effects include:

• skin rash;

• muscle spasm or contractions;

• heartburn;

• stomach pain;

• loss of appetite; or

• skin flaking, cracking, or thickening;

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 Syprine (trientine)?

There may be other drugs that can interact with trientine. 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 trientine.

• 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 4:39:55 PM.

Generic Name: sodium chloride (Injection route)

SOE-dee-um KLOR-ide

Commonly used brand name(s):

In the U.S.

• Sterile Saline Diluent Tip-Lok Syringe
• Syrex

Available Dosage Forms:

• Solution

Therapeutic Class: Parenteral Electrolyte, Sodium

Uses For Syrex

Sodium chloride as a 20% solution is given by injection into the uterus to cause abortion. It is to be administered only by or under the immediate care of your doctor.

Before Using Syrex

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Bleeding problems or

• Epilepsy or

• Heart or blood vessel disease or

• High blood pressure (hypertension) or

• Kidney disease—Sodium chloride injection may make these conditions worse or increase the chance of side effects occurring

• Fibroid tumors of the uterus—Large fibroid tumors may cause a problem with injecting sodium chloride into the uterus. Special injection precautions can be taken by the doctor if he knows that you have this type of tumor

• Previous major surgery of the uterus, including a cesarean—Scars in the uterus from any previous surgery of the uterus may increase the chance of medical problems occurring. Special precautions can be taken by the doctor to prevent problems from occurring

Proper Use of sodium chloride

This section provides information on the proper use of a number of products that contain sodium chloride. It may not be specific to Syrex. Please read with care.

During the procedure, you will be awake and asked questions about how you are doing by the health care team. This helps them to react quickly to any problems you might have and to keep side effects to a minimum.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Precautions While Using Syrex

Do not have sexual intercourse and avoid using tampons or douches for 2 to 3 weeks after the abortion to allow your body time to heal. This will also help protect you from getting an infection of the vagina or uterus.

Spotting (or slight bleeding from the uterus) is normal after the abortion. This may continue for 2 weeks. Heavier spotting or uterine bleeding should be reported to your health care professional.

Contraception should be considered for the near future because you may ovulate before your first menstrual period. Your first menstrual period will occur 4 to 6 weeks after the abortion.

Syrex Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

• Excessive blood loss
• fever

Rare

• Anxiety
• burning pain in lower abdomen
• chest pain, severe
• chills
• confusion
• convulsions (seizures)
• coughing
• dizziness
• feeling of heat
• feeling of warmth in lips and tongue
• headache (severe or dull)
• nervousness
• numbness of the fingertips
• pain in lower back, pelvis, or stomach
• ringing in the ears
• shortness of breath
• sweating
• thirst (sudden) or salty taste
• unconsciousness
• vision problems
• weakness

After the procedure is completed, some side effects may occur that need medical attention. Check with your doctor if you notice any of the following side effects:

• Abdominal cramping
• bad smelling discharge from vagina
• bleeding at place of injection
• chills or shivering
• fever
• increase in bleeding from the uterus
• pain in lower abdomen
• passing of pieces of tissue from the uterus
• redness at place of injection

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided “AS IS” and “as available” for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

Generic Name: oxytocin (ox e TOW sin)
Brand Names: Pitocin, Syntocinon

What is Syntocinon (oxytocin)?

Oxytocin is a natural hormone that causes the uterus to contract.

Oxytocin is used to induce labor, strengthen labor contractions during childbirth, control bleeding after childbirth, or to induce an abortion.

Oxytocin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Syntocinon (oxytocin)?

Oxytocin should be administered as an injection into a muscle or intravenously by a healthcare provider. It should be administered in a clinical setting where a healthcare provider can monitor uterine contractions and other vital signs (blood pressure, heart rates) and where an emergency situation can be handled properly.

What should I discuss with my healthcare provider before using Syntocinon (oxytocin)?

Do not take oxytocin without first talking to your doctor if you

• have or have had cervical cancer;

• have an allergy to oxytocin, other medications, dyes, foods, or preservatives;

• have eclampsia;

• have herpes;

• have had more than 7 pregnancies;

• are experiencing premature labor;

• have had a caesarean section (C-section);

• have had any surgery on the cervix or uterus;

• have a prolapsed uterus; or

• have a breech, placenta previa or any other issues with the fetus or umbilical cord.

You may not be able to use oxytocin, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Tell your doctor about all prescription or over-the-counter medicines including vitamins, minerals, and herbal products that your are taking.

Tell your doctor if you drink alcohol or caffeine drinks regularly, if you are a smoker or if you use illegal drugs. These factors can affect the way oxytocin works in your body.

There are no known indications for the use of oxytocin in the first or second trimester of pregnancy other than in relation to spontaneous or induced abortion. Based on the wide experience with this drug and its properties, it would not be expected to present a risk of harm to the baby when used as indicated under the supervision of a trained healthcare professional. Ask your doctor to answer any questions you have about the use of oxytocin and your pregnancy. Do not use oxytocin without first talking to your doctor if you are breast-feeding a baby.

How should I use Syntocinon (oxytocin)?

Oxytocin should be administered as an injection into a muscle or intravenously by a healthcare provider. It should be administered in a clinical setting where a healthcare provider can monitor uterine contractions and other vital signs (blood pressure, heart rates) and where an emergency situation can be handled properly.

Your healthcare provider will store oxytocin as directed by the manufacturer.

What happens if I miss a dose?

Since the medication will be administered by a healthcare provider, missing a dose should not occur.

What happens if I overdose?

If an overdose of oxytocin is suspected, seek emergency medical attention or contact your healthcare provider immediately.

Oxytocin should be administered in a clinical setting where a healthcare provider can monitor uterine contractions and other vital signs (blood pressure, heart rates) and where an emergency situation can be handled immediately.

What should I avoid while using Syntocinon (oxytocin)?

Tell your doctor if you drink alcohol or caffeine drinks regularly, if you are a smoker or if you use illegal drugs. These factors can affect the way oxytocin works in your body.

Syntocinon (oxytocin) side effects

Side effects with oxytocin are not common. Serious side effects include:

• an allergic reaction (shortness of breath; closing of the throat; hives; swelling of the lips, face, or tongue; rash; or fainting);

• difficulty urinating;

• chest pain or irregular heart beat;

• difficulty breathing;

• confusion;

• sudden weight gain or excessive swelling;

• severe headache;

• rash;

• excessive vaginal bleeding; or

• seizures.

Other, less serious side effects may be more likely to occur. Talk to your doctor if you experience

• redness or irritation at the injection site;

• loss of appetite; or

• nausea or vomiting.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Syntocinon (oxytocin)?

Other drugs can interact with oxytocin resulting in dangerous side effects and/or decreased effectiveness. Do not take any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, without first talking to your doctor during treatment with oxytocin.

Where can I get more information?

• Your pharmacist has additional information about oxytocin written for health professionals that you may read.

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

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.02. Revision Date: 4/12/2009 4:37:45 PM.

Generic Name: hylan G-F 20 (HI lan G F 20)
Brand Names: Synvisc

What is hylan G-F 20?

Hylan G-F 20 is similar to synovial fluid, a substance that occurs naturally in the joints. Synovial fluid acts as a lubricant and shock absorber.

Hylan G-F 20 is injected into the knee joints for the treatment of pain in individuals with osteoarthritis.

Hylan G-F 20 may also be used for purposes other than those listed here.

What is the most important information I should know about hylan G-F 20?

Talk to your doctor before using hylan G-F 20 if you have an allergy to birds or bird products, feathers, or egg products.

What should I discuss with my health care provider before using hylan G-F 20?

Talk to your doctor before using hylan G-F 20 if you have an allergy to birds or bird products, feathers, or egg products.

Hylan G-F 20 should not be used if there is an infection or skin disease at the site of injection.

It is not known whether hylan G-F 20 will be harmful to an unborn baby. Do not use hylan G-F 20 without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is not known whether hylan G-F 20 will be harmful to a nursing baby. Do not use hylan G-F 20 without first talking to your doctor if you are breast-feeding a baby.

How should I use hylan G-F 20?

Hylan G-F 20 is administered by a healthcare professional as an intra-articular (into the joint) injection.

Temporary pain or swelling of the affected joint may occur after injection of hylan G-F 20.

Avoid strenuous activity or prolonged (longer than one hour) weight-bearing activity such as jogging, tennis, or lifting weights for 48 hours following an injection, unless otherwise directed by your doctor.

What happens if I miss a dose?

Contact your doctor if a dose of hylan G-F 20 is missed.

What happens if I overdose?

An overdose of hylan G-F 20 is unlikely to threaten life. Contact your doctor or seek emergency medical attention if an overdose of hylan G-F 20 is suspected.

What should I avoid while using hylan G-F 20?

Avoid strenuous activity or prolonged (longer than one hour) weight-bearing activity such as jogging, tennis, or lifting weights for 48 hours following an injection, unless otherwise directed by your doctor.

Hylan G-F 20 side effects

Notify your doctor immediately if you experience a rare but serious allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives) to hylan G-F 20.

Other less serious side effects may also occur. Talk to your doctor if you experience

• temporary pain or swelling of the affected joint;

• rash or bruising at the injection site;

• headache; or

• upset stomach.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect hylan G-F 20?

It is not known whether other medications will interact with hylan G-F 20. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products during treatment with hylan G-F 20.

Where can I get more information?

• Your pharmacist has additional information about hylan G-F 20 written for health professionals that you may read.

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

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.04. Revision Date: 4/12/2009 4:43:02 PM.

Generic Name: Hylan (HIGH-lan)
Brand Name: Synvisc

Synvisc Solution is used for:

Treating pain associated with osteoarthritis of the knee.

Synvisc Solution is a visco supplement. It works by replacing the viscous or “thick” fluid naturally found in joints. The viscous fluid is needed to coat and protect the cartilage and joint of the knee, which lessens the pain of osteoarthritis.

Do NOT use Synvisc Solution if:

• you are allergic to any ingredient in Synvisc Solution
• you have an infection where Synvisc Solution will be injected

Contact your doctor or health care provider right away if any of these apply to you.

Before using Synvisc Solution:

Some medical conditions may interact with Synvisc Solution. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have a skin disease
• if you have an allergy to bird proteins, feathers, or eggs
• if you have blood flow problems

Some MEDICINES MAY INTERACT with Synvisc Solution. However, no specific interactions with Synvisc Solution are known at this time.

This may not be a complete list of all interactions that may occur. Ask your health care provider if Synvisc Solution may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Synvisc Solution:

Use Synvisc Solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Synvisc Solution comes with an additional patient leaflet. Read it carefully and reread it each time you get Synvisc Solution refilled.
• Synvisc Solution is administered as an injection at your doctor’s office, hospital, or clinic.
• Do not miss your doctor appointments while you are taking Synvisc Solution. If you must miss an appointment, notify your doctor as soon as possible.
• Do not miss your doctor appointments while you are taking Synvisc Solution. If you must miss an appointment, notify your doctor as soon as possible.
• If you miss a dose of Synvisc Solution, contact your doctor right away.

Ask your health care provider any questions you may have about how to use Synvisc Solution.

Important safety information:

• It may take several injections for Synvisc Solution to work fully. Complete the full treatment course, even if you are already feeling better.
• Avoid strenuous activities or prolonged weight-bearing activities, such as jogging or tennis, after receiving an injection.
• Use Synvisc Solution with extreme caution in CHILDREN. Safety and effectiveness have not been confirmed.
• PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Synvisc Solution during pregnancy. It is unknown if Synvisc Solution is excreted in breast milk. If you are or will be breast-feeding while you are using Synvisc Solution, check with your doctor or pharmacist to discuss the risks to your baby.

Possible side effects of Synvisc Solution:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Knee pain or swelling after injection.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); ankle swelling; bruising; calf cramping; fast heartbeat; fever; hemorrhoids; muscle pain; nausea; persistent pain, redness, or swelling at injection site; sweating.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately.

Proper storage of Synvisc Solution:

Synvisc Solution is usually handled and stored by a health care provider. Keep Synvisc Solution, as well as needles and syringes, out of the reach of children and away from pets.

General information:

• If you have any questions about Synvisc Solution, please talk with your doctor, pharmacist, or other health care provider.
• Synvisc Solution is to be used only by the patient for whom it is prescribed. Do not share it with other people.
• If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Synvisc Solution. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Generic name: Levothyroxine
Brand names: Synthroid, Levothroid, Levoxyl, Unithroid

Why is Synthroid prescribed?

Synthroid, a synthetic thyroid hormone may be given in any of the following cases:

If your own thyroid gland is not making enough hormone;

If you have an enlarged thyroid (a goiter) or are at risk for developing a goiter;

If you have certain cancers of the thyroid;

If your thyroid production is low due to surgery, radiation, certain drugs, or disease of the pituitary gland or hypothalamus in the brain.

Most important fact about Synthroid

If you are taking Synthroid to make up for a lack of natural hormone, it is important to take it regularly at the same time every day. You will probably need to take it for the rest of your life.

How should you take Synthroid?

Take Synthroid as a single dose, preferably on an empty stomach, one-half to one hour before breakfast. The drug is absorbed better on an empty stomach.

If an infant or child cannot swallow whole tablets, you may crush a Synthroid tablet and mix it into 1 or 2 teaspoonfuls of water.

While taking Synthroid, your doctor will perform periodic blood tests to determine whether you are getting the right amount.

–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. If you miss 2 or more doses in a row, consult your doctor.

–Storage instructions…

Keep Synthroid in a tightly closed container. Store it at room temperature, away from light and moisture.

Synthroid side effects

Side effects from Synthroid, other than overdose symptoms, are rare. People who are treated with Synthroid may initially lose some hair, but this effect is usually temporary. You may have an allergic reaction such as a rash or hives. Children may have an increase in pressure within the skull. Excessive dosage or a too rapid increase in dosage may lead to overstimulation of the thyroid gland. Notify your doctor immediately if you develop any if the following symptoms.

• Symptoms of overstimulation:
  Abdominal cramps, anxiety, changes in appetite, change in menstrual periods, chest pain, diarrhea, emotional instability, fatigue, fever, flushing, hair loss, headache, heart attack or failure, heat intolerance, hyperactivity, increased heart rate, irregular heartbeat, irritability, muscle weakness, nausea, nervousness, palpitations, shortness of breath, sleeplessness, sweating, tremors, vomiting, weight loss

Why should Synthroid not be prescribed?

You should not be treated with Synthroid if you are hypersensitive to thyroid hormone; your thyroid gland is making too much thyroid hormone; you have had a recent heart attack; or your adrenal glands are not making enough corticosteroid hormone. If you are sensitive to dyes, you can take the Synthroid 50-microgram tablet, which is made without color additives.

Although Synthroid will speed up your metabolism, it is not effective as a weight-loss drug and should not be used as such. An overdose may cause life-threatening side effects, especially if you take Synthroid with an appetite-suppressant medication.

Special warnings about Synthroid

Synthroid has profound effects on the body. Make sure your doctor is aware of all your medical problems, especially heart disease, clotting disorders, diabetes, and disorders of the adrenal or pituitary glands. The doctor will also need to know about any allergies you may have to food or medicine, and will ask for the names of any medications you take, whether prescription or over-the-counter.

You should receive low doses of Synthroid, under very close supervision, if you are an older person, or if you suffer from high blood pressure, angina (chest pain caused by a heart condition), or other types of heart disease. If you develop chest pain or additional circulatory problems, your dosage may have to be reduced.

If you have diabetes, or if your body makes insufficient adrenal corticosteroid hormone, Synthroid will tend to make your symptoms worse. If you take medication for any of these disorders, the dosage will probably have to be adjusted once you begin taking Synthroid. If diabetes is the problem, you should immediately report to your doctor any change in your glucose readings.

Postmenopausal women on long-term Synthroid therapy may suffer a loss of bone density, increasing the danger of osteoporosis (brittle bones). To minimize the loss, the doctor will prescribe the lowest dosage needed to control symptoms of thyroid deficiency.

Synthroid may cause seizures at the beginning of treatment, although this is rare. You may also notice some hair loss at first, but this is temporary.

It may take a few weeks for Synthroid to begin working, and you may not see any change in your symptoms until then.

Tell your doctor or dentist you are taking Synthroid before you have surgery of any kind.

Tell your doctor if you become pregnant while you are taking Synthroid. Your dose may need to be increased.

Do not switch to another brand of levothyroxine without consulting your doctor.

Excessive doses of Synthroid in infants may cause the top of the skull to close too early. In children, overtreatment can stunt growth.

Possible food and drug interactions when taking Synthroid

Synthroid can interact with a wide variety of medications. It’s advisable to check with your doctor before taking any other drug, but you should be especially wary of the following:

Amiodarone (Cordarone)
Androgens (male hormones)
Antacids and anti-gas medications
Antidepressants such as Elavil, Ludiomil, and Zoloft
Blood pressure drugs such as beta blockers, nitroprusside, and thiazide diuretics
Blood-thinning drugs such as Coumadin and heparin
Chloral hydrate (a sedative)
Diabetes drugs such as insulin and Micronase
Digitalis-type drugs such as Lanoxin
Estrogen products and oral contraceptives
Furosemide (Lasix)
Growth hormones
Hormone inhibitors such as Cytadren and Tapazole
Iodide
Iron supplements
Kayexalate
Ketamine (Ketalar)
Lithium (Eskalith, Lithobid)
Methadone and heroin
Metoclopramide (Reglan)
Nonsteroidal anti-inflammatory drugs such as phenylbutazone and aspirin
Parkinson’s drugs such as Sinemet
Propylthiouracil (a thyroid inhibitor)
Seizure medications such as Dilantin, Tegretol, and phenobarbital
Steroids such as dexamethasone and hydrocortisone
Stimulants such as epinephrine (EpiPen)
Sucralfate (Carafate)
The cancer drugs 5-fluorouracil, 6-mercaptopurine, mitotane, and tamoxifen
The cholesterol-lowering drugs Colestid, Mevacor, and Questran
The immune-system drugs interferon and interleukin
The tranquilizers Trilafon and Valium
The tuberculosis drugs aminosalicylate, rifampin, and ethionamide
Theophylline (Theo-Dur)

A high-fiber diet, soy-containing supplements, and walnuts can also interfere with Synthroid effects.

Special information if you are pregnant or breastfeeding

If you need to take Synthroid because of a thyroid hormone deficiency, you can continue to take Synthroid during pregnancy. In fact, your doctor will test you regularly and may increase your dose. Once your baby is born, you may breastfeed while continuing to take carefully regulated doses of Synthroid.

Recommended dosage for Synthroid

Your doctor will tailor the dosage to meet your individual requirements, taking into consideration the status of your thyroid gland and other medical conditions you may have. Older adults often require somewhat smaller doses. To make sure the dosage is right for you, the doctor will monitor your thyroid hormone level with periodic blood tests.

Overdosage

An overdose of Synthroid can produce the same symptoms of overstimulation listed under “Synthroid side effects” Confusion and disorientation are also possible, and there have been reports of stroke, shock, coma, and death. If you suspect a massive overdose, seek emergency medical attention immediately.

Generic Name: esterified estrogens and methyltestosterone (ess TER if fyed ESS troe jenz and METH il tes TOS te rone)
Brand Names: Covaryx, Covaryx HS, EEMT, Essian H.S., Estratest, Estratest H.S., Syntest DS, Syntest HS

What is Syntest DS (esterified estrogens and methyltestosterone)?

Esterified estrogens are female sex hormones necessary for many processes in the body.

Methyltestosterone is a man-made form of testosterone, a naturally occurring sex hormone that is produced in a man’s testicles. Small amounts of testosterone are also produced in a woman’s ovaries and adrenal system.

The combination of esterified estrogens and methyltestosterone is used to treat symptoms of menopause such as hot flashes, and vaginal dryness, burning, and irritation.

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

What is the most important information I should know about Syntest DS (esterified estrogens and methyltestosterone)?

Do not use this medication if you have any of the following conditions: liver disease, a recent history of heart attack, stroke or circulation problems, a hormone-related cancer such as breast or uterine cancer, abnormal vaginal bleeding, or if you are pregnant or breast-feeding. This medication should not be used to prevent heart disease or stroke. This medication can cause birth defects in an unborn baby. Do not use if you are pregnant. Tell your doctor if you become pregnant during treatment.

Esterified estrogens and methyltestosterone increases your risk of developing endometrial hyperplasia, a condition that may lead to cancer of the uterus. Taking progestins while using esterified estrogens and methyltestosterone may lower this risk. If your uterus has not been removed, your doctor may prescribe a progestin for you to take while you are taking esterified estrogens and methyltestosterone.

Long-term esterified estrogens and methyltestosterone treatment may increase your risk of breast cancer, heart attack, or stroke. Talk with your doctor about your individual risks before using esterified estrogens and methyltestosterone long-term. Your doctor should check your progress on a regular basis (every 3 to 6 months) to determine whether you should continue this treatment.

Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using esterified estrogens and methyltestosterone.

What should I discuss with my health care provider before using Syntest DS (esterified estrogens and methyltestosterone)?

Esterified estrogens and methyltestosterone should not be used to prevent heart disease or stroke.

Do not use esterified estrogens and methyltestosterone if you have:

• liver disease;

• a recent history of heart attack, stroke or circulation problems;

• abnormal vaginal bleeding that a doctor has not checked;

• any type of breast, uterine, or hormone-dependent cancer; or

• if you are pregnant or breast-feeding.

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

• high blood pressure, heart disease, or coronary artery disease;

• high cholesterol or triglycerides;

• kidney disease;

• asthma;

• epilepsy or other seizure disorder;

• migraines;

• endometriosis;

• diabetes;

• lupus;

• depression;

• gallbladder disease;

• if you smoke; or

• if you have had your uterus removed (hysterectomy).

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

Esterified estrogens and methyltestosterone increases your risk of developing endometrial hyperplasia, a condition that may lead to cancer of the uterus. Taking progestins while using esterified estrogens and methyltestosterone may lower this risk. If your uterus has not been removed, your doctor may prescribe a progestin for you to take while you are using esterified estrogens and methyltestosterone.

Long-term esterified estrogens and methyltestosterone treatment may increase your risk of stroke. Talk with your doctor about your individual risks before using esterified estrogens and methyltestosterone long-term. Your doctor should check your progress on a regular basis (every 3 to 6 months) to determine whether you should continue this treatment.

FDA pregnancy category X. This medication can cause birth defects. Do not use esterified estrogens and methyltestosterone if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Esterified estrogens and methyltestosterone can pass into breast milk and may harm a nursing baby. This medication may also slow breast milk production. Do not use if you are breast-feeding a baby.

How should I use Syntest DS (esterified estrogens and methyltestosterone)?

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the directions on your prescription label.

This medication is usually taken in a cycle of 3 weeks on and 1 week off. Follow your doctor’s instructions.

Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using esterified estrogens and methyltestosterone.

If you need to have any type of medical tests or surgery, or if you will be on bed rest, you may need to stop using this medication for a short time. Esterified estrogens and methyltestosterone may also cause unusual results with certain medical tests. Tell any doctor who treats you that you are taking this medication.

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

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include nausea, vomiting, or vaginal bleeding.

What should I avoid while using Syntest DS (esterified estrogens and methyltestosterone)?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity while you are taking this medication.

Syntest DS (esterified estrogens and methyltestosterone) 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:

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

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

• sudden headache, confusion, problems with vision, speech, or balance;

• swelling, rapid weight gain;

• confusion, unusual thoughts or behavior;

• pain, swelling, or tenderness in your stomach;

• nausea, stomach pain, loss of appetite jaundice (yellowing of the skin or eyes);

• breast lump, nipple discharge;

• acne, skin color changes, increased facial hair, male pattern baldness, voice changes; or

• changes in your menstrual periods, break-through bleeding.

Less serious side effects may include:

• mild nausea, stomach upset;

• swollen or painful breasts;

• headache;

• hair loss;

• depression, anxiety; or

• decreased sex drive, impotence, or difficulty having an orgasm.

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 Syntest DS (esterified estrogens and methyltestosterone)?

Many drugs can interact with esterified estrogens and methyltestosterone. Below is just a partial list. Tell your doctor if you are using:

• a blood thinner such as warfarin (Coumadin);

• insulin;

• ketoconazole (Nizoral);

• St. John’s wort;

• rifampin (Rifadin, Rifater, Rifamate, Rimactane);

• an antidepressant;

• seizure medicines such as phenytoin (Dilantin), carbamazepine (Tegretol), topiramate (Topamax), and others;

• an antibiotic such as clarithromycin (Biaxin), erythromycin (E-Mycin, Ery-Tab, Erythrocin), telithromycin (Ketek), and others; or

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

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

• 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: 3.04. Revision Date: 06/11/2009 1:15:10 PM.

Generic Name: esterified estrogens and methyltestosterone (Oral route)

es-TER-i-fide ES-troe-jenz, meth-il-tes-TOS-ter-one

Commonly used brand name(s):

In the U.S.

• Covaryx
• Covaryx HS
• Essian
• Estratest
• Menogen
• Syntest D.S.
• Syntest H.S.

Available Dosage Forms:

• Tablet

Therapeutic Class: Estrogen/Androgen Combination

Pharmacologic Class: Estrogen

Uses For Syntest H.S.

Esterified estrogens and methyltestosterone combination is used to treat the symptoms of menopause in patients who did not get relief after being treated with estrogens alone. These symptoms may include a feeling of heat, sweating, and warmth in the face, neck, or chest (“hot flashes”); and dryness, burning, and itching in the vagina.

Esterified estrogens are a man-made mixture of estrogens. Estrogen is a hormone that is produced by the body in greater amounts in females. It is necessary for normal sexual development of the female and for regulation of the menstrual cycle during the childbearing years. Methyltestosterone is a man-made form of testosterone, a hormone that is produced by the body in greater amounts in males and small amounts in females. Menopause symptoms occur when the hormone balance changes in the female body. This combination of hormones will relieve the symptoms of menopause by adding more hormones to the body.

This medicine is available only with your doctor’s prescription.

Before Using Syntest H.S.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

The use of esterified estrogens and methyltestosterone combination is not recommended in children.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of esterified estrogens and methyltestosterone combination in the elderly. However, elderly patients are more likely to develop dementia and age-related kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving this medicine.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	X	Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Anisindione
• Bupropion
• Dicumarol
• Phenprocoumon

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Clarithromycin
• Ginseng
• Itraconazole
• Ketoconazole
• Levothyroxine
• Licorice
• Tipranavir
• Warfarin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Abnormal vaginal bleeding, undiagnosed or
• Blood clotting problems (e.g., deep vein thrombosis, pulmonary embolism), history of or
• Breast cancer, or history of or
• Heart attack, recent or history of or
• Liver disease, severe or
• Stroke, recent or history of—Should not be used in patients with these conditions.

• Asthma or
• Cancer (e.g., breast, cervix, liver, vagina) or
• Depression, history of or
• Diabetes or
• Edema (fluid retention) or
• Endometriosis (problem with the lining of the uterus) or
• Epilepsy or
• Eye or vision problems (e.g., retinal vascular thrombosis) or
• Gallbladder disease or
• Hepatitis (including cholestatic jaundice), history of or
• Hypercalcemia (high calcium in the blood) or
• Hypocalcemia (high calcium in the blood) or
• Hypothyroidism (underactive thyroid) or
• Migraine headaches, history of or
• Porphyria (enzyme problem) or
• Systemic lupus erythematosus—Use with caution. May make these conditions worse.

• Heart or blood vessel disease or
• Hypercholesterolemia (high cholesterol in the blood) or
• Hypertension (high blood pressure) or
• Hypertriglyceridemia (high triglycerides or fat in the blood) or
• Venous thromboembolism (clot in the veins), history of—May increase risk for more serious side effects.

Proper Use of esterified estrogens and methyltestosterone

This section provides information on the proper use of a number of products that contain esterified estrogens and methyltestosterone. It may not be specific to Syntest H.S.. Please read with care.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine comes with a patient information insert. Read and follow the instructions in the insert carefully. Ask your doctor if you have any questions.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • For treatment of menopause symptoms:
    • Adults—One to two tablets once a day.
    • Children—Use is not recommended.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using Syntest H.S.

It is very important that your doctor check your progress at regular visits to make sure the medicine is working properly and to decide if you should continue to take it. These visits should be every 6 to 12 months or as otherwise directed by your doctor.

It is unlikely that a postmenopausal woman may become pregnant. But, you should know that using this medicine while you are pregnant could harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.

Very rarely, this medicine can cause serious side effects such as a heart attack or stroke. You are much more likely to have these side effects if you smoke cigarettes or are overweight, or if you have diabetes, high blood pressure, or a high blood cholesterol. Talk with your doctor if you think you might be at risk.

Using large doses of estrogen alone over a long period of time may increase the risk of some kinds of cancer (e.g., endometrial cancer). Talk with your doctor about this risk. If you have vaginal bleeding with this medicine, call your doctor right away.

This medicine may increase the risk of getting breast cancer. It is very important that you check your breasts on a regular basis for any unusual lumps or discharge, and that you have breast x-rays every year as directed by your doctor. These exams are very important if you have a family member with a history of breast cancer. Talk with your doctor about this risk.

This medicine may increase the risk of getting dementia in elderly women (above 65 years of age). Talk with your doctor if this concerns you.

Check with your doctor right away if blurred vision, difficulty with reading, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

Using large doses of methyltestosterone over a long period of time may increase the risk of serious liver problems (e.g., peliosis hepatis or liver cancer). Talk with your doctor about this risk.

Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine. Also, you may need to stop using this medicine for a few weeks before and after having surgery, or if you are inactive for a long period of time.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Syntest H.S. Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

• Absent, missed, or irregular menstrual periods
• acne or oily skin
• decreased breast size
• enlarging clitoris
• hoarseness or deepening of the voice
• menstrual changes
• stopping of menstrual bleeding
• unnatural hair growth or loss

Rare

• Continuing nausea
• cough
• dark-colored urine
• difficulty with swallowing
• dizziness
• fast heartbeat
• fever
• hives
• itching
• light-colored stools
• loss of appetite
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• purple or red-colored spots on the body or inside the mouth or nose
• shortness of breath
• skin rash
• sore throat
• tightness in the chest
• unusual tiredness or weakness
• vomiting
• wheezing

Incidence not known

• Abdominal or stomach bloating, cramps, or pain
• anxiety
• bleeding from gums or nose
• blistering, peeling, or loosening of the skin
• bloating
• bloody or cloudy urine
• burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
• change in vaginal discharge
• changes in skin color, pain, or tenderness
• chest pain or discomfort
• chills
• clay-colored stools
• clear or bloody discharge from nipple
• confusion
• constipation
• convulsions
• darkening of urine
• decrease in amount of urine
• diarrhea
• difficult, burning, or painful urination
• difficulty with breathing
• difficulty with moving
• difficulty with speaking
• dimpling of the breast skin
• dizziness or lightheadedness
• double vision
• eye pain
• fainting
• fever
• fluid-filled skin blisters
• frequent urge to urinate
• headache
• heavy bleeding
• inability to move the arms, legs, or facial muscles
• inability to speak
• indigestion
• inverted nipple
• irregular heartbeats
• itching of the vagina or genital area
• joint or muscle pain
• large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
• light-colored stools
• loss of appetite
• lump in the breast or under the arm
• mood or mental changes
• muscle cramps in the hands, arms, feet, legs, or face
• muscle pain or stiffness
• nausea
• noisy, rattling breathing
• numbness and tingling around the mouth, fingertips, or feet
• pain
• pain during sexual intercourse
• pain in the ankles or knees
• pain or discomfort in the arms, jaw, back, or neck
• pain or feeling of pressure in pelvis
• painful, red lumps under the skin, mostly on the legs
• pains in the stomach, side, or abdomen, possibly radiating to the back
• pelvic pain
• persistent crusting or scaling of the nipple
• pinpoint red or purple spots on the skin
• poor insight and judgment problems with memory or speech
• red, irritated eyes
• redness or swelling of the breast
• ringing in the ears
• sensitivity to the sun
• shortness of breath
• skin thinness
• slow speech
• sore on the skin of the breast that does not heal
• sore throat
• sores, ulcers, or white spots in the mouth or on the lips
• stomach pain
• sudden shortness of breath or troubled breathing
• sweating
• swelling
• swelling of the fingers, hands, feet, or lower legs
• tenderness of the breast
• thick, white curd-like vaginal discharge without odor or with mild odor
• tiredness
• tremor
• trouble recognizing objects
• trouble thinking and planning
• trouble walking
• troubled breathing at rest
• unexpected or excess milk flow from breasts
• unpleasant breath odor
• vaginal bleeding
• vision changes
• vomiting of blood
• weakness
• weight gain
• yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

• Blemishes on the skin
• brown, blotchy spots on the exposed skin
• decreased interest in sexual intercourse
• depression
• headache, severe and throbbing
• inability to have or keep an erection
• increase or decrease in weight
• increased hair growth, especially on the face
• increased in sexual ability, desire, drive, or performance
• increased interest in sexual intercourse
• irritability
• leg cramps
• loss in sexual ability, desire, drive, or performance
• loss of hair
• mental depression
• pimples
• redness of the skin
• swelling or inflammation of the mouth
• twitching, uncontrolled movements of the tongue, lips, face, arms, or legs

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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