Generic Name: s-adenosylmethionine (s ad in O si l met hi o nine)
Brand Names:

What is s-adenosylmethionine?

S-adenosylmethionine is a naturally occurring chemical in the body.

S-adenosylmethionine has been used for depression, osteoarthritis, joint health and liver problems.

S-adenosylmethionine has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of s-adenosylmethionine may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold which were contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

S-adenosylmethionine may also have uses other than those listed in this medication guide.

The use of s-adenosylmethionine in cultural and traditional settings may differ from concepts accepted by current Western medicine. When considering the use of herbal/health supplements, consultation with a primary health care professional is advisable. 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.

What is the most important information I should know about s-adenosylmethionine?

S-adenosylmethionine has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of s-adenosylmethionine may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold which were contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Talk to your doctor before taking s-adenosylmethionine if you are taking anti-depressant medications. Do not stop or adjust your dose of anti-depressant medication without first talking to your doctor.

What should I discuss with my healthcare provider before taking s-adenosylmethionine?

Before taking s-adenosylmethionine, talk to your doctor, pharmacist, or health care professional if you have any other medical conditions, allergies, or if you take other medicines or other herbal/health supplements. S-adenosylmethionine may not be recommended in some situations.

Talk to your doctor before taking s-adenosylmethionine if you are taking anti-depressant medications. Do not stop or adjust your dose of anti-depressant medication without first talking to your doctor.

Do not take s-adenosylmethionine without first talking to your doctor if you are pregnant or could become pregnant. Do not take s-adenosylmethionine without first talking to your doctor if you are breast-feeding a baby. There is no information available regarding the use of s-adenosylmethionine by children. Do not give any herbal/health supplement to a child without first talking to the child’s doctor.

How should I take s-adenosylmethionine?

If you choose to take s-adenosylmethionine, use it as directed on the package or as directed by your doctor, pharmacist, or other health care provider.

Do not use different formulations (e.g., tablets and powder) of s-adenosylmethionine at the same time, unless specifically directed to do so by a health care professional.

Store s-adenosylmethionine as directed on the package. In general, s-adenosylmethionine should be protected from light and moisture and stored in a sealed container.

What happens if I miss a dose?

No information is available regarding a missed dose of s-adenosylmethionine. Consult your doctor, pharmacist, or health care professional if you require further information.

What happens if I overdose?

Seek emergency medical attention if an overdose is suspected.

Symptoms of a s-adenosylmethionine overdose are not known.

What should I avoid while taking s-adenosylmethionine?

There are no known restrictions on food, beverages, or activity while taking s-adenosylmethionine, unless otherwise directed by your health care professional.

S-adenosylmethionine side effects

Stop taking s-adenosylmethionine and seek emergency medical attention if you experience symptoms of a serious allergic reaction including difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives.

Other less serious side effects of s-adenosylmethionine may include stomach ache, nausea, diarrhea, gas, anxiety, spasms and insomnia. Talk to your doctor, pharmacist, or health care professional if you experience any side effects from s-adenosylmethionine.

What other drugs will affect s-adenosylmethionine?

Interactions between s-adenosylmethionine and other prescription or over-the-counter medicines or herbal/health supplements have not been reported. Talk to your doctor, pharmacist, or health care professional before taking s-adenosylmethionine if you are taking any other medicines or supplements.

Where can I get more information?

• Your doctor, pharmacist, or health care provider may have more information about s-adenosylmethionine.

• 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.

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.01. Revision Date: 8/31/05 12:25:38 PM.

Generic Name: chlorpheniramine and hydrocodone (KLOR fen IR a meen and HYE droe KOE done)
Brand Names: HyTan, Novasus, S-T Forte 2, TussiCaps, Tussionex PennKinetic

What is S-T Forte 2 (chlorpheniramine and hydrocodone)?

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

Hydrocodone is a narcotic cough suppressant.

The combination of chlorpheniramine and hydrocodone is used to treat runny or stuffy nose, sneezing, and cough caused by the common cold or flu.

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

What is the most important information I should know about S-T Forte 2 (chlorpheniramine and hydrocodone)?

Do not take this medication more often than prescribed. An overdose of chlorpheniramine and hydrocodone can cause life-threatening side effects. To be sure you get the correct dose, measure this medicine carefully with a marked measuring spoon or syringe, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Before you take chlorpheniramine and hydrocodone, tell your doctor if you have asthma or another breathing disorder, a history of head injury or brain tumor, stomach or intestinal problems, liver or kidney disease, glaucoma, urination problems or an enlarged prostate, Addison’s disease, or underactive thyroid.

Chlorpheniramine and hydrocodone can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol while using chlorpheniramine and hydrocodone. Alcohol may increase drowsiness and dizziness. Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. This medication should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Do not give this medicine to a child younger than 6 years old.

What should I discuss with my healthcare provider before taking S-T Forte 2 (chlorpheniramine and hydrocodone)?

You should not take this medication if you are allergic to chlorpheniramine or hydrocodone.

Before taking chlorpheniramine and hydrocodone, tell your doctor if you are allergic to any drugs, or if you have:

• asthma or other breathing disorder;

• a history of head injury or brain tumor;

• stomach or intestinal problems;

• liver or kidney disease;

• glaucoma;

• urination problems or an enlarged prostate;

• Addison’s disease; or

• underactive thyroid.

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

FDA pregnancy category C. Chlorpheniramine and hydrocodone 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 chlorpheniramine and hydrocodone passes into breast milk or if it could harm a nursing baby. Do not take this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more likely to have side effects from this medicine. Do not give chlorpheniramine and hydrocodone to a child younger than 6 years old.

How should I take S-T Forte 2 (chlorpheniramine and hydrocodone)?

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.

Do not take this medication more often than you doctor has prescribed. An overdose of chlorpheniramine and hydrocodone can cause life-threatening side effects. Shake the oral solution (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid carefully with a marked measuring spoon or syringe, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Do not mix this medicine with any other liquid before taking it. Chlorpheniramine and hydrocodone can be taken with food if it upsets your stomach. Store chlorpheniramine and hydrocodone at room temperature away from moisture and heat. Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. This medication should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of chlorpheniramine and hydrocodone can be fatal, especially to a child.

Overdose symptoms may include dry mouth, cold and clammy skin, flushing, large pupils, nausea, vomiting, severe dizziness or drowsiness, seizure (convulsions), shallow breathing, slow heart rate, blue colored skin, feeling light-headed, or fainting.

What should I avoid while taking S-T Forte 2 (chlorpheniramine and hydrocodone)?

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol while using chlorpheniramine and hydrocodone. Alcohol may increase drowsiness and dizziness.

S-T Forte 2 (chlorpheniramine and hydrocodone) 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:

• weak or shallow breathing;

• chest tightness;

• painful urination;

• urinating less than usual or not at all; or

• confusion, hallucinations, or unusual behavior.

Less serious side effects may include:

• dizziness, drowsiness, trouble concentrating;

• mood changes, anxiety;

• blurred vision;

• constipation, nausea, vomiting, loss of appetite;

• dry mouth or throat;

• sweating; or

• mild itching or skin rash.

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 S-T Forte 2 (chlorpheniramine and hydrocodone)?

Narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by chlorpheniramine and hydrocodone. Tell your doctor if you regularly use any of these medicines, or any other cold or allergy medicine.

Tell your doctor about all other medications you use, especially:

• atropine (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm-Scop);

• bronchodilators such as ipratroprium (Atrovent) or tiotropium (Spiriva);

• glycopyrrolate (Robinul);

• mepenzolate (Cantil);

• bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);

• irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin, and others), or propantheline (Pro-Banthine); or

• an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

This list is not complete and there may be other drugs that can interact with chlorpheniramine and hydrocodone. 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 chlorpheniramine and hydrocodone.

• 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: 2.04. Revision Date: 4/12/2009 4:40:53 PM.

Generic Name: Chlorpheniramine/Hydrocodone (klor-fen-EER-a-meen/hye-droe-KOE-done)
Brand Name: S-T Forte 2

S-T Forte 2 Liquid is used for:

Treating symptoms of the common cold, flu, or hayfever, and other upper respiratory allergies such as cough, runny nose, sneezing, itching of the nose and throat, and itchy, watery eyes. S-T Forte 2 Liquid may also be used for other conditions as determined by your doctor.

S-T Forte 2 Liquid is a narcotic antitussive (cough suppressant) and antihistamine combination. The antitussive (hydrocodone) works by suppressing the cough center in the brain. The antihistamine (chlorpheniramine) works by blocking the action of histamine, which reduces the symptoms of an allergic reaction such as itch, watery eyes and runny nose.

Do NOT use S-T Forte 2 Liquid if:

• you are allergic to any ingredient in S-T Forte 2 Liquid or any other codeine-related medicine (eg, codeine)
• you have diarrhea associated with poisoning, antibiotic use, or a bacterial infection (from eating or drinking contaminated food or water)
• you are taking sodium oxybate (GHB)

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

Before using S-T Forte 2 Liquid:

Some medical conditions may interact with S-T Forte 2 Liquid. 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 or have ever had alcoholism, substance abuse, narcotic dependence, or if you consume more than 3 alcoholic drinks per day
• if you have considered or attempted suicide
• if you have increased pressure in the eyes, glaucoma, or are at risk for glaucoma
• if you have acute head injury, increased pressure in the head, brain injury or tumor, epilepsy or seizures, or Reye syndrome
• if you are having an asthma attack, or have lung disease, including shortness of breath or sleep apnea
• if you have a stomach or intestinal problem, chronic inflammation and ulceration of the bowel or recent abdominal surgery; chronic constipation; difficulty urinating; enlargement of the prostate gland; heart problems, including heart failure; low blood pressure; liver problems; Parkinson disease; porphyria; stomach, intestinal, or urinary blockage; or thyroid problems

Some MEDICINES MAY INTERACT with S-T Forte 2 Liquid. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Barbiturate anesthetics (eg, thiopental), cimetidine, ketorolac, naltrexone, or sodium oxybate (GHB) because the risk of side effects of S-T Forte 2 Liquid, including dangerous sleepiness and a decrease in the ability to breathe, may be increased
• Rifampin or risperidone because they may decrease S-T Forte 2 Liquid’s effectiveness
• Hydantoins (eg, phenytoin) because their actions and the risk of their side effects may be increased by S-T Forte 2 Liquid
• Mexiletine because its effectiveness may be decreased by S-T Forte 2 Liquid
• Naltrexone because the effectiveness of S-T Forte 2 Liquid will be decreased and withdrawal symptoms may occur in patients who have become physically dependent on opioids. You must not take naltrexone until you have stopped taking S-T Forte 2 Liquid for 7 to 10 days and after a naloxone challenge test is negative.

This may not be a complete list of all interactions that may occur. Ask your health care provider if S-T Forte 2 Liquid 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 S-T Forte 2 Liquid:

Use S-T Forte 2 Liquid as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take S-T Forte 2 Liquid by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
• Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
• If you miss a dose of S-T Forte 2 Liquid and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use S-T Forte 2 Liquid.

Important safety information:

• S-T Forte 2 Liquid may cause drowsiness or dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use S-T Forte 2 Liquid with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
• Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using S-T Forte 2 Liquid; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
• If your symptoms do not get better within 7 days or if you develop a high fever or persistent headache, check with your doctor.
• Use S-T Forte 2 Liquid with caution in the ELDERLY; they may be more sensitive to its effects, especially possible breathing problems and drowsiness.
• S-T Forte 2 Liquid should not be used in CHILDREN younger than 6 months old; safety and effectiveness in these children have not been confirmed.
• PREGNANCY and BREAST-FEEDING: S-T Forte 2 Liquid has been shown to cause harm to the fetus, especially during the last 3 months of pregnancy. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using S-T Forte 2 Liquid while you are pregnant. S-T Forte 2 Liquid is found in breast milk. If you are or will be breast-feeding while you use S-T Forte 2 Liquid, check with your doctor. Discuss any possible risks to your baby.

When used for long periods of time or at high doses, S-T Forte 2 Liquid may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if S-T Forte 2 Liquid stops working well. Do not take more than prescribed.

Some people who use S-T Forte 2 Liquid for a long time without a break may develop a physical need to continue taking it. This is known as physical DEPENDENCE. The early sign of addiction is medicine ineffectiveness. Dependence is not an issue in terminal illness where pain relief is more important. If using S-T Forte 2 Liquid for an extended period of time, do not suddenly stop taking S-T Forte 2 Liquid without your doctor’s approval. If you suddenly stop taking S-T Forte 2 Liquid, you may experience WITHDRAWAL symptoms, including anxiety; diarrhea; fever; runny nose or sneezing; goose bumps and abnormal skin sensations; nausea and vomiting; pain; rigid muscles; seeing, hearing, or feeling things that are not there; shivering or tremors; sweating; trouble sleeping. Contact your doctor if you notice any of these symptoms after stopping this medication.

Possible side effects of S-T Forte 2 Liquid:

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:

Constipation; dizziness; drowsiness; dry mouth, throat, or nose; excitement; nausea; stomach upset; thickening or mucus in nose or throat.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); difficulty urinating; flushing or redness of face; rapid or pounding heartbeat.

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. Symptoms may include agitation; coma; confusion; deep sleep or loss of consciousness; difficulty breathing; diminished mental alertness; hallucinations; hot or cold skin; large and unchanging pupils; sedation; seizures; shaking; sleeplessness; slowed breathing; slow heartbeat.

Proper storage of S-T Forte 2 Liquid:

Store S-T Forte 2 Liquid at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep S-T Forte 2 Liquid out of the reach of children and away from pets.

General information:

• If you have any questions about S-T Forte 2 Liquid, please talk with your doctor, pharmacist, or other health care provider.
• S-T Forte 2 Liquid 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 S-T Forte 2 Liquid. 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.