temporarily relieves these symptoms associated with the common cold, or flu:
headache
fever
sinus pressure
nasal congestion
minor body aches and pains
Warnings
Allergy alert: Ibuprofen may cause a severe allergic reaction, especially in people allergic to aspirin. Symptoms may include:
hives
facial swelling
asthma (wheezing)
shock
skin reddening
rash
blisters
If an allergic reaction occurs, stop use and seek medical help right away.
Stomach bleeding warning: This product contains a nonsteroidal anti-inflammatory drug (NSAID), which may cause stomach bleeding.
The chance is higher if you:
are age 60 or older
have had stomach ulcers or bleeding problems
take a blood thinning (anticoagulant) or steroid drug
take other drugs containing an NSAID [aspirin, ibuprofen, naproxen, or others]
have 3 or more alcoholic drinks every day while using this product
take more or for a longer time than directed
Do not use
if you have ever had an allergic reaction to any other pain reliever/fever reducer
right before or after heart surgery
if you are now taking a prescription monoamine oxidase inhibitor (MAOI) (certain drugs for depression, psychiatric, or emotional conditions, or Parkinson’s disease), or for 2 weeks after stopping the MAOI drug. If you do not know if your prescription drug contains an MAOI, ask a doctor or pharmacist before taking this product.
in children under 12 years of age
Ask a doctor before use if you have
problems or serious side effects from taking pain relievers or fever reducers
stomach problems that last or come back, such as heartburn, upset stomach, or stomach pain
ulcers
bleeding problems
high blood pressure
heart or kidney disease
thyroid disease
diabetes
trouble urinating due to an enlarged prostate gland
taken a diuretic
reached age 60 or older
asthma
Ask a doctor or pharmacist before use if you are
taking any other drug containing an NSAID (prescription or nonprescription)
taking a blood thinning (anticoagulant) or steroid drug
under a doctor’s care for any serious condition
taking any other product that contains pseudoephedrine, or any other nasal decongestant
taking aspirin to prevent heart attack or stroke, because ibuprofen may decrease this benefit of aspirin
taking any other drug
When using this product
take with food or milk if stomach upset occurs
long term continuous use may increase the risk of heart attack or stroke
Stop use and ask a doctor if
you feel faint, vomit blood, or have bloody or black stools. These are signs of stomach bleeding.
fever gets worse or lasts more than 3 days
nasal congestion lasts for more than 7 days
symptoms continue or get worse
stomach pain or upset gets worse or lasts
redness or swelling is present in the painful area
you get nervous, dizzy, or sleepless
any new symptoms appear
If pregnant or breast-feeding,
ask a health professional before use. It is especially important not to use ibuprofen during the last 3 months of pregnancy unless definitely directed to do so by a doctor because it may cause problems in the unborn child or complications during delivery.
Keep out of reach of children.
In case of overdose, get medical help or contact a Poison Control Center right away.
Directions
do not take more than directed
the smallest effective dose should be used
do not take longer than 7 days, unless directed by a doctor (see Warnings)
adults and children 12 years of age and over:
take 1 caplet every 4 to 6 hours while symptoms persist. If symptoms do not respond to 1 caplet, 2 caplets may be used.
do not use more than 6 caplets in any 24-hour period unless directed by a doctor
children under 12 years of age: do not use
Other information
store at 20-25°C (68-77°F). Avoid excessive heat above 40°C (104°F).
read all warnings and directions before use. Keep carton.
Generic Name: ascorbic acid (vitamin C) (as KORE bik AS id)
Brand Names: Acerola, Ascorbic Acid Quick Melts, C-Time, C/Rose Hips, Cecon, Cemill 1000, Cemill 500, Ester-C, N Ice with Vitamin C, Sunkist Vitamin C, Vicks Vitamin C Drops, Vitamin C, Vitamin C TR, Vitamin C with Rose Hips
What is ascorbic acid?
Ascorbic acid (vitamin C) occurs naturally in foods such as citrus fruit, tomatoes, potatoes, and leafy vegetables. Ascorbic acid is important for bones and connective tissues, muscles, and blood vessels. Vitamin C also helps the body absorb iron, which is needed for red blood cell production.
Ascorbic acid is used to treat and prevent vitamin C deficiency.
Ascorbic acid may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about ascorbic acid?
You should not use this medication if you have ever had an allergic reaction to ascorbic acid.
Ask a doctor or pharmacist about using ascorbic acid if you have kidney disease or a history of kidney stones, liver disease (especially cirrhosis), or an enzyme deficiency called glucose-6-phosphate dehydrogenase deficiency (G6PD).
It is not known whether ascorbic acid is harmful to an unborn baby or a nursing baby. Some vitamins and minerals are needed during pregnancy or for breast milk production, but some may be harmful if taken in large doses. Do not take ascorbic acid without telling your doctor if you are pregnant or breast-feeding.
Ascorbic acid can be harmful to the kidneys, and this effect is increased when ascorbic acid is used together with other medicines that can harm the kidneys. Before taking ascorbic acid, tell your doctor if you are receiving chemotherapy, or using medicines to treat a bowel disorder, medication to prevent organ transplant rejection, antiviral medications, pain or arthritis medicines, or any injected antibiotics. You may need dose adjustments or special tests when taking any of these medications together with ascorbic acid.
Before taking ascorbic acid, tell your doctor about all other medications you take.
Stop using ascorbic acid and call your doctor at once if you have severe pain in your lower back or side, blood in your urine, pain when you urinate, severe or ongoing diarrhea, or feel like you might pass out.
What should I discuss with my healthcare provider before taking ascorbic acid?
You should not use this medication if you have ever had an allergic reaction to ascorbic acid.
Ask a doctor or pharmacist about using ascorbic acid if you have:
kidney disease or a history of kidney stones;
liver disease (especially cirrhosis); or
an enzyme deficiency called glucose-6-phosphate dehydrogenase deficiency (G6PD).
It is not known whether ascorbic acid is harmful to an unborn baby. Some vitamins and minerals can harm an unborn baby if taken in large doses. You may need to use a prenatal vitamin specially formulated for pregnant women. Do not take ascorbic acid without telling your doctor if you are pregnant. Ascorbic acid can pass into breast milk, but it is not known whether it would be harmful to a nursing baby. Some vitamins and minerals are needed for breast milk production, but some may harm a nursing baby. Do not take ascorbic acid without telling your doctor if you are breast-feeding a baby.
How should I take ascorbic acid?
Use this medication exactly as directed on the label, or as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended.
The recommended dietary allowance of ascorbic acid increases with age, and whether you are pregnant or breast-feeding. Follow your doctor’s instructions. You may also consult the National Academy of Sciences “Dietary Reference Intake” or the U.S. Department of Agriculture’s “Dietary Reference Intake” (formerly “Recommended Daily Allowances” or RDA) listings for more information.
Take the ascorbic acid regular tablet or capsule with a full glass (8 ounces) of water.
The ascorbic acid chewable tablet must be chewed before swallowing. Ascorbic acid gum may be chewed over a long period and then spit out and thrown away.
Remove the disintegrating tablet from the package using dry hands, and place the tablet in your mouth. It will begin to dissolve right away. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. Swallow several times as the tablet dissolves.
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.
Dissolve the powder form of ascorbic acid in a small amount of water or other liquid. Follow the directions on the package label about what types of liquid you may use. Stir the mixture and drink all of it right away. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.
Store ascorbic acid at room temperature away from moisture and heat.
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?
Seek emergency medical attention if you think you have used too much of this medicine.
An overdose of ascorbic acid is not likely to cause life-threatening symptoms.
What should I avoid while taking ascorbic acid?
Follow your doctor’s instructions about any restrictions on food, beverages, or activity.
Smoking can make ascorbic acid less effective.
Ascorbic acid side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using ascorbic acid and call your doctor at once if you have a serious side effect such as:
severe pain in your lower back or side;
blood in your urine;
pain when you urinate;
severe or ongoing diarrhea; or
feeling like you might pass out.
Less serious side effects may include:
heartburn, stomach cramps;
nausea, vomiting, diarrhea;
headache, dizziness;
flushing (warmth, redness, or tingling under your skin);
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 ascorbic acid?
Ascorbic acid can be harmful to the kidneys, and this effect is increased when ascorbic acid is used together with other medicines that can harm the kidneys. Before taking ascorbic acid, tell your doctor if you are receiving chemotherapy, or using medicines to treat a bowel disorder, medication to prevent organ transplant rejection, antiviral medications, pain or arthritis medicines, or any injected antibiotics.
You may need dose adjustments or special tests when taking any of these medications together with ascorbic acid.
The following drugs can interact with ascorbic acid. Tell your doctor if you are using any of these:
aspirin or acetaminophen (Tylenol);
fluphenazine (Permitil);
indinavir (Crixivan);
levodopa (Atamet, Larodopa, Parcopa, Sinemet);
nicotine patches (Nicoderm, Habitrol, Commit);
antacids that contain aluminum (such as Amphojel, Maalox, Mylanta, Rulox, and others);
an antibiotic such as demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap); or
a barbiturate such as butabarbital (Butisol), secobarbital (Seconal), pentobarbital (Nembutal), or phenobarbital (Solfoton);
birth control pills or hormone replacement therapy, including Premarin, Estratest, Vivelle, Climara, Estring, Estrace, and others; or
a blood thinner such as warfarin (Coumadin).
This list is not complete and there may be other drugs that can interact with ascorbic acid. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.
Where can I get more information?
Your doctor, pharmacist, or health care provider may have more information about ascorbic acid.
Consultation with a licensed health care professional is advisable before using any herbal/health supplement. Additionally, consultation with a practitioner trained in the uses of herbal/health supplements may be beneficial and coordination of treatment among all health care providers involved may be advantageous. Remember, keep this and all other prescription drug products, over-the-counter drug products, and herbal/health supplements out of the reach of children.
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.
relieves heartburn associated with acid indigestion and sour stomach
prevents heartburn associated with acid indigestion and sour stomach brought on by eating or drinking certain food and beverages
Warnings
Allergy alert: Do not use if you are allergic to famotidine or other acid reducers
Do not use
if you have trouble or pain swallowing food, vomiting with blood, or bloody or black stools. These may be signs of a serious condition. See your doctor.
with other acid reducers
Ask a doctor before use if you have
had heartburn over 3 months. This may be a sign of a more serious condition.
heartburn with lightheadedness, sweating, or dizziness
chest pain or shoulder pain with shortness of breath; sweating; pain spreading to arms, neck or shoulders; or lightheadedness
frequent chest pain
frequent wheezing, particularly with heartburn
unexplained weight loss
nausea or vomiting
stomach pain
Stop use and ask a doctor if
your heartburn continues or worsens
you need to take this product for more than 14 days
If pregnant or breast-feeding,
ask a health professional before use.
Keep out of reach of children.
In case of overdose, get medical help or contact a Poison Control Center right away.
Directions
adults and children 12 years and over:
to relieve symptoms, swallow 1 tablet with a glass of water. Do not chew.
to prevent symptoms, swallow 1 tablet with a glass of water 60 minutes before eating food or drinking beverages that cause heartburn
do not use more than 2 tablets in 24 hours
children under 12 years: ask a doctor
Other information
read the directions and warnings before use
keep the carton and package insert. They contain important information.
store at 20°-25°C (68°-77°F)
protect from moisture and light
Inactive ingredients
colloidal silicon dioxide, corn starch, hydroxypropyl cellulose, hypromellose, indigo carmine aluminum lake FD&C blue no. 2, iron oxide red, iron oxide yellow, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol 4000, pregelatinized corn starch, titanium dioxide
Questions or comments?
1-800-719-9260
Principal Display Panel
Compare to the active ingredient of Pepcid® AC
Famotidine Tablets, 10 mg
Acid Reducer
Just One Tablet Relieves & Prevents Heartburn Due to Acid Indigestion
Original Strength
Actual Size
(# Doses) {Replace # with the amount in package}
Acid Reducer Carton
Sunmark Acid Reducer
famotidine tablet, coated
Product Information
Product Type
HUMAN OTC DRUG
NDC Product Code (Source)
49348-442
Route of Administration
ORAL
DEA Schedule
Active Ingredient/Active Moiety
Ingredient Name
Basis of Strength
Strength
FAMOTIDINE (FAMOTIDINE)
FAMOTIDINE
10 mg
Inactive Ingredients
Ingredient Name
Strength
No Inactive Ingredients Found
Product Characteristics
Color
PINK
Score
no score
Shape
ROUND
Size
8mm
Flavor
Imprint Code
93;968
Contains
Packaging
#
NDC
Package Description
Multilevel Packaging
1
49348-442-59
4 BLISTER PACK In 1 CARTON
contains a BLISTER PACK
1
10 TABLET In 1 BLISTER PACK
This package is contained within the CARTON (49348-442-59)
2
49348-442-44
3 BLISTER PACK In 1 CARTON
contains a BLISTER PACK
2
10 TABLET In 1 BLISTER PACK
This package is contained within the CARTON (49348-442-44)
3
49348-442-12
1 BOTTLE In 1 CARTON
contains a BOTTLE
3
60 TABLET In 1 BOTTLE
This package is contained within the CARTON (49348-442-12)
4
49348-442-13
1 BOTTLE In 1 CARTON
contains a BOTTLE
4
90 TABLET In 1 BOTTLE
This package is contained within the CARTON (49348-442-13)
Chronic heartburn caused by acid reflux is one of the most common complaints among Americans, and a new study outlines which approaches appear to work best to …
relieves heartburn associated with acid indigestion and sour stomach
prevents heartburn associated with acid indigestion and sour stomach brought on by eating or drinking certain foods and beverages
Warnings
Allergy alert: Do not use if you are allergic to ranitidine or other acid reducers
Do not use
if you have trouble or pain swallowing food, vomiting with blood, or bloody or black stools. These may be signs of a serious condition. See your doctor.
with other acid reducers
Ask a doctor before use if you have
frequent chest pain
frequent wheezing, particularly with heartburn
unexplained weight loss
nausea or vomiting
stomach pain
had heartburn over 3 months. This may be a sign of a more serious condition
heartburn with lightheadedness, sweating or dizziness
chest pain or shoulder pain with shortness of breath; sweating; pain spreading to arms, neck or shoulders; or lightheadedness
Stop use and ask a doctor if
your heartburn continues or worsens
you need to take this product for more than 14 days
If pregnant or breast-feeding,
ask a health professional before use.
Keep out of reach of children.
In case of overdose, get medical help or contact a Poison Control Center right away.
Directions
adults and children 12 years and over:
to relieve symptoms, swallow 1 tablet with a glass of water
to prevent symptoms, swallow 1 tablet with a glass of water 30 to 60 minutes before eating food or drinking beverages that cause heartburn
can be used up to twice daily (do not take more than 2 tablets in 24 hours)
children under 12 years: ask a doctor
Other information
do not use if printed foil under cap is broken or missing
Chronic heartburn caused by acid reflux is one of the most common complaints among Americans, and a new study outlines which approaches appear to work best to …
Generic Name: sunitinib (soo NIT in ib)
Brand Names: Sutent
What is sunitinib?
Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.
Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.
Sunitinib may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about sunitinib?
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.
Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.
To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.
Stop using sunitinib and call your doctor at once if you have chest pain, shortness of breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.
What should I discuss with my healthcare provider before using sunitinib?
You should not use this medication if you are allergic to it.
If you have any of these other conditions, you may need a dose adjustment or special tests to safely use this medication:
high blood pressure;
a thyroid disorder;
a heart rhythm disorder;
a personal or family history of “Long QT syndrome”;
a history of heart attack or congestive heart failure; or
a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).
If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.
FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib 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. It is not known if sunitinib 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 sunitinib?
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.
Your doctor may occasionally change your dose to make sure you get the best results from this medication.
Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.
Sunitinib may be taken with or without food.
To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.
Store sunitinib at room temperature away from moisture and heat.
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.
Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.
What should I avoid while taking sunitinib?
Avoid taking an herbal supplement containing St. John’s wort at the same time you are taking sunitinib.
Sunitinib 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 sunitinib and call your doctor at once if you have any of these serious side effects:
chest pain, general ill feeling;
uneven heart rate;
feeling short of breath, even with mild exertion;
swelling of your ankles or feet;
weakness, tired feeling, loss of appetite, weight loss;
sudden numbness or weakness, especially on one side of the body;
sudden headache, confusion, problems with vision, speech, or balance;
redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;
bloody, or black, tarry stools;
coughing up blood or vomit that looks like coffee grounds;
easy bruising or bleeding, unusual weakness; or
white patches or sores inside your mouth or on your lips.
Less serious side effects may include:
unusual or unpleasant taste in the mouth;
nausea, vomiting, stomach pain or upset;
diarrhea or constipation;
skin rash, hair loss, changes in skin or hair color; or
headache, joint 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 side effects to FDA at 1-800-FDA-1088.
Sunitinib Dosing Information
Usual Adult Dose for Renal Cell Carcinoma:
50 mg orally once a day with or without food.
Sunitinib is given on a schedule of four weeks on treatment followed by two weeks off treatment.
Usual Adult Dose for Gastrointestinal Stromal Tumor:
50 mg orally once a day with or without food.
Sunitinib is given on a schedule of four weeks on treatment followed by two weeks off treatment.
What other drugs will affect sunitinib?
Tell your doctor about all other medications you are using, especially:
clarithromycin (Biaxin), telithromycin (Ketek); or
HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).
This list is not complete and there may be other drugs that can interact with sunitinib. 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 sunitinib.
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.
Sunitinib malate belongs to the group of medicines known as antineoplastics. It is used to treat patients with gastrointestinal stromal tumor (GIST) when the medicine imatinib mesylate did not stop the cancer from growing or when the patient cannot take imatinib mesylate. GIST is a group of cancer cells that start growing in the wall of the stomach, intestines, or rectum. Sunitinib malate is also used to treat advanced (late-stage) kidney cancer.
Sunitinib malate interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by sunitinib malate, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur for months or years after the medicine is used.
Before you begin treatment with sunitinib malate, you and your doctor should talk about the good sunitinib malate will do as well as the risks of using it.
sunitinib malate is available only with your doctor’s prescription.
Importance of Diet
Grapefruit and grapefruit juice may change the amount of sunitinib malate in the body. You should not eat grapefruit or drink grapefruit juice while you are taking sunitinib malate.
Before Using sunitinib malate
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 sunitinib malate, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to sunitinib malate 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
Appropriate studies have not been performed on the relationship of age to the effects of sunitinib malate in the pediatric population. Safety and efficacy have not been established.
Geriatric
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of sunitinib malate in the elderly.
Pregnancy
Pregnancy Category
Explanation
All Trimesters
D
Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.
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 sunitinib malate with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Pimozide
Thioridazine
Using sunitinib malate 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.
Amiodarone
Arsenic Trioxide
Astemizole
Atazanavir
Bretylium
Carbamazepine
Cisapride
Clarithromycin
Dexamethasone
Disopyramide
Dofetilide
Halofantrine
Indinavir
Itraconazole
Ketoconazole
Lapatinib
Levofloxacin
Lumefantrine
Methadone
Moxifloxacin
Nefazodone
Nelfinavir
Nilotinib
Pazopanib
Phenobarbital
Phenytoin
Procainamide
Quinidine
Quinine
Ranolazine
Rifabutin
Rifampin
Rifapentine
Ritonavir
Saquinavir
Sodium Phosphate
Sotalol
St John’s Wort
Telavancin
Telithromycin
Terfenadine
Tetrabenazine
Voriconazole
Ziprasidone
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 sunitinib malate. Make sure you tell your doctor if you have any other medical problems, especially:
Bleeding problems or
High blood pressure or
Hyperthyroidism (overactive thyroid) or
Hypothyroidism (underactive thyroid) or
Kidney function problems (other than cancer) or
Liver problems or
Seizures or
Stomach ulcers—Use with caution. May make these conditions worse.
Electrolyte imbalance (e.g., low magnesium or potassium in the blood) or
Heart disease or
Heart rhythm problems (e.g., QT prolongation or slow heartbeat), history of—Patients with these conditions should be monitored closely when using sunitinib malate.
Infection, recent or
Surgery, recent or
Trauma or injury, recent—Your chances of having serious side effects may be increased.
Proper Use of sunitinib malate
Your doctor will tell you how much of sunitinib malate to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to.
You may take sunitinib malate with or without food. Do not open the capsules.
sunitinib malate comes with a patient information leaflet. Read and follow the instructions carefully. Ask your doctor if you have any questions.
Dosing
The dose of sunitinib malate 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 sunitinib malate. 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 (capsules):
For the treatment of GIST and late-stage kidney cancer:
Adults—50 milligrams (mg) once a day for four weeks (28 days) then stop for two weeks (14 days). The cycle may be repeated as long as your doctor tells you.
Children—Use and dose must be determined by your doctor.
Missed Dose
sunitinib malate needs to be given on a fixed schedule. If you miss a dose, call your doctor, home health caregiver, or treatment clinic for instructions.
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 sunitinib malate
It is very important that your doctor check your progress at regular visits to see if the medicine is working properly. Blood tests may be needed to check for unwanted effects.
If you are a woman who can get pregnant, your doctor may do tests to make sure you are not pregnant before starting sunitinib malate therapy.
Using sunitinib malate while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
Before you have any medical tests, tell the medical doctor in charge that you are taking sunitinib malate. The results of some tests may be affected by sunitinib malate.
Cancer medicines can cause nausea and/or vomiting in most people, sometimes even after receiving medicines to prevent it. Ask your doctor or nurse about other ways to control these side effects.
Sunitinib malate can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:
If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
Avoid contact sports or other situations where bruising or injury could occur.
Do not take St. John’s Wort while taking sunitinib malate.
sunitinib malate 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
Bleeding gums
bloating or swelling of the face, arms, hands, fingers, lower legs, or feet
blurred vision
chest pain
chills
confusion
coughing up blood
cracked lips
decreased urination
decreased urine output
diarrhea
difficulty in breathing or swallowing
dilated neck veins
dizziness
dry mouth
extreme fatigue
fainting
fast, slow, or irregular heartbeat
fever
headache
increase in heart rate
increased menstrual flow or vaginal bleeding
irregular breathing
labored breathing
lightheadedness
nervousness
nosebleeds
paralysis
pounding in the ears
prolonged bleeding from cuts
rapid breathing
rapid weight gain
red or black, tarry stools
red or dark brown urine
shortness of breath
sores, ulcers, or white spots on the lips, tongue, or inside the mouth
sunken eyes
swelling or inflammation of the mouth
thirst
tightness in the chest
tingling of the hands or feet
troubled breathing
unusual tiredness or weakness
unusual weight gain or loss
wheezing
wrinkled skin
yellow eyes or skin
Less common
Constipation
depressed mood
dry skin and hair
feeling cold
hair loss
indigestion
hoarseness or husky voice
loss of appetite
muscle cramps and stiffness
nausea
pain in the chest, groin, or legs, especially the calves
pain in the stomach, side, or abdomen, possibly radiating to the back
severe, sudden headache
slurred speech
sudden loss of coordination
sudden, severe weakness or numbness in the arm or leg
sudden, unexplained shortness of breath
vision changes
vomiting
Rare
Back pain
chest discomfort
cloudy or bloody urine
convulsions
darkening of the skin
drowsiness
general feeling of tiredness or weakness
irregular or slow heart rate
light-colored stools
mental depression
skin rash
stomach pain, continuing
swelling of the face, feet, or lower legs
Incidence not known
Cough
dark-colored urine
decreased frequency or amount of urine
increased thirst
lower back or side pain
muscle cramps or spasms
muscular pain, tenderness, wasting, or weakness
painful or difficult urination
pale skin
sore throat
sudden, severe chest pain
unusual bleeding or bruising
weight gain
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
Abdominal pain
acid or sour stomach
belching
blistering, peeling, redness, and/or swelling of the palms, hands, or bottoms of the feet
change in color of treated skin
change in taste
difficulty in moving
discouragement
excess air or gas in stomach or intestines
feeling sad or empty
full feeling
hair color changes
hair loss or thinning of the hair
heartburn
irritability
joint pain
lack of appetite
lack or loss of strength
loss of interest or pleasure
muscle aches or pains
numbness, pain, tingling, or unusual sensations in the palms of hands or bottoms of feet
pain or burning in the throat
passing gas
sleeplessness
stomach discomfort, upset, or pain
swollen joints
trouble concentrating
trouble sleeping
unable to sleep
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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Sunitinib inhibits multiple receptor tyrosine kinases, some of which are implicated in tumor growth, pathologic angiogenesis, and metastatic progression of cancer.
Pharmacokinetics
Absorption
T max between 6 and 12 h. Food does not affect bioavailability.
Distribution
Plasma protein binding is 95%. Protein binding of primary metabolite is 90%. Vd is 2,230 L. C max and AUC increase proportionally with the dose in the range of 25 to 100 mg.
Metabolism
Sunitinib and its active metabolite are metabolized by CYP3A4.
Elimination
Elimination in feces 61% and renal 16%. Oral Cl ranged from 34 to 62 L/h. Terminal t ½ of sunitinib and the primary metabolite are 40 to 60 h and 80 to 110 h, respectively. With repeat daily dosing, sunitinib accumulates 3- to 4-fold, and the primary active metabolite accumulates 7- to 10-fold. Steady-state concentrations of the primary drug and primary metabolite are achieved within 10 to 14 days. The combined plasma levels of sunitinib plus active metabolite range from 62.9 to 101 ng/mL.
Special Populations
Renal Function Impairment
No studies conducted.
Hepatic Function Impairment
No studies conducted.
Elderly
No clinically relevant effect.
Gender
No clinically relevant effect.
Indications and Usage
Treatment of GI stromal tumor after disease progression on, or intolerance to, imatinib mesylate; treatment of advanced renal cell carcinoma.
Contraindications
Standard considerations.
Dosage and Administration
GI Stromal Tumor Adults
PO 50 mg once daily on a schedule of 4 wk on treatment followed by 2 wk off treatment.
Renal Cell Carcinoma Adults
PO 50 mg once daily on a schedule of 4 wk on treatment followed by 2 wk off treatment.
Dose modification
Increase or decrease in 12.5 mg increments based on individual safety and tolerability. Reduce dose to minimum of 37.5 mg once daily if coadministered with strong CYP3A4 inhibitor. Increase dose to max of 87.5 mg if coadministered with CYP3A4 inducer.
General Advice
Administer without regard to meals. Administer with food if GI upset occurs.
Storage/Stability
Store capsules at controlled room temperature (59° to 86°F).
Limb pain/myalgia (14%); arthralgia (12%); back pain (11%).
Treatment of metastatic renal cell carcinoma
Arthralgia (28%); limb pain (18%); back pain, myalgia (17%).
Respiratory
Treatment of GI stromal tumor
Dyspnea (10%); cough (8%).
Treatment of metastatic renal cell carcinoma
Dyspnea (28%); cough (17%).
Miscellaneous
Treatment of GI stromal tumor
Fever (18%).
Treatment of metastatic renal cell carcinoma
Fever (15%).
Precautions
Monitor
Perform CBC with platelet count and serum chemistries, including phosphate, at the beginning of each treatment cycle. Monitor for clinical signs and symptoms of CHF. Consider baseline and periodic evaluations of left ventricular ejection fraction in patients with history of cardiac events within 12 mo prior to sunitinib administration (eg, coronary artery/peripheral artery bypass graft; MI; symptomatic CHF, cerebrovascular accident, or transient ischemic attack; pulmonary embolus). Monitor thyroid function in patient with symptoms suggestive of hypothyroidism. Monitor for myelosuppression and hypertension regularly during treatment.
Pregnancy
Category D .
Lactation
Undetermined.
Children
Safety and efficacy not established.
Adrenal function
Adrenal toxicity has been noted in animals. Abnormal adrenal function tests have been reported in patients during treatment. Monitor patients who experience stress (eg, severe infection, surgery, trauma) for adrenal insufficiency.
GI effects
Serious, sometimes fatal GI complications including GI perforation, have occurred rarely in patients with intra-abdominal malignancies treated with sunitinib.
Hemorrhagic events
Have been reported during treatment. Epistaxis was most commonly reported but rectal, gingival, upper GI, genital, and wound bleeding have been documented. Tumor-related hemorrhage has been observed.
Hypertension
May develop during treatment. Treat as needed with standard antihypertensive agents. Temporarily suspend therapy in cases of severe hypertension until hypertension has been controlled.
Left ventricular dysfunction
May occur or worsen during treatment. Interrupt therapy or reduce dose of sunitinib in patients without clinical evidence of heart failure who have an ejection fraction greater than 20% but less than 50% below baseline. Discontinue therapy if clinical manifestations of heart failure develop.
Pancreatitis
Has occurred rarely. Discontinue therapy and provide supportive care if patient develops symptoms of pancreatitis.
Overdosage
Symptoms
No overdose reported in clinical studies.
Patient Information
Advise patient or caregiver to read patient information leaflet carefully before starting therapy, and to read and check for new information each time the medication is refilled.
Advise patient that usual dose is 50 mg taken once daily for 4 wk followed by 2 wk off medication. Advise patient that the dose may be increased (when certain other medications are used concurrently), reduced, or the medication temporarily withheld, if bothersome side effects develop or when certain other medications are used concurrently.
Advise patient to take each dose without regard to meals but to take with food if stomach upset occurs.
Instruct patient not to change the dose or stop taking unless advised by health care provider.
Advise patient that sunitinib can cause high BP and to check BP periodically during treatment. Advise patient that BP medications may be needed to control elevated BP.
Instruct patient to immediately notify health care provider if any of the following occur: bleeding or unusual bruising; blistering, pain, redness, or swelling of palms or hands or soles of feet; chills, fever, sore throat, or other symptoms of infection; mouth sores; rapid weight gain or swelling in ankles and/or feet; rash or itching; unexplained shortness of breath.
Advise patient or caregiver that GI disorders (eg, diarrhea, indigestion, mouth sores, nausea, vomiting) occur commonly and to report intolerable GI symptoms to health care provider. Advise patient that additional therapy (eg, antidiarrheal, antiemetic) may be needed.
Advise patient that a yellowish skin discoloration may occur because of the color of drug.
Advise patient that skin changes (eg, dryness, thickening, cracking, blistering, or rash on palms of hands or soles of feet), and loss of skin or hair pigment may occur during treatment.
Caution women of childbearing potential to avoid becoming pregnant during treatment.
Instruct patient not to take St. John’s wort while taking sunitinib.
What is Sunkist Child Chewable with Iron (multivitamin with iron)?
Multivitamin are a combination of many different vitamins that are normally found in foods and other natural sources.
Iron is normally found in foods like red meat. In the body, iron becomes a part of your hemoglobin (HEEM o glo bin) and myoglobin (MY o glo bin). Hemoglobin carries oxygen through your blood to tissues and organs. Myoglobin helps your muscle cells store oxygen.
Multivitamin and iron are used to provide vitamins and iron that are not taken in through the diet. They are also used to treat iron or vitamin deficiencies caused by illness, pregnancy, poor nutrition, digestive disorders, and many other conditions.
Multivitamin and iron may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about Sunkist Child Chewable with Iron (multivitamin with iron)?
Never take more than the recommended dose of a multivitamin. Avoid taking any other multivitamin product within 2 hours before or after you take multivitamin with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects. Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects. Iron and other minerals contained in a multivitamin can also cause serious overdose symptoms if you take too much.
Overdose symptoms may include severe stomach pain, vomiting, bloody diarrhea, coughing up blood, constipation, loss of appetite, hair loss, peeling skin, warmth or tingly feeling, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine or stools, black and tarry stools, pale skin, easy bruising or bleeding, weakness, shallow breathing, weak and rapid pulse, pale skin, blue lips, and seizure (convulsions).
Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin with iron.
What should I discuss with my healthcare provider before taking Sunkist Child Chewable with Iron (multivitamin with iron)?
Iron and certain vitamins can cause serious or life-threatening side effects if taken in large doses. Do not take more of this medication than directed on the label or prescribed by your doctor.
If you have any medical conditions, ask your doctor before taking a multivitamin with iron. If you have certain conditions, you may need a certain vitamin formulation or special tests while taking this product.
Do not take multivitamin with iron without telling your doctor if you are pregnant or plan to become pregnant. Some vitamins and minerals can harm an unborn baby if taken in large doses. You may need to use a prenatal vitamin specially formulated for pregnant women. Multivitamin 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.
How should I take Sunkist Child Chewable with Iron (multivitamin with iron)?
Use this medication as directed on the label, or as your doctor has prescribed. Do not use the medication in larger amounts or for longer than recommended.
Never take more than the recommended dose of multivitamin with iron. Avoid taking any other multivitamin product within 2 hours before or after you take multivitamin with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.
Many multivitamin products also contain minerals such as calcium, magnesium, potassium, and zinc. Minerals (especially taken in large doses) can cause side effects such as tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, and muscle weakness or limp feeling. Read the label of any multivitamin product you take to make sure you are aware of what it contains.
Take your multivitamin with a full glass of water. You may take the multivitamin with food if it upsets your stomach.
The chewable tablet must be chewed or allowed to dissolve in the mouth before swallowing.
Measure the liquid form of this multivitamin using a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.
Liquid multivitamin may sometimes be mixed with water, fruit juice, or infant formula (but not milk or other dairy products). Follow the directions on the medicine label.
Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.
It is important to take multivitamin with iron regularly to get the most benefit.
Store this medication at room temperature away from moisture and heat. Keep the liquid medicine from freezing.
Store multivitamin in their original container. Storing multivitamin in a glass container can ruin the medication.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects. Iron and other minerals contained in a multivitamin can also cause serious overdose symptoms.
Overdose symptoms may include severe stomach pain, vomiting, bloody diarrhea, coughing up blood, constipation, loss of appetite, hair loss, peeling skin, warmth or tingly feeling, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine or stools, black and tarry stools, pale skin, easy bruising or bleeding, weakness, shallow breathing, weak and rapid pulse, pale skin, blue lips, and seizure (convulsions).
What should I avoid while taking Sunkist Child Chewable with Iron (multivitamin with iron)?
Avoid taking any other multivitamin product within 2 hours before or after you take multivitamin with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.
Avoid the regular use of salt substitutes in your diet if your multivitamin contains potassium. If you are on a low-salt diet, ask your doctor before taking a vitamin or mineral supplement.
Avoid taking an antibiotic medicine within 2 hours before or after you take multivitamin with iron. This is especially important if you are taking an antibiotic such as ciprofloxacin (Cipro), demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), levofloxacin (Levaquin), lomefloxacin (Maxaquin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), norfloxacin (Noroxin), ofloxacin (Floxin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).
Certain foods can also make it harder for your body to absorb iron. Avoid taking this multivitamin within 1 hour before or 2 hours after eating fish, meat, liver, and whole grain or “fortified” breads or cereals.
Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin.
Sunkist Child Chewable with Iron (multivitamin with iron) 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 if you have serious side effects such as:
bright red blood in your stools; or
pain in your chest or throat when swallowing a ferrous fumarate tablet.
When taken as directed, multivitamin are not expected to cause serious side effects. Less serious side effects may include:
constipation, diarrhea;
nausea, vomiting, heartburn;
stomach pain, upset stomach;
black or dark-colored stools or urine;
temporary staining of the teeth;
headache; or
unusual or unpleasant taste in your mouth.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect Sunkist Child Chewable with Iron (multivitamin with iron)?
Vitamin and mineral supplements can interact with certain medications, or affect how medications work in your body. Before taking multivitamin with iron, tell your doctor if you also use:
trimethoprim and sulfamethoxazole (Cotrim, Bactrim, Septra, TMP/SMX); or
an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), and others.
This list is not complete and there may be other medications that can interact with or be affected by multivitamin with iron. 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 multivitamin with iron.
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.