What is oral cyanocobalamin?

Cyanocobalamin, also known as Vitamin B12, is a form of vitamin B found in foods. Vitamin B12 is important for growth, cell reproduction and energy, healthy red blood cell formation and to keep your nerve cells healthy.

Cyanocobalamin is likely effective in alternative medicine as an aid in treating or preventing low levels of vitamin B12 in your body. Low levels of Vitamin B12 can be caused by an autoimmune disease, pernicious anemia, certain types of surgery, stomach disorders, or malnutrition.

Cyanocobalamin has been used in alternative medicine as a possibly effective aid in treating canker sores, and may help lower homocysteine levels in blood (a risk factor for heart disease).

Cyanocobalamin has also been used to treat memory and thinking problems, Alzheimer’s disease, reduce falls, help with bone health, cataracts, and sleep disorders. However, research has shown that cyanocobalamin may not be effective in treating these conditions.

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

Oral cyanocobalamin side effects

Get emergency medical help if you have signs of an allergic reaction: hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Less serious side effects may be more likely, and you may have none at all.

This is not a complete list of side effects and others may occur.

Warnings

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use cyanocobalamin if you are allergic to vitamin B12, cobalamin, or cobalt.

Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have ever had:

• any condition that makes it hard for your body to absorb nutrients from food (malabsorption);
• cancer; or
• if you use a blood thinner (such as warfarin).

Ask a doctor before using cyanocobalamin if you are pregnant or breastfeeding.

Do not give cyanocobalamin to a child without medical advice.

How should I use oral cyanocobalamin?

When considering the use of cyanocobalamin, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use cyanocobalamin, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Do not use different forms of cyanocobalamin (pills, liquids, and others) at the same time or you could have an overdose.

Carefully follow instructions about whether to take your cyanocobalamin with or without food.

Swallow the extended-release tablet whole and do not crush, chew, or break it.

You must chew the chewable tablet thoroughly before you swallow it.

Measure cyanocobalamin liquid with the supplied measuring device (not a kitchen spoon).

Do not swallow a lozenge, disintegrating tablet, or sublingual tablet whole. Allow it to dissolve in your mouth without chewing. sublingual tablet or liquid should be placed under your tongue.

If you need surgery, tell the surgeon ahead of time that you are using cyanocobalamin. You may need to stop using cyanocobalamin for a short time.

Cyanocobalamin can affect the results of certain lab tests. Tell any doctor who treats you that you are using cyanocobalamin.

The recommended daily dose of cyanocobalamin changes with age. Follow your healthcare provider’s instructions. You may also consult the Office of Dietary Supplements of the NIH, or the USDA Nutrient Database of recommended daily allowances for more information.

Call your doctor if the condition you are treating with cyanocobalamin does not improve, or if it gets worse while using this product.

Store at room temperature away from moisture, heat, and light.

Store the cyanocobalamin liquid in the refrigerator after opening for best results.

Cyanocobalamin dosing information

Usual Adult Dose for Pernicious Anemia:

Initial dose: 100 mcg intramuscularly or deep subcutaneous once a day for 6 to 7 days
If clinical improvement and reticulocyte response is seen from the above dosing:
-100 mcg every other day for 7 doses, then:
-100 mcg every 3 to 4 days for 2 to 3 weeks, then:
Maintenance dose: 100 to 1000 mcg monthly
Duration of therapy: Life

Comments:
-Administer concomitant folic acid if needed.
-Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption.

Usual Adult Dose for B12 Nutritional Deficiency:

25 to 2000 mcg orally daily

Usual Adult Dose for Schilling Test:

1000 mcg intramuscularly is the flushing dose

Usual Pediatric Dose for B12 Nutritional Deficiency:

0.5 to 3 mcg daily

What happens if I miss a dose?

Use cyanocobalamin as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while using oral cyanocobalamin?

Avoid drinking large amounts of alcohol. Heavy drinking can make it harder for your body to absorb cyanocobalamin.

What other drugs will affect oral cyanocobalamin?

Do not use cyanocobalamin without medical advice if you are using any of the following medications:

• vitamin C supplements;
• folic acid;
• potassium supplements;
• oral diabetes medicine that contains metformin; or
• medicines that reduce stomach acid, such as cimetidine, omeprazole, lansoprazole, Nexium, Prevacid, Prilosec, Zantac, and others.

What is calcium carbonate?

Calcium is a mineral that is found naturally in foods. Calcium is necessary for many normal functions of the body, especially bone formation and maintenance.

Calcium carbonate is used to prevent or to treat a calcium deficiency.

There are many brands and forms of calcium carbonate available. Not all brands are listed on this leaflet.

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

Calcium carbonate side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Calcium carbonate may cause serious side effects. Call your doctor at once if you have:

• little or no urinating;
• swelling, rapid weight gain; or
• high levels of calcium in your blood–nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, confusion, lack of energy, or feeling tired.

Common side effects of calcium carbonate may include:

• upset stomach, gas; or
• constipation.

This is not a complete list of side effects and others may occur.

Warnings

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

Ask a doctor or pharmacist if it is safe for you to take calcium carbonate if you have ever had:

• kidney disease;
• kidney stones;
• cancer;
• a parathyroid gland disorder; or
• high levels of calcium in your blood.

Ask a doctor before using calcium carbonate if you are pregnant or breast-feeding. Your dose needs may be different during pregnancy or while you are nursing.

How should I take calcium carbonate?

Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Check the label of your calcium carbonate product to see if it should be taken with or without food.

Swallow the calcium carbonate regular tablet with a full glass of water.

The chewable tablet should be chewed before you swallow it.

Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Use the calcium carbonate powder as directed. Allow the powder to dissolve completely, then consume the mixture.

Calcium carbonate may be only part of a complete program of treatment that also includes dietary changes. Learn about the foods that contain calcium.

Your calcium carbonate dose may need to be adjusted as you make changes to your diet. Follow your doctor’s instructions very closely.

Store at room temperature away from moisture and heat. Do not freeze.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line.

What should I avoid while taking calcium carbonate?

Ask a doctor or pharmacist before taking any multivitamins, mineral supplements, or antacids while you are taking calcium carbonate.

What other drugs can affect calcium carbonate?

Calcium can make it harder for your body to absorb certain medicines. If you take other medications, take them at least 2 hours before or 4 or 6 hours after you take calcium carbonate.

Other drugs may interact with calcium carbonate, including prescription and over-the-counter medicines, vitamins, and herbal products. 

What is Crestor?

Crestor belongs to a group of drugs called HMG CoA reductase inhibitors, or “statins.” Rosuvastatin is used together with diet to lower blood levels of “bad” cholesterol (low-density lipoprotein, or LDL), to increase levels of “good” cholesterol (high-density lipoprotein, or HDL), and to lower triglycerides (a type of fat in the blood).

Crestor is used in adults and children who are at least 8 years old to lower cholesterol and triglycerides in the blood.

Crestor is used in adults to slow the progression of atherosclerosis (a build-up of plaque in blood vessels that can block blood flow).

Crestor is used to lower the risk of stroke, heart attack, and certain other heart complications in men 50 years and older and women 60 years and older who have coronary heart disease or other risk factors.

Crestor is also used to treat hereditary forms of high cholesterol, including the heterozygous type (inherited from one parent) and the homozygous type (inherited from both parents). For the heterozygous type, Crestor can be used in children who are at least 8 years old. For the homozygous type, this medicine can be used in children as young as 7 years old.

Warnings

Crestor can harm an unborn baby or cause birth defects. Do not use rosuvastatin if you are pregnant.

Before taking Crestor, tell your doctor if you have ever had liver or kidney disease, diabetes, or a thyroid disorder, if you are of Chinese descent, or if you drink more than 2 alcoholic beverages daily.

In rare cases, Crestor can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness especially if you also have fever, unusual tiredness, and dark colored urine.

You should not take rosuvastatin if you have liver disease, or if you are breastfeeding a baby.

Avoid eating foods that are high in fat or cholesterol. Crestor will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan.

There are many other drugs that can increase your risk of serious medical problems if you take them together with Crestor. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Crestor is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

Before taking this medicine

You should not take Crestor if you are allergic to rosuvastatin, or if you have:

• liver disease/high levels of liver enzymes in your blood; or
• if you are pregnant or breastfeeding.

Do not take Crestor if you are pregnant. Rosuvastatin could harm the unborn baby or cause birth defects. Stop taking this medicine and tell your doctor right away if you become pregnant. Use effective birth control to prevent pregnancy while you are taking this medicine.

Rosuvastatin may pass into breast milk and could harm a nursing baby. Do not breastfeed while you are taking this medicine.

To make sure Crestor is safe for you, tell your doctor if you have ever had:

• liver problems;
• kidney disease;
• a thyroid disorder;
• a habit of drinking more than 2 alcoholic beverages per day;
• if you are of Asian descent; or
• if you are 65 or older.

Crestor can cause the breakdown of muscle tissue, which can lead to kidney failure. This happens more often in women, in older adults, or people who have kidney disease or poorly controlled hypothyroidism (underactive thyroid).

People of Asian descent may absorb rosuvastatin at a higher rate than other people which may cause muscle weakness/dysfunction. Make sure your doctor knows if you are Asian. You may need a lower than normal starting dose.

How should I take Crestor?

Take Crestor exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Crestor is usually taken once a day, with or without food. Take the medicine at the same time each day.

While using this medicine, you may need frequent blood tests.

Keep using this medicine as directed, even if you feel well. High cholesterol usually has no symptoms. You may need to take Crestor on a long-term basis.

You may need to stop using this medicine for a short time if you have:

• uncontrolled seizures;
• an electrolyte imbalance (such as high or low potassium levels in your blood);
• severely low blood pressure;
• a severe infection or illness;
• dehydration; or
• surgery or a medical emergency.

You should not stop using Crestor unless your doctor tells you to.

Crestor is only part of a treatment program that may also include diet, exercise, and weight control. Follow your doctor’s instructions very closely.

Store at room temperature away from moisture, heat, and light.

Dosing information

Usual Adult Dose for Hyperlipoproteinemia:

Initial dose: 5 mg to 10 mg once a day with or without food
Maintenance dose: 5 mg to 40 mg once a day with or without food

Usual Adult Dose for Hyperlipoproteinemia Type IIa (Elevated LDL):

Initial dose: 5 mg to 10 mg once a day with or without food
Maintenance dose: 5 mg to 40 mg once a day with or without food

Usual Adult Dose for Hyperlipoproteinemia Type IIb (Elevated LDL + VLDL):

Initial dose: 5 mg to 10 mg once a day with or without food
Maintenance dose: 5 mg to 40 mg once a day with or without food

Usual Adult Dose for Hyperlipoproteinemia Type IV (Elevated VLDL):

Initial dose: 5 mg to 10 mg once a day with or without food
Maintenance dose: 5 mg to 40 mg once a day with or without food

Usual Adult Dose for Atherosclerosis:

Initial dose: 5 mg to 10 mg once a day with or without food
Maintenance dose: 5 mg to 40 mg once a day with or without food

Usual Adult Dose for Homozygous Familial Hypercholesterolemia:

Initial dose: 20 mg once a day with or without food
Maintenance dose: 20 mg to 40 mg once a day with or without food

Usual Adult Dose for Prevention of Cardiovascular Disease:

Initial dose: 5 mg to 10 mg once a day with or without food Maintenance dose: 5 mg to 40 mg once a day with or without food

Response to therapy should be estimated from preapheresis LDL-C levels.

Usual Geriatric Dose for Hyperlipidemia:

Initial dose: 5 mg once a day with or without food
Maintenance dose: 5 mg to 20 mg once a day with or without food

Usual Pediatric Dose for Heterozygous Familial Hypercholesterolemia:

Pediatric patients 10 to 17 years of age:

Usual dose range: 5 to 20 mg orally once a day with or without food. Doses should be individualized according to the recommended goal of therapy. Adjustments should be made at intervals of 4 weeks or more.

Maximum dose: 20 mg orally once a day

What happens if I miss a dose?

Take the missed dose as soon as you remember. If you are more than 12 hours late, skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line.

Avoid eating foods high in fat or cholesterol, or Crestor will not be as effective.

Avoid drinking alcohol. It can raise triglyceride levels and may increase your risk of liver damage.

Avoid using antacids without your doctor’s advice. Use only the type of antacid your doctor recommends, and do not take it within 2 hours after taking Crestor. Some antacids can make it harder for your body to absorb rosuvastatin.

Avoid eating foods that are high in fat or cholesterol. Crestor will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan.

Crestor side effects

Get emergency medical help if you have any signs of an allergic reaction to Crestor: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• unexplained muscle pain, tenderness, or weakness;
• muscle weakness in your hips, shoulders, neck, and back;
• trouble lifting your arms, trouble climbing or standing;
• confusion, memory problems; or
• liver problems – upper stomach pain, tiredness, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes).

Common side effects may include:

• headache;
• weakness;
• muscle aches; or
• nausea, stomach pain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect Crestor?

When you start or stop taking Crestor, your doctor may need to adjust the doses of any other medicines you take on a regular basis. Using certain medicines together with rosuvastatin can increase your risk of serious muscle problems. It is very important to tell your doctor about all medicines you use, and those you start or stop using during your treatment with Crestor, especially:

• colchicine;
• cyclosporine;
• another “statin” medicine – atorvastatin, lovastatin, simvastatin, Lipitor, Pravachol, Zocor, Vytorin, and others;
• antiviral medicine to treat HIV or hepatitis C – atazanavir, fosamprenavir, ledipasvir, lopinavir, ritonavir, simeprevir, sofosbuvir, tipranavir, Epclusa, Mavyret, Viekira, Vosevi, and others;
• a blood thinner – warfarin, Coumadin, Jantoven;
• cancer medicine – darolutamide, regorafenib;
• other cholesterol medications – fenofibrate, gemfibrozil; or
• medicines that contain niacin or nicotinic acid – vitamin B3, Advicor, Niaspan, Niacor, Simcor, Slo-Niacin, and others.

Coumadin is an anticoagulant (blood thinner). Warfarin reduces the formation of blood clots.

Coumadin is used to treat or prevent blood clots in veins or arteries, which can reduce the risk of stroke, heart attack, or other serious conditions.

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

Warnings

You should not take Coumadin if you are prone to bleeding because of a medical condition, if you have an upcoming surgery, or if you need a spinal tap or epidural. Talk to your doctor if you think you will not be able to take Coumadin on time every day.

Warfarin increases your risk of severe or fatal bleeding, especially if you have certain medical conditions, if you are 65 or older, or if you have had a stroke, or bleeding in your stomach or intestines. Seek emergency help if you have any bleeding that will not stop.

Call your doctor at once if you have other signs of bleeding such as: swelling, pain, feeling very weak or dizzy, unusual bruising, bleeding gums, nosebleeds, heavy menstrual periods or abnormal vaginal bleeding, blood in your urine, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.

Many other drugs can increase your risk of bleeding when used with Coumadin. Tell your doctor about all medicines you have recently used.

Avoid making any changes in your diet without first talking to your doctor. Some foods can make warfarin less effective.

Before taking this medicine

You should not take Coumadin if you are allergic to warfarin, or if:

• you have malignant hypertension, which is a specific type of very high blood pressure that comes on suddenly and quickly;
• you recently had or will have surgery on your brain, spine, or eye;
• you undergo a spinal tap or spinal anesthesia (epidural); or
• if you think you will not be able to take Coumadin on time every day, talk to your prescriber about other treatment options.

You also should not take Coumadin if you are are prone to bleeding because of a medical condition, such as:

• a blood cell disorder (such as low red blood cells or low platelets);
• ulcers or bleeding in your stomach, intestines, lungs, or urinary tract;
• an aneurysm or bleeding in the brain; or
• an infection of the lining of your heart.

Do not take Coumadin if you are pregnant, unless your doctor tells you to. Warfarin can cause birth defects, but preventing blood clots may outweigh any risks to the baby. If you are not pregnant, use effective birth control to prevent pregnancy while taking warfarin and for at least 1 month after your last dose. Tell your doctor right away if you become pregnant.

Coumadin can make you bleed more easily, especially if you have ever had:

• high blood pressure or serious heart disease;
• kidney disease;
• cancer or low blood cell counts;
• an accident or surgery;
• bleeding in your stomach or intestines;
• a stroke; or
• if you are 65 or older.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• diabetes;
• congestive heart failure;
• liver disease, kidney disease (or if you are on dialysis);
• a hereditary clotting deficiency; or
• low blood platelets after receiving heparin.

It is not known whether warfarin passes into breast milk. Watch for signs of bruising or bleeding in the baby if you take Coumadin while you are breast-feeding a baby.

How should I take Coumadin?

Take Coumadin exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may change your dose based on your blood tests. Do not take warfarin in larger or smaller amounts or for longer than your doctor tells you to.

Take this medicine at the same time every day, with or without food. Never take a double dose.

Coumadin can make it easier for you to bleed. Seek emergency help if you have any bleeding that will not stop.

You will need frequent “INR” or prothrombin time tests (to measure your blood-clotting time and determine your warfarin dose). You must remain under the care of a doctor while taking Coumadin.

If you receive Coumadin in a hospital, call or visit your doctor 3 to 7 days after you leave the hospital. Your INR will need to be tested at that time. Do not miss any follow-up appointments.

Tell your doctor if you are sick with diarrhea, fever, chills, or flu symptoms, or if your body weight changes.

You may need to stop taking Coumadin 5 to 7 days before having any surgery, dental work, or a medical procedure. Call your doctor for instructions.

Wear a medical alert tag or carry an ID card stating that you take warfarin. Any medical care provider who treats you should know that you are taking this medicine.

Store at room temperature away from heat, moisture, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What to avoid

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth. You may still bleed more easily for several days after you stop taking Coumadin.

Avoid making any changes in your diet without first talking to your doctor. Foods that are high in vitamin K (liver, leafy green vegetables, or vegetable oils) can make warfarin less effective. If these foods are part of your diet, eat a consistent amount on a weekly basis.

Grapefruit juice, cranberry juice, noni juice, and pomegranate juice may interact with warfarin and lead to unwanted side effects. Avoid the use of these juice products while taking Coumadin.

Avoid drinking alcohol.

Ask your doctor before using any medicine for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. These medicines may affect blood clotting and may also increase your risk of stomach bleeding.

Coumadin side effects

Get emergency medical help if you have signs of an allergic reaction to Coumadin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Coumadin increases your risk of bleeding, which can be severe or life-threatening. Call your doctor at once if you have any signs of bleeding such as:

• sudden headache, feeling very weak or dizzy;
• swelling, pain, unusual bruising;
• bleeding gums, nosebleeds;
• bleeding from wounds or needle injections that will not stop;
• heavy menstrual periods or abnormal vaginal bleeding;
• blood in your urine, bloody or tarry stools; or
• coughing up blood or vomit that looks like coffee grounds.

Clots formed by Coumadin may block normal blood flow, which could lead to tissue death or amputation of the affected body part. Get medical help at once if you have:

• pain, swelling, hot or cold feeling, skin changes, or discoloration anywhere on your body; or
• sudden and severe leg or foot pain, foot ulcer, purple toes or fingers.

What other drugs will affect Coumadin?

Many drugs (including some over-the-counter medicines and herbal products) can affect your INR and may increase the risk of bleeding if you take them with Coumadin. Not all possible drug interactions are listed in this medication guide. It is very important to ask your doctor and pharmacist before you start or stop using any other medicine, especially:

• other medicines to prevent blood clots;
• an antibiotic or antifungal medicine;
• supplements that contain vitamin K; or
• herbal (botanical) products – coenzyme Q10, cranberry, echinacea, garlic, ginkgo biloba, ginseng, goldenseal, or St. John’s wort.

What is Cosentyx?

Cosentyx (secukinumab) is a prescription medicine used to treat plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and other inflammatory autoimmune conditions.

Cosentyx helps reduce skin lesions, joint pain, swelling, and spine inflammation by blocking interleukin-17A (IL-17A), a protein involved in immune and inflammatory responses. Cosentyx is a monoclonal antibody that acts as an interleukin-17A antagonist.

Cosentyx is administered once a month as a subcutaneous injection (under the skin), after an initial loading period. It can also be given as an intravenous (IV) Infusion for adults with psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis (nr-axSpA).

What is Cosentyx used for?

Cosentyx is FDA-approved to be used for:

• Plaque psoriasis: Moderate to severe, affecting large or multiple areas of the body, in patients 6 years and older who are candidates for systemic therapy or phototherapy.
• Psoriatic arthritis (PsA): Active disease in patients 2 years and older.
• Ankylosing spondylitis (AS): Active disease in adults.
• Non-radiographic axial spondyloarthritis (nr-axSpA): Active disease in adults with objective signs of inflammation.
• Enthesitis-related arthritis (ERA): Active disease in patients 4 years and older.
• Hidradenitis suppurativa (HS): Moderate to severe disease in adults.

Cosentyx FDA approval was first granted on January 21, 2015, for plaque psoriasis, and since then, its use has expanded to include these listed conditions.

How does Cosentyx work?

Cosentyx is an IL-17A antagonist. 

In autoimmune diseases, the immune system becomes overactive and produces excessive IL-17A, a cytokine (protein) that promotes inflammation, pain, and tissue damage.

Cosentyx works by binding to and blocking IL-17A, preventing it from triggering the inflammatory response. This helps calm the immune system, reduce inflammation, and relieve symptoms associated with these chronic conditions.

Cosentyx targets the underlying cause of inflammation rather than just masking symptoms.

Cosentyx side effects

Common Cosentyx side effects may include diarrhea and cold symptoms such as a stuffy nose, sneezing, and sore throat.

Serious Cosentyx side effects

Get emergency medical help if you have signs of an allergic reaction to Cosentyx with symptoms of hives, chest tightness, difficulty breathing, feeling like you might pass out, swelling of your face, lips, tongue, or throat.

This medicine can cause serious bacterial, viral, and fungal opportunistic infections. Call your doctor right away if you have signs of infection, such as

• redness, warmth, or painful sores on your skin;
• cough, shortness of breath, cough with red or pink mucus;
• increased urination, burning when you urinate;
• sores or white patches in your mouth or throat (yeast infection or “thrush”);
• new or worsening diarrhea or stomach pain; or
• fever, chills, sweating, muscle pain, weight loss.

Cases of Hepatitis B virus reactivation have occurred using this medicine.

Further doses may be delayed until your infection clears up.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects.

Warnings

You may get infections more easily while using Cosentyx, as it lowers your immune system’s ability to fight infections. Call your doctor right away if you have signs of infection such as fever, chills, sweats, muscle aches, skin sores, stomach pain, diarrhea, burning when you urinate, weight loss, cough, shortness of breath, or a cough with red or pink mucus.

Tell your doctor if you have an active infection or have ever been diagnosed with tuberculosis or inflammatory bowel disease before using this medicine.

Before using this medicine

You should not use Cosentyx if you are allergic to the active ingredients, secukinumab, or any of the inactive ingredients contained in the medicine.

Latex allergy. You should not handle the needle cap of the Cosentyx Sensoready pen, or the 75 mg/0.5 mL or 150 mg/mL prefilled syringes if you are sensitive to latex.

Tell your doctor if you’ve had or been exposed to tuberculosis, or if you recently traveled. Some infections are more common in certain parts of the world, and you may have been exposed during travel.

To make sure you can safely use Cosentyx, tell your doctor if you have ever had:

• an active or chronic infection;
• inflammatory bowel disease (Crohn’s disease or ulcerative colitis);
• an allergy to latex; or
• if you currently have signs of infection such as fever, sweats, chills, muscle pain, cough, shortness of breath, cough with bloody mucus, weight loss, skin sores, stomach pain, diarrhea, or painful urination.

Make sure you are current on all vaccines before you start using this medicine. You should not have any vaccinations during your treatment with Cosentyx without first talking to your doctor.

Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant. It is not known if Cosentyx can harm your unborn baby. You and your healthcare provider should decide if you will use this medicine.

Breastfeeding

Tell your doctor or healthcare professional if you are breastfeeding or plan to breastfeed. It is not known if Cosentyx passes into your breast milk.

How should I use Cosentyx?

Subcutaneous Cosentyx

Cosentyx subcutaneous injection can be self-administered or administered by a caregiver in your own home. Pediatric patients should not self-administer this medicine; an adult caregiver can inject this medicine after proper training in subcutaneous injection technique.

Subcutaneous Cosentyx instructions

• Take the injection pen out of the refrigerator and let it reach room temperature for 15 to 30 minutes before use. Give the injection within 1 hour after removing the medicine from the refrigerator.  Do not try to warm the medication by heating it in a microwave, placing it in hot water, or using any other method. 
• Prepare an injection only when you are ready to give it. You may need to use 2 injections to get your total dose.
• The solution should be clear or light yellow. Call your pharmacist if the liquid in your vial, pen, or syringe looks cloudy, has changed colors, or has particles in it.
• Do not shake the syringe or dosing pen.
• The injection can be given anywhere on the front of your thighs (upper leg), upper outer arms, or abdomen (stomach) except your navel and the area 2 inches (5 centimeters) around it. Do not inject into the same place two times in a row. Avoid injecting into the skin that is hard, red, bruised, swollen, tender, or affected by psoriasis. 
• Throw away a prefilled syringe or injection pen after one use, even if there is still medicine left inside.
• Do not reuse a needle or syringe. Place them in a puncture-proof “sharps” container and dispose of them following state or local laws. Keep out of the reach of children and pets.

Intravenous Cosentyx

Cosentyx can also be administered as an intravenous infusion by your healthcare professional (HCP) for adults with psoriatic arthritis (PsA), ankylosing spondylitis (AS), or non-radiographic axial spondyloarthritis (nr-axSPA). Cosentyx intravenous infusion should be administered over a period of 30 minutes

General information

You may get infections more easily, even serious infections. You will need frequent medical tests.

Use Cosentyx exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Ask your doctor or pharmacist if you don’t understand how to use an injection.

Cosentyx Dosing Information

Cosentyx is supplied as a Sensoready pen, UnoReady Pen prefilled syringe, or single-dose vial.

Intravenous dosing (administered by a healthcare provider)

Intravenous dosing can be used for psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis. Dilute before use. Administer infusion over 30 minutes.

• With a loading dose: 6 mg/kg initially at week 0 followed by 1.75 mg/kg every 4 weeks thereafter (maximum 300mg per infusion).
• Without a loading dose: 1.75 mg/kg every 4 weeks (maximum 300mg per infusion).

Subcutaneous dosing

Usual Adult Cosentyx Dose for Plaque Psoriasis

Dose:

• 300 mg subcutaneously at weeks 0, 1, 2, 3, and 4 followed by 300 mg every 4 weeks.
• Each 300 mg dose is given as 2 subcutaneous injections of 150 mg.
• For some patients, a dose of 150 mg subcutaneously may be acceptable.

Use: Moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy.

Usual Pediatric Dose for Plaque Psoriasis (6 years and older)

Dose:

• Dose is based on body weight, given by subcutaneous injection at Weeks 0, 1, 2, 3, and 4, followed by dosing every 4 weeks.
• Body weight less than 50kg: recommended dose is 75mg.
• Body weight is greater than or equal to 50kg: recommended dose 150mg.
• Safety and effectiveness of Cosentyx in pediatric patients with plaque psoriasis below the age of 6 years have not been established.

Use: Moderate to severe plaque psoriasis in pediatric patients 6 years and older who are candidates for systemic therapy or phototherapy.

Usual Adult Dose for Psoriatic Arthritis

Dose:

• With a loading dose: 150 mg subcutaneously at weeks 0, 1, 2, 3, and 4 and every 4 weeks thereafter.
• Without a loading dose: 150 mg subcutaneously every 4 weeks; if the patient continues to have active psoriatic arthritis, consider increasing the dose to 300 mg subcutaneously every 4 weeks.

Comments:

• For psoriatic arthritis patients with coexistent moderate to severe plaque psoriasis, use the dosage for plaque psoriasis.
• This drug may be administered with or without methotrexate.

Use: Active psoriatic arthritis.

Usual Pediatric Dose for Psoriatic Arthritis (2 years and older)

Dose:

• Dose is based on body weight, given by subcutaneous injection at Weeks 0, 1, 2, 3, and 4 followed by dosing every 4 weeks.
• Body weight 15 kg to less than 50kg: recommended dose is 75mg
• Body weight is greater than or equal to 50kg: recommended dose 150mg.
• The safety and effectiveness of Cosentyx in pediatric patients below the age of 2 years and with a body weight of less than 15 kg (33 pounds) have not been established.

Comment: This drug may be administered with or without methotrexate.

Use: Active psoriatic arthritis in patients 2 years and older.

Usual Adult Dose for Ankylosing Spondylitis

Dose:

• With a loading dose: 150 mg subcutaneously at weeks 0, 1, 2, 3, and 4 and every 4 weeks thereafter.
• Without a loading dose: 150 mg subcutaneously every 4 weeks.

Comment: If a patient continues to have active AS, consider a dosage of 300 mg every 4 weeks.

Uses: For active ankylosing spondylitis.

Usual Adult Dose for Non-Radiographic Axial Spondyloarthritis

Dose:

• The loading dosage is 150 mg at Weeks 0, 1, 2, 3, and 4 and every 4 weeks thereafter
• Without a loading dosage is 150 mg every 4 weeks

Use: Active non-radiographic axial spondyloarthritis (nr-axSpA) in adult patients who have objective signs of inflammation.

Usual Dose for Enthesitis-Related Arthritis 

Dose:

• Dose is based on body weight, given by subcutaneous injection at Weeks 0, 1, 2, 3, and 4 followed by dosing every 4 weeks.
• Body weight 15 kg to less than 50kg: the recommended dose is 75mg
• Body weight is greater than or equal to 50kg: recommended dose 150mg.

Use: Active enthesitis-related arthritis (ERA) in patients 4 years of age and older.

Usual Adult Dose for Hidradenitis Suppurativa

Dose:

• Recommended dosage is 300 mg administered by subcutaneous injection at Weeks 0, 1, 2, 3 and 4 and every 4 weeks thereafter.
• If a patient does not adequately respond, consider increasing the dosage to 300 mg every 2 weeks. 

Use: moderate to severe hidradenitis suppurativa (HS) in adults

Cosentyx products

Subcutaneous Injection

• Cosentyx Sensoready pen: 150 mg/mL single dose.
• Cosentyx UnoReady pen and single-dose prefilled syringe: 300 mg/2 mL.
• Cosentyx prefilled syringe (for pediatric patients less than 50 kg): 75 mg/0.5 mL single dose.

Intravenous Infusion

• Cosentyx injection: 125 mg/5 mL in a single-dose vial (healthcare professional use only)

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of Cosentyx.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while using Cosentyx?

Avoid receiving a “live” vaccine. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), and zoster (shingles).

What other drugs will affect Cosentyx?

Cosentyx may interact with other products, so tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Know the medicines you take and keep a list to show your healthcare provider and pharmacist when you start a new medicine or stop a regular medicine.

When starting or stopping this medicine, patients who are receiving a CYP450 substrate medicine, particularly those with a narrow therapeutic index,  your therapeutic effect or drug concentration monitored, and you may need to have a dosage adjustment of the CYP450 substrate. To check for interactions with Cosentyx, click on the link below.

Cosentyx Package Insert 

HCPs and patients often use the Cosentyx Package Insert (PI) for more detailed information about this medicine. The Package Insert contains more comprehensive information on Indications and Usage, Dosage and Administration, Clinical Pharmacology, Clinical Studies, Drug Interactions, and more. Discuss any medical questions you have with your HCP (health care professional). This is not all the information you need to know about this medicine for safe and effective use, and it does not take the place of talking to your doctor about your treatment.

The Package Insert is sometimes called Cosentyx Prescribing Information (PI) or FDA label.

Cosentyx J code

Cosentyx J code is J3247 (1 mg, intravenous).
J codes are used for medicines that are not taken orally and include injections, inhalations, and chemotherapies. J codes are important for accurate and consistent coding for billing and reimbursement purposes.

The J code is only required for the intravenous infusion.

Your physician will need the Cosentyx J code when filling out forms for your intravenous infusion treatment.

Storage

• Store this medicine in a refrigerator between 36°F to 46°F (2°C to 8°C). Do not freeze this medicine.
• Keep this medicine in the original carton until ready for use to protect it from light.
• If necessary, the Sensoready pen, Unoready pen, and prefilled syringes may be stored at room temperature, up to 86°F (30°C), for up to 4 days.   
• Write the date the medicine was removed from the refrigerator in the space provided on the carton.
• If unused and stored below 30°C (86°F), the Sensoready pen, Unoready pen, and prefilled syringes may be returned to the refrigerator only one time. Throw them away if they have been kept outside of the refrigerator and have not been used in over 4 days.
• Do not shake this medicine.
• Keep all medicines out of the reach of children.

Ingredients

Active ingredient: secukinumab.

Inactive ingredients:

Cosentyx Sensoready pen and prefilled syringe: L-histidine/histidine hydrochloride monohydrate, L-methionine, polysorbate 80, trehalose dihydrate, and sterile water for injection.

Cosentyx Vial: L-histidine/histidine hydrochloride monohydrate, polysorbate 80, and sucrose.

Latex: Do not handle the needle cap of the Cosentyx Sensoready pen, or the 75 mg/0.5 mL or 150 mg/mL prefilled syringes if you are sensitive to latex.

Consentyx Manufacturer

Cosentyx manufacturer Novartis Pharmaceuticals Corporation, East Hanover, New Jersey 07936.

Cosentyx Biosimilars

Biosimilar and interchangeable products are biological products that are highly similar to and have no clinically meaningful differences from the reference product.

Reference products

These are biological products that have already been approved by the FDA, against which biosimilar products are compared. There is 1 for Cosentyx.Cosentyx (secukinumab) – Novartis Pharmaceuticals Corporation

Coreg is a beta-blocker. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).

Coreg is used to treat heart failure and hypertension (high blood pressure).

Coreg is also used after a heart attack that has caused your heart not to pump as well.

Warnings

You should not take Coreg if you have asthma, bronchitis, emphysema, severe liver disease, or a serious heart condition such as heart block, “sick sinus syndrome,” or slow heart rate (unless you have a pacemaker).

Avoid drinking alcohol within 2 hours before or after taking extended-release Coreg CR capsules. Also avoid taking medicines or other products that might contain alcohol. Alcohol may cause the carvedilol in the controlled release (CR) capsule to be released too quickly into the body.

If you are being treated for high blood pressure, keep using Coreg even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your l

Before taking this medicine

You should not take Coreg if you are allergic to carvedilol, or if you have:

• asthma, bronchitis, emphysema;
• severe liver disease; or
• a serious heart condition such as severe heart failure, heart block, “sick sinus syndrome,” or slow heart rate (unless you have a pacemaker).

To make sure Coreg is safe for you, tell your doctor if you have:

• coronary artery disease (clogged arteries);
• slow heartbeats that have caused you to faint;
• fluid retention;
• asthma or other lung problems;
• angina (chest pain);
• diabetes (taking carvedilol can make it harder for you to tell when you have low blood sugar);
• a thyroid disorder;
• kidney disease;
• circulation problems (such as Raynaud’s syndrome); or
• pheochromocytoma (tumor of the adrenal gland).

Tell your doctor if you are pregnant or breastfeeding.

Coreg is not approved for use by anyone younger than 18 years old.

How should I take Coreg?

Take Coreg exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Coreg works best if you take it with food, at the same time every day.

Swallow the extended-release capsule whole and do not crush, chew, break, or open it.

If you cannot swallow a capsule whole, open it and sprinkle the medicine into a spoonful of cold applesauce. Swallow the mixture right away without chewing. Do not save it for later use.

If you are switched from the tablets to Coreg CR extended-release capsules, your daily total dose of this medicine may be higher or lower than before. Older adults may be more likely to become dizzy or feel faint when switching from tablets to extended-release capsules. Follow your doctor’s instructions.

Your blood pressure will need to be checked often.

If you need surgery (including cataract surgery), tell your surgeon you currently use this medicine. You may need to stop for a short time.

You should not stop using Coreg suddenly. Stopping suddenly may cause chest pain or a heart attack. Follow your doctor’s instructions about tapering your dose.

If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Coreg is only part of a complete treatment program that may also include diet, exercise, and weight control. Follow your doctor’s instructions very closely.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include uneven heartbeats, shortness of breath, bluish-colored fingernails, dizziness, weakness, fainting, and seizure (convulsions).

What to avoid

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Coreg side effects

Get emergency medical help if you have signs of an allergic reaction to Coreg: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• a light-headed feeling, like you might pass out;
• slow or uneven heartbeats;
• cold feeling or numbness in your fingers or toes;
• chest pain, dry cough, wheezing, chest tightness;
• heart problems – swelling, rapid weight gain, feeling short of breath; or
• high blood sugar – increased thirst, increased urination, dry mouth, fruity breath odor.

Common Coreg side effects may include:

• dizziness;
• slow heartbeats;
• diarrhea;
• weight gain;
• dry eyes; or
• problems wearing contact lenses.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect Coreg?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Other drugs may interact with carvedilol, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Concerta is a central nervous system stimulant prescription medicine. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control.

Concerta extended-release tablets are used to treat attention deficit hyperactivity disorder (ADHD) in children 6 years of age and older, adolescents, and in adults up to the age of 65.

Concerta should be used as a part of a total treatment program for ADHD that may include counseling or other therapies.

Is Concerta a controlled substance?

Yes, Concerta (methylphenidate) is a Schedule 2 controlled substance and therefore has a high potential for abuse. It has a currently accepted medical use in the United States or a currently accepted medical use with severe restrictions. Abuse may lead to severe psychological or physical dependence. There may be variations in CSA schedules between individual states.

Warnings

You should not use Concerta if you have glaucoma, tics or Tourette’s syndrome, or severe anxiety, tension, or agitation.

Methylphenidate may be habit-forming, and this medicine is a drug of abuse. Tell your doctor if you have had problems with drug or alcohol abuse. Keep the medication where others cannot get to it.

Stimulants have caused stroke, heart attack, and sudden death in people with high blood pressure, heart disease, or a heart defect. Call your doctor right away if you have chest pain or feel lightheaded or short of breath while taking Concerta.

Do not use Concerta if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, or tranylcypromine or have used a methylene blue injection.

Concerta may cause new or worsening psychosis (unusual thoughts or behavior), especially if you have a history of depression, mental illness, or bipolar disorder. Call your doctor right away if you have signs of psychosis such as paranoia, aggression, new behavior problems, or seeing or hearing things that are not real.

Before taking this medicine

You should not use Concerta if you are allergic to methylphenidate.

You should not take Concerta if you have:

• glaucoma;
• severe high blood pressure or a heart problem;
• overactive thyroid;
• a personal or family history of tics (muscle twitches) or Tourette’s syndrome; or
• severe anxiety, tension, or agitation (stimulant medicine can make these symptoms worse).

Stimulants have caused stroke, heart attack, and sudden death in certain people. Tell your doctor if you have:

• heart problems or a congenital heart defect;
• high blood pressure; or
• a family history of heart disease or sudden death.

Do not use Concerta if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine.

Tell your doctor if you also use opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with methylphenidate could cause a serious condition called serotonin syndrome.

Tell your doctor if you or anyone in your family has ever had:

• depression, mental illness, bipolar disorder, psychosis, or suicidal thoughts or actions;
• blood circulation problems in the hands or feet; or
• alcoholism or drug addiction.

To make sure Concerta is safe for you, tell your doctor if you have:

• problems with the esophagus, stomach, or intestines; or
• seizures, epilepsy, or an abnormal brain wave test (EEG).

Becoming dependent on this medicine during pregnancy can cause premature birth or low birth weight. Tell your doctor if you are pregnant or plan to become pregnant. If you are pregnant, your name may be listed on a pregnancy registry to track the effects of methylphenidate on the baby.

Ask a doctor if it is safe to breastfeed while using this medicine. If you are breastfeeding, tell your doctor if you notice symptoms in the baby such as agitation, sleep problems, feeding problems, or reduced weight gain.

Concerta is not approved for use by anyone younger than 6 years old.

How should I take Concerta?

Take Concerta exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Methylphenidate may be habit-forming. Misuse can cause addiction, overdose, or death. Keep the medication where others cannot get to it. Selling or giving away Concerta is against the law.

Take Concerta once each day in the morning. Concerta is an extended-release tablet. It releases medication into your or your child’s body throughout the day.

Concerta can be taken with or without food, but take it the same way each time.

Do not chew, crush, or break the Concerta tablets. Swallow the tablets whole with water or other liquids. Tell your doctor if you or your child cannot swallow the tablet whole. A different medicine may need to be prescribed.

The Concerta tablet does not dissolve completely in the body after all the medicine has been released. You or your child may sometimes notice the empty tablet in a bowel movement. This is normal.

Children should have their height and weight checked often while taking this medicine.

Tell your doctor if you have a planned surgery.

Your treatment may also include counseling or other treatments.

Your doctor will need to check your progress on a regular basis. From time to time, your doctor may stop treatment for a while to check ADHD symptoms. Your heart and blood pressure may also need to be checked often.

Store Concerta tightly closed at room temperature, away from moisture, heat, and light. Keep your medicine in a place where no one can use it improperly.

Do not keep leftover medicine. Ask your pharmacist about a drug take-back program. You may also mix the leftover medicine with cat litter or coffee grounds in a sealed plastic bag and throw the bag in the trash.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of methylphenidate could be fatal.

Overdose symptoms may include nausea, dry mouth, vomiting, diarrhea, anxiety, agitation, restlessness, tremor, muscle twitches, rapid breathing, confusion, hallucinations, dilated pupils, muscle pain or weakness, fever, sweating, headache, pounding in your neck or ears, fast or pounding heartbeats, feeling light-headed, fainting, seizure (convulsions), or coma.

What should I avoid while taking Concerta?

Avoid drinking alcohol.

Avoid driving or hazardous activity until you know how Concerta will affect you. Your reactions could be impaired.

Concerta side effects

Get emergency medical help if you have signs of an allergic reaction to Concerta: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• signs of heart problems – chest pain, trouble breathing, feeling like you might pass out;
• signs of psychosis – hallucinations (seeing or hearing things that are not real), new behavior problems, aggression, hostility, paranoia;
• signs of circulation problems – numbness, pain, cold feeling, unexplained wounds, or skin color changes (pale, red, or blue appearance) in your fingers or toes; or
• penis erection that is painful or lasts 4 hours or longer.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Methylphenidate can affect growth in children. Your child’s height and weight may need to be checked often. Tell your doctor if your child is not growing at a normal rate.

Common Concerta side effects may include:

• sweating, increased blood pressure;
• mood changes, anxiety, feeling nervous or irritable, trouble sleeping;
• fast heart rate, pounding heartbeats or fluttering in your chest;
• loss of appetite, weight loss;
• dry mouth, nausea, vomiting, stomach pain, indigestion; or
• headache, dizziness.

Colchicine is an oral, plant-based prescription alkaloid derived from the dried seeds of the autumn crocus or meadow saffron (Colchicum autumnale) that, depending on the brand or generic, may be used to:

• treat and prevent gout flares in adults (Colcrys, generics)
• prevent gout flares in adults and children aged 16 years and older (Colcrys, Gloperba, Mitigare, generics)
• treat symptoms of Behçet disease (BD), such as redness, swelling, or pain) (generics)
• treat familial Mediterranean fever (FMF) in adults and children 4 years of age or older (Colcrys)
• reduce the risk of heart attack, stroke, and cardiovascular death in adults with heart disease or at high risk of developing it (Lodoco tablets).

Colchicine is not an analgesic medication and should not be used to treat pain from other causes.

How colchicine works is not fully understood. However, it’s believed the mechanism of action (MOA) of colchicine is to reduce the inflammatory reaction to urate crystals by interfering with a process in white blood cells that triggers inflammation and prevents their migration to areas of inflammation. Colchicine does not affect uric acid production or excretion.

Colchicine was initially approved in 1961 and developed before federal regulations requiring FDA review of all marketed drug products. Colchicine may also be used for purposes not listed here.

Colchicine uses

Colcrys tablets 0.6 mg are FDA-approved to:

• treat or prevent gout in adults (FDA-approval October 22, 2009)
• treat a genetic condition called Familial Mediterranean Fever in adults and children who are at least 4 years old (FDA-approval July 31,  2009).

Mitigare capsules 0.6 mg are FDA-approved to prevent gout flares in adults (FDA-approval September 26, 2014).

Gloperba oral solution (0.6 mg/5mL) is FDA-approved to prevent gout attacks (FDA-approval January 30, 2019).

Lodoco tablets 0.5 mg are FDA-approved to lower the risk of heart attack, stroke, and cardiovascular death in adults with heart disease or at high risk of developing it (FDA-approval June 16, 2023). 

Generic forms of colchicine (colchicine 0.6 mg) have been used to treat or prevent attacks of gout, or to treat symptoms of Behcet’s syndrome (such as swelling, redness, warmth, and pain).

Colchicine is not a cure for gouty arthritis or Behcet’s syndrome, and it will not prevent these diseases from progressing.

Colchicine side effects

The most common side effects of colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal (stomach) pain

Serious side effects and warnings

Do not take colchicine if you have liver or kidney problems and you take certain other medicines. Serious side effects, including death, have been reported in these patients even when taken as directed.

Blood problems (such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia) have been reported (have happened in some people taking colchicine. Get medical help right away if you have a pale or gray color to your lips, tongue, or palms of your hands; feel weak or tired; unusual bleeding or bruising; or increased infections

Muscle weakness has happened in some people taking colchicine. Get medical help right away if you have any of these symptoms muscle weakness or pain, numbness, or tingling in your fingers or toes.

Colchicine can cause serious side effects or death if levels of colchicine are too high in your body. Get medical help right away if you have:

• Muscle weakness or pain
• Numbness or tingling in your fingers or toes
• Unusual bleeding or bruising
• Increased infections
• Feel weak or tired
• Pale or gray color to your lips, tongue, or palms of your hands
• Severe diarrhea or vomiting.

These are not all of the possible side effects of colchicine For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects.

Before taking

Do not take colchicine if you have liver or kidney problems and you take certain other medicines. Serious side effects, including death, have been reported in these patients even when taken as directed.

Before you take colchicine, tell your healthcare provider about all your medical conditions, including if you:

• have liver or kidney problems
• take other medications, including ones that are only taken for a short time, such as antibiotics, because they may interact with colchicine
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed.

Your dose of colchicine may need to be changed.

Colchicine may rarely and transiently impair fertility in males who can father children.

Pregnancy

 It is not known if colchicine will harm your unborn baby. Talk to your healthcare provider if you are pregnant or plan to become pregnant.

Breastfeeding

Colchicine passes into your breast milk. You and your healthcare provider should decide if you will take colchicine or breastfeed. If you take colchicine and breastfeed, you should talk to your child’s healthcare provider about how to watch for side effects in your child.

How should I take colchicine?

Take colchicine exactly as your healthcare provider tells you to take it. If you are not sure about your dosing, call your healthcare provider.

• Colchicine tablets, capsules, or the solution can be taken with or without food.
• Measure Gloperba liquid with an accurate milliliter measuring device. A household teaspoon is not an accurate measuring device. Ask your pharmacist to recommend a measuring device and for instructions on how to measure the correct dose.

Gastrointestinal symptoms, such as diarrhea, are often the first sign of colchicine toxicity. Contact your healthcare provider immediately if new symptoms develop.

If you have a gout flare while taking colchicine daily, report this to your healthcare provider.

Do not stop taking colchicine even if you start to feel better unless your healthcare provider tells you.

Colchicine dosage

Dosage adjustments may be needed in patients with kidney or liver disease, younger patients, or when colchicine is taken with certain other medications.

• Your healthcare provider may do blood tests while you take colchicine.

How to take colchicine for gout flares in adults

Colcrys: 1.2 mg (two tablets) at the first sign of a gout flare followed by 0.6 mg (one tablet) one hour later.

• The maximum recommended dose of colchicine for the treatment of gout flares is 1.8 mg over one hour.
• Do not repeat this course for at least 3 days.
• Colchicine is taken to ease the pain of a gout attack.
• After taking the colchicine dose to treat a gout attack (flare), wait 12 hours and then resume the preventive dose.
• If you are already taking colchicine to prevent gout flares, talk to your healthcare provider about what you should take during a gout flare. 

How to take colchicine to prevent gout flares in adults

Colcrys: 0.6 mg once or twice daily in adults and adolescents older than 16 years. Maximum dose 1.2 mg/day.

Mitigare: 0.6 mg once or twice daily.  Maximum dose 1.2 mg per day.

Gloperba: 0.6 mg (5 mL) once or twice daily. Maximum dose 1.2 mg/day.

Colchicine dosage for Familial Mediterranean fever (FMF)

Colcrys:

• Adults and children older than 12 years: 1.2 – 2.4 mg
• Children 6 to 12 years: 0.9 – 1.8 mg
• Children 4 to 6 years: 0.3 – 1.8 mg.

Give the total daily dose in one or two divided doses.

Increase or decrease the dose as indicated and as tolerated in increments of 0.3 mg/day, not to exceed the maximum recommended daily dose

Colchicine dosage for Behçet disease (BD)

Generic colchicine: Experimental doses ranged from colchicine 0.6 mg/day to 2 mg/day in divided doses.

Colchicine dosage to reduce the risk of heart attack, stroke, and cardiovascular death

Lodoco tablets: 0.5 mg (1 tablet) daily.

Colchicine poisoning

Colchicine is extremely dangerous if too much is taken. Even small amounts can be fatal, especially in children. The difference between a safe dose and an overdose is very small. Many people have died after accidentally taking too much colchicine. Handle and store colchicine carefully.

What happens if I miss a dose?

If you take colchicine daily and you miss a dose, then take it as soon as you remember. If it is almost time for your next dose, just skip the missed dose. Take the next dose at your regular time. Do not take two doses at the same time.

What happens if I overdose?

 If you take too much colchicine, go to the nearest hospital emergency room right away.

 Fatal overdoses have been reported with colchicine in adults and children. Keep out of the reach of children.

What should I avoid while taking colchicine?

Avoid eating grapefruit or drinking grapefruit juice while taking colchicine. It can increase your chances of getting serious side effects.

Colchicine interacts with many other medications. Do not start a new medication without asking your healthcare provider first if it interacts with colchicine.

What other drugs can affect colchicine?

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Taking certain medicines with colchicine can cause your level of colchicine to become too high, especially if you have kidney or liver problems.

Even medicines that you take for a short period, such as antibiotics, can interact with colchicine and cause serious side effects or death. Especially tell your healthcare provider if you take:

• atazanavir sulfate (Reyataz)                
• clarithromycin (Biaxin)
• cyclosporine (Neoral, Gengraf, Sandimmune)
• darunavir (Prezista)
• digoxin
• fosamprenavir (Lexiva) with or without  ritonavir
• indinavir (Crixivan)                    
• itraconazole (Sporanox)
• ketoconazole (Nizoral)                           
• lopinavir/ritonavir (Kaletra)
• nefazodone (Serzone)                            
• nelfinavir mesylate (Viracept)
• ritonavir (Norvir)                         
• saquinavir mesylate (Invirase)
• telithromycin (Ketek)               
• tipranavir (Aptivus).

Using colchicine with HMG CoA reductase inhibitors (such as simvastatin, atorvastatin, or pravastatin), gemfibrozil, and fenofibric acid or cyclosporine may potentiate the development of muscle problems, including muscles weakness, or fatigue.

Co-administration of colchicine with dual CYP3A4 and P-gp inhibitors (such as clarithromycin or cyclosporine) has resulted in life-threatening interactions and death.

Grapefruit and grapefruit juice may also interact and should not be consumed during colchicine treatment.

Ask your healthcare provider or pharmacist if you are not sure if you take any of the medicines listed above. This is not a complete list of all the medicines that can interact with Colchicine. See the colchicine prescribing information for a complete list. Do not start a new medicine without talking to your healthcare provider.

Colchicine storage

Store colchicine tablets and liquid at room temperature between 68°F and 77°F (20°C and 25°C).

Keep in a tightly closed container, away from light.

Keep out of the reach of children.

Colchicine ingredients

Colcrys 0.6 mg tablets

Active Ingredient: colchicine 0.6 mg             

Inactive Ingredients: carnauba wax, FD&C blue #2, FD&C red #40, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polydextrose, polyethylene glycol, pregelatinized starch, sodium starch glycolate, titanium dioxide, and triacetin.

Mitigare 0.6 mg capsule

Active Ingredient: colchicine 0.6 mg             

Inactive Ingredients: colloidal silicon dioxide, lactose anhydrous, magnesium stearate,

microcrystalline cellulose and sodium starch glycolate.

The capsule shell contains gelatin, purified water, titanium dioxide, erythrosine, Brilliant Blue FCF, and Quinoline Yellow.

Lodoco 0.5 mg tablets

Active Ingredient: colchicine 0.5 mg             

Inactive Ingredients: gelatin, lactose monohydrate, magnesium stearate, potato starch, and talc.

Gloperba 0.6 mg/5 mL oral solution

Active Ingredient: colchicine 0.6 mg/5 mL oral solution

Inactive Ingredients: benzyl alcohol, FD&C Red No. 40, artificial cherry flavor, anhydrous citric acid, dibasic sodium phosphate, glycerin, propylene glycol, sucralose, xanthan gum, and purified water.

Generic colchicine 0.6 mg tablets

Refer to the manufacturer’s medication guide.

Generic colchicine 0.6 mg capsules

Refer to the manufacturer’s medication guide.

Who makes colchicine?

Takeda Pharmaceuticals U.S.A., Inc. makes Colcrys.

West-Ward Columbus Inc. makes Mitigare capsules for Hikma Americas Inc.

Agepha Pharma USA, LLC. distributes Lodoco.

Gloperba is manufactured for Scilex Pharmaceuticals, Inc.

Various manufacturers make generic colchicine 0.6 mg tablets including Camber Pharmaceuticals, Inc., Ascend Laboratories, LLC., and Actavis Pharma, Inc.

Various manufacturers make generic colchicine 0.6 mg capsules including Par Pharmaceuticals, Inc., Aurobindo Pharma Limited, and Hikma Pharmaceuticals USA Inc.

The Colazal brand of balsalazide is used to treat mild to moderate active ulcerative colitis in adults and children who are at least 5 years old.

The Giazo brand of balsalazide is used to treat mild to moderate active ulcerative colitis in men who are at least 18 years old.

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

Colazal side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Colazal may cause serious side effects. Call your doctor at once if you have:

• pain or burning when you urinate;
• worsening colitis symptoms–fever, stomach pain, cramps, or bloody diarrhea;
• kidney problems–little or no urinating, swelling, rapid weight gain;
• liver problems–upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
• low red blood cells (anemia)–pale skin, unusual tiredness, feeling light-headed or short of breath, cold hands and feet.

Common side effects of Colazal may include:

• headache;
• mild or occasional nausea, vomiting, stomach pain, diarrhea;
• joint pain;
• fever; or
• cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use Colazal if you are allergic to Colazal or mesalamine, or to aspirin or other salicylates (including Kaopectate, Pamprin, Pepto-Bismol, Tricosal, Trilisate, and others).

Tell your doctor if you have ever had:

• kidney disease;
• liver disease; or
• a stomach condition called pyloric stenosis.

Colazal tablets contain sodium. Talk to your doctor before using this form of balsalazide if you are on a low salt diet.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether Colazal will harm an unborn baby. However, having active ulcerative colitis during pregnancy may cause premature delivery or low birth weight. The benefit of treating ulcerative colitis may outweigh any risks to the baby.

If you are breastfeeding, tell your doctor if you notice diarrhea in the nursing baby.

Colazal capsules should not be given to a child younger than 5 years old. This medicine tablets should not be given to anyone under 18 years old.

How should I take Colazal?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Colazal can be taken with or without food.

If you cannot swallow a capsule whole, open it and sprinkle the medicine into a spoonful of applesauce. Swallow the mixture right away. Medicine from the capsule may stain your teeth or tongue yellow/orange when mixed with food. Do not save the mixture for later use.

Call your doctor if your symptoms do not improve, or if they get worse.

Colazal is usually taken only for a short time (8 to 12 weeks). Follow your doctor’s dosing instructions very carefully.

Colace is a stool softener. It makes bowel movements softer and easier to pass.

Colace is used to treat or prevent occasional constipation, and to reduce pain or rectal damage caused by hard stools or by straining during bowel movements.

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

Warnings

You should not use Colace if you have a blockage in your intestines.

Do not use Colace while you are sick with nausea, vomiting, or severe stomach pain.

You should not use docusate if you also use mineral oil, unless your doctor tells you to.

Before taking this medicine

You should not use Colace if you are allergic to docusate.

Ask a doctor or pharmacist if this medicine is safe to use if you have:

• stomach pain;
• nausea;
• vomiting; or
• a sudden change in bowel habits that lasts over 2 weeks.

Ask a doctor before using this medicine if you are pregnant or breastfeeding.

Do not give this medicine to a child without medical advice.

How should I use Colace?

Use Colace exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Take this medicine with a full glass of water. Drink plenty of liquids while you are taking this medicine.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

Colace generally produces bowel movement in 12 to 72 hours. Call your doctor if your symptoms do not improve after 72 hours.

You should not use this medicine for longer than 1 week, unless your doctor tells you to. Call your doctor if your symptoms do not improve, or if you have not had a bowel movement within 1 to 3 days. Overuse of a stool softener can lead to serious medical problems.

Store at room temperature away from moisture, light, and heat. Do not freeze liquid medicine.

Dosing information

Usual Adult Dose for Constipation:

50 to 300 mg daily divided in 1 to 4 doses each day.

Usual Pediatric Dose for Constipation:

Less than 2 years: Check with your doctor.

2 to 12 years: 50 to 150 mg daily divided in 1 to 4 doses each day.

What happens if I miss a dose?

Since Colace is used when needed, you may not be on a dosing schedule. Skip any missed dose if it’s almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line.

What should I avoid while using Colace?

Avoid using mineral oil, unless told to do so by a doctor.

Colace side effects

Get emergency medical help if you have signs of an allergic reaction to Colace : hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using this medicine and call your doctor at once if:

• you have rectal bleeding;
• no bowel movement occurs after using a laxative;
• you need to use a stool softener for more than 1 week; or
• if a rash occurs.

Less serious Colace side effects may be more likely, and you may have none at all.

This is not a complete list of side effects and others may occur.

What is codeine?

Codeine is an opioid pain reliever which is used to treat mild to moderately severe pain and to help reduce coughing. Codeine is available as a single ingredient tablet and also available in multi ingredients products combined with other pain relieving medicines or cold and flu medicines.

Warnings

You should not use codeine if you have severe breathing problems, a blockage in your stomach or intestines, or frequent asthma attacks or hyperventilation.

Codeine can slow or stop your breathing, cause profound sedation, and may be habit-forming. MISUSE OF THIS MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.

Codeine is not for use in anyone under 18 years old.

Taking codeine during pregnancy may cause life-threatening withdrawal symptoms in the newborn.

Fatal side effects can occur if you use codeine with alcohol, or with other drugs that cause drowsiness, sedation or slow your breathing.

Before taking this medicine

You should not use this medicine if you are allergic to it, or if you have:

• severe asthma or breathing problems;
• a blockage in your stomach or intestines; or
• frequent asthma attacks or hyperventilation.

In some people, codeine breaks down rapidly in the liver and reaches higher than normal levels in the body. This can cause dangerously slow breathing and may cause death, especially in a child.

Do not give codeine to anyone younger than 18 years old.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• liver disease;
• breathing problems, sleep apnea;
• asthma, COPD, sleep apnea, or other breathing disorders;
• abnormal curvature of the spine that affects breathing;
• kidney disease;
• a head injury or brain tumor;
• low blood pressure;
• blockage in your digestive tract (stomach or intestines);
• a gallbladder or pancreas disorder;
• underactive thyroid;
• Addison’s disease or other adrenal gland disorder;
• enlarged prostate, urination problems; or
• mental illness, drug or alcohol addiction.

Some medicines can interact with codeine and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

If you use this medicine while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant.

Do not breast-feed while taking codeine. This medicine can pass into breast milk and cause drowsiness, breathing problems, or death in a nursing baby.

How should I take codeine?

Take codeine exactly as prescribed by your doctor. Follow all directions on your prescription label. Codeine can slow or stop your breathing. Never use this medicine in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Codeine may be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Selling or giving away codeine is against the law.

Take this medicine with food or milk if it upsets your stomach.

Drink 6 to 8 full glasses of water daily to help prevent constipation while you are taking this medicine. Do not use a stool softener (laxative) without first asking your doctor.

Do not stop using codeine suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Store at room temperature away from moisture and heat. Keep track of your medicine. Codeine is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Do not keep leftover opioid medication. Just one dose can cause death in someone using this medicine accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, mix the leftover medicine with cat litter or coffee grounds in a sealed plastic bag throw the bag in the trash.

What happens if I miss a dose?

Since this medicine is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . A codeine overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose can cause severe muscle weakness, cold and clammy skin, pinpoint pupils, very slow breathing, extreme drowsiness, or coma.

What to avoid

Do not drink alcohol. Dangerous side effects or death could occur.

Codeine may impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Codeine side effects

Get emergency medical help if you have signs of an allergic reaction to codeine: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Like other narcotic medicines, codeine can slow your breathing. Death may occur if breathing becomes too weak.

A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Call your doctor at once if you have:

• noisy breathing, sighing, shallow breathing, breathing that stops during sleep;
• a slow heart rate or weak pulse;
• a light-headed feeling, like you might pass out;
• confusion, agitation, hallucinations, unusual thoughts or behavior;
• feelings of extreme happiness or sadness;
• seizure (convulsions);
• problems with urination; or
• low cortisol levels–nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Serious side effects may be more likely in older adults and those who are overweight, malnourished, or debilitated.

Long-term use of opioid medication may affect fertility (ability to have children) in men or women. It is not known whether opioid effects on fertility are permanent.

Common codeine side effects include:

• feeling dizzy or drowsy;
• nausea, vomiting, stomach pain;
• constipation;
• sweating; or
• mild itching or rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Dosing information

Usual Adult Dose for Pain:

Initial dose: 15 to 60 mg orally up to every 4 hours as needed
Maximum dose: 360 mg in 24 hours

Comments:
-Initial doses should be individualized taking into account severity of pain, response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse.
-Doses higher than 60 mg have not been shown to improve pain relief and are associated with an increased incidence of adverse effects.
-Because of the risks of addiction, abuse and misuse, the lowest effective dose for the shortest duration consistent with individual patient treatment goals should be used.
-Monitor patients closely for respiratory depression within the first 24 to 72 hours of initiating therapy and following any increase in dose.

Use: For the management of mild to moderate pain where treatment with an opioid is appropriate and from which alternative treatments are inadequate.

What other drugs will affect codeine?

You may have breathing problems or withdrawal symptoms if you start or stop taking certain other medicines. Tell your doctor if you also use an antibiotic, antifungal medication, heart or blood pressure medication, seizure medication, or medicine to treat HIV or hepatitis C.

Opioid medication can interact with many other drugs and cause dangerous side effects or death. Be sure your doctor knows if you also use:

• cold or allergy medicines, bronchodilator asthma/COPD medication, or a diuretic (“water pill”);
• medicines for motion sickness, irritable bowel syndrome, or overactive bladder;
• other narcotic medications – opioid pain medicine or prescription cough medicine;
• a sedative like Valium – diazepam, alprazolam, lorazepam, Xanax, Klonopin, Versed, and others;
• drugs that make you sleepy or slow your breathing – a sleeping pill, muscle relaxer, medicine to treat mood disorders or mental illness; or
• drugs that affect serotonin levels in your body– a stimulant, or medicine for depression, Parkinson’s disease, migraine headaches, serious infections, or nausea and vomiting.

Cobenfy (xanomeline and trospium chloride) is a new treatment for schizophrenia used to improve positive and negative symptoms. Cobenfy contains xanomeline, which helps schizophrenia symptoms, and trospium, which works to reduce the side effects. Cobenfy is a new class of medicine and works differently than traditional schizophrenia medications so it does not have a boxed warning and atypical antipsychotic class warnings and precautions.

Schizophrenia is related to imbalances in messenger systems in the brain involving muscarinic acetylcholine and dopamine. It is thought that Cobenfy works by xanomeline activating muscarinic receptors  (M1 and M4) in the brain (central nervous system), which improves schizophrenia. Trospium chloride cannot enter the brain easily, so it works mainly around the body, reducing side effects by blocking muscarinic receptors.

Cobenfy has two mechanisms of action (MOA). Cobenfy’s active ingredient xanomeline’s MOA is a muscarinic agonist that selectively targets M1 and M4 receptors in the brain without blocking D2 receptors. Cobenfy’s active ingredient trospium chloride’s MOA is a muscarinic antagonist that blocks the muscarinic receptors primarily in the peripheral tissues.

Cobenfy FDA approval is for the treatment of schizophrenia in adults. Cobenfy capsules are taken twice daily on an empty stomach, at least 1 hour before a meal or at least 2 hours after a meal. During drug development, it was named KarXT, and once approved, Bristol Myers Squibb renamed it Cobenfy.

What is the schizophrenia?

Schizophrenia is a mental illness that affects how you think, feel, and behave. Signs and symptoms usually appear first in the teenage years or early adulthood. There are three main areas of symptoms areas, which are positive (hallucinations and delusions), negative (social withdrawal, lack of enjoyment in life), and cognitive impairment (problems with concentration, memory, and decision-making).
Tradition schizophrenia medicines mainly target positive symptoms, whereas Cobenfy helps to improve positive and negative symptoms.

Cobenfy side effects 

Common Cobenfy side effects

The most common Cobenfy side effects were:

• feeling sick (nausea),
• indigestion (dyspepsia),
• constipation,
• vomiting,
• high blood pressure (hypertension),
• abdominal pain,
• diarrhea,
• fast heart rate (tachycardia),
• dizziness,
• and heartburn (gastrointestinal reflux disease).

These side effects occurred in 5% or more of patients, and at least twice the placebo rates in clinical trials.

Serious Cobenfy side effects

Urinary Retention: Cobenfy cause the side effect of urinary retention. Patients may be at increased risk of urinary retention if they are geriatric patients, patients with clinically significant bladder outlet obstruction and incomplete bladder emptying (e.g., patients with benign prostatic hyperplasia (BPH), or diabetic cytopathic patients). It should not be used in patients with pre-existing urinary retention and is not recommended in patients with moderate or severe renal impairment.

Patients with Hepatic Impairment: Patients with hepatic impairment have higher systemic exposures of xanomeline, a component of Cobenfy, compared to patients with normal hepatic function, which may result in an increased incidence of adverse reactions.

It should not be used in patients with moderate or severe hepatic impairment and is not recommended in patients with mild hepatic impairment. Assess liver enzymes before starting treatment and as clinically indicated during treatment.

Biliary Disease: In clinical studies with Cobenfy, side effects included transient increases in liver enzymes with rapid decline occurred, consistent with transient biliary obstruction due to biliary contraction and possible gallstone passage.

It is not recommended for patients with active biliary disease, such as symptomatic gallstones. Assess liver enzymes and bilirubin before starting treatment and as clinically indicated during treatment. The occurrence of symptoms such as dyspepsia, nausea, vomiting, or upper abdominal pain should prompt assessment for gallbladder disorders, biliary disorders, and pancreatitis, as clinically indicated.

Cobenfy should be stopped in the presence of signs or symptoms of substantial liver injury, such as jaundice, pruritus, or alanine aminotransferase levels more than five times the upper limit of normal or five times baseline values.

Decreased Gastrointestinal Motility: Cobenfy contains trospium chloride which like other antimuscarinic agents, may decrease gastrointestinal motility. Use this medicine with caution in patients with gastrointestinal obstructive disorders due to the risk of gastric retention. Use these capsules with caution in patients with conditions such as ulcerative colitis, intestinal atony, and myasthenia gravis.

Risk of Angioedema: Angioedema of the face, lips, tongue, and/or larynx has been reported with Cobenfy and trospium chloride, an ingredient of Cobenfy. In one case, angioedema occurred after the first dose of trospium chloride. Angioedema associated with upper airway swelling may be life-threatening. If involvement of the tongue, hypopharynx, or larynx occurs, discontinue medicine and initiate appropriate therapy and/or measures necessary to ensure a patent airway. This medicine is contraindicated in patients with a history of hypersensitivity to trospium chloride.

Patients with Narrow-angle Glaucoma: Pupillary dilation may occur due to the anticholinergic effects of this medicine. This may trigger an acute angle closure attack in patients with anatomically narrow angles. In patients known to have anatomically narrow angles, Cobenfy should only be used if the potential benefits outweigh the risks and with careful monitoring.

Increases in Heart Rate: Cobenfy can increase heart rate so assess heart rate at baseline and as clinically indicated during treatment with this medicine.

Anticholinergic Adverse Reactions in Patients with Renal Impairment: Trospium chloride, an active ingredient in this medicine, is substantially excreted by the kidney. It is not recommended in patients with moderate or severe renal impairment (estimated glomerular filtration rate (eGFR) <60 mL/min). Systemic exposure of trospium chloride is higher in patients with moderate and severe renal impairment. Therefore, anticholinergic adverse reactions (including dry mouth, constipation, dyspepsia, urinary tract infection, and urinary retention) are expected to be greater in patients with moderate and severe renal impairment.

Central Nervous System Effects: Trospium chloride, an active ingredient in this medicine is associated with anticholinergic central nervous system (CNS) effects. A variety of CNS anticholinergic effects have been reported with trospium chloride, including dizziness, confusion, hallucinations, and somnolence. Monitor patients for signs of anticholinergic CNS effects, particularly after beginning treatment or increasing the dose. Patients should not to drive or operate heavy machinery until they know how this medicine affects them. If a patient experiences anticholinergic CNS effects, consider dose reduction or drug discontinuation.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects.

Who should not take this medicine?

Cobenfy should not be taken if you have:

• urinary retention 
• moderate or severe hepatic impairment 
• gastric retention  
• history of hypersensitivity to Cobenfy or trospium chloride (4) 
• untreated narrow-angle glaucoma 

Before taking this medicine

Before taking this Cobenfy, tell your healthcare provider about all of your medical conditions, including if you: 

• have an enlarged prostate, problems passing urine, or a blockage in your urinary bladder 
• have liver problems 
• have or had gallstones or problems with your bile ducts or pancreas 
• have stomach or intestinal problems including constipation, ulcerative colitis, slow emptying of your stomach, or myasthenia gravis 
• have an eye condition called narrow-angle glaucoma 
• have kidney problems 

Pregnancy

Tell your healthcare provider if you are pregnant or plan to become pregnant, as it is not known if this Cobenfy may harm your unborn baby. If you become pregnant or think you are pregnant during treatment with this medicine, tell your healthcare provider. There is a pregnancy exposure registry for women who take this medicine during pregnancy. The purpose of this registry is to collect information about the health of women exposed to Cobenfy and their baby. If you become pregnant during treatment while taking this medicine, your healthcare provider will register you by calling 1-866-961-2388. 

Breastfeeding

Tell your healthcare provider if you are breastfeeding or plan to breastfeed. It is not known if Cobenfy passes into your breast milk or if it can harm your baby.

How should I take Cobenfy?

• Take capsule 2 times each day at least 1 hour before a meal or at least 2 hours after a meal. 
• Do not open the capsules. 
• Take this medicine exactly as your healthcare provider tells you. Do not change the dose or stop taking this medicine without first talking to your healthcare provider. 

Cobenfy Dosing Information

Recommended starting Cobenfy dosage

•  50mg/20mg orally twice daily for at least two days, then increase the dosage to 100mg/20mg twice daily for at least five days.
• Dosage may be increased to 125 mg/30 mg orally twice daily based on patient tolerability and response. 
• See the full prescribing information for the recommended titration and maximum recommended dosage.

Geriatric patients: Recommended starting dosage is 50 mg/20mg orally twice daily. Consider a slower titration. The maximum recommended dosage is 100mg/20mg twice daily. (2.3)

General dosing information

• Take at least 1 hour before a meal or at least 2 hours after a meal. 
• Do not open capsules. (2.2) 
• Assess liver enzymes and bilirubin before starting treatment with this medicine and as clinically indicated during treatment. 
• Assess heart rate at baseline and as clinically indicated during treatment with Cobenfy.

Cobenfy capsules are available in strengths: 50mg/20mg, 100mg/20mg, 125mg/30mg (xanomeline/trospium chloride)

What happens if I overdose?

If you take too much Cobenfy call your healthcare provider or Poison Help Line at 1-800-222-1222, or go to the nearest hospital emergency room right away.

Interactions

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Cobenfy and other medicines may affect each other, causing side effects. Know the medicines you take and keep a list of them to show your healthcare provider or pharmacist when you get a new medicine.

Medications that interact with Cobenfy include:

Drugs Eliminated by Active Tubular Secretion: Monitor for increased frequency and/ or severity of adverse reactions related to Cobenfy and to drugs eliminated by active tubular secretion. 

Strong CYP2D6 Inhibitors: Monitor for increased frequency and/or severity of Cobenfy related adverse reactions.

Sensitive Substrates of CYP3A4 or P-glycoprotein: Monitor for increased frequency and/ or severity of adverse reactions from these substrates. 

Antimuscarinic Drugs: Monitor for increased frequency or severity of anticholinergic adverse reactions.

Not all possible interactions are listed here. Other drugs may interact with Cobenfy, including prescription and over-the-counter medicines, vitamins, and herbal products. 

Storage

Store at room temperature between 68°F to 77°F (20°C to 25°C)

Cobenfy ingredients 

Active ingredients:  xanomeline and trospium chloride 

Inactive ingredients: ascorbic acid, lactose monohydrate, microcrystalline cellulose, and talc Capsule shell: contains black iron oxide (only100mg/20mg), hypromellose, red iron oxide, titanium dioxide, and yellow iron oxide (only 50mg/20mg and 100mg/20mg)

Clozapine is an antipsychotic medicine. It works by changing the actions of chemicals in the brain.

Clozapine is used to treat schizophrenia in adults after other treatments have failed.

Clozapine is also used to reduce the risk of suicidal behavior in adults with schizophrenia or similar disorders.

Warnings

Clozapine affects your immune system. You may get infections more easily, even serious or fatal infections. Call your doctor if you have a fever, sore throat, weakness, or lack of energy.

Clozapine can increase your risk of seizure, especially at high doses. Avoid any activity that could be dangerous if you have a seizure or lose consciousness.

Clozapine can cause serious heart problems. Call your doctor right away if you have chest pain, trouble breathing, fast or pounding heartbeats or sudden dizziness.

Clozapine is not approved for use in older adults with dementia-related psychosis.

Before taking this medicine

Clozapine may increase the risk of death in older adults with dementia-related psychosis and is not approved for this use.

You should not take clozapine if you are allergic to it.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• heart problems, high blood pressure,
• a heart attack or stroke (including “mini-stroke”);
• long QT syndrome (in you or a family member);
• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);
• a seizure, head injury, or brain tumor;
• diabetes, or risk factors such as being overweight or having a family history of diabetes;
• high cholesterol or triglycerides;
• constipation or problems with your bowel movements;
• liver or kidney disease;
• an enlarged prostate or urination problems;
• glaucoma;
• malnourishment or dehydration; or
• if you smoke.

Taking antipsychotic medicine in the last 3 months of pregnancy may cause breathing problems, feeding problems, or withdrawal symptoms in the newborn. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy. If you get pregnant, tell your doctor right away. Do not stop taking clozapine without your doctor’s advice.

You should not breastfeed while using this medicine.

Clozapine is not approved for use by anyone younger than 18 years old.

How should I take clozapine?

Take clozapine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

You may take clozapine with or without food.

Shake the oral suspension (liquid) for 10 seconds before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Remove an orally disintegrating tablet from the package only when you are ready to take the medicine. Place the tablet in your mouth and allow it to dissolve, without chewing. Swallow several times as the tablet dissolves.

Clozapine affects your immune system and can have long lasting effects on your body. You may get infections more easily, even serious or fatal infections. You may need frequent medical tests while using this medicine and for a short time after your last dose.

You should not stop using clozapine suddenly. Follow your doctor’s instructions about tapering your dose.

If you start taking clozapine again after 2 or more days off the medicine, you may need to use a lower dose than when you stopped. Follow your doctor’s dosing instructions very carefully.

Your doctor may recommend you use a laxative while taking clozapine. Use only the type of laxative your doctor recommends.

Store at room temperature away from moisture and heat.

Dosing information

Usual Adult Dose for Schizophrenia:

Initial dose: 12.5 mg orally once or twice a day
Titration and Maintenance dose: May increase total daily dose in increments of 25 mg to 50 mg per day to a target dose of 300 mg to 450 mg per day (administered in divided doses) by the end of week 2. Subsequent dose increases can be in increments of up to 100 mg once or twice weekly.
Maximum dose: 900 mg per day

Comments:
-The absolute neutrophil count (ANC) must be 1500/microL or greater for the general population and at least 1000/microL for patients with documented Benign Ethnic Neutropenia (BEN) prior to initiating treatment; to continue therapy, the ANC must be monitored regularly.
-A low starting dose, gradual titration, and divided doses are necessary to minimize the risk of orthostatic hypotension, bradycardia, and syncope.
-When therapy is interrupted for 2 or more days, re-initiate with 12.5 mg once or twice a day; based on tolerability, a dose that is restarted may be increased to a previously therapeutic dose more quickly than it was for initial treatment.

Uses:
-For the treatment of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment
-To reduce the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder, who are judged to be at chronic risk for re-experiencing suicidal behavior, based on history and recent clinical state

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

If you miss taking clozapine for more than 2 days in a row, call your doctor before you start taking it again.

Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include drowsiness, confusion, fast heartbeats, feeling light-headed, weak or shallow breathing, drooling, choking, or seizure.

What to avoid

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid coffee, tea, cola, energy drinks or other sources of caffeine.

Avoid driving or hazardous activity until you know how clozapine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Clozapine side effects

Get emergency medical help if you have signs of an allergic reaction to clozapine (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

You may get infections more easily, even serious or fatal infections. Call your doctor right away if you have signs of infection such as:

• fever, flu-like symptoms, extreme weakness;
• mouth sores, skin sores;
• new or worsening cough, trouble breathing;
• pain or burning when you urinate; or
• vaginal itching or discharge.

Further doses may be delayed until your infection clears up.

High doses or long-term use of clozapine can cause a serious movement disorder that may not be reversible. The longer you use clozapine, the more likely you are to develop this disorder, especially if you are a woman or an older adult.

Clozapine can increase your risk of seizure, especially at high doses. Avoid any activity that could be dangerous if you have a seizure or lose consciousness.

Call your doctor at once if you have:

• uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement);
• a seizure (blackout or convulsions);
• severe constipation;
• dry or hard bowel movements, or painful gas;
• nausea, vomiting, stomach pain or bloating;
• heart problems – chest pain, fast or pounding heartbeats, fluttering in your chest, slow heartbeats, shortness of breath, and sudden dizziness (like you might pass out);
• liver problems – loss of appetite, stomach pain (upper right side), tiredness, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• severe nervous system reaction – very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out; or
• signs of a blood clot in the lung – chest pain, sudden cough, wheezing, rapid breathing, coughing up blood.

Untreated constipation may lead to serious bowel complications, hospitalization, or death. Tell your doctor right away if you are not having bowel movements at least 3 times per week.

Common clozapine side effects may include:

• weight gain;
• dizziness, tremor;
• fast heart rate;
• headache, drowsiness;
• nausea, constipation;
• dry mouth, or increased salivation;
• vision problems; or
• fever, increased sweating.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect clozapine?

When you start or stop taking clozapine, your doctor may need to adjust the doses of any other medicines you take on a regular basis.

Clozapine can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Using clozapine with other drugs that make you drowsy or slow your breathing can cause dangerous side effects or death. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, cold or allergy medicine, or medicine for anxiety or seizures.

Many drugs can affect clozapine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Clotrimazole is used to treat and prevent yeast infections of the mouth and throat in adults and children older than 3 years.

The clotrimazole lozenge is not absorbed through your stomach. clotrimazole will not treat fungal infections in any other part of your body.

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

Clotrimazole side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Common side effects of clotrimazole may include:

• abnormal liver function tests;
• nausea, vomiting;
• itching, or
• an unpleasant sensation in the mouth.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Use only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies.

Before taking this medicine

You should not use clotrimazole if you are allergic to it.

Tell your doctor if you have ever had liver disease.

Tell your doctor if you are pregnant or breastfeeding.

How should I take clotrimazole?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Clotrimazole is usually given 3 to 5 times per day. Allow the lozenge to dissolve slowly in your mouth without chewing.

You may need liver function tests.

Store at room temperature away from moisture and heat. Avoid freezing.

Clotrimazole dosing information

Usual Adult Dose for Oral Thrush:

Treatment: 10 mg orally 5 times a day for 14 days

Prophylaxis: 10 mg orally 3 times a day for the duration of chemotherapy OR until steroids are reduced to maintenance levels

Comment:
-Safety and efficacy of treatment doses given for a prolonged duration have not been established. Treatment should be limited to short-term use when possible.

Uses:
-Local treatment of oropharyngeal candidiasis that has been confirmed by a KOH smear of other culture before treatment.
-Prophylaxis to reduce the incidence of oropharyngeal candidiasis in patients who are immunocompromised (e.g., chemotherapy, radiotherapy, steroid therapy in the treatment of leukemia, solid tumors, or renal transplantation)

Usual Pediatric Dose for Oral Thrush:

3 years and older:
Treatment: 10 mg orally 5 times a day for 14 days

Prophylaxis: 10 mg orally 3 times a day for the duration of chemotherapy OR until steroids are reduced to maintenance levels

Comment:
-Safety and efficacy of treatment doses given for a prolonged duration have not been established. Treatment should be limited to short-term use when possible.

Uses:
-Local treatment of oropharyngeal candidiasis that has been confirmed by a KOH smear of other culture before treatment.
-Prophylaxis to reduce the incidence of oropharyngeal candidiasis in patients who are immunocompromised (e.g., chemotherapy, radiotherapy, steroid therapy in the treatment of leukemia, solid tumors, or renal transplantation)

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while taking clotrimazole?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

What other drugs will affect clotrimazole?

Clotrimazole is not absorbed through your stomach and is not likely to be affected by other drugs you use. However, tell your doctor about all your current medicines, including prescription and over-the-counter medicines, vitamins, and herbal products.

Clopidogrel is used to lower your risk of having a stroke, blood clot, or serious heart problem after you’ve had a heart attack, severe chest pain (angina), or circulation problems.

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

Clopidogrel side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Clopidogrel increases your risk of bleeding, which can be severe or life-threatening. Call your doctor or seek emergency medical attention if you have bleeding that will not stop, if you have blood in your urine, black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds.

Also call your doctor at once if you have:

• nosebleeds, pale skin, easy bruising, purple spots under your skin or in your mouth;
• jaundice (yellowing of your skin or eyes);
• fast heartbeats, shortness of breath;
• headache, fever, weakness, feeling tired;
• little or no urination;
• a seizure;
• low blood sugar–headache, hunger, sweating, irritability, dizziness, fast heart rate, and feeling anxious or shaky; or
• signs of a blood clot–sudden numbness or weakness, confusion, problems with vision or speech.

Common side effects of clopidogrel may include:

• bleeding.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

You should not use clopidogrel if you have any active bleeding such as a stomach ulcer or bleeding in the brain.

Clopidogrel increases your risk of bleeding, which can be severe or life-threatening. Call your doctor or seek emergency medical attention if you have bleeding that will not stop, if you have blood in your urine, black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds.

Do not stop taking clopidogrel without first talking to your doctor, even if you have signs of bleeding. Stopping clopidogrel may increase your risk of a heart attack or stroke.

Before taking this medicine

You should not use clopidogrel if you are allergic to it, or if you have:

• any active bleeding; or
• a stomach ulcer or bleeding in the brain (such as from a head injury).

Tell your doctor if you have ever had:

• an ulcer in your stomach or intestines; or
• a bleeding disorder or blood clotting disorder.

Clopidogrel may not work as well if you have certain genetic factors that affect the breakdown of this medicine in your body. Your doctor may perform a blood test to make sure clopidogrel is right for you.

This medicine is not expected to harm an unborn baby. However, taking clopidogrel within 1 week before childbirth can cause bleeding in the mother. Tell your doctor if you are pregnant or plan to become pregnant.

You should not breastfeed while using this medicine.

How should I take clopidogrel?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use these medicines exactly as directed.

Clopidogrel can be taken with or without food.

Clopidogrel is sometimes taken together with aspirin. Take aspirin only if your doctor tells you to.

Clopidogrel keeps your blood from coagulating (clotting) and can make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have any bleeding that will not stop.

You may need to stop using clopidogrel for a short time before a surgery, medical procedure, or dental work. Any healthcare provider who treats you should know that you are taking clopidogrel.

Do not stop taking clopidogrel without first talking to your doctor, even if you have signs of bleeding. Stopping the medicine could increase your risk of a heart attack or stroke.

Store at room temperature away from moisture and heat.

Clopidogrel dosing information

Usual Adult Dose for Acute Coronary Syndrome:

Unstable Angina (UA)/Non-ST-Elevation Myocardial Infarction (NSTEMI):
-Loading dose: 300 mg orally once
-Maintenance dose: 75 mg orally once a day
-Duration of therapy: Optimal duration unknown.

ST-Elevation Myocardial Infarction (STEMI):
-Loading dose: 300 mg orally once (OPTIONAL)
-Maintenance dose: 75 mg orally once a day, with or without thrombolytics
-Duration of therapy: Optimal duration unknown.

Comments:
-Administer this drug in combination with aspirin 75 mg to 325 mg orally once a day.
-The benefit of this drug for patients who undergo primary percutaneous coronary intervention is unknown.

Uses: Prevention of atherothrombotic events in patients with non-ST-segment elevation acute coronary syndrome (UA, NSTEMI, those who are to be managed medically, those who are to be managed with coronary revascularization) and STEMI.

Usual Adult Dose for Ischemic Stroke:

75 mg orally once a day

Uses: Prevention of atherothrombotic events in patients with a history of recent myocardial infarction, recent stroke, or established peripheral arterial disease.

Usual Adult Dose for Myocardial Infarction:

75 mg orally once a day

Uses: Prevention of atherothrombotic events in patients with a history of recent myocardial infarction, recent stroke, or established peripheral arterial disease.

Usual Adult Dose for Peripheral Arterial Disease:

75 mg orally once a day

Uses: Prevention of atherothrombotic events in patients with a history of recent myocardial infarction, recent stroke, or established peripheral arterial disease.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . Overdose can cause excessive bleeding.

What should I avoid while taking clopidogrel?

Avoid alcohol. It can increase your risk of stomach bleeding.

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

If you also take aspirin: Ask a doctor or pharmacist before using medicines for pain, fever, swelling, or cold/flu symptoms. They may contain ingredients similar to aspirin (such as salicylates, ibuprofen, ketoprofen, or naproxen). Taking these products together can increase your risk of bleeding.

What other drugs will affect clopidogrel?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Tell your doctor about all your other medicines, especially:

• a stomach acid reducer such as omeprazole, Nexium, or Prilosec;
• an antidepressant such as citalopram, fluoxetine, sertraline, Cymbalta, Effexor, Lexapro, Pristiq, or Prozac;
• rifampin;
• a blood thinner–warfarin, Coumadin, Jantoven; or
• NSAIDs (nonsteroidal anti-inflammatory drugs)–aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

What is clonidine?

Clonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily.

Clonidine (Catapres tablet/patch, Javadin) is used to treat hypertension (high blood pressure).

The Kapvay brand is an extended-release tablet used to treat attention deficit hyperactivity disorder (ADHD).

Onyda XR is an extended-release oral suspension used to treat ADHD in children 6 years and older.

Clonidine is sometimes given with other medications. Clonidine is also available as a transdermal patch worn on the skin. Do not use two forms of this medicine at the same time.

Warnings

Before you take clonidine, tell your doctor if you have heart disease or severe coronary artery disease, a heart rhythm disorder, slow heartbeats, low blood pressure, a history of heart attack or stroke, kidney disease, or if you have ever had an allergic reaction to a Catapres TTS transdermal skin patch.

Use only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies.

Before taking this medicine

You should not take this medicine if you are allergic to clonidine.

To make sure clonidine is safe for you, tell your doctor if you have:

• heart disease or severe coronary artery disease;
• a heart rhythm disorder, slow heartbeats;
• high or low blood pressure, or a history of fainting spells;
• a heart attack or stroke;
• pheochromocytoma (tumor of the adrenal gland);
• kidney disease; or
• if you have ever had an allergic reaction to a Catapres TTS transdermal skin patch.

It is not known if clonidine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of clonidine on the baby.

Clonidine may affect fertility in men or women. Pregnancy could be harder to achieve while either parent is using this medicine.

If you are breastfeeding, tell your doctor if you notice somnolence, tiredness, rapid breathing, and poor feeding in the nursing baby.

Catapres is not approved for use by anyone younger than 18 years old. Do not give Kapvay to a child younger than 6 years old.

How should I take clonidine?

Take clonidine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Clonidine is usually taken in the morning and at bedtime. If you take different doses of this medicine at each dosing time, it may be best to take the larger dose at bedtime.

Clonidine may be taken with or without food.

Swallow the extended-release tablet whole and do not crush, chew, or break it.

Javadin oral solution is for adults with hypertension and can be taken with or without food.

Tell your doctor if you have a planned surgery.

You may have withdrawal symptoms if you stop using this medicine suddenly. Ask your doctor before stopping the medicine.

Call your doctor if you are sick with vomiting. This is especially important for a child taking clonidine.

If you have high blood pressure, keep using this medicine even if you feel well. High blood pressure often has no symptoms.

Store at room temperature away from moisture, heat, and light.

Dosing information

Usual Clonidine Adult Dose for Hypertension

Oral Tablets:

• Initial dose: 0.1 mg orally 2 times a day (morning and bedtime)
• Titration: Increments of 0.1 mg orally per day may be made at weekly intervals to desired response
• Maintenance dose: 0.2 to 0.6 mg orally per day in divided doses
• Maximum dose: 2.4 mg orally per day in divided doses

Comments:
Taking the larger portion of the oral daily dose at bedtime may minimize the transient adjustment effects of dry mouth and drowsiness

Transdermal patches:

• Initial dose: 0.1 mg/24 hr patch applied every 7 days
• Maintenance dose: If, after 1 to 2 weeks, the desired reduction in blood pressure is not achieved, increase the dosage by adding another 0.1 mg/24 hr patch or changing to a larger system
• Maximum dose: Doses above two 0.3 mg/24 hr patches applied every 7 days is usually not associated with additional efficacy

Comments:
-The transdermal patch should be applied to a hairless area of intact skin on the upper outer arm or chest.
-Each new patch should be applied on a different skin site from the previous location.
-If the patch loosens during 7-day wearing, the adhesive cover should be applied directly over the system to ensure good adhesion.
-There have been rare reports of the need for patch changes prior to 7 days to maintain blood pressure control.
-When substituting patches for the oral formulation or for other antihypertensive drugs, physicians should be aware that the antihypertensive effect of the patches may not commence until 2 to 3 days after initial application; therefore, gradual reduction of prior drug dosage is advised. Some or all previous antihypertensive treatment may have to be continued, particularly in patients with more severe forms of hypertension.
Use: For hypertension, alone or in combination with other antihypertensive agents

Javadin Oral Solution:

• Initial dose: 0.1 mg orally twice daily with or without food (morning and bedtime).
• Titrate in increments of 0.1 mg per day at weekly intervals if necessary until the desired response is achieved.
• Usual maintenance dose: 0.2 mg-0.6 mg per day, given in divided doses.

Comments: Store at 20°C to 25°C (68°F to 77°F). Discard unused portion 60 days after first opening. 

Usual Pediatric Dose for Attention Deficit Disorder

Kapvay Extended-release tablets:
6 years and older:
-Initial dose: 0.1 mg orally at bedtime
-Titration: Increase in 0.1 mg/day increments every 7 days until desired response; doses should be administered twice daily (either split equally or with the higher split dosage given at bedtime)
-Maximum dose: 0.4 mg/day in 2 divided doses

Comments:
-May be taken with or without food.
-If a dose is missed, that dose should be skipped and take the next dose as scheduled.
-Tablets should be swallowed whole, and not crushed, chewed, or broken to avoid increasing the rate of drug release.
-When discontinuing therapy, taper daily dose by no more than 0.1 mg every 3 to 7 days.

Use: For the treatment of attention deficit hyperactivity disorder (ADHD) as monotherapy or as adjunctive therapy to stimulant medications.

Onyda XR Extended-release oral suspension
–Children 6 years and older.
-Initial Onyda XR dose: 0.1 mg orally once daily at bedtime with or without food. Dosage may be increased in increments of 0.1 mg per day at weekly intervals.
-Maximum recommended dosage: 0.4 mg once daily at bedtime.
-Comments: Do not substitute Onyda XR for other clonidine products on a mg-per-mg basis because of differing pharmacokinetic profiles.
-When discontinuing: Taper the dose in decrements of no more than 0.1 mg every 3 to 7 days to avoid rebound hypertension.

What happens if I miss a dose?

Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include feeling cold, irritable, weak, drowsy, or light-headed, or having weak reflexes, pinpoint pupils, slow heartbeats, shallow breathing, or a seizure.

What should I avoid while taking clonidine?

Avoid drinking alcohol. It may increase certain side effects of clonidine.

Avoid driving or hazardous activity until you know how clonidine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Avoid becoming overheated or dehydrated during exercise and in hot weather.

Clonidine side effects

Get emergency medical help if you have signs of an allergic reaction to clonidine: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• severe chest pain, shortness of breath, irregular heartbeats;
• a very slow heart rate; or
• a light-headed feeling, like you might pass out.

Common clonidine side effects may include:

• drowsiness, dizziness;
• feeling tired or irritable;
• dry mouth;
• constipation, loss of appetite; or
• sleep problems (insomnia), nightmares.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect clonidine?

Using clonidine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your other medicines, especially:

• other heart or blood pressure medications;
• an antidepressant; or
• any other medicine that contains clonidine.

This list is not complete. Other drugs may interact with clonidine, including prescription and over-the-counter medicines, vitamins, and herbal products. 

Clonazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain.

Clonazepam is used to treat certain seizure disorders (including absence seizures or Lennox-Gastaut syndrome) in adults and children.

Clonazepam is also used to treat panic disorder (including agoraphobia) in adults.

Warnings

Clonazepam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing.

MISUSE OF CLONAZEPAM CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it. Never share clonazepam with another person. Selling or giving away this medicine is against the law.

Some people have thoughts about suicide while taking clonazepam. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide.

Get medical help right away if you stop using clonazepam and have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, or thoughts about suicide.

Do not stop using clonazepam without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. Some withdrawal symptoms may last up to 12 months or longer.

Before taking this medicine

You should not take clonazepam if you allergic to it or if you have:

• narrow-angle glaucoma;
• severe liver disease; or
• a history of allergic reaction to any benzodiazepine (including alprazolam, diazepam, lorazepam, Valium, Xanax, Versed, and others).

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• kidney or liver disease;
• breathing problems;
• depression, mood problems, or suicidal thoughts or behavior; or
• porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system).

Some people have thoughts about suicide while taking clonazepam. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.

Tell your doctor if you are pregnant or plan to become pregnant. If you use clonazepam during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks.

Do not start or stop seizure medication during pregnancy without your doctor’s advice. Clonazepam may harm an unborn baby, but having a seizure during pregnancy could harm both mother and baby. Preventing seizures may outweigh these risks. Tell your doctor right away if you become pregnant.

Ask a doctor if it is safe to breastfeed while using this medicine.

Do not give this medicine to a child without medical advice. Clonazepam is not approved to treat panic disorder in anyone younger than 18 years old.

How should I take clonazepam?

Take clonazepam exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Your doctor may occasionally change your dose. Never use this medicine in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of this medicine.

Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it. Selling or giving away this medicine is against the law.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

You will need frequent medical tests.

Do not stop using clonazepam suddenly, even if you feel fine. Stopping suddenly may cause increased seizures or unpleasant withdrawal symptoms. Follow your doctor’s instructions about tapering your dose.

Swallow the regular tablet whole, with a full glass of water.

Clonazepam doses are based on weight in children. Your child’s dose needs may change if the child gains or loses weight.

Remove an orally disintegrating tablet from the package only when you are ready to take the medicine. Place the tablet in your mouth and allow it to dissolve, without chewing. Swallow several times as the tablet dissolves.

Your doctor will need to check your progress on a regular basis.

Call your doctor if this medicine seems to stop working as well in treating your seizures or panic attacks.

Seizures are often treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor’s advice.

Store at room temperature away from moisture, heat, and light. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of clonazepam can be fatal if you take it with alcohol, opioid medicine, or other drugs that cause drowsiness or slow your breathing.

Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, or coma.

What should I avoid while taking clonazepam?

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how clonazepam will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Clonazepam side effects

Get emergency medical help if you have signs of an allergic reaction to clonazepam: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Clonazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• new or worsening seizures;
• severe drowsiness;
• weak or shallow breathing;
• unusual changes in mood or behavior;
• confusion, paranoia, nightmares, hallucinations;
• thoughts of suicide or hurting yourself;
• unusual or involuntary eye movements.

Drowsiness or dizziness may last longer in older adults. Use caution to avoid falling or accidental injury.

Common clonazepam side effects may include:

• drowsiness, dizziness;
• feeling tired or depressed;
• memory problems; or
• problems with walking or coordination.

After you stop using clonazepam, get medical help right away if you have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, suicidal thoughts or actions.

Some withdrawal symptoms may last up to 12 months or longer after stopping this medicine suddenly. Tell your doctor if you have ongoing anxiety, depression, problems with memory or thinking, trouble sleeping, ringing in your ears, a burning or prickly feeling, or a crawling sensation under your skin.

Clobetasol is a highly potent steroid that helps reduce inflammation in the body.

Clodan (for the skin) is used to treat inflammation and itching caused by plaque psoriasis or skin conditions that respond to steroid medication.

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

Clodan side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Clodan may cause serious side effects. Call your doctor at once if you have:

• worsening of your skin condition;
• redness, warmth, swelling, oozing, or severe irritation of any treated skin;
• blurred vision, tunnel vision, eye pain, or seeing halos around lights;
• high blood sugar–increased thirst, increased urination, dry mouth, fruity breath odor; or
• possible signs of absorbing Clodan through your skin–weight gain in your face and shoulders, slow wound healing, skin discoloration, thinning skin, increased body hair, tiredness, mood changes, menstrual changes, sexual changes.

Common side effects of Clodan may include:

• burning, itching, swelling, or irritation of treated skin;
• dry or cracking skin;
• redness or crusting around your hair follicles;
• spider veins;
• stretch marks, thinning skin;
• rash or hives;
• acne; or
• temporary hair loss.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Starting Clodan? Read this first

Before taking this medicine

You should not use Clodan if you are allergic to it.

Tell your doctor if you have ever had:

• any type of skin infection;
• a skin reaction to any steroid medicine;
• liver disease; or
• an adrenal gland disorder.

Steroid medicines can increase the glucose (sugar) levels in your blood or urine. Tell your doctor if you have diabetes.

It is not known whether Clodan will harm an unborn baby. Tell your doctor if you are pregnant.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. If you apply clobetasol to your chest, avoid areas that may come into contact with the baby’s mouth.

Some brands or forms of this medicine are for use only in adults 18 and over.

Children can absorb larger amounts of this medicine through the skin and may be more likely to have side effects.

How should I use Clodan?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Do not take by mouth. Topical medicine is for use only on the skin. Rinse with water if this medicine gets in your eyes or mouth.

Do not use Clodan on broken or infected skin. Also avoid using this medicine in open wounds.

Wash your hands before and after using clobetasol, unless you are using the medicine to treat the skin on your hands.

Apply a thin layer of medicine to the affected skin and rub it in gently. Do not apply this medicine over a large area of skin unless your doctor has told you to.

Do not cover the treated skin area with a bandage or other covering unless your doctor tells you to. Covering treated areas can increase the amount of medicine absorbed through your skin and may cause harmful effects.

If you are treating the diaper area, do not use plastic pants or tight-fitting diapers.

This medicine is for short-term use only (2 weeks, or up to 4 weeks for scalp psoriasis). Follow your doctor’s dosing instructions very carefully.

If you use clobetasol to treat plaque psoriasis, you should stop using the medicine once your skin symptoms are controlled.

Call your doctor if your symptoms do not improve, or if they get worse.

You should not stop using clobetasol suddenly. Follow your doctor’s instructions about tapering your dose.

Store at room temperature away from moisture and heat. Keep from freezing.

Clobetasol foam is flammable. Do not use near high heat or open flame. Do not smoke until the foam has completely dried on your skin.

What happens if I miss a dose?

Apply the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not apply two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line if anyone has accidentally swallowed the medication.

High doses or long-term use of Clodan can lead to thinning skin, easy bruising, changes in body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using clobetasol topical?

Avoid applying Clodan to your face, underarms, or groin area.

Do not use this medicine to treat any condition that has not been checked by your doctor.

Avoid using other topical steroid medications on the areas you treat with clobetasol unless your doctor tells you to.

Clobetasol is a highly potent steroid that helps reduce inflammation in the body.

Clobex (for the skin) is used to treat inflammation and itching caused by plaque psoriasis or skin conditions that respond to steroid medication.

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

Clobex side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Clobex may cause serious side effects. Call your doctor at once if you have:

• worsening of your skin condition;
• redness, warmth, swelling, oozing, or severe irritation of any treated skin;
• blurred vision, tunnel vision, eye pain, or seeing halos around lights;
• high blood sugar–increased thirst, increased urination, dry mouth, fruity breath odor; or
• possible signs of absorbing Clobex through your skin–weight gain in your face and shoulders, slow wound healing, skin discoloration, thinning skin, increased body hair, tiredness, mood changes, menstrual changes, sexual changes.

Common side effects of Clobex may include:

• burning, itching, swelling, or irritation of treated skin;
• dry or cracking skin;
• redness or crusting around your hair follicles;
• spider veins;
• stretch marks, thinning skin;
• rash or hives;
• acne; or
• temporary hair loss.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use Clobex if you are allergic to it.

Tell your doctor if you have ever had:

• any type of skin infection;
• a skin reaction to any steroid medicine;
• liver disease; or
• an adrenal gland disorder.

Steroid medicines can increase the glucose (sugar) levels in your blood or urine. Tell your doctor if you have diabetes.

It is not known whether Clobex will harm an unborn baby. Tell your doctor if you are pregnant.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. If you apply clobetasol to your chest, avoid areas that may come into contact with the baby’s mouth.

Clobex is not approved for use by anyone younger than 12 years old. Some brands or forms of this medicine are for use only in adults 18 and over.

Children can absorb larger amounts of this medicine through the skin and may be more likely to have side effects.

How should I use Clobex?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Do not take by mouth. Topical medicine is for use only on the skin. Rinse with water if this medicine gets in your eyes or mouth.

Do not use Clobex on broken or infected skin. Also avoid using this medicine in open wounds.

Wash your hands before and after using clobetasol, unless you are using the medicine to treat the skin on your hands.

Apply a thin layer of medicine to the affected skin and rub it in gently. Do not apply this medicine over a large area of skin unless your doctor has told you to.

Do not cover the treated skin area with a bandage or other covering unless your doctor tells you to. Covering treated areas can increase the amount of medicine absorbed through your skin and may cause harmful effects.

If you are treating the diaper area, do not use plastic pants or tight-fitting diapers.

This medicine is for short-term use only (2 weeks, or up to 4 weeks for scalp psoriasis). Follow your doctor’s dosing instructions very carefully.

If you use clobetasol to treat plaque psoriasis, you should stop using the medicine once your skin symptoms are controlled.

Call your doctor if your symptoms do not improve, or if they get worse.

You should not stop using clobetasol suddenly. Follow your doctor’s instructions about tapering your dose.

Store at room temperature away from moisture and heat. Keep from freezing.

Clobetasol foam is flammable. Do not use near high heat or open flame. Do not smoke until the foam has completely dried on your skin.

What happens if I miss a dose?

Apply the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not apply two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line if anyone has accidentally swallowed the medication.

High doses or long-term use of Clobex can lead to thinning skin, easy bruising, changes in body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using clobetasol topical?

Avoid applying Clobex to your face, underarms, or groin area.

Do not use this medicine to treat any condition that has not been checked by your doctor.

Avoid using other topical steroid medications on the areas you treat with clobetasol unless your doctor tells you to.

What other drugs will affect Clobex?

Medicine used on the skin is not likely to be affected by other drugs you use. But many drugs can interact with each other. Tell each of your health care providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.

Clobetasol is used to treat the itching, redness, dryness, crusting, scaling, inflammation, and discomfort of various scalp and skin conditions, including plaque psoriasis (a skin disease in which red, scaly patches form on some areas of the body) and eczema (a skin disease that causes the skin to be dry and itchy and sometimes to develop red, scaly rashes). Clobetasol is also used to treat lichen sclerosus.

Clobetasol is a highly potent corticosteroid that helps reduce inflammation in the body. It works by activating natural substances in the skin to reduce swelling, redness, and itching.

Clobetasol is available in a cream, gel, ointment, lotion, solution, foam, or spray.

Warnings

Do not use clobetasol topical to treat acne, rosacea, or a rash around the mouth.

Use care when putting on a large part of the skin or where there are open wounds. Talk with the doctor.

Clobetasol may cause harm if swallowed. If swallowed, call a doctor or poison control center right away.

This drug may raise the chance of cataracts or glaucoma. Talk with your doctor.

It may affect growth in children and teens in some cases. They may need regular growth checks.

If you are breast-feeding, do not apply clobetasol cream, gel, ointment, lotion, solution, foam or spray to the nipple or the area around it.

Before taking this medicine

You should not use clobetasol topical if you are allergic to it.

To make sure this drug is safe for you, tell your doctor if you have ever had:

• any type of skin infection;
• a skin reaction to any steroid medicine;
• liver disease; or
• an adrenal gland disorder.

Steroid medicines can increase the glucose (sugar) levels in your blood or urine. Tell your doctor if you have diabetes.

It is not known whether clobetasol topical will harm an unborn baby. Tell your doctor if you are pregnant.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. If you apply this drug to your chest, avoid areas that may come into contact with the baby’s mouth.

Clobetasol is not approved for use by anyone younger than 12 years old. Some brands or forms of this medicine are for use only in adults 18 and over.

Children can absorb larger amounts of this medicine through the skin and may be more likely to have side effects.

How should I use clobetasol?

Use this drug exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Do not take by mouth. Topical medicine is for use only on the skin. Rinse with water if this medicine gets in your eyes or mouth.

Do not use clobetasol on broken or infected skin. Also avoid using this medicine in open wounds.

Wash your hands before and after using this drug, unless you are using the medicine to treat the skin on your hands.

Apply a thin layer of medicine to the affected skin and rub it in gently. Do not apply this medicine over a large area of skin unless your doctor has told you to.

Do not cover the treated skin area with a bandage or other covering unless your doctor tells you to. Covering treated areas can increase the amount of medicine absorbed through your skin and may cause harmful effects.

If you are treating the diaper area, do not use plastic pants or tight-fitting diapers.

This medicine is for short-term use only (2 weeks, or up to 4 weeks for scalp psoriasis). Follow your doctor’s dosing instructions very carefully.

If you use clobetasol to treat plaque psoriasis, you should stop using the medicine once your skin symptoms are controlled.

Call your doctor if your symptoms do not improve, or if they get worse.

You should not stop using this drug suddenly. Follow your doctor’s instructions about tapering your dose.

Store at room temperature away from moisture and heat. Keep from freezing.

Clobetasol foam is flammable. Do not use near high heat or open flame. Do not smoke until the foam has completely dried on your skin.

What happens if I miss a dose?

Apply the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not apply two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line if anyone has accidentally swallowed the medication.

High doses or long-term use of clobetasol can lead to thinning skin, easy bruising, changes in body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using clobetasol?

Avoid applying clobetasol topical to your face, underarms, or groin area. However, clobetasol can be applied to the groin area, under strict medical supervision, to treat lichen sclerosus.

Do not use this medicine to treat any condition that has not been checked by your doctor.

Avoid using other topical steroid medications on the areas you treat with clobetasol unless your doctor tells you to.

Clobetasol side effects

Get emergency medical help if you have signs of an allergic reaction to clobetasol: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• worsening of your skin condition;
• redness, warmth, swelling, oozing, or severe irritation of any treated skin;
• blurred vision, tunnel vision, eye pain, or seeing halos around lights;
• high blood sugar – increased thirst, increased urination, dry mouth, fruity breath odor; or
• possible signs of absorbing this medicine through your skin – weight gain in your face and shoulders, slow wound healing, skin discoloration, thinning skin, increased body hair, tiredness, mood changes, menstrual changes, sexual changes.

Common side effects may include:

• burning, itching, swelling, or irritation of treated skin;
• dry or cracking skin;
• redness or crusting around your hair follicles;
• spider veins;
• stretch marks, thinning skin;
• rash or hives;
• acne; or
• temporary hair loss.

Clindamycin is an antibiotic that fights bacteria in the body.

Clindamycin is used to treat serious infections caused by bacteria.

Clindamycin is usually available as one of three salts: clindamycin phosphate, clindamycin hydrochloride, or clindamycin nicotinamide. These salt forms are all prodrugs of clindamycin but once inside the body or applied to the skin, they are rapidly converted to active clindamycin by hydrolysis. All three salt forms of clindamycin: clindamycin phosphate, clindamycin hydrochloride, and clindamycin nicotinamide have the same antimicrobial spectrum and effectiveness.

Clindamycin first gained FDA approval on February 22, 1970.

What is clindamycin phosphate?

Clindamycin phosphate is a salt of clindamycin that is usually used for injectable or topical formulations of clindamycin.

• Clindamycin phosphate is a prodrug of clindamycin that is rapidly converted to active clindamycin once inside the body or applied to the skin.
• Clindamycin phosphate has the same antimicrobial spectrum and effectiveness as clindamycin hydrochloride, clindamycin nicotinamide, and clindamycin.
• Clindamycin nicotinamide is another topical form of clindamycin.

What is clindamycin hydrochloride?

Clindamycin hydrochloride is a salt of clindamycin that is usually used for oral formulations of clindamycin.

• Clindamycin hydrochloride is a prodrug of clindamycin that is rapidly converted to active clindamycin once inside the body.
• Clindamycin hydrochloride has the same antimicrobial spectrum and effectiveness as clindamycin phosphate, clindamycin nicotinamide, and clindamycin.

What is clindamycin used to treat?

Clindamycin may be used to treat a wide range of infections, although it should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria to reduce the development of drug-resistant bacteria and to maintain its effectiveness.

Infections clindamycin treats in adults and children include serious:

• Infections caused by susceptible anaerobic bacteria
• Infections due to susceptible isolates of streptococci, pneumococci, and staphylococci, if a less toxic alternative (such as erythromycin) is not suitable
• Lower respiratory tract infections including pneumonia, empyema, and lung abscess caused by susceptible isolates of anaerobes, Streptococcus pneumoniae, other streptococci (except Enterococcus faecalis), and Staphylococcus aureus in adults and children
• Skin and skin structure infections caused by susceptible isolates of Streptococcus pyogenes, Staphylococcus aureus, and anaerobes in adults and children
• • Topical clindamycin 1% may be used to help treat and control severe acne.

• Gynecological infections including endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection caused by susceptible anaerobes in adults and children
• Intra-abdominal infections including peritonitis and intra-abdominal abscesses caused by susceptible anaerobic organisms in adults and children
• Septicemia caused by susceptible isolates of Staphylococcus aureus, streptococci (except E. faecalis), and susceptible anaerobes in adults and children
• Bone and joint infections including acute hematogenous osteomyelitis caused by susceptible isolates of S. aureus and as adjunctive therapy in the surgical treatment of chronic bone and joint infections due to susceptible organisms in adults and children.

Clindamycin does not adequately penetrate the cerebrospinal fluid and should NOT be used to treat meningitis.

Clindamycin side effects

The most common clindamycin side effects include:

• nausea or vomiting
• stomach (abdominal) pain
• mild skin rash
• vaginal itching or discharge.

Clindamycin may also cause a metallic taste in your mouth. Talk to your healthcare provider about ways you can manage this.

Serious side effects and warnings

Clindamycin carries a Boxed Warning for Clostridium difficile-associated diarrhea (CDAD).

Clindamycin can cause diarrhea, which may range in severity from mild to fatal colitis. Diarrhea associated with clindamycin use is sometimes caused by an overgrowth of dangerous Clostridium difficile bacteria in the large intestine. Seniors especially should be monitored for diarrhea. If you have diarrhea that is watery or bloody, stop using clindamycin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to. Seek urgent medical attention.

Get emergency medical help if you have any signs of an allergic reaction to clindamycin: (hives, difficulty breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Serious skin and other reactions can occur with clindamycin. Seek medical treatment if you have symptoms of a drug reaction such as skin rash, fever, swollen glands, flu-like symptoms, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes. This reaction may occur several weeks after starting clindamycin.

Call your healthcare provider at once if you have:

• any change in bowel habits (for example, you start going to the toilet very frequently or don’t go at all)
• severe stomach pain
• diarrhea that is watery or bloody
• little or no urination.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Before taking this medicine

Do not take clindamycin if you are allergic to clindamycin, lincomycin, Cleocin, Clindesse, ClindaMax, or any of the inactive ingredients in the clindamycin preparation you are taking (refer to the clindamycin Package Insert).

To make sure clindamycin is safe for you, tell your doctor if you have ever had:

• kidney or liver disease
• an intestinal disorder such as ulcerative colitis or Crohn’s disease
• eczema
• an allergic skin reaction
• asthma or a severe allergic reaction to aspirin
• an allergy to yellow food dye.

Also, tell your healthcare provider if you are pregnant or intend to become pregnant or are breastfeeding.

Pregnancy

Animal studies have not shown any harm during pregnancy, but it is not known whether clindamycin will harm an unborn baby in humans.

Breastfeeding

Clindamycin does pass into breast milk and may cause side effects in the nursing baby. If you are breastfeeding while taking this medicine, call your doctor if your baby has diaper rash, redness or white patches in the mouth or throat, stomach discomfort, or diarrhea that is watery or bloody. Let your doctor know if you are breastfeeding before taking clindamycin.

Young infants

Clindamycin injection may contain an ingredient that can cause serious side effects or death in very young or premature babies. Do not give this medicine to a child without medical advice.

How should I take clindamycin?

Take clindamycin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Oral clindamycin capsules are taken by mouth.

Clindamycin injection is injected into a muscle, or as an infusion into a vein. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.

Take the capsule with a full glass of water to keep it from irritating your throat.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

You may need frequent medical tests during treatment.

If you need surgery, let your surgeon know you use clindamycin as it may interact with certain drugs used for anesthesia.

Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Clindamycin will not treat a viral infection such as the flu or a common cold.

Store at room temperature away from moisture and heat. Protect the injectable medicine from high heat.

Do not store the oral liquid in the refrigerator. Throw away any unused oral liquid after 2 weeks.

Take clindamycin for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Clindamycin will not treat a viral infection such as the common cold or flu.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while using clindamycin?

Do not use clindamycin at the same time as erythromycin, another antibiotic.

What other drugs will affect clindamycin?

Other drugs may interact with clindamycin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicines you start or stop using.

Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents, such as succinylcholine, rocuronium, or vecuronium. Use with caution.

Clindamycin is metabolized predominantly by CYP3A4 hepatic enzymes, and to a lesser extent by CYP3A5, to the major metabolite clindamycin sulfoxide and minor metabolite N‑desmethylclindamycin. Caution should be used when using with strong or moderate inhibitors of CYP3A4 and CYP3A5, such as clarithromycin, nefazodone, itraconazole, ketoconazole, atazanavir, darunavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, or tipranavir. Caution should also be used when used together with inducers of these enzymes such as phenobarbital, phenytoin, rifampicin, St. John’s Wort, and glucocorticoids because concentrations of clindamycin may be reduced and it may not be as effective.

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

Claritin is used to treat sneezing, runny nose, watery eyes, hives, skin rash, hay fever, itching, and other cold or allergy symptoms.

Claritin is also used to treat skin hives and itching in people with chronic skin reactions

Warnings

You should not take Claritin if you are allergic to loratadine or to desloratadine (Clarinex).

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Some chewable dosage forms of Claritin may contain phenylalanine. Talk to your doctor before using these forms of loratadine if you have phenylketonuria (PKU).

Ask a doctor or pharmacist before taking Claritin if you have liver or kidney disease.

Before taking this medicine

Ask a doctor or pharmacist if Claritin is safe to use if you have ever had:

• kidney disease; or
• liver disease.

The chewable Claritin tablet may contain phenylalanine and could be harmful if you have phenylketonuria (PKU).

Ask a doctor before using this medicine if you are pregnant or breastfeeding.

Do not give this medicine to a child younger than 2 years old without medical advice.

How should I take Claritin?

Use Claritin exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Cold or allergy medicine is usually taken only for a short time until your symptoms clear up.

Do not give Claritin to a child younger than 2 years old. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children.

Claritin is usually taken once per day. Follow your doctor’s instructions.

Do not crush, chew, or break the regular tablet. Swallow the tablet whole.

A child’s dose is based on age and some forms of loratadine are not for use in children younger than 6 years old. Carefully follow the dosing instructions provided with this medicine.

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

The Claritin chewable tablet must be chewed before you swallow it.

To take the orally disintegrating tablet (Claritin RediTab):

• Keep the tablet in its blister pack until you are ready to take it. Open the package and peel back the foil. Do not push a tablet through the foil or you may damage the tablet.
• Use dry hands to remove the tablet and place it in your mouth.
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. If desired, you may drink liquid to help swallow the dissolved tablet.

Call your doctor if your symptoms do not improve, or if they get worse.

Store at room temperature away from moisture and heat.

Claritin side effects

Get emergency medical help if you have signs of an allergic reaction to Claritin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using this medicine and call your doctor at once if you have:

• fast or uneven heart rate;
• severe headache; or
• a light-headed feeling, like you might pass out;

Common Claritin side effects may include:

• headache;
• feeling tired or drowsy;
• stomach pain, vomiting;
• dry mouth; or
• feeling nervous or hyperactive.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Dosing information

Usual Adult Dose for Allergic Rhinitis:

10 mg orally once a day
-Maximum dose: 10 mg/day

Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat)

Usual Adult Dose for Urticaria:

10 mg orally once a day
-Maximum dose: 10 mg/day

Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat)

Usual Pediatric Dose for Allergic Rhinitis:

2 to 5 years: 5 mg orally once a day
-Maximum dose: 5 mg/day

6 years and older: 10 mg orally once a day
-Maximum dose: 10 mg/day

Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat)

Usual Pediatric Dose for Urticaria:

2 to 5 years: 5 mg orally once a day
-Maximum dose: 5 mg/day

6 years and older: 10 mg orally once a day
-Maximum dose: 10 mg/day

Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat)

What other drugs will affect Claritin?

Other drugs may interact with loratadine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

What happens if I miss a dose?

Claritin is used when needed. Do not use Claritin more than once in a 24-hour period. Do not use two doses at one time.

What happens if I overdose?

Overdose symptoms may include headache, drowsiness, and fast or pounding heartbeat.

Seek emergency medical attention or call the Poison Help line .

What should I avoid while taking Claritin?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Clarithromycin is a macrolide antibiotic that fights bacteria in your body.

Clarithromycin is used to treat many different types of bacterial infections affecting the skin and respiratory system.

Clarithromycin is also used together with other medicines to treat stomach ulcers caused by Helicobacter pylori.

Warnings

Take clarithromycin for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. This medicine will not treat a viral infection such as the common cold or flu.

You should not use this medicine if you are allergic to clarithromycin or similar antibiotics, if you have ever had jaundice or liver problems caused by taking this medicine, or if you have liver or kidney disease and are also taking colchicine.

Tell your doctor about all your current medicines and any you start or stop using. Many drugs can interact with clarithromycin, and some drugs should not be used together.

Before taking this medicine

You should not use this medicine if you are allergic to clarithromycin or similar medicines such as azithromycin (Zithromax, Z-Pak, Zmax), erythromycin, or telithromycin, or if:

• you have had jaundice or liver problems caused by taking clarithromycin; or
• you have liver or kidney disease and you also take a medicine called colchicine.

Some medicines can cause unwanted or dangerous effects when used with clarithromycin. Your doctor may need to change your treatment plan if you use any of the following drugs:

• cisapride;
• pimozide;
• lomitapide
• lovastatin or simvastatin; or
• ergotamine or dihydroergotamine.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• heart problems;
• long QT syndrome (in you or a family member);
• coronary artery disease (clogged arteries);
• myasthenia gravis;
• liver disease;
• kidney disease;
• diabetes; or
• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood).

Clarithromycin may harm an unborn baby. Use effective birth control to prevent pregnancy while you are using this medicine. Tell your doctor if you become pregnant.

In animal studies, clarithromycin caused birth defects. However, it is not known whether these effects would occur in humans. Ask your doctor about your risk.

Clarithromycin can pass into breast milk and may cause side effects in the nursing baby. Tell your doctor if you are breast-feeding.

This medicine is not approved for use by anyone younger than 6 months old.

How should I take clarithromycin?

Take clarithromycin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Do not use this medicine to treat any condition that has not been checked by your doctor. Do not share this medicine with another person, even if they have the same symptoms you have.

You may take the regular tablets and oral suspension (liquid) with or without food.

Clarithromycin extended-release tablets (Biaxin XL) should be taken with food.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

Shake the oral liquid well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Clarithromycin is usually given for 7 to 14 days. Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Clarithromycin will not treat a viral infection such as the flu or a common cold.

Store this medicine in the original container at room temperature, away from moisture, heat, and light.

Do not keep the oral liquid in a refrigerator. Throw away any liquid that has not been used within 14 days.

If your infection is treated with a combination of drugs, use all medications as directed by your doctor. Read the instructions provided with each medication. Do not change your doses or medication schedule without your doctor’s advice.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include severe stomach pain, nausea, vomiting, or diarrhea.

What to avoid

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Clarithromycin side effects

Get emergency medical help if you have signs of an allergic reaction to clarithromycin: (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody;
• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• confusion, spinning sensation;
• liver problems – loss of appetite, upper stomach pain, tiredness, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
• kidney problems – little or no urination, swelling in your feet or ankles, feeling tired or short of breath.

If you’ve ever had heart problems, clarithromycin may cause a heart attack or stroke years after you’ve taken this medicine. Seek medical attention right away if you have chest pain spreading to your jaw or shoulder, trouble breathing, slurred speech, or sudden numbness or weakness on one side of your body.

Older adults may be more likely to have heart rhythm side effects, including a life-threatening fast heart rate.

Common clarithromycin side effects may include:

• stomach pain, nausea, vomiting;
• diarrhea; 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.

What other drugs will affect clarithromycin?

When you start or stop taking clarithromycin, your doctor may need to adjust the doses of any other medicines you take on a regular basis.

Clarithromycin can cause a serious heart problem, especially if you use certain medicines at the same time, such as antibiotics, antifungal medicine, antidepressants, anti-malaria medicine, asthma inhalers, antipsychotic medicine, cancer medicine, certain HIV/AIDS medicine, heart or blood pressure medicine, or medicine to prevent vomiting.

Many drugs can interact with clarithromycin, and some drugs should not be used together. Tell your doctor about all your current medicines and any medicine you start or stop using. This includes prescription and over-the-counter medicines, vitamins, and herbal products.

Citalopram is a prescription medicine used in adults to treat depression.

Citalopram is also used to treat major depressive disorder (MDD).

Citalopram belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

Citalopram side effects

Get emergency medical help if you have signs of an allergic reaction to citalopram: hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Citalopram may cause serious side effects. Call your doctor at once if you have:

• a light-headed feeling, like you might pass out;
• blurred vision, eye pain or redness, seeing halos around lights;
• fast or pounding heartbeats, pain or fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• a seizure;
• unusual bleeding – nosebleeds, bleeding gums, abnormal vaginal bleeding, any bleeding that will not stop;
• manic episodes – racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, being agitated or talkative;
• severe nervous system reaction – very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors; or
• low blood sodium – headache, confusion, problems with thinking or memory, weakness, feeling unsteady.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Citalopram can affect growth in children. Tell your doctor if your child is not growing at a normal rate while using this medicine.

Common citalopram side effects may include:

• sexual problems;
• dizziness, drowsiness;
• dry mouth, thirst, increased sweating or urination;
• loss of appetite, nausea, diarrhea, constipation;
• feeling anxious, agitated, or shaky;
• feeling weak or tired, sleep problems (insomnia), yawning;
• increased muscle movement;
• nosebleed, heavy menstrual bleeding; or
• cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Do not stop taking citalopram without your doctor’s advice.

Citalopram can cause a serious heart problem. Call your doctor right away if you have chest pain, fast or pounding heartbeats, shortness of breath, and sudden dizziness.

You should not use citalopram if you also take pimozide, as the combination can cause problems with your heart rhythm.

Do not use citalopram if you have used a MAO inhibitor in the past 14 days (such as isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, or tranylcypromine) or have received a methylene blue injection. A fatal reaction may occur.

People with depression or mental illness may have thoughts about suicide. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not stop using citalopram without first asking your doctor.

Before taking this medicine

You should not use this medicine if you are allergic to citalopram or escitalopram (Lexapro), or if you also take pimozide.

Do not use citalopram if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine. Wait at least 14 days after stopping an MAO inhibitor before you take citalopram.

Tell your doctor if you also use stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with citalopram could cause a serious condition called serotonin syndrome.

To make sure citalopram is safe for you, tell your doctor if you have ever had:

• heart problems, high blood pressure, long QT syndrome;
• a stroke;
• bleeding problems;
• sexual problems;
• narrow-angle glaucoma;
• seizures or epilepsy;
• bipolar disorder (manic depression) in you or a family member;
• an electrolyte imbalance (such as low levels of potassium, magnesium, or sodium in your blood); or
• liver or kidney disease.

People with depression or mental illness may have thoughts about suicide. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.

Taking this medicine during the last 3 months of pregnancy may harm the unborn baby, but stopping the medicine may not be safe for you. Do not start or stop citalopram without asking your doctor.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of citalopram on the baby.

Ask a doctor if it is safe to breastfeed while using this medicine.

How should I take citalopram?

Take citalopram exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the medicine your doctor prescribes.

You may take citalopram with or without food, but take it the same way each time.

Measure liquid medicine with the supplied measuring device (not a kitchen spoon).

Your symptoms may not improve for up to 4 weeks.

Tell your doctor if you have any changes in sexual function, such as loss of interest in sex, trouble having an orgasm, or (in men) problems with erections or ejaculation. Some sexual problems can be treated.

Do not stop using citalopram suddenly, or you could have unpleasant symptoms (such as agitation, confusion, tingling or electric shock feelings). Follow your doctor’s instructions about tapering your dose.

You may need frequent vision exams before starting treatment.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Citalopram dosing information

Usual Adult Dose for Depression:

Initial dose: 20 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Maximum dose: 40 mg orally per day

Comments:
-The initial dose may be increased if necessary to 40 mg once a day after at least 1 week of therapy.
-Doses of 60 mg/day did not demonstrate an advantage in efficacy over 40 mg/day doses.
-Acute episodes of depression may require several months or more of sustained pharmacologic therapy

Use: Treatment of depression

Usual Geriatric Dose for Depression:

Over 60 years of age:
Recommended dose: 20 mg orally once a day

Comments:
-Doses of 60 mg/day did not demonstrate an advantage in efficacy over 40 mg/day doses.
-Acute episodes of depression may require several months or more of sustained pharmacologic therapy.

Use: Treatment of depression

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while taking citalopram?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, naproxen, Advil, Aleve, Motrin, and others. Using an NSAID with citalopram may cause you to bruise or bleed easily.

Do not drink alcohol.

Avoid driving or hazardous activity until you know how citalopram will affect you. Your reactions could be impaired.

What other drugs will affect citalopram?

Citalopram can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Tell your doctor about all your current medicines. Many drugs can interact with citalopram, especially:

• cimetidine;
• a blood thinner (warfarin, Coumadin, Jantoven);
• a diuretic or “water pill”; or
• gatifloxacin or moxifloxacin.

Ciprofloxacin is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic, it is used to treat different types of bacterial infections. It is also used to treat people who have been exposed to anthrax or certain types of plague. Ciprofloxacin extended-release is only approved for use in adults.

Fluoroquinolone antibiotics can cause serious or disabling side effects that may not be reversible.

Ciprofloxacin should be used only for infections that cannot be treated with a safer antibiotic.

Warnings

Ciprofloxacin can cause serious side effects, including tendon problems, nerve damage, serious mood or behavior changes, or low blood sugar.

Stop using ciprofloxacin and call your doctor at once if you have: headache, hunger, irritability, numbness, tingling, burning pain, confusion, agitation, paranoia, problems with memory or concentration, thoughts of suicide, or sudden pain or movement problems in any of your joints.

In rare cases, ciprofloxacin may cause damage to your aorta, which could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

You may not be able to use this medicine if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.

Before taking this medicine

You should not use ciprofloxacin if you are allergic to it, or if:

• you also take tizanidine; or
• you are allergic to other fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).

Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles’ tendon of the heel. This can happen during treatment or several months after you stop taking ciprofloxacin. Tendon problems may be more likely in children and older adults, or people who use steroid medicine or have had an organ transplant.

To make sure ciprofloxacin is safe for you, tell your doctor if you have ever had:

• arthritis or problems with your tendons, bones or joints (especially in children);
• diabetes, low blood sugar;
• nerve problems;
• an aneurysm or blood circulation problems;
• heart problems, or a heart attack;
• muscle weakness, myasthenia gravis;
• liver or kidney disease;
• a seizure, head injury, or brain tumor;
• trouble swallowing pills;
• long QT syndrome (in you or a family member); or
• low levels of potassium in your blood (hypokalemia).

Do not give this medicine to a child without medical advice.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.

You should not breastfeed while taking ciprofloxacin and for 2 days after your last dose. Ask your doctor about breastfeeding if you take this medicine for anthrax exposure.

How should I take ciprofloxacin?

Take ciprofloxacin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Take ciprofloxacin at the same time each day, with or without food.

Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Do not give ciprofloxacin oral suspension through a feeding tube.

Swallow the extended-release tablet whole and do not crush, chew, or break it.

Drink plenty of liquids while you are taking this medicine.

Use ciprofloxacin for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Ciprofloxacin will not treat a viral infection such as the flu or a common cold.

Do not share this medicine with another person.

Store at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze. Throw away any unused liquid after 14 days.

What happens if I miss a dose?

If you take regular tablets or oral suspension: Take the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 6 hours.

If you take extended-release tablets: Take the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 8 hours.

Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What to avoid

Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink these products with your meals, but do not use them alone when taking this medicine.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.

Ciprofloxacin could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Tell your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Avoid driving or hazardous activity until you know how ciprofloxacin will affect you. Your reactions could be impaired.

Ciprofloxacin side effects

Get emergency medical help if you have signs of an allergic reaction to ciprofloxacin (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Ciprofloxacin can cause serious side effects, including tendon problems, damage to your nerves (which may be permanent), serious mood or behavior changes (after just one dose), or low blood sugar (which can lead to coma).

Stop taking this medicine and call your doctor at once if you have:

• low blood sugar – headache, hunger, irritability, dizziness, nausea, fast heart rate, or feeling shaky;
• nerve damage symptoms – numbness, tingling, burning pain in your hands, arms, legs, or feet:
• serious mood or behavior changes – nervousness, confusion, agitation, paranoia, hallucinations, memory problems, trouble concentrating, thoughts of suicide; or
• signs of tendon rupture – sudden pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive medical care or instructions).

In rare cases, ciprofloxacin may cause damage to your aorta, the main blood artery of the body. This could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

Also, stop using this medicine and call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody;
• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• any skin rash, no matter how mild;
• muscle weakness, breathing problems;
• little or no urination;
• jaundice (yellowing of the skin or eyes); or
• increased pressure inside the skull – severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

Common ciprofloxacin side effects may include:

• nausea, vomiting, diarrhea, stomach pain;
• headache; or
• abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect ciprofloxacin?

Some medicines can make ciprofloxacin much less effective when taken at the same time. If you take any of the following medicines, take your ciprofloxacin dose 2 hours before or 6 hours after you take the other medicine.

• the ulcer medicine sucralfate, or antacids that contain calcium, magnesium, or aluminum (such as Maalox, Milk of Magnesia, Mylanta, Pepcid Complete, Rolaids, Tums, and others);
• didanosine (Videx) powder or chewable tablets;
• vitamin or mineral supplements that contain calcium, iron, magnesium, or zinc.

Tell your doctor about all your other medicines, especially:

• clozapine, cyclosporine, methotrexate, phenytoin, probenecid, ropinirole, sildenafil, or theophylline;
• a blood thinner (warfarin, Coumadin, Jantoven);
• heart medication or a diuretic or “water pill”;
• oral diabetes medicine;
• products that contain caffeine;
• medicine to treat depression or mental illness;

Cipro is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic that fights bacteria in the body.

Cipro is used to treat different types of bacterial infections. Cipro is also used to treat people who have been exposed to anthrax or certain types of plague.

Fluoroquinolone antibiotics can cause serious or disabling side effects that may not be reversible.

Cipro should be used only for infections that cannot be treated with a safer antibiotic.

Warnings

Cipro can cause serious side effects, including tendon problems, nerve damage, serious mood or behavior changes, or low blood sugar.

Stop using this medicine and call your doctor at once if you have: headache, hunger, irritability, numbness, tingling, burning pain, confusion, agitation, paranoia, problems with memory or concentration, thoughts of suicide, or sudden pain or movement problems in any of your joints.

In rare cases, ciprofloxacin may cause damage to your aorta, which could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

You may not be able to use Cipro if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.

Before taking this medicine

You should not use Cipro if you are allergic to ciprofloxacin, or if:

• you also take tizanidine; or
• you are allergic to other fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).

Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles’ tendon of the heel. This can happen during treatment or several months after you stop taking Cipro. Tendon problems may be more likely in children and older adults, or people who use steroid medicine or have had an organ transplant.

To make sure Cipro is safe for you, tell your doctor if you have ever had:

• arthritis or problems with your tendons, bones or joints (especially in children);
• diabetes, low blood sugar;
• nerve problems;
• an aneurysm or blood circulation problems;
• heart problems, or a heart attack;
• muscle weakness, myasthenia gravis;
• liver or kidney disease;
• a seizure, head injury, or brain tumor;
• trouble swallowing pills;
• long QT syndrome (in you or a family member); or
• low levels of potassium in your blood (hypokalemia).

Do not give Cipro to a child without medical advice.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.

You should not breastfeed while taking ciprofloxacin and for 2 days after your last dose. Ask your doctor about breastfeeding if you take ciprofloxacin for anthrax exposure.

How should I take Cipro?

Take Cipro exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Take Cipro at the same time each day, with or without food.

Shake the Cipro oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Do not give Cipro oral suspension through a feeding tube.

Drink plenty of liquids while you are taking this medicine .

Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Ciprofloxacin will not treat a viral infection such as the flu or a common cold.

Do not share Cipro with another person.

Store at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze. Throw away any unused liquid after 14 days.

What happens if I miss a dose?

If you take regular tablets or oral suspension: Take the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 6 hours.

Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What to avoid

Do not take Cipro with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink these products with your meals, but do not use them alone when taking Cipro.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.

Ciprofloxacin could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Tell your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Ciprofloxacin side effects

Get emergency medical help if you have signs of an allergic reaction to Cipro (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Ciprofloxacin can cause serious side effects, including tendon problems, damage to your nerves (which may be permanent), serious mood or behavior changes (after just one dose), or low blood sugar (which can lead to coma).

Stop taking this medicine and call your doctor at once if you have:

• low blood sugar – headache, hunger, irritability, dizziness, nausea, fast heart rate, or feeling shaky;
• nerve damage symptoms – numbness, tingling, burning pain in your hands, arms, legs, or feet:
• serious mood or behavior changes – nervousness, confusion, agitation, paranoia, hallucinations, memory problems, trouble concentrating, thoughts of suicide; or
• signs of tendon rupture – sudden pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive medical care or instructions).

In rare cases, ciprofloxacin may cause damage to your aorta, the main blood artery of the body. This could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

Also, stop using Cipro and call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody;
• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• any skin rash, no matter how mild;
• muscle weakness, breathing problems;
• little or no urination;
• jaundice (yellowing of the skin or eyes); or
• increased pressure inside the skull – severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

Common Cipro side effects may include:

• nausea, vomiting, diarrhea, stomach pain;
• headache; or
• abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect Cipro?

Some medicines can make Cipro much less effective when taken at the same time. If you take any of the following medicines, take your dose 2 hours before or 6 hours after you take the other medicine.

• the ulcer medicine sucralfate, or antacids that contain calcium, magnesium, or aluminum (such as Maalox, Milk of Magnesia, Mylanta, Pepcid Complete, Rolaids, Tums, and others);
• didanosine (Videx) powder or chewable tablets;
• vitamin or mineral supplements that contain calcium, iron, magnesium, or zinc.

Tell your doctor about all your other medicines, especially:

• clozapine, cyclosporine, methotrexate, phenytoin, probenecid, ropinirole, sildenafil, or theophylline;
• a blood thinner (warfarin, Coumadin, Jantoven);
• heart medication or a diuretic or “water pill”;
• oral diabetes medicine;
• products that contain caffeine;
• medicine to treat depression or mental illness;
• steroid medicine (such as prednisone)

Cinryze is a man-made form of a protein that occurs naturally in the blood stream and helps control swelling in the body. People with a condition called hereditary angioedema do not have enough of this protein. Hereditary angioedema can cause attacks of swelling and symptoms such as stomach problems or trouble breathing.

Cinryze is used to prevent attacks of angioedema.

The Berinert brand of complement C1 esterase inhibitor is used to treat attacks of angioedema.

Warnings

You should not use Cinryze if have ever had a life-threatening allergic reaction to complement C1 esterase inhibitor.

Before you receive Cinryze, tell your doctor if you have a history of stroke or blood clot.

Do not give this medication to a child without medical advice.

You may be shown how to use Cinryze in an IV at home. Cinryze comes with patient instructions for safe and effective use. Follow all directions carefully. Ask your doctor or pharmacist if you have any questions.

Do not self-inject Cinryze if you do not fully understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine. Be sure you understand how to properly mix and store the medication. Stop your IV infusion and get emergency medical help if you have any of these signs of an allergic reaction: hives; wheezing or difficult breathing; feeling like you might pass out; or swelling of your face, lips, tongue, or throat.

Cinryze is made from human plasma (part of the blood) which may contain viruses and other infectious agents. Donated plasma is tested and treated to reduce the risk of it containing infectious agents, but there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.

Before taking this medicine

You should not use Cinryze if have ever had a life-threatening allergic reaction to complement C1 esterase inhibitor.

Tell your doctor if you have ever had:

• a stroke or blood clot;
• heart problems; or
• an “in-dwelling” catheter.

Tell your doctor if you are pregnant or breast-feeding.

Cinryze is made from donated human plasma and may contain viruses or other infectious agents. Donated plasma is tested and treated to reduce the risk of contamination, but there is still a small possibility it could transmit disease. Ask your doctor about any possible risk.

How should I use Cinryze?

Use Cinryze exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Cinryze is injected into a vein through an IV.

You may be shown how to use injections at home. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of needles, IV tubing, and other items used.

Cinryze is usually given every 3 or 4 days to prevent angioedema attacks.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Cinryze is a powder medicine that must be mixed with a liquid (diluent) before using it. If you are using this medicine at home, you will need to use two vials to make up a single dose. Follow all directions carefully. Be sure you understand how to properly mix and store the medicine.

Gently swirl but do not shake the mixed medicine or you may ruin it. Prepare your dose only when you are ready to give yourself an injection.

The powder and diluent mixture should be clear and colorless. Mixed Cinryze should be clear or slightly blue in color. Do not use the mixed medicine if it has changed colors or has particles in it. Call your pharmacist for new medicine.

Each single-use vial (bottle) of Cinryze is for one use only. Throw it away after one use, even if there is still medicine left inside.

Cinryze contains no preservative. Once you have pierced the rubber top of a vial with a needle, you must use that vial right away or throw it away.

Store the unmixed dry powder in a refrigerator or at cool room temperature. Protect from light and do not freeze. Throw away any unused vial after the expiration date on the label has passed.

After mixing Cinryze with the diluent, use the injection right away or store the mixture at room temperature and use it within 3 hours.

Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof “sharps” disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Dosing information

Usual Adult Dose for Hereditary Angioedema:

For routine prophylaxis against angioedema attacks in HAE patients.
1,000 Units by intravenous infusion at a rate of 1 mL per minute (1,000 units/ 10 mL) every 3 or 4 days.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose.

Keep this medicine on hand at all times to prevent angioedema, especially while traveling.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid after using Cinryze?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Cinryze side effects

Get emergency medical help if you have signs of an allergic reaction to Cinryze: hives; chest tightness, fast heartbeats, feeling light-headed; wheezing or difficult breathing, blue lips or gums; or swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• sudden numbness or weakness on one side of the body;
• pain, swelling, warmth, or redness in an arm or leg;
• sudden severe headache, confusion, problems with vision, speech, or balance;
• chest pain while taking deep breaths; or
• fast heart rate.

Common Cinryze side effects may include:

• unusual or unpleasant taste in your mouth;
• headache, dizziness;
• nausea, vomiting;
• pain, bruising, itching, swelling, bleeding, warmth, or a hard lump where the medicine was injected;
• stuffy nose, sore throat;
• rash; or
• fever.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect Cinryze?

Tell your doctor about all your other medicines, especially:

• testosterone; or
• birth control pills.

This list is not complete. Other drugs may interact with complement C1 esterase inhibitor, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Cinryze Biosimilars

Biosimilar and interchangeable products are biological products that are highly similar to and have no clinically meaningful differences from the reference product.

Reference products

These are biological products that have already been approved by the FDA, against which biosimilar products are compared. There is 1 for Cinryze.Cinryze (C1 Esterase Inhibitor (Human)) – Takeda Pharmaceuticals U.S.A., Inc.

Cimzia injection is used to treat Crohn’s disease, rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, polyarticular juvenile idiopathic arthritis, and non-radiographic axial spondyloarthritis in certain patients. Cimzia works to reduce inflammation and improve symptoms by blocking a protein called TNFα (tumor necrosis factor alpha).  Cimzia (certolizumab  pegol) belongs to the drug class TNF alfa inhibitors.

In autoimmune conditions, like Crohn’s disease, rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, and non-radiographic axial spondyloarthritis inflammation can be caused or worsened when TNF is released in the body. By Cimzia blocking TNFα there is less inflammation so symptoms of the condition improve.

Cimzia first received FDA approval on April 22, 2008, for moderate to severe active Crohn’s disease in adults who have an inadequate response to conventional therapy to reduce signs and symptoms of the disease and to maintain clinical response. Since then, it has also been approved for specific adult patients with rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, and non-radiographic axial spondyloarthritis.

Cimzia Indications

Cimzia FDA-approved indications for adults are 

• Crohn’s disease for reducing signs and symptoms and maintaining clinical response in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
• active rheumatoid arthritis  that is moderate to severe
• active psoriatic arthritis
• active ankylosing spondylitis 
• active non-radiographic axial spondyloarthritis with objective signs of inflammation
• plaque psoriasis that is moderate to severe in patients who are candidates for systemic therapy or phototherapy.

Cimzia FDA-approved indication for patients 2 years of age and older is 

• active polyarticular juvenile idiopathic arthritis (pJIA)

Cimzia side effects

Common Cimzia side effects may include rash, pain or burning when you urinate, and cold symptoms such as stuffy nose, sneezing, and a sore throat.

Serious Cimzia side effects

Get emergency medical help if you have signs of an allergic reaction to Cimzia: hives, difficulty breathing, swelling of your face, lips, tongue, or throat.

Serious and sometimes fatal infections may occur during treatment with Cimzia. Tell your doctor if you have signs of infection, such as fever, chills, cough, sweating, muscle pain, open sores or skin wounds, unusual tiredness, feeling short of breath, painful urination, diarrhea, or weight loss.

Call your doctor right away if you have any of these symptoms of lymphoma:

• chest pain, cough, feeling short of breath;
• swelling in your neck, underarm, or groin (this swelling may come and go);
• fever, night sweats, itching, weight loss, feeling tired;
• feeling full after eating only a small amount; or
• pain in your upper stomach that may spread to your back or shoulder.

Stop using Cimzia and call your doctor at once if you have Cimzia side effect symptoms of:

• shortness of breath (even with mild exertion), swelling, rapid weight gain;
• pale skin, easy bruising or bleeding;
• a new growth on your skin (may be red or purple), or any change in the size or color of a mole, freckle, or bump on your skin;
• nerve problems – vision problems, dizziness, numbness or tingly feeling, muscle weakness in your arms or legs;
• liver problems – loss of appetite, right-sided stomach pain, tiredness, jaundice (yellowing of the skin or eyes); or
• new or worsening symptoms of lupus – joint pain, and a skin rash on your cheeks or arms that worsens in sunlight.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Cimzia affects your immune system. Serious and sometimes fatal infections may occur.

Your risk of infection may be higher if you have diabetes, HIV, a weak immune system, hepatitis B, chronic infections, if you use certain medications, or if you live in or travel to certain areas.

Call your doctor at once if you have symptoms such as fever, chills, cough, diarrhea, night sweats, flu symptoms, or skin sores.

Using Cimzia may also increase your risk of developing certain types of cancer, including a rare fast-growing type of lymphoma that can be fatal.

Do not receive a “live” vaccine while you are being treated with Cimzia.

Do NOT use this medicine if you have had a serious hypersensitivity reaction to certolizumab pegol or to any of the inactive ingredients. 

Before taking this medicine

You should not use Cimzia if you are allergic to certolizumab. You may not be able to use Cimzia if you have symptoms of an infection such as fever, chills, cough, skin sores, shortness of breath, weight loss, diarrhea, or painful urination.

Tell your doctor if you have ever had tuberculosis, or anyone in your household has tuberculosis. Also tell your doctor if you have recently traveled. Tuberculosis and some fungal infections are more common in certain parts of the world, and you may have been exposed during travel.

Cimzia may cause a rare type of lymphoma (cancer) of the liver, spleen, and bone marrow that can be fatal. This has occurred mainly in teenagers and young men with Crohn’s disease or ulcerative colitis. However, anyone with an inflammatory autoimmune disorder may have a higher risk of lymphoma. Talk with your doctor about your own risk.

Tell your doctor if you have ever had:

• a chronic infection;
• hepatitis B (or if you are a carrier of the virus);
• lymphoma or other types of cancer;
• a blood cell disorder;
• congestive heart failure;
• a seizure;
• an allergy to latex;
• numbness or tingling, or a nervous system disorder such as multiple sclerosis; or
• if you are scheduled to receive any vaccines, or have recently been vaccinated with BCG (Bacille Calmette-Guerin).

It is not known whether Cimzia will harm an unborn baby. Tell your doctor if you are pregnant. Your name may be listed on a pregnancy registry to track the effects of Cimzia on the baby.

It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks.

Cimzia is not approved for use by anyone younger than 18 years old.

How is Cimzia given?

Cimzia is injected under the skin. A healthcare provider may teach you how to use the medication by yourself properly.

Cimzia is usually given every 2 to 4 weeks. You may need to use more than 1 injection to get a full dose. Follow your doctor’s dosing instructions very carefully.

Read and carefully follow any Instructions for Use provided with your medicine. Do not use Cimzia if you don’t understand all instructions for proper use. Ask your doctor or pharmacist if you have questions.

Prepare your injection only when you are ready to give it. Do not use if the medicine looks cloudy, has changed colors, or has particles in it. Call your pharmacist for new medicine.

Cimzia can increase your risk of bleeding or infection by changing the way your immune system works. You will need frequent medical tests.

Store Cimzia in its original carton in the refrigerator. Protect from light and do not freeze.

Take the syringe out of the refrigerator and let it reach room temperature before injecting your dose.

Unopened prefilled syringes may also be stored at room temperature for up to 7 days, away from heat and light. Throw away any prefilled syringe not used within 7 days. Do not put it back in the refrigerator.

Each prefilled syringe is for one use only. Throw away after one use, even if there is still medicine left inside.

Use a needle and syringe only once and then place them in a puncture-proof “sharps” container. Follow state or local laws about how to dispose of this container. Keep it out of the reach of children and pets.

If you’ve ever had hepatitis B, using Cimzia can cause this virus to become active or get worse. You may need frequent liver function tests while using this medicine and for several months after you stop.

Before you start treatment with Cimzia, your doctor may perform tests to make sure you do not have tuberculosis or other infections.

Dosing information

Usual Adult Cimzia Dose for Rheumatoid Arthritis

Initial Cimzia dose: 400 mg subcutaneously (given as two subcutaneous injections of 200 mg) at weeks 0, 2, and 4, followed by 200 mg subcutaneously every other week
Maintenance Cimzia dose: 400 mg subcutaneously every 4 weeks can be considered
Use: For the treatment of adults with moderately to severely active rheumatoid arthritis (RA)

Usual Adult Cimzia Dose for Psoriatic Arthritis

Initial dose: 400 mg subcutaneously (given as two subcutaneous injections of 200 mg) at weeks 0, 2, and 4, followed by 200 mg subcutaneously every other week
Use: For the treatment of adult patients with active psoriatic arthritis (PsA)

Usual Adult Dose for Ankylosing Spondylitis

Initial dose: 400 mg subcutaneously (given as two subcutaneous injections of 200 mg) at weeks 0, 2, and 4, followed by 200 mg subcutaneously every 2 weeks or 400 mg subcutaneously every 4 weeks
Use: For the treatment of adults with active ankylosing spondylitis

Usual Adult Cimzia Dose for Crohn’s Disease

Initial dose: 400 mg subcutaneously (given as two subcutaneous injections of 200 mg) at weeks 0, 2, and 4
Maintenance dose: 400 mg subcutaneously every 4 weeks
Use: For reducing signs and symptoms of Crohn’s disease and maintaining clinical response in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy

Usual Adult Dose for Plaque Psoriasis

Initial dose: 400 mg subcutaneously (given as 2 subcutaneous injections or 200 mg) every other week
For certain patients with body weight <=90 kg: 400 mg (given as 2 subcutaneous injections or 200 mg) at weeks 0, 2, and 4 followed by 200 mg every other week can be considered
Use: For the treatment of adults with moderate-to-severe plaque psoriasis (PsO) who are candidates for systemic therapy or phototherapy

Usual Adult Dose for Non-Radiographic Axial Spondyloarthritis

Initial dose: 400 mg subcutaneously (given as two subcutaneous injections of 200 mg) at weeks 0, 2, and 4, followed by 200 mg subcutaneously every 2 weeks or 400 mg subcutaneously every 4 weeks
Use: For the treatment of adults with active non-radiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation.

Usual dose for Polyarticular Juvenile Idiopathic Arthritis  patients 2 years of age and older)

Dose is weight dependant, every other week:

10 kg (22 lbs) to less than 20 kg (44 lbs): dose 100 mg initially and at week 2 and 4, followed by maintenance dose of 50 mg every other week
20 kg (44 lbs) to less than 40 kg (88 lbs): dose 200 mg initially and at week 2 and 4, followed by a maintenance dose of 100 mg every other week
Greater than or equal to 40 kg (88 lbs): dose 400 mg initially and at week 2 and 4, followed by  a maintenance dose of 200 mg every other week 

General Cimzia Dosing Information

• Rotate injection sites.
• Do not inject into skin that is tender, bruised, red, or hard.
• When a 400 mg dose is needed (given as 2 subcutaneous injections of 200 mg), injections should occur at separate sites in the thigh or abdomen.
• This drug can be given as monotherapy or concomitantly with non-biological disease modifying anti-rheumatic drugs (DMARDs).
• The use of this drug in combination with biological DMARDs or another tumor necrosis factor (TNF) blocker therapy is not recommended.

Cimzia is available as 200 mg lyophilized powder in a single-dose vial and 200 mg/mL solution in a single-dose prefilled syringe

Withdrawal from Cimzia

Your healthcare profession will guide you on how long you will use Cimzia.
Withdrawal from Cimzia may be required if you have severe allergic reactions.  Clinical trials have also studied reducing the dose of Cimza and stopping Cimza after sustained low disease activity in treating rheumatoid arthritis. However, the NCT01521923 clinical study failed to meet its primary endpoint.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of Cimzia.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while receiving Cimzia?

Avoid injecting Cimzia into scars or stretch marks, or into skin that is red, bruised, swollen, hard, or tender.

Ask your doctor before receiving any vaccine while you are being treated with Cimzia.

Avoid being near people who are sick or have infections. Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

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

Cetirizine is used to treat cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose.

Cetirizine is also used to treat an allergic reaction, itching and swelling caused by chronic urticaria (hives) and minimizes or eliminates the symptoms of perennial allergic rhinitis, seasonal allergic rhinitis, chronic idiopathic urticaria, allergic asthma, physical urticaria, and atopic dermatitis.

Warnings

Cetirizine 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. It can increase some of the side effects of cetirizine.

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

Call your doctor if your symptoms do not improve, if they get worse, or if you also have a fever.

Rarely, some people have reported severe itching when stopping cetirizine after daily, long-term use of at least a few months or several years. If you experience widespread, severe itching on stopping this medication, contact your healthcare provider.

Before taking this medicine

You should not use this medication if you are allergic to or had an adverse reaction to cetirizine.

Before taking cetirizine, tell your doctor about all of your medical conditions or if you have ever had kidney or liver disease.

Cetirizine is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Cetirizine can pass into breast milk and may harm a nursing baby. Do not use cetirizine without telling your doctor if you are breast-feeding a baby.

Cetirizine is indicated for chronic idiopathic urticaria in adults and children 6 months of age and older.

Older adults may need to take a lower than normal dose. Follow your doctor’s instructions.

How should I take cetirizine?

Take cetirizine exactly as directed on the label, or as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended.

You may take cetirizine with or without food.

The chewable tablet must be chewed before you swallow it.

Oral doses: measure liquid medicine (oral solution) 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.

Call your doctor if your symptoms do not improve, if they get worse, or if you also have a fever. Store cetirizine 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 or add extra doses 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 feeling restless or nervous, and then feeling drowsy.

What should I avoid?

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

Cetirizine 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. It can increase some of the side effects of cetirizine.

Cetirizine acute and common side effects

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

• fast, pounding, or uneven heartbeat;
• weakness, tremors (uncontrolled shaking), or sleep problems (insomnia);
• severe restless feeling, hyperactivity;
• confusion;
• problems with vision; or
• urinating less than usual or not at all.

Less serious cetirizine side effects may include:

• dizziness, drowsiness;
• tired feeling;
• dry mouth;
• sore throat, cough;
• nausea, constipation; or
• headache.

Cialis relaxes muscles of the blood vessels and increases blood flow to particular areas of the body.

Cialis is used to treat erectile dysfunction (impotence) and symptoms of benign prostatic hypertrophy (enlarged prostate).

Another brand of tadalafil is Adcirca, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. Do not take Cialis while also taking Adcirca, unless your doctor tells you to.

Warnings

Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as “poppers”. Taking tadalafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

Some medicines can cause unwanted or dangerous effects when used with Cialis. Tell your doctor about all your current medicines, especially riociguat (Adempas).

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Get medical help at once if you have nausea, chest pain, or dizziness during sex.

Stop using Cialis and get emergency medical help if you have sudden vision loss.

Before taking this medicine

You should not take Cialis if you are allergic to tadalafil.

Taking Cialis with certain other medicines can cause a sudden and serious decrease in blood pressure. Do not take this medicine if you also use:

• riociguat (to treat pulmonary arterial hypertension); or
• a nitrate drug (for chest pain or heart problems) such as nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, or recreational drugs such as amyl nitrate or nitrite “poppers”.

Some tadalafil can remain in your bloodstream for 2 or more days after each dose you take (longer if you have liver or kidney disease). Avoid nitrate use during this time.

To make sure this Cialis is safe for you, tell your doctor if you have ever had:

• heart disease or heart rhythm problems;
• a heart attack or stroke;
• angina (chest pain), high or low blood pressure;
• pulmonary hypertension (unless you are taking tadalafil for this);
• a condition called pulmonary veno-occlusive disease (narrowing of the veins that carry blood from the lungs to the heart);
• liver or kidney disease (or if you are on dialysis);
• vision loss, or retinitis pigmentosa (an inherited condition of the eye);
• a bleeding disorder;
• a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
• a physical deformity of the penis (such as Peyronie’s disease), or an erection lasting longer than 4 hours;
• a stomach ulcer; or
• health problems that make sexual activity unsafe.

Sudden vision loss has occurred in a small number of people taking medicines like tadalafil (Viagra or others). Most of these people already had certain eye problems or had high cholesterol, diabetes, coronary artery disease, a history of smoking, or were over 50 years old). It is not clear whether the medicine was the actual cause of vision loss.

Cialis is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether tadalafil passes into breast milk or if it could affect the nursing baby. Tell your doctor if you are breast-feeding.

Cialis is not approved for use by anyone younger than 18 years old.

How should I take Cialis?

Cialis is usually taken only once per day. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Cialis can be taken with or without food.

Do not break or split a tablet. Swallow it whole.

For erectile dysfunction, take Cialis just before sexual activity but not more than once per day.

Cialis can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor’s instructions.

Do not take Cialis for erectile dysfunction if you are taking Adcirca for pulmonary arterial hypertension.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

As Cialis is used as needed, you are not likely to be on a dosing schedule.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What to avoid

Drinking alcohol with this medicine can cause side effects.

Grapefruit and grapefruit juice may interact with tadalafil and lead to unwanted side effects. Avoid the use of grapefruit products while taking this medicine.

Cialis side effects

Get emergency medical help if you have signs of an allergic reaction to Cialis: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop and get medical help at once if you have nausea, chest pain, or dizziness during sex. You could be having a life-threatening side effect.

Stop using this medicine and call your doctor at once if you have:

• a light-headed feeling, like you might pass out;
• an erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis);
• vision changes or sudden vision loss;
• ringing in your ears or sudden hearing loss; or
• heart attack symptoms – chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Common Cialis side effects may include:

• headache;
• flushing (warmth, redness, or tingly feeling);
• nausea, upset stomach;
• stuffy nose; or
• muscle pain, back pain, pain in your arms, legs, or back.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect Cialis?

Tell your doctor about all your current medicines and any you start or stop using, especially:

seizure medicine.

medicines to treat erectile dysfunction or pulmonary arterial hypertension;

an antibiotic or antifungal medicine;

antiviral medicine to treat hepatitis C or HIV/AIDS;

drugs to treat high blood pressure or a prostate disorder; or