Fioricet

Generic Name: acetaminophen, butalbital, and caffeine (oral) (a seet a MIN oh fen, bue TAL bi tal, and KAF een)
Brand Names: Anolor 300, Dolgic LQ, Esgic, Fioricet, Geone, Margesic, Medigesic, Repan, Zebutal

What is Fioricet?

cetaminophen is a pain reliever and fever reducer.

Butalbital is in a group of drugs called barbiturates. It relaxes muscle contractions involved in a tension headache.

Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow. Fioricet is a combination of acetaminophen, butalbital, and caffeine.

Fioricet is used to treat tension headaches that are caused by muscle contractions.

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

Important information about Fioricet

Do not use Fioricet if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take Fioricet before the MAO inhibitor has cleared from your body. Do not take more of Fioricet than is recommended. An overdose of acetaminophen can cause damage to your liver. Do not use any other over-the-counter cough, cold, allergy, or menstrual pain medication without first asking your doctor or pharmacist. If you take certain products together you may accidentally take too much of a certain drug. Read the label of any other medicine you are using to see if it contains acetaminophen or caffeine. Avoid drinking alcohol. It can increase the risk of liver damage while you are taking acetaminophen. If you drink more than three alcoholic beverages per day, do not take acetaminophen without your doctor's advice, and never take more than 2 grams (2000 mg) per day.

What should I discuss with my healthcare provider before taking Fioricet?

Butalbital may be habit-forming and should be used only by the person it was prescribed for. Fioricet should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Do not take this medication without first talking to your doctor if you drink more than three alcoholic beverages per day or if you have had alcoholic liver disease (cirrhosis). You may not be able to take medication that contains acetaminophen.

You should not take Fioricet if you are allergic to acetaminophen, butalbital, or caffeine, or if you have porphyria.

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

• kidney disease,

• liver disease; or

• a history of mental illness or suicidal thoughts.

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

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Fioricet can pass into breast milk and may harm a nursing baby. Do not use Fioricet without telling your doctor if you are breast-feeding a baby.

How should I take Fioricet?

Take Fioricet exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Take the medicine with food or milk if it upsets your stomach. An overdose of acetaminophen can cause serious harm. The maximum amount of acetaminophen for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Taking more acetaminophen could cause damage to your liver. One tablet may contain up to 750 mg of acetaminophen. Know the amount of acetaminophen in the specific product you are taking. Store Fioricet at room temperature away from moisture and heat.

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

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include insomnia, restlessness, tremor, dizziness, drowsiness, nausea, vomiting, diarrhea, stomach pain, loss of appetite, increased sweating, shallow breathing, confusion, uneven heartbeats, seizure (convulsions), or coma.

What should I avoid while taking Fioricet?

Fioricet 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. Tell your doctor if you regularly use other medicines that make you sleepy (such as 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 butalbital. Avoid drinking alcohol. It can increase the risk of liver damage while you are taking acetaminophen. If you drink more than three alcoholic beverages per day, do not take acetaminophen without your doctor's advice, and never take more than 2 grams (2000 mg) of acetaminophen per day. Do not use any other over-the-counter cough, cold, allergy, or menstrual pain medication without first asking your doctor or pharmacist. Acetaminophen or caffeine are contained in many product over-the-counter medicines. If you take certain products together you may accidentally take too much of a certain drug. Read the label of any other medicine you are using to see if it contains acetaminophen or caffeine.

While you are taking Fioricet, avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor's advice.

Fioricet side effects

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

• fast, pounding, or uneven heartbeat;

• feeling light-headed or short of breath;

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

• easy bruising or bleeding, unusual weakness, fever, chills, body aches, flu symptoms.

Less serious side effects may include:

• drowsiness;

• dizziness,, confusion or lightheadedness;

• dry mouth;

• nausea, vomiting, stomach pain, loss of appetite;

• feeling anxious or jittery;

• drunk feeling; or

• headache.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Fioricet?

The following drugs can interact with Fioricet. Tell your doctor if you are using any of these:

• an antibiotic;

• a blood thinner such as warfarin (Coumadin);

• isoniazid;

• zidovudine (Retrovir, AZT);

• seizure medication such as phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton);

• gout medications such as probenecid (Benemid) or sulfinpyrazone;

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

• steroids such as prednisone, fluticasone (Advair), mometasone (Asmanex, Nasonex), dexamethasone (Decadron, Hexadrol) and others; or

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

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

Where can I get more information?

• Your pharmacist can provide more information about Fioricet.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Fioricet only for the indication prescribed.
• Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

Copyright 1996-2008 Cerner Multum, Inc. Version: 1.08. Revision Date: 01/04/2008 8:54:41 AM.

Yaz

Generic Name: drospirenone and ethinyl estradiol (dro SPY re nown, ETH in il, ESS tra dy ol )
Brand Names: Yasmin, Yaz

What is Yaz?

Yaz prevents ovulation (the release of an egg from an ovary) and also cause changes in your cervical and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Yaz is used as contraception to prevent pregnancy. It is also used to treat moderate acne in women who are at least 14 years old and have started having menstrual periods, and who wish to use birth control pills to prevent pregnancy.

Yaz is also used to treat the symptoms of premenstrual dysphoric disorder (PMDD), such as anxiety, depression, irritability, trouble concentrating, lack of energy, sleep or appetite changes, breast tenderness, joint or muscle pain, headache, and weight gain.

Important information about Yaz

Yaz can cause birth defects in an unborn baby. Do not use if you are pregnant. Do not use Yaz if you have any of the following conditions: a history of stroke or blood clot, circulation problems (especially if caused by diabetes), a heart valve disorder, breast or uterine cancer, abnormal vaginal bleeding, kidney or liver disease, an adrenal gland disorder, severe high blood pressure, migraine headaches, or a history of jaundice caused by birth control pills.

Before taking Yaz

Do not take Yaz if you are allergic to drospirenone or ethinyl estradiol, or if you have:

• uncontrolled high blood pressure, migraine headaches, or a heart valve disorder;

• a history of stroke, blood clot, or circulation problems of diabetes;

• kidney or liver disease;

• adrenal gland disorder;

• unusual vaginal bleeding;

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

• a history of jaundice caused by birth control pills.

Before using Yaz, tell your doctor if you have any of the following conditions.

• high blood pressure or heart disease;

• high cholesterol or if you are overweight;

• liver cancer;

• gallbladder disease;

• diabetes;

• seizures or epilepsy; or

• a history of depression, irregular menstrual cycles, or history of breast or uterine cancer.

FDA pregnancy category X. Yaz can cause birth defects. Do not use Yaz if you are pregnant. Tell your doctor right away if you become pregnant during treatment. The hormones in Yaz can pass into breast milk and may harm a nursing baby. Yaz may also slow breast milk production. Do not use if you are breast-feeding a baby. Drospirenone may raise potassium levels in your blood. Other medical conditions can also affect potassium levels, including liver disease, kidney disease, and adrenal gland disorders. Before using Yaz, tell your doctor if you have any of these conditions.

How should I take Yaz?

Take Yaz exactly as it was prescribed for you. Do not take larger amounts, or take it for longer than recommended by your doctor. You will take your first pill on the first day of your period or on the first Sunday after your period begins (follow your doctor's instructions).

Take one pill every day, no more than 24 hours apart. When the pills run out, start a new pack the following day. Get your prescription refilled before you run out of pills completely.

You may have breakthrough bleeding. Tell your doctor if this bleeding continues or is very heavy.

If you need to have any type of medical tests or surgery, or if you will be on bed rest, you may need to stop using Yaz for a short time. Any doctor or surgeon who treats you should know that you are using birth control pills.

Your doctor will need to see you on a regular basis while you are using Yaz. Do not miss any appointments. Self-examine your breasts monthly to check for lumps while you are taking Yaz.

Store Yaz at room temperature away from moisture and heat.

What happens if I miss a dose?

Missing a pill increases your risk of becoming pregnant.

If you miss one"active" pill, take the dose as soon as you remember or take two pills at the time of your next regularly scheduled dose. You do not need to use backup birth control.

If you miss two"active" tablets in a row in week one or two, take two tablets each for the next two regularly scheduled doses (one missed tablet plus one regularly scheduled tablet for 2 days in a row). Use another form of birth control for at least 7 days following the missed tablets.

If you miss two "active" tablets in a row in week three, or if you miss three tablets in a row during any of the first 3 weeks, throw out the rest of the pack and start a new package on the same day if you are a Day 1 starter. If you are a Sunday starter, keep taking a pill every day until Sunday.

On Sunday, throw out the rest of the pack and start a new pack of pills that same day. You may not have a period that month, but this is expected. However, if you miss your period 2 months in a row, call your doctor because you might be pregnant.

If you miss one of the reminder pills in week four, skip that dose and take the next one as directed.

If you miss a pill, you may become pregnant if you have sex in the 7 days after your missed pill. You MUST use another birth control method (such as condoms or spermicides) as a back-up for those 7 days.

What happens if I overdose?

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

What should I avoid while taking Yaz?

Do not smoke while using Yaz, especially if you are older than 35. Smoking can increase your risk of blood clots, stroke, or heart attack caused by birth control pills.

Yaz will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

Yaz side effects

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

• sudden numbness or weakness, confusion, pain behind the eyes, problems with vision, speech, or balance;

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

• a change in the pattern or severity of migraine headaches;

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

• a breast lump; or

• symptoms of depression (sleep problems, weakness, mood changes).

Less serious side effects may include:

• breast pain, tenderness, or swelling;

• freckles or darkening of facial skin, increased hair growth, or loss of scalp hair;

• changes in weight or appetite, swelling of your hands or feet;

• problems with contact lenses;

• vaginal itching or discharge; or

• changes in your menstrual periods.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Yaz?

Some drugs can make Yaz less effective, which may result in pregnancy. Other drugs may be affected by Yaz. Before using Yaz, tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about Yaz.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Yaz only for the indication prescribed.
• Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

Copyright 1996-2008 Cerner Multum, Inc. Version: 3.08. Revision Date: 12/03/2007 3:10:29 PM.

Seroquel

Generic Name: quetiapine (kwe TYE a peen)
Brand Names: Seroquel

What is Seroquel?

Seroquel is an antipsychotic medication. It works by changing the actions of chemicals in the brain.

Seroquel is used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression).

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

Important information about Seroquel

Seroquel is not for use in psychotic conditions that are related to dementia. Seroquel has caused fatal pneumonia or heart failure in older adults with dementia-related conditions. Stop using Seroquel and call your doctor at once if you have the following symptoms: fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, uncontrolled muscle movements, symptoms that come on suddenly such as numbness or weakness, severe headache, and problems with vision, speech, or balance.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms 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.

Before taking Seroquel

Seroquel is not for use in psychotic conditions that are related to dementia. Seroquel has caused fatal pneumonia or heart failure in older adults with dementia-related conditions.

Before you take Seroquel, tell your doctor if you have:

• liver or kidney disease;

• heart disease, high blood pressure, heart rhythm problems;

• a history of heart attack or stroke;

• a thyroid disorder;

• seizures or epilepsy;

• high cholesterol or triglycerides;

• a personal or family history of diabetes; or

• trouble swallowing.

If you have any of these conditions, you may not be able to use Seroquel, or you may need a dosage adjustment or special tests during treatment.

Seroquel may cause you to have high blood sugar (hyperglycemia). Talk to your doctor if you have any signs of hyperglycemia such as increased thirst or urination, excessive hunger, or weakness. If you are diabetic, check your blood sugar levels on a regular basis while you are taking Seroquel.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Seroquel passes into breast milk or if it could harm a nursing baby. Do not use Seroquel without telling your doctor if you are breast-feeding a baby. Do not give Seroquel to anyone younger than 18 years old without the advice of a doctor.

How should I take Seroquel?

Take Seroquel exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Your doctor may occasionally change your dose to make sure you get the best results from Seroquel.

Take each dose with a full glass of water. Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Breaking the pill may cause too much of the drug to be released at one time.

To be sure Seroquel is helping your condition, your doctor will need to check your progress on a regular basis. Do not miss any scheduled appointments.

Store Seroquel tablets 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, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include extreme drowsiness, fast heart rate, feeling light-headed, or fainting.

What should I avoid while taking Seroquel?

Seroquel 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 getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid drinking alcohol, which can increase some of the side effects of Seroquel. Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Seroquel. Tell your doctor if you need to use any of these other medicines while you are taking Seroquel.

Seroquel side effects

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

Call your doctor at once if you have any new or worsening symptoms 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.

Other serious side effects include:

• fever, stiff muscles, confusion, sweating, fast or uneven heartbeats;

• jerky muscle movements you cannot control;

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

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

• increased thirst, frequent urination, excessive hunger, or weakness;

• feeling like you might pass out; or

• urinating less than usual or not at all.

Less serious side effects may include:

• dizziness, drowsiness, or weakness;

• dry mouth, runny nose, sore throat;

• nausea, vomiting, stomach pain, constipation;

• blurred vision, headache, anxiety, agitation;

• breast swelling or discharge;

• missed menstrual periods; or

• weight gain.

This is not a complete list of Seroquel side effects and others may occur. Tell your doctor about unusual or bothersome side effect.

What other drugs will affect Seroquel?

Before taking Seroquel, tell your doctor if you are taking any of the following medicines:

• cimetidine (Tagamet);

• lorazepam (Ativan);

• rifabutin (Mycobutin) or rifampin (Rifadin, Rimactane, Rifater);

• steroids (prednisone and others);

• thioridazine (Mellaril);

• an antibiotic such as erythromycin (E-Mycin, E.E.S, Ery-Tab), fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox);

• medicine for depression or mental illness, such as fluoxetine (Prozac), haloperidol (Haldol), imipramine (Tofranil), or risperidone (Risperdal);

• a medication to treat high blood pressure or a heart condition; or

• seizure medication such as carbamazepine (Tegretol), divalproex (Depakote), phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), or valproate (Depakene).

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

Where can I get more information?

• Your pharmacist can provide more information about Seroquel.

What do my pills look like?

Quetiapine is available with a prescription under the brand name Seroquel. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about Seroquel, especially if it is new to you.

• Seroquel 25 mg - round, peach-colored tablets

• Seroquel 100 mg - round, yellow tablets

• Seroquel 200 mg - round, white tablets

• Seroquel 300 mg - white, capsule-shaped, film-coated tablets

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

Copyright 1996-2006 Cerner Multum, Inc. Version: 5.07 Revision Date: 11/30/2007 2:56:57 PM.

Nicotine

Generic Name: nicotine (oral/patches/nasal) (NIK oh teen)
Brand names: Commit, Habitrol, Nicoderm C-Q, Nicorette, Nicotrol Inhaler, Nicotrol NS

What is nicotine?

Nicotine is the primary ingredient in tobacco products.

Nicotine in medical products is used to aid in smoking cessation. Using a controlled amount helps reduce withdrawal symptoms when you quit smoking. It works by providing low levels, which may help you to quit smoking by lessening physical signs of withdrawal symptoms.

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

Important information about nicotine

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

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

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

Before using nicotine

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

Before using nicotine, tell your doctor if you have:

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

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

• an overactive thyroid;

• diabetes;

• pheochromocytoma (tumor of the adrenal gland);

• liver or kidney disease;

• a stomach ulcer; or

• asthma or chronic pulmonary disease.

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

Nicotine can cause harm to an unborn baby. Do not use nicotine if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Nicotine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take nicotine?

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

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

To use the patches:

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

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

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

To use the chewing gum or oral lozenges:

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

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

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

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

To use the nasal spray:

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

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

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

To use the inhaler:

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

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

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

What happens if I miss a dose?

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

What happens if I overdose?

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

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

What should I avoid while taking nicotine?

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

Nicotine side effects

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

• seizures; or

• chest pain or uneven heartbeats.

Less serious side effects may include:

• dizziness;

• belching or hiccups;

• stomach upset or nausea;

• mouth or throat soreness;

• dry or watering mouth;

• watering eyes;

• headache;

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

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

• constipation;

• sneezing and coughing;

• changes in taste; or

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

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect nicotine?

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

• imipramine (Tofranil);

• oxazepam (Serax);

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

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

• pentazocine (Talwin), or

• insulin.

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

Where can I get more information?

• Your pharmacist can provide more information about nicotine.

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

Copyright 1996-2008 Cerner Multum, Inc. Version: 5.02. Revision Date: 04/01/2008 1:21:31 PM.

Methamphetamine

Generic Name: methamphetamine (meth am FET a meen)
Brand Names: Desoxyn, Desoxyn Gradumet

What is methamphetamine?

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

Methamphetamine is used to treat attention deficit hyperactivity disorder (ADHD). It is also used to treat obesity after other diets or medications have been tried without successful weight loss.

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

Important information about methamphetamine

Do not use methamphetamine if you have used an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam) within the past 14 days. Serious, life-threatening side effects can occur if you take methamphetamine before the MAO inhibitor has cleared from your body. Do not use this medication if you are allergic to methamphetamine, or if you have hardened arteries (arteriosclerosis), heart disease, moderate to severe high blood pressure (hypertension), overactive thyroid, glaucoma, severe anxiety or agitation, or a history of drug or alcohol addiction. Some stimulants have caused sudden death in children and adolescents with serious heart problems or congenital heart defects. Before taking this medication, tell your doctor if you have any type of heart problems. Do not give methamphetamine to a child younger than 12 years old without the advice of a doctor.

Long-term use of this medication can slow a child's growth. Tell your doctor if the child using methamphetamine is not growing or gaining weight properly.

Methamphetamine is a drug of abuse and may be habit-forming. Keep track of how many pills have been used from each new bottle of methamphetamine. You should be aware if any person in the household is using this medicine improperly or without a prescription. Using this medication improperly can cause death or serious side effects on the heart.

Before taking methamphetamine

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

Do not use this medication if you are allergic to methamphetamine or if you have:

• heart disease or moderate to severe high blood pressure (hypertension);

• arteriosclerosis (hardening of the arteries);

• overactive thyroid;

• glaucoma;

• severe anxiety, tension, or agitation; or

• if you have a history of drug or alcohol addiction.

Some stimulants have caused sudden death in children and adolescents with serious heart problems or congenital heart defects.

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

• a congenital heart defect;

• high blood pressure;

• heart failure, heart rhythm disorder, or recent heart attack;

• a personal or family history of mental illness, psychotic disorder, bipolar illness, depression, or suicide attempt;

• diabetes; or

• tics (muscle twitches) or Tourette's syndrome.

If you have any of these conditions, you may not be able to use this medication, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. It could also cause premature birth, low birth weight, or withdrawal symptoms in a newborn if the mother takes methamphetamine during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Methamphetamine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Long-term use of methamphetamine can slow a child's growth. Tell your doctor if the child using methamphetamine is not growing or gaining weight properly.

Do not give this medication to a child younger than 12 years old without the advice of a doctor.

How should I take methamphetamine?

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

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take this medication with a full glass of water.

Do not take methamphetamine in the evening because it may cause sleep problems (insomnia).

If you are taking methamphetamine for weight loss and your appetite gradually increases, do not take more of the medication to suppress appetite. Stop taking methamphetamine and call your doctor.

To be sure this medication is helping your condition, your doctor will need to see you on a regular basis. Do not miss any scheduled visits.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using methamphetamine.

Store methamphetamine at room temperature away from moisture, heat, and light. Methamphetamine is a drug of abuse and may be habit-forming. Keep track of how many pills have been used from each new bottle of this medicine. You should be aware if any person in the household is using this medicine improperly or without a prescription. Using this medication improperly can cause death or serious side effects on the heart.

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, or if it is already evening, skip the missed dose and take the medicine the next morning. Taking this medicine late in the day can cause sleep problems. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

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

Symptoms of a methamphetamine overdose include restlessness, tremor, muscle twitches, rapid breathing, confusion, hallucinations, panic, aggressiveness, unexplained muscle pain or tenderness, muscle weakness, fever or flu symptoms, and dark colored urine. These symptoms may be followed by depression and tiredness. Other overdose symptoms include nausea, vomiting, diarrhea, stomach pain, uneven heartbeats, feeling light-headed, fainting, seizure (convulsions), or coma.

What should I avoid while taking methamphetamine?

Methamphetamine 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.

Do not take methamphetamine late in the day. A dose taken too late in the day can cause sleep problems (insomnia).

Avoid drinking fruit juices or taking vitamin C at the same time you take methamphetamine. These can make your body absorb less of the medicine.

Methamphetamine side effects?

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

Stop using methamphetamine and call your doctor at once if you have any of these serious side effects:

• fast, pounding, or uneven heartbeats;

• feeling light-headed, fainting;

• increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure); or

• tremor, restlessness, hallucinations, unusual behavior, or motor tics (muscle twitches).

Continue taking methamphetamine and talk to your doctor if you have any of these less serious side effects:

• headache or dizziness;

• sleep problems (insomnia);

• dry mouth or an unpleasant taste in your mouth;

• diarrhea, constipation;

• loss of appetite, weight loss; or

• loss of interest in sex, impotence, or difficulty having an orgasm.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect methamphetamine?

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

• insulin;

• cold medicines (decongestants);

• guanethidine (Ismelin);

• phenothiazines such as chlorpromazine (Thorazine), fluphenazine (Prolixin), mesoridazine (Serentil), perphenazine (Trilafon), prochlorperazine (Compazine), thioridazine (Mellaril), or trifluperazine (Stelazine); or

• antidepressants such as amitriptyline (Elavil), amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), or nortriptyline (Pamelor).

If you are using any of these drugs, you may not be able to use methamphetamine, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect methamphetamine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

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

What does my medication look like?

Methamphetamine is available with a prescription under the brand name Desoxyn. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Desoxyn 5 mg - white tablets

• Desoxyn Gradumet 5 mg (long-acting) - round, white tablets

• Desoxyn Gradumet 10 mg (long-acting) - round, orange tablets

• Desoxyn Gradumet 15 mg (long-acting) - round, yellow tablets

• Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
• Click here for more information on Methamphetamine

Copyright 1996-2006 Cerner Multum, Inc. Version: 3.04. Revision Date: 2/23/07 12:55:10 PM.

Metformin

Generic Name: metformin (met FOR min)
Brand Names: Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet

What is metformin?

Metformin is an oral diabetes medicine that helps control blood sugar levels.

Metformin is for people with type 2 (non-insulin-dependent) diabetes. Metformin is sometimes used in combination with insulin or other medications, but it is not for treating type 1 diabetes.

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

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

Do not use metformin if you have kidney disease, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Before taking metformin, tell your doctor if you have liver disease or a history of heart disease.

Some people have developed a life-threatening condition called lactic acidosis while taking metformin. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop taking metformin. Be sure the doctor knows ahead of time that you are using metformin.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them, including hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma (severe hypoglycemia can be fatal). Always keep a source of sugar available in case you have symptoms of low blood sugar.

What should I discuss with my healthcare provider before taking metformin?

Some people have developed a life-threatening condition called lactic acidosis while taking metformin. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

You may be more likely to develop lactic acidosis if you have congestive heart failure. Older adults may also have a higher risk of developing lactic acidosis. Talk with your doctor about your individual risk.

Do not use this medication if you are allergic to metformin, if you have kidney disease or kidney failure, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

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

• liver disease; or

• a history of heart disease.

If you have any of these conditions, you may not be able to use metformin, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether metformin passes into breast milk or if it could harm a nursing baby. Do not take metformin without first talking to your doctor if you are breast-feeding a baby. Metformin should not be given to a child younger than 10 years old. Extended-release metformin (Glucophage XR) should not be given to a child younger than 17 years old.

How should I take metformin?

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

Your doctor may occasionally change your dose to make sure you get the best results from metformin.

Take metformin with a meal, unless your doctor tells you otherwise. Some forms of metformin are taken only once daily with the evening meal. Follow your doctor's instructions.

metformin is only part of a complete program of treatment that also includes diet, exercise, and weight control. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Do not crush, chew, or break an extended-release tablet (Glucophage XR). Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

To be sure metformin is helping your condition, your blood will need to be tested on a regular basis. Your kidney function may also need to be tested. It is important that you not miss any scheduled appointments.

Your medication needs may change if you become sick or injured, if you have a serious infection, or if you have any type of surgery. Your doctor may want you to stop taking metformin for a short time if any of these situations affect you.

Take care not to let your blood sugar get too low, causing hypoglycemia. You may have hypoglycemia if you skip a meal, exercise too long, drink alcohol, or are under stress.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them:

• hunger, headache, confusion, irritability;

• drowsiness, weakness, dizziness, tremors;

• sweating, fast heartbeat;

• seizure (convulsions); or

• fainting, coma (severe hypoglycemia can be fatal).

Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. If you have severe hypoglycemia and cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection.

Your doctor may have you take extra vitamin B12 while you are taking metformin. Take only the amount of vitamin B12 that your doctor has prescribed.

If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop taking metformin. Be sure the doctor knows ahead of time that you are using metformin.

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

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. You may have signs of low blood sugar, such as hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma. An overdose of metformin may cause a life-threatening condition called lactic acidosis. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

What should I avoid while taking metformin?

Avoid drinking alcohol while taking metformin. Alcohol lowers blood sugar and may increase the risk of lactic acidosis while you are taking this medicine.

Metformin side effects

Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting. Stop using metformin and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• feeling short of breath, even with mild exertion;

• swelling or rapid weight gain; or

• fever, chills, body aches, flu symptoms.

Less serious side effects may include:

• headache or muscle pain;

• weakness; or

• mild nausesa, vomiting, diarrhea, gas, stomach pain.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect metformin?

You may be more likely to have hyperglycemia (high blood sugar) if you are taking metformin with other drugs that raise blood sugar. Drugs that can raise blood sugar include:

• isoniazid;

• diuretics (water pills);

• steroids (prednisone and others);

• phenothiazines (Compazine and others);

• thyroid medicine (Synthroid and others);

• birth control pills and other hormones;

• seizure medicines (Dilantin and others); and

• diet pills, or medicines to treat asthma, colds or allergies.

You may be more likely to have hypoglycemia (low blood sugar) if you are taking metformin with other drugs that lower blood sugar. Drugs that can lower blood sugar include:

• some nonsteroidal anti-inflammatory drugs (NSAIDs);

• aspirin or other salicylates (including Pepto-Bismol);

• sulfa drugs (Bactrim and others);

• a monoamine oxidase inhibitor (MAOI);

• beta-blockers (Tenormin and others); or

• probenecid (Benemid).

Some medications may interact with metformin. Tell your doctor if you are using any of the following drugs:

• furosemide (Lasix);

• nifedipine (Adalat, Procardia);

• cimetidine (Tagamet) or ranitidine (Zantac);

• amiloride (Midamor) or triamterene (Dyrenium);

• digoxin (Lanoxin);

• morphine (MS Contin, Kadian, Oramorph);

• procainamide (Procan, Pronestyl, Procanbid);

• quinidine (Cardioquin, Quinidex, Quinaglute);

• trimethoprim (Proloprim, Primsol, Bactrim, Cotrim, Septra); or

• vancomycin (Vancocin, Lyphocin).

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

Where can I get more information?

• Your pharmacist can provide more information about metformin.

What does my medication look like?

Metformin is available with a prescription under the brand names Glucophage, Fortamet, and Riomet. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about metformin, especially if it is new to you.

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

Copyright 1996-2006 Cerner Multum, Inc. Version: 7.09. Revision Date: 08/30/2007 9:36:50 AM.

Xanax

Generic Name: alprazolam (al PRAY zoe lam)
Brand Names: Niravam, Xanax, Xanax XR

What is Xanax?

Xanax is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). Xanax affects chemicals in the brain that may become unbalanced and cause anxiety.

Xanax is used to treat anxiety disorders, panic disorders, and anxiety caused by depression.

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

Important information about Xanax

Do not use this medication if you are allergic to Xanax or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax). This medication can cause birth defects in an unborn baby. Do not use Xanax if you are pregnant.

Before taking Xanax, tell your doctor if you have any breathing problems, glaucoma, kidney or liver disease, or a history of depression, suicidal thoughts, or addiction to drugs or alcohol.

Do not drink alcohol while taking Xanax. This medication can increase the effects of alcohol.

Avoid using other medicines that make you sleepy. They can add to sleepiness caused by Xanax.

Xanax may be habit-forming and should be used only by the person it was prescribed for. Xanax should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

It is dangerous to try and purchase Xanax on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of Xanax purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.

Before taking Xanax

It is dangerous to try and purchase Xanax on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of Xanax purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.

Do not use this medication if you have:

• narrow-angle glaucoma;

• if you are also taking itraconazole (Sporanox) or ketoconazole (Nizoral); or

• if you are allergic to alprazolam or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).

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

• asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;

• glaucoma;

• kidney or liver disease (especially alcoholic liver disease);

• a history of depression or suicidal thoughts or behavior; or

• a history of drug or alcohol addiction.

If you have any of these conditions, you may not be able to use Xanax, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D. Xanax can cause birth defects in an unborn baby. Do not use Xanax without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Xanax can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. The sedative effects of Xanax may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking Xanax. Do not give this medication to anyone under 18 years old.

How should I take Xanax?

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

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Xanax may be habit-forming and should be used only by the person it was prescribed for. Xanax should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Measure the liquid form of Xanax 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.

To take alprazolam orally disintegrating tablets (Niravam):

• Using dry hands, remove a tablet from the bottle and place the tablet on your tongue. It will begin to dissolve right away.

• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

• Swallow several times as the tablet dissolves. If desired, you may drink liquid after the tablet has completely dissolved.

Contact your doctor if this medicine seems to stop working as well in treating your panic or anxiety symptoms.

Your symptoms may return when you stop using Xanax after using it over a long period of time. You may also have seizures or withdrawal symptoms when you stop using Xanax. Withdrawal symptoms may include blurred vision, trouble concentrating, loss of appetite, diarrhea, muscle twitching, numbness or tingling, or increased sensations.

Do not stop using Xanax suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

To be sure this medication is helping your condition, your doctor will need to check your progress on a regular basis. Do not miss any scheduled visits to your doctor.

Store Xanax at room temperature away from moisture, heat, and light. Remove any cotton from the bottle of disintegrating tablets, and keep the bottle tightly closed.

Keep track of how many pills have been used from each new bottle of this medicine. Benzodiazepines are drugs of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

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

What happens if I overdose?

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

Symptoms of an Xanax overdose may include extreme drowsiness, confusion, muscle weakness, loss of balance or coordination, feeling light-headed, fainting, or coma.

What should I avoid while taking Xanax?

Do not drink alcohol while taking Xanax. This medication can increase the effects of alcohol. Xanax 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 using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can increase some of the side effects of Xanax.

Grapefruit and grapefruit juice may interact with Xanax and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

What are the possible side effects of Xanax?

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

• unusual risk-taking behavior, decreased inhibitions, no fear of danger;

• depressed mood, thoughts of suicide or hurting yourself;

• hyperactivity, agitation, hostility, hallucinations;

• feeling light-headed, fainting;

• seizure (convulsions);

• urinating less than usual or not at all;

• muscle twitching, tremor; or

• jaundice (yellowing of the skin or eyes).

Less serious side effects are more likely to occur, such as:

• drowsiness, dizziness, feeling irritable;

• amnesia or forgetfulness, trouble concentrating;

• sleep problems (insomnia);

• muscle weakness, lack of balance or coordination, slurred speech;

• blurred vision;

• nausea, vomiting, constipation, appetite or weight changes;

• dry or watery mouth, increased sweating; or

• loss of interest in sex.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Xanax?

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

• birth control pills;

• cimetidine (Tagamet);

• diltiazem (Tiazac, Cartia, Cardizem);

• isoniazid (Nydrazid, Rifamate);

• propoxyphene (Darvon, Darvocet);

• seizure medication;

• antibiotics such as fluconazole (Diflucan), itraconazole (Sporanox) or ketoconazole (Nizoral); or

• antidepressants such as fluvoxamine (Luvox), desipramine (Norpramin), or imipramine (Janimine, Tofranil).

If you are using any of these drugs, you may not be able to use Xanax, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect Xanax. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

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

What does my medication look like?

Alprazolam is available with a prescription under the brand names Xanax and Niravam. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

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

Copyright 1996-2006 Cerner Multum, Inc. Version: 6.02. Revision Date: 2/23/07 11:20:38 AM.

Tramadol

Generic Name: tramadol (TRAM a dol)
Brand Names: Ultram, Ultram ER

What is tramadol?

Tramadol is a narcotic-like pain reliever.

Tramadol is used to treat moderate to severe pain. Tramadol extended-release is used to treat moderate to severe chronic pain when treatment is needed around the clock.

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

Important information about tramadol

You should not take tramadol if you have ever been addicted to drugs or alcohol.

Seizures (convulsions) have occurred in some people taking tramadol. You may be more likely to have a seizure while taking tramadol if you have a history of seizures or head injury, a metabolic disorder, or if you are taking certain medicines such as antidepressants, muscle relaxers, or medicine for nausea and vomiting.

Take tramadol exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Do not take more than 300 milligrams of tramadol in one day.

Seek emergency medical attention if you think you have used too much of this medicine. A tramadol overdose can be fatal. Overdose symptoms of a tramadol overdose may include drowsiness, shallow breathing, slow heartbeat, extreme weakness, cold or clammy skin, feeling light-headed, fainting, or coma. Tramadol may be habit-forming and should be used only by the person it was prescribed for. Tramadol should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Tramadol 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. Do not stop using tramadol suddenly, or you could have unpleasant withdrawal symptoms such as anxiety, sweating, nausea, diarrhea, tremors, chills, hallucinations, trouble sleeping, or breathing problems. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Do not crush the tramadol tablet. This medicine is for oral (by mouth) use only. Powder from a crushed tablet should not be inhaled or diluted with liquid and injected into the body. Using this medicine by inhalation or injection can cause life-threatening side effects, overdose, or death.

Before taking tramadol

You should not take tramadol if you have ever been addicted to drugs or alcohol, if you are currently intoxicated (drunk), or if you have recently used any of the following drugs:

• alcohol;

• narcotic pain medicine;

• sedatives or tranquilizers (such as Valium);

• medicine for depression or anxiety;

• medicine for mental illness (such as bipolar disorder, schizophrenia); or

• street drugs.

Seizures have occurred in some people taking tramadol. Your risk of a seizure may be higher if you have any of these conditions:

• a history of drug or alcohol addiction;

• a history of epilepsy or other seizure disorder;

• a history of head injury;

• a metabolic disorder; or

• if you are also taking an antidepressant, muscle relaxer, or medicine for nausea and vomiting.

Talk with your doctor about your individual risk of having a seizure while taking tramadol.

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

• kidney disease;

• liver disease;

• a stomach disorder; or

• a history of depression, mental illness, or suicide attempt.

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

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tramadol may also cause serious or fatal side effects in a newborn if the mother uses the medication during pregnancy or labor. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Tramadol can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Tramadol should not be given to a child younger than 18 years of age.

How should I take tramadol?

Take tramadol exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label. Do not take more than 300 milligrams of tramadol in one day.

Take this medication with a full glass of water.

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

Do not crush the tramadol tablet. This medicine is for oral (by mouth) use only. Powder from a crushed tablet should not be inhaled or diluted with liquid and injected into the body. Using this medicine by inhalation or injection can cause life-threatening side effects, overdose, or death. Do not crush, chew, break, or open a controlled-release, delayed-release, or extended-release tablet or capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

If you use the tramadol extended-release tablet, the tablet shell may pass into your stools (bowel movements). This is normal and does not mean that you are not receiving enough of the medicine.

Tramadol may be habit-forming. Tell your doctor if you feel the medicine is not working as well in relieving your pain. Do not change your dose without talking to your doctor. Do not stop using tramadol suddenly, or you could have unpleasant withdrawal symptoms such as anxiety, sweating, nausea, diarrhea, tremors, chills, hallucinations, trouble sleeping, or breathing problems. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Store tramadol at room temperature away from moisture and heat. Keep track of how many pills have been used from each new bottle of this medicine. Tramadol is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

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

What happens if I overdose?

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

Overdose symptoms may include drowsiness, shallow breathing, slow heartbeat, extreme weakness, cold or clammy skin, feeling light-headed, fainting, or coma.

What should I avoid while taking tramadol?

Do not drink alcohol while you are taking tramadol. Alcohol may cause a dangerous decrease in your breathing when used together with tramadol. Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by tramadol. Tell your doctor if you regularly use any of these other medicines. Tramadol 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.

Tramadol side effects

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

• seizure (convulsions);

• a red, blistering, peeling skin rash; or

• shallow breathing, weak pulse.

Less serious side effects may include:

• dizziness, drowsiness, weakness;

• nausea, vomiting, constipation, loss of appetite;

• blurred vision;

• flushing (redness, warmth, or tingly feeling); or

• sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect tramadol?

You may be more likely to have a seizure (convulsions) if you take tramadol while you are using certain other medicines. Do not take tramadol without telling your doctor if you also use any of the following medications:

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

• an antidepressant such as amitriptyline (Elavil), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor); paroxetine (Paxil), or sertraline (Zoloft).

Before taking tramadol, tell your doctor if you also use:

• carbamazepine (Tegretol);

• warfarin (Coumadin);

• digoxin (Lanoxin, Lanoxicaps);

• ketoconazole (Nizoral);

• erythromycin (E-Mycin, E.E.S., Ery-Tab);

• rifampin (Rifadin, Rimactane, Rifater);

• St. John's wort;

• quinidine (Quinaglute, Quinadex, Cardioquin, Quinora); or

• drugs that make you sleepy (such as cold medicine, other pain medications, muscle relaxants, and medicine for seizures, depression or anxiety).

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

Where can I get more information?

• Your pharmacist can provide more information about tramadol.

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

Copyright 1996-2006 Cerner Multum, Inc. Version: 9.04. Revision Date: 10/05/2007 12:51:47 PM.

Viagra

Generic Name: sildenafil (oral) (sil DEN uh fil)
Brand Names: Revatio, Viagra

What is Viagra?

Viagra relaxes muscles and increases blood flow to particular areas of the body.

Sildenafil under the name Viagra is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women.

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

Important information about Viagra

Do not take Viagra if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking Viagra with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack. During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Viagra. Do not take Viagra more than once a day. Allow 24 hours to pass between doses. 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.

Viagra can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Viagra, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether Viagra is the actual cause of vision loss.

Stop using Viagra and get emergency medical help if you have sudden vision loss.

Before taking Viagra

Do not take Viagra if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking Viagra with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.

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

• heart disease or heart rhythm problems;

• a recent history (in the past 6 months) of a heart attack, stroke, or heart rhythm disorder;

• congestive heart failure;

• high or low blood pressure;

• coronary artery disease;

• liver disease;

• kidney disease;

• a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;

• a bleeding disorder such as hemophilia;

• a stomach ulcer;

• retinitis pigmentosa (an inherited condition of the eye);

• a physical deformity of the penis (such as Peyronie's disease); or

• if you have been told you should not have sexual intercourse for health reasons.

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

Viagra can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Viagra, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether Viagra is the actual cause of vision loss. Stop using Viagra and get emergency medical help if you have sudden vision loss. FDA pregnancy category B: This medication is not expected to be harmful to an unborn baby. Do not use Viagra without telling your doctor if you are pregnant or plan to become pregnant during treatment. It is not known if Viagra passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Viagra?

Take Viagra exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label.

Revatio is usually taken three times each day, about 4 to 6 hours apart.

Viagra is usually taken only when needed, 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Viagra more than once per day.

Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor's instructions.

During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Viagra. Store this medication at room temperature away from moisture and heat.

What happens if I miss a dose?

Viagra is used as needed, so you are not likely to be on a dosing schedule.

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

What should I avoid while taking Viagra?

Avoid drinking alcohol, which can increase some of the side effects of Viagra. Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor.

Viagra side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Viagra.

Stop using Viagra and call your doctor at once if you have any of these serious side effects:

• sudden vision loss;

• ringing in your ears, or sudden hearing loss;

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

• irregular heartbeat;

• swelling in your hands, ankles, or feet;

• shortness of breath;

• vision changes;

• feeling light-headed, fainting; or

• penis erection that is painful or lasts 4 hours or longer.

Less serious Viagra side effects may include:

• warmth or redness in your face, neck, or chest;

• stuffy nose;

• headache;

• upset stomach; or

• back pain.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Viagra?

Do not take Viagra if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite ("poppers").

Before taking Viagra, tell your doctor about all other medications you use for erectile dysfunction, or if you are using any of the following medications:

• bosentan (Tracleer);

• a blood thinner such as warfarin (Coumadin);

• cimetidine (Tagamet, Tagamet HB);

• an antibiotic such as erythromycin (E-Mycin, Eryc, Ery-Tab) or clarithromycin (Biaxin);

• doxazosin (Cardura), prazosin (Minipress), Terazosin (Hytrin);

• HIV medicines such as amprenavir (Agenerase), tipranavir (Aptivus), darunavir (Prezista), efavirenz (Sustiva), nevirapine (Viramune), indinavir (Crixivan), saquinavir (Invirase, Fortovase), lopinavir/ritonavir (Kaletra), fosamprenavir (Lexiva), ritonavir (Norvir), atazanavir (Reyataz), or nelfinavir (Viracept);

• an antifungal medication such as itraconazole (Sporanox) or ketoconazole (Nizoral);

• carbamazepine (Tegretol), phenobarbital (Luminal), or phenytoin (Dilantin); or

• rifampin (Rifadin, Rimactane) or rifabutin (Mycobutin).

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

Where can I get more information?

• Your pharmacist can provide more information about Viagra.

What does my medication look like?

Sildenafil is available with a prescription under the brand names Viagra and Revatio. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Revatio 20 mg - white, film-coated round tablets

• Viagra 25 mg - blue, film-coated tablets with a rounded-diamond shape

• Viagra 50 mg - blue, film-coated tablets with a rounded-diamond shape

• Viagra 100 mg - blue, film-coated tablets with a rounded-diamond shape

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

Copyright 1996-2008 Cerner Multum, Inc. Version: 6.05. Revision Date: 11/05/2007 10:00:34 AM.