Savella (Milnacipran)

Author , posted on July 2, 2017

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Milnacipran (Generic)

Milnacipran Hydrochloride

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Lower the cost of Savella by $10 with coupon code SAV10.

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Savella (Milnacipran) Dosage and Side Effects

SAVELLA is used to treat fibromyalgia.  Fibromyalgia is a condition that causes pain, muscle tenderness, fatigue, and sleeping difficulties.

Proper Use of this medication

It’s typically taken two times a day, with or without food. Try to take SAVELLA around the same time each day.

Your doctor will probably start you on a low dose of SAVELLA and gradually increase it.

Follow the instructions on your prescription label carefully. Don’t take more or less SAVELLA than your doctor prescribes.

SAVELLA Overdose

Symptoms of an overdose may include:

  • Confusion
  • Extreme sleepiness
  • Coma
  • Slowed or stopped breathing
  • Slowed or stopped heartbeat

If you suspect an overdose, contact a poison control center or emergency room immediately.

Missed Dose of SAVELLA

If you miss a dose of SAVELLA, take it as soon as you remember.

However, if it’s almost time for your next dose, skip the missed dose and continue on your regular medication schedule.

Don’t double up on doses to make up for a missed one.

Side Effects

Common Side Effects of SAVELLA

Tell your doctor if any of the following side effects become severe or don’t go away:

  • Nausea, vomiting, or stomach pain
  • Constipation
  • Weight loss
  • Dry mouth
  • Facial warmth or redness
  • Headache
  • Blurred vision
  • Decreased sexual desire or ability
  • Pain or swelling of the testicles
  • Difficulty urinating
  • Itching or rash

Serious Side Effects of SAVELLA

Tell your doctor right away if you experience any of the symptoms listed in the SAVELLA Warnings section above, or any of the following serious side effects:

  • Confusion
  • Hallucinations
  • Difficulty concentrating or memory problems
  • Fever
  • Sweating
  • Diarrhea
  • Dizziness or fainting
  • Severe muscle stiffness
  • Uncontrollable shaking of a part of the body
  • Weakness
  • Unsteady walking that can cause a fall
  • Seizures
  • Coma
  • Slowed, difficult, or stopped breathing
  • Fast or pounding heartbeat
  • Extreme fatigue or lack of energy
  • Loss of appetite
  • Pain in the upper right part of the stomach
  • Yellowing of the skin or eyes (jaundice)
  • Flu-like symptoms
  • Black, tarry, or bloody stools
  • Bloody vomit or vomit that looks like coffee grounds
  • Unusual bruising or bleeding
  • Nosebleeds
  • Little red spots directly under the skin

Warnings and Precautions

SAVELLA isn’t used to treat depression, but it works like many antidepressants.

In some clinical studies, antidepressants increased the chances of suicidal behavior in a small number of children, teenagers, and young adults.

Young people who take antidepressants for mental health disorders may have a higher risk of suicidal behavior than those who take drugs like SAVELLA for fibromyalgia.

However, this drug may still cause changes in your mental health.

You or your caregiver should call your doctor right away if you experience any of the following symptoms while taking SAVELLA:

  • New or worsening depression
  • Thoughts about suicide
  • Extreme worry
  • Agitation
  • Panic attacks
  • Difficulty falling asleep or staying asleep
  • Aggressive behavior
  • Irritability
  • Severe restlessness
  • Acting without thinking
  • Frenzied, abnormal excitement

Don’t give this medicine to anyone younger than 17 years old without talking to a doctor.

Older adults may be more sensitive to the side effects of SAVELLA. Talk to your doctor if you’re over the age of 65.

SAVELLA can help control symptoms of fibromyalgia, but it isn’t a cure. Don’t stop taking this drug without first talking to your doctor because you could experience unpleasant withdrawal symptoms.

Before taking SAVELLA, tell your doctor if you have or have had:

  • Allergies to any medications
  • A history of heavy alcohol use
  • Bipolar disorder or another mental health condition
  • Glaucoma (an eye condition)
  • High blood pressure
  • Seizures
  • An irregular heartbeat
  • An enlarged or irregular prostate
  • Bleeding problems
  • Difficulty urinating
  • Kidney, heart, or liver disease

Tell your doctor you’re taking SAVELLA before any type of surgery, including dental procedures.

This medicine may cause an increase in blood pressure and heart rate.

Your healthcare provider will want to check your blood pressure and conduct other lab tests often while you’re taking SAVELLA. Keep all appointments with your doctor and laboratory.

Pregnancy and SAVELLA

It’s not known if SAVELLA will harm an unborn baby. Tell your doctor if you’re pregnant or plan to become pregnant while taking this medicine.

It’s also not known whether SAVELLA passes into breast milk and could hurt a breastfeeding baby. Talk to your doctor before using this drug while breastfeeding.

Interactions with this medication

Tell your doctor about all prescription, non-prescription, illegal, recreational, herbal, nutritional, or dietary drugs you’re taking, especially:

  • Anticoagulants (blood thinners) such as warfarin (Coumadin, Jantoven)
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
  • Buspirone (BuSpar)
  • Clonidine (Catapres)
  • Digoxin (Lanoxicaps, Digitek, Lanoxin)
  • Diuretics (water pills)
  • Epinephrine (EpiPen, Primatene Mist)
  • Fentanyl (Abstral, Actiq, Fentora, Onsolis, others)
  • Lithium (Eskalith, Lithobid)
  • Medications for anxiety, mental illness, pain, or seizures
  • Medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
  • Sedatives
  • Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)
  • Sleeping pills
  • Tramadol
  • Tranquilizers
  • Serotonin–norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta), desvenlafaxine (Pristiq), and venlafaxine (Effexor)
  • Supplements such as St. John’s wort and tryptophan
  • Tricyclic antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil)

Also, tell your doctor if you’re taking a monoamine oxidase inhibitor (MAOI) or have taken one in the last 14 days. These drugs include:

  • Isocarboxazid (Marplan)
  • Linezolid (Zyvox)
  • Methylene blue
  • Phenelzine (Nardil)
  • Selegiline (Eldepryl, Emsam, Zelapar)
  • Tranylcypromine (Parnate)

You should also wait at least five days after you stop taking SAVELLA to start taking an MAOI.

SAVELLA and Other Interactions

SAVELLA may make you drowsy.

Don’t drive a car or operate machinery until you know how this medicine affects you.

SAVELLA and Alcohol

Alcohol may worsen certain side effects of SAVELLA and increase your risk of liver damage.

Talk to your doctor about how much alcohol is safe to consume while taking this medicine.

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Sensipar (Cinacalcet)

Author , posted on July 2, 2017

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Sensipar

Cinacalcet Hydrochloride

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Sensipar

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Cinacalcet (Generic)

Cinacalcet Hydrochloride

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Cinacalcet (Generic)

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Cinacalcet (Generic)

Cinacalcet Hydrochloride

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Sensipar (Cinacalcet) Dosage and Side Effects

SENSIPAR is used:

  • to treat secondary hyperparathyroidism (high-per-pear-uh-THIGH-royd-izm) in patients with chronic kidney disease (CKD) receiving dialysis;
  • to reduce high levels of calcium in the blood (hypercalcemia) in patients with parathyroid cancer;
  • to reduce high levels of calcium in the blood (hypercalcemia) in patients with primary hyperparathyroidism when removal of the gland(s) is not possible.

Warnings and Precautions

BEFORE you use SENSIPAR talk to your doctor or pharmacist if:

  1. You have or had seizures (convulsions). The risk of having a seizure is greater if you have had seizures before.
  2. You have or had heart problems (low blood pressure or worsening heart failure).
  3. You have or had liver problems.
  4. You have lower blood calcium levels.
  5. You are pregnant, breastfeeding, or plan to do so.

Low calcium levels can have an effect on your heart rhythm. Tell your doctor if you experience an unusually fast or pounding heart beat, if you have heart rhythm problems, or if you take medicines known to cause heart rhythm problems, while taking SENSIPAR.

SENSIPAR is not recommended for patients with CKD not receiving dialysis.

SENSIPAR should not be used in children. A death was reported in an adolescent clinical trial patient with very low calcium levels in the blood (hypocalcemia).

Side Effects

If you have any of the following side effects while taking SENSIPAR, you should tell your doctor right away.

  • Nausea and vomiting. These are the most common side effects seen with SENSIPAR treatment. This may make it difficult to take your medicines.
  • Diarrhea, muscle pain and back pain. These side effects also are commonly reported.
  • Rash or hypersensitivity (allergic reactions). Cases of rash have been commonly reported, while cases of hypersensitivity (allergic reactions) have been uncommonly reported.
  • Hives (urticaria) is very rarely reported.
  • Swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing (angioedema) is also very rarely reported.

Interactions with this medication

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, even those not prescribed.

Drugs that may interact with SENSIPAR include: ketoconazole, erythromycin, itraconazole, metoprolol, flecainide, vinblastine, thioridazine, rifampin, phenytoin, or medicines such as tricyclic antidepressants (desipramine, amitriptyline).

Proper Use of this medication

It is important to take SENSIPAR exactly as your doctor has instructed you. Your doctor will tell you how much SENSIPAR to take. Your doctor will order regular blood tests to measure how you are responding to SENSIPAR and may increase or decrease your dose based on your PTH, calcium, and phosphate levels.

Usual adult dose:

If you have secondary hyperparathyroidism the usual starting dose for SENSIPAR is one 30 mg tablet once daily.

If you have parathyroid cancer or primary hyperparathyroidism, the usual starting dose for SENSIPAR is one 30 mg tablet twice daily.

SENSIPAR is taken once a day with food or right after a meal. SENSIPAR tablets must be taken whole and are not to be divided. It's best to take SENSIPAR at the same time each day.

Overdose:

In case of drug overdose, contact a health care practitioner, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

Tell your doctor or contact your regional Poison Control Centre immediately if you think you took more than the recommended dose of SENSIPAR.

Missed dose:

Do not take a double dose to make up for forgotten daily doses. If you have forgotten a dose of SENSIPAR, you should take your next daily dose as normal.

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Serevent Diskus (Salmeterol Xinafoate)

Author , posted on July 2, 2017

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Salmeterol Xinafoate

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Serevent (Salmeterol) Dosage and Side Effects

SEREVENT inhalation is used to prevent asthma attacks or exercise-induced bronchospasm. SEREVENT inhalation is also used to treat chronic obstructive pulmonary disease (COPD) including emphysema and chronic bronchitis.

Proper Use of this medication

SEREVENT may increase the risk of asthma-related death. Use only the prescribed dose of this medication, and do not use it for longer than your doctor recommends. Follow all patient instructions for safe use. Tell your doctor if your symptoms do not improve after 1 week of treatment.

Do not use SEREVENT inhalation to treat an asthma attack that has already begun. It will not work fast enough. Use only a fast-acting inhalation medication.

Asthma is often treated with a combination of different drugs. If you use SEREVENT inhalation to treat asthma, you must use it together with another asthma control medication. Use all of your medications as directed by your doctor. Talk with your doctor if your medications do not seem to work as well in treating or preventing attacks. Do not change your doses or medication schedule without advice from your doctor.

Serevent Diskus is a powder form of SEREVENT inhalation that comes with a special inhaler device preloaded with blister packs containing measured doses of the medicine. The device opens and loads a blister each time you use the inhaler. This device is not to be used with a spacer.

Use SEREVENT inhalation regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Do not stop using SEREVENT inhalation without first talking to your doctor. Your asthma symptoms may get worse after you stop using the medication.

If you also use a steroid medication, do not stop using the steroid suddenly or you may have unpleasant withdrawal symptoms. Talk with your doctor about taking less and less of the steroid before stopping completely.

Seek medical attention if you think any of your asthma medications are not working as well as usual. An increased need for medication could be an early sign of a serious asthma attack. If you use a peak flow meter at home, call your doctor if your numbers are lower than normal.

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

Do not try to clean or take apart the Diskus device. Throw it away 6 weeks after you have taken it out of the foil pouch, or if the dose indicator shows a zero, whichever comes first. Each Diskus device contains 60 doses.

Seek emergency medical attention or call the Poison Help line.

Use the medication as soon as you remember, then wait 12 hours before using the medication again. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Side Effects

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

Call your doctor at once if you have:

  • worsening asthma symptoms, or other breathing problems after using this medication;
  • muscle cramps, sleep problems (insomnia), tremors;
  • chest pain, fast or irregular heartbeats, feeling light-headed, fainting, or seizure (convulsions);
  • low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or
  • high blood sugar (increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss).

Common side effects may include:

  • headache;
  • flu symptoms;
  • joint or muscle pain;
  • throat irritation, cough; or
  • stuffy or runny nose.

Warnings and Precautions

Do not use SEREVENT inhalation to treat an asthma attack that has already begun.

SEREVENT may increase the risk of asthma-related death. Use only the prescribed dose of this medication, and do not use it for longer than your doctor recommends. Follow all patient instructions for safe use. Talk with your doctor about your individual risks and benefits of using SEREVENT inhalation.

If you use SEREVENT inhalation for asthma, you must use it together with another long-term asthma control medication. Seek medical attention if you think any of your asthma medications are not working as well as usual.

You should not use this medication if you are allergic to SEREVENT or to milk proteins.

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

  • a food or drug allergy;
  • heart disease or high blood pressure;
  • epilepsy or other seizure disorder;
  • diabetes;
  • a thyroid disorder; or
  • liver disease.

It is not known whether SEREVENT inhalation will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether SEREVENT inhalation passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

SEREVENT can increase the risk of asthma-related hospitalization in children and teenagers. It is very important that children using SEREVENT inhalation for asthma use it together with another long-term asthma control medication.

Do not give this medication to a child younger than 4 years old.

Interactions with this medication

Do not use a second form of SEREVENT (such as Advair) or use a similar inhaled bronchodilator such as formoterol or arformoterol (Foradil, Perforomist, Symbicort, or Brovana) unless your doctor has told you to.

Do not exhale or blow into the Diskus device. Do not take the device apart or allow it to get wet.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with SEREVENT inhalation, especially:

  • an antidepressant--nefazodone;
  • an antibiotic--clarithromycin, telithromycin; antifungal medication--itraconazole, ketoconazole, voriconazole; a beta blocker--carvedilol, labetalol, nadolol, metoprolol, penbutolol, pindolol, propranolol, sotalol, timolol;
  • hepatitis C medications--boceprevir, telaprevir; HIV/AIDS medication--atazanavir, cobicistat, darunavir, delavirdine, fosamprenavir, indinavir, nelfinavir, ritonavir, saquinavir.

This list is not complete. Other drugs may interact with SEREVENT, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

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Sibelium (Flunarizine)

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Sibelium (Flunarizine) Dosage and Side Effects

SIBELIUM (flunarizine) is a drug classified as a calcium antagonist. It is effective in the prophylaxis of migraine, occlusive peripheral vascular disease, vertigo of central and peripheral origin, and as an adjuvant in the therapy of epilepsy.

Proper Use of this medication

info...

Side Effects

Common side effects include drowsiness (20% of patients), weight gain (10%), as well as extrapyramidal effects and depression in elderly patients.

Warnings and Precautions

info...

Interactions with this medication

The effects of other sedating drugs and alcohol, as well as antihypertensives, can be increased. No relevant pharmacokinetic interactions have been described

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Silvadene (Silver Sulfadiazine)

Author , posted on July 1, 2017

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Flamazine (Silver Sulfadiazine) Dosage and Side Effects

FLAMAZINE (silver sulfadiazine) belongs to the class of medications called topical antibiotics. It is used to treat and prevent infection of skin wounds, especially in victims of serious burns. It may also be used in leg ulcers, skin grafts, surgical incisions, and minor cuts and scrapes. It is applied directly to the wounded area and works by stopping the action of bacteria that may cause infection.

Proper Use of this medication

Burns: Clean burn wounds and apply FLAMAZINE (silver sulfadiazine) over all the affected areas to a depth of 3 mm to 5 mm.

One way to apply the cream is with a sterile gloved hand or a sterile nonmetallic spatula. Where necessary, reapply the cream to any area from which it has been removed by activity. Reapply the cream at least every 24 hours.

For hand burns and finger injuries, a recommended method is to apply the medication to the burn and then enclose the hand in a clear plastic bag or glove, which is then closed at the wrist. Change the dressing every 3 days or whenever there is a lot of drainage in the bag.

Silver sulfadiazine cream is also used for treatment of leg ulcers. Clean leg ulcer and fill the cavity with silver sulfadiazine to a depth of at least 3 mm to 5 mm. Avoid applying the silver sulfadiazine to the surrounding skin. Apply appropriate dressing to the area and change every 2 or 3 days.

Ask your health care professional about the best way to apply the cream and care for the affected area.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, apply it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not apply a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Side Effects

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • burning feeling on treated area(s)
  • itching or skin rash

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

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

  • shen-grey discolouration of the skin
  • blistering, peeling, or loosening of skin
  • bloody or cloudy urine
  • chills or fever
  • cough
  • decreased amount of urine or less frequent urination
  • increased sensitivity of skin to sunlight, especially for patients with burns on large areas
  • intense itching of burn wounds
  • pain at site of application
  • painful or difficult urination
  • red skin lesions, often with a purple centre
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on lips or in mouth
  • swollen glands
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Warnings and Precautions

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

Flamazine (silver sulfadiazine) should not be used by anyone who:

  • is allergic to silver sulfadiazine or to any of the ingredients of the medication
  • is a premature infant or newborn in their first month of life
  • is currently on sulfonamide therapy
  • is pregnant at term

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergy to sulfonamides: People who have previously shown sensitization reactions to sulfonamides should exercise caution in the use of silver sulfadiazine.

Glucose 6 phosphate dehydrogenase deficiency: Silver sulfadiazine should be used with caution by patients with a history of G-6-PD (glucose 6 phosphate dehydrogenase) deficiency, as hemolysis (breakdown of blood cells) may occur.

Liver and kidney function: Silver sulfadiazine should be used with caution by patients with significant liver or kidney impairment.

Oral hypoglycemic agents and phenytoin: In patients with large area burns where serum sulfadiazine levels may approach therapeutic levels, the action of antidiabetic agents and phenytoin may be increased and it is recommended that blood levels be monitored.

Pregnancy: The safety of silver sulfadiazine has not been established for use during pregnancy. Silver sulfadiazine should only be used by badly burned pregnant women if the benefits outweigh the risks. Silver sulfadiazine should not be used by a pregnant woman near term.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are using silver sulfadiazine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Interactions with this medication

There may be an interaction between FLAMAZINE (silver sulfadiazine) and any of the following:

  • antidiabetes medications
  • cimetidine
  • enzymatic debriding agents
  • phenytoin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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Complera (Tenofovir Disoproxil Fumarate, Emtricitabine, Rilpivirine Hydrochloride)

Author , posted on June 30, 2017

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Complera (Tenofovir Disoproxil Fumarate, Emtricitabine, Rilpivirine Hydrochloride) Dosage and Side Effects

COMPLERA is used as a complete regimen to treat people with HIV infection.

Proper Use of this medication

Stay under a doctor's care when taking COMPLERA. Do not change your treatment or stop treatment without first talking with your doctor.

Take COMPLERA every day exactly as your doctor prescribed it. Follow the directions from your doctor, exactly as written on the label. Set up a dosing schedule and follow it carefully.

Always take COMPLERA with food. COMPLERA must be taken with food which will help make sure the medicine is absorbed into your body. A protein drink is not a substitute for food. An example of suitable foods to take with COMPLERA would be 2 pieces of toast with a butter substitute, with 250 mL (8 ounces) of 2% milk and 4 ounces of apple juice. There are other food options that can be taken to achieve the food requirement. Talk to your doctor.

When your COMPLERA supply starts to run low, get more from your doctor or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to COMPLERA and become harder to treat.

Only take medicine that has been prescribed specifically for you. Do not give COMPLERA to others or take medicine prescribed for someone else.

If you take an antacid (a medicine to treat heartburn from acid reflux such as aluminum/magnesium hydroxide, calcium carbonate), take the antacid either at least 2 hours before or at least 4 hours after COMPLERA. If you take an H2-receptor antagonist (medicines used to treat stomach ulcers, heartburn or acid reflux disease such as cimetidine, famotidine, nizatidine or ranitidine), take the H2-receptor antagonist at least 12 hours before or at least 4 hours after COMPLERA. Importantly, proton pump inhibitors (such as omeprazole, lansoprazole, rabeprazole, pantoprazole, esomeprazole) also available for these conditions should not be taken with COMPLERA.

For patients receiving rifabutin, an additional 25 mg tablet of Edurant per day is recommended to be taken concomitantly with COMPLERA for the duration of the rifabutin coadministration.

Do not use if seal over bottle opening is broken or missing.

Usual adult dose:

  • The usual dose of COMPLERA is one tablet orally (by mouth) once a day. Swallow with plenty of water.
  • Always take COMPLERA with food; food is important to make sure the medicine is absorbed into your body. A protein drink is not a substitute for food. See further instructions above.

Overdosage:

In case of drug overdose, contact your healthcare practitioner (e.g. doctor), hospital emergency department or regional poison control centre, even if there are no symptoms.

As with all medicines, COMPLERA should be kept out of reach of children.

Missed dose:

It is important that you do not miss any doses. If you miss a dose of COMPLERA within 12 hours of the time it is usually taken, you should take COMPLERA with food as soon as possible Take the next dose of COMPLERA at the regularly scheduled time.

If you miss a dose of COMPLERA by more than 12 hours of the time you usually take it, wait and then take the next dose of COMPLERA at the regularly scheduled time. Do not double the next dose to make up for a missed dose.

Side Effects

The most common side effects of COMPLERA are abdominal pain, depression, headache, rash and sleeping problems (including difficulty falling asleep).

Other side effects include vomiting, nausea, intestinal gas, dizziness, allergic reaction (including skin rash, redness, irritation, swelling of the face, lips, tongue or throat, difficulty in breathing), sleepiness, abnormal dreams, stomach pain or discomfort, indigestion, diarrhea, skin discoloration (small spot or freckles), pain, weakness, decreased appetite, increased weight and fatigue.

Severe skin reactions have been reported with COMPLERA. If you develop a rash, along with any of the following symptoms, stop taking COMPLERA and contact your doctor right away: blisters, mouth sores, swelling of the face, lips, tongue, mouth, or throat, swollen eyes (pink eye), or fever, dark urine, or pain on the right side of the stomach-area.

Changes in your immune system (Immune Reconstitution Inflammatory Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time, or you could develop an autoimmune disease in which your immune system reacts against your own body (e.g. Graves' disease (which affects the thyroid gland), Guillain-Barré syndrome (which affects the nervous system) or polymyositis (which affects the muscles) and it may develop at any time, sometimes months later after the start of HIV therapy). Sometimes symptoms can be severe, so if you develop high temperature (fever), joint or muscle pain, redness, rash, swelling or fatigue, or any new symptoms, contact your doctor right away.

Other common sides effects reported for EMTRIVA and VIREAD are:

  • Inflammation of the pancreas
  • Shortness of breath
  • Allergic reaction

Lactic acidosis is a medical emergency and must be treated in the hospital. You may be more likely to get lactic acidosis or serious liver problems if you are very overweight (obese) or have been taking nucleoside analog medicines, like COMPLERA, for a long time.

Muscle pain, muscle weakness, bone pain and softening of the bone (infrequently contributing to fractures) have also been reported due to tenofovir DF (a component of COMPLERA).

There have been other side effects in patients taking EMTRIVA, Edurant or VIREAD. This is not a complete list of side effects. If you have questions about side effects, ask your doctor, nurse, or pharmacist. You should report any new or continuing symptoms to your doctor right away. Your doctor may be able to help you manage these side effects.

Warnings and Precautions

Serious Warnings and Precautions

  • The most serious possible side effect is harm to the kidneys, including damage to kidney cells, kidney tissue inflammation and kidney failure. Your doctor may monitor your kidney function before beginning and while receiving COMPLERA. Some patients treated with tenofovir DF (a component of COMPLERA) have had kidney problems. Your doctor may need to perform additional blood tests if you have had kidney problems in the past or need to take another drug that can cause kidney problems.
  • If you are also infected with the Hepatitis B Virus, “flare-ups” of Hepatitis B Virus infection, in which the disease suddenly returns in a worse way than before, can occur if you stop taking COMPLERA. Do not stop taking COMPLERA without your doctor's advice. If you stop taking COMPLERA, tell your doctor immediately about any new, unusual or worsening symptoms that you notice after stopping treatment. After you stop taking COMPLERA, your doctor will still need to check your health and take blood tests to check your liver. COMPLERA is not approved for the treatment of hepatitis B virus infection.
  • The class of medicines to which emtricitabine and tenofovir DF, two of the components of COMPLERA, belong (NRTIs) can cause a condition called lactic acidosis (build up of acid in the blood). The symptoms that may be signs of lactic acidosis include: feeling very weak, tired or uncomfortable; unusual or unexpected stomach discomfort; feeling cold; feeling dizzy or lightheaded; suddenly developing a slow or irregular heartbeat. This rare but serious side effect has occasionally been fatal.
  • Severe liver problems can happen in people who take COMPLERA or similar medicines. You may develop an enlarged liver (hepatomegaly) or a fatty liver (steatosis). Non-specific symptoms such as yellowing of skin and eyes, nausea, vomiting and stomach pain might indicate the development of liver problems. Lactic acidosis or severe liver problems occurs more often in women, particularly if they are very overweight. You should consult your doctor immediately if such symptoms occur while you are receiving COMPLERA. If you notice these symptoms, stop taking COMPLERA and consult a doctor immediately.
  • Tenofovir DFcaused harm to the bones of animals. Tenofovir DF reduced bone density in humans. If you notice bone pain, suffer a bone fracture, or other bone problem, consult your doctor. If you have bone problems, you may wish to discuss calcium and/or vitamin D supplements with your doctors.
  • Changes in body fat have been seen in some patients taking antiretroviral therapy. These changes may include increased amounts of fat in the upper back and neck (“buffalo hump”), breast, and around the trunk. Loss of fat from the legs, arms and face may also happen. The cause and long term health effects of these conditions are not known at this time.

BEFORE you use COMPLERA (emtricitabine/rilpivirine/tenofovir DF) talk to your doctor or pharmacist:

If you have an eating disorder or are following a strict diet.

If you have any drug allergies.

If you are pregnant or planning to become pregnant: The effects of COMPLERA on pregnant women or their unborn babies are not known. Pregnant women should not take COMPLERA unless specifically directed by the doctor. If you use COMPLERA while you are pregnant, talk to your doctor about how you can be on the COMPLERA Antiviral Pregnancy Registry.

If you are breastfeeding or plan to breast-feed: Do not breastfeed if you are taking COMPLERA or have HIV. Tenofovir and emtricitabine pass into your baby in your breast milk. You should not breast-feed because of the risk of passing HIV to your baby. Talk to your doctor about the best way to feed your baby.

If you have a heart disease or a heart condition, including a heart rhythm disorder (QT prolongation) or family history of heart rhythm disorders (QT prolongation) or sudden (heart) death under 50 years of age.

If you have other medical conditions: Let your doctor know if you have other medical conditions, especially liver problems, including hepatitis B or C virus infection, pancreatitis (inflammation of the pancreas), have or are at risk for bone disease or bone related problems, have kidney problems or are undergoing kidney dialysis treatment, or have or develop feelings of depression.

If you are taking other medicines: Some medicines can interact when taken together, including prescription and non-prescription medicines, herbal products and dietary supplements.

Interactions with this medication

Drugs that should not be taken with COMPLERA:

  • Do not take COMPLERA if you are on other medications that may affect your kidneys and have not discussed this with your doctor.
  • ATRIPLA, EMTRIVA, GENVOYA, STRIBILD, TRUVADA, VIREAD, Combivir (lamivudine/zidovudine), 3TC or Heptovir (lamivudine), Kivexa (abacavir sulfate/lamivudine), HEPSERA, Trizivir (abacavir sulfate/lamivudine/zidovudine) and Triumeq (dolutegravir/abacavir sulfate/lamivudine) should not be used with those medicines.
  • Edurant, unless recommended by your doctor and you are taking rifabutin with COMPLERA.

Tell your doctor if you are taking any of the following medicines. Some of these medicines may be obtained without a prescription and some of these may be available under other names.

These are not all the medicines that may cause problems if you take COMPLERA. Be sure to tell your doctor about all the medicines you take.

Keep a complete list of all the prescription and nonprescription medicines as well as any herbal medicines that you are taking, how much you take and how often you take them. Make a new list when medicines or herbal medicines are added or stopped, or if the dose changes. Give copies of this list to all your doctors and pharmacists every time you visit them or fill a prescription. This will give your doctor a complete picture of the medicines you use. Then he or she can decide the best approach for the situation.

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Simbrinza Opthalmic (Brimonidine/Brinzolamide)

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Simbrinza

Brinzolamide, Brimonidine Tartrate

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Simbrinza (Brinzolamide and Brimonidine) Medication Information

Uses

Simbrinza is an alpha 2 adrenergic receptor agonist and carbonic anhydrase inhibitor used to decrease high intraocular pressure in patients with ocular hypertension or open-angle glaucoma. 

Dosage

Simbrinza is an ophthalmic solution that contains 10 mg/mL brinzolamide and 2 mg/mL brimonidine tartrate. 

Side Effects

The most common side effects of Simbrinza include:

  • eye irritation
  • bad taste
  • eye allergy
  • blurred vision
  • dry mouth 

Speak with your doctor for a full list of side effects that apply to you if you are taking Simbrinza.

Precautions

Simbrinza is not recommended in patients with severe renal impairment due to lack of efficacy and safety data in patients with CrCl <30 mL/min. 

Because brinzolamide is a sulfonamide, Simbrinza may cause sulfonamide hypersensitivity reactions which can lead to serious complications such as Stevens-Johnson syndrome. Discontinue Simbrinza if a serious reaction occurs.

Bacterial keratitis may occur secondary to accidental contamination of multiple-dose ophthalmic solutions.

Interactions

Known drug interactions with Simbrinza include medications in the following classes: central nervous system depressants, tricyclic antidepressants, monoamine oxidase inhibitors, antihypertensives, oral carbonic anhydrase inhibitors, and high-dose salicylate therapy. 

Storage

This medication should be stored between  36°F - 77°F.

Pharmacist Tips

  • Contact lenses should be removed prior to Simbrinza administration. 15 minutes post Simbrinza administration, you may reinsert lenses. 
  • Simbrinza should be administered 5 minutes apart from any other eye drops you may be taking. 
  • Simbrinza may cause fatigue and/or drowsiness, you should avoid hazardous activities such as driving until you know how Simbrinza will affect you. 

Simbrinza FAQs

When signs should I look out for when taking Simbrinza?

When taking Simbrinza, you should look out for any signs of allergic reactions such as rashes, wheezing, tightness in chest, difficulty breathing, or face swelling. 

 

What should I do if I miss my dose of Simbrinza?

Use Simbrinza as soon as you remember you missed a dose. If it is almost time for your next dose, only take one dose. It is important to not take two doses of Simbrinza at the same time.

Can I wear contact lenses while taking Simbrinza?

Contact lenses should be removed prior to SImbrinza administration. You may reinsert your contact lens after 15 minutes. 

 

Does Simbrinza cause low blood pressure? 

Simbrinza contains brimonidine which may lower blood pressure. In studies, Simbrinza had less than a 5% mean decrease in blood pressure 2 hours after administration. Exercise caution if you are taking any antihypertensives or cardiac glycosides. 

 

Is it possible to lose hair when on Simbrinza? 

Hair loss is not a reported side effect of Simbrinza.

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References:

https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/204251s000lbl.pdf

Simbrinza. Lexi-Drugs. Hudson, OH: Lexicomp, 2015. http://online.lexi.com/. Updated July 27, 2015. Accessed March 3, 2021.

PharmD Medical Writer

Author: Dr. Larisa Roybal, PharmD

Dr. Roybal is a board-certified pharmacotherapy specialist who has practiced in both ambulatory and acute care settings. Her pharmacy interests include oncology and general inpatient pharmacy.

Compazine (Prochlorperazine)

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Stemetil

Prochlorperazine Maleate

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Compazine (Prochlorperazine) Dosage and Side Effects

COMPAZINE is as an anti-nausea and anti-vomiting medication, and as well as an antipsychotic agent.

Proper Use of this medication

COMPAZINE in suppository form comes in 25 milligram (mg) doses that can be taken twice a day. Tablets come in 5 and 10 mg formulas with a recommended dose of 10 to 40 mg a day.

While adults can take tablets three or four times a day, children's doses are usually given one to three times a day.

COMPAZINE should not be given to children younger than two years or weighing less than 20 pounds.

Side Effects

Common Side Effects of COMPAZINE

Side effects reported by those on COMPAZINE include:

•Drowsiness

•Difficulty falling or staying asleep

•Dizziness

•Increased appetite, weight gain

•Dry mouth

•Blurred vision

•Decreased sexual ability in men

If these symptoms seem severe or persist, tell your doctor.

Severe Side Effects of COMPAZINE

If you have any of these side effects, contact your doctor right away, as they can be serious:

•Fever

•Confusion

•Fast, irregular heartbeat

•Stiffness in muscles

•Sweating

•Breathing or swallowing problems

•Rash, hives, itching, swelling of eyes, face or other parts

•Yellow skin, eyes

•Erection lasting for hours

Warnings and Precautions

COMPAZINE must carry a black-box warning about an increased risk of death when used in elderly patients with psychosis related to dementia.

The medicine is not approved for treating patients with dementia-related psychosis.

Using COMPAZINE increases the risk of a serious movement disorder called tardive dyskinesia. The condition may remit once the drug is stopped.

If you are taking COMPAZINE regularly, you should not stop taking it without first talking to your doctor.

If you have the eye condition glaucoma, be sure to tell your doctor. COMPAZINE may affect intraocular pressure, which can be dangerous.

Pregnancy and COMPAZINE

COMPAZINE is a Pregnancy Category C drug, according to the FDA. That means harm to a woman's fetus cannot be ruled out. If you are pregnant, you should talk to your doctor about the benefits of taking COMPAZINE versus the potential risks to the baby.

The drug may interfere with the results of home pregnancy tests. If you suspect you are pregnant while taking COMPAZINE, see your doctor.

COMPAZINE is excreted in the breast milk of nursing mothers. Ask your doctor if it would be better to stop the drug or stop breastfeeding.

Interactions with this medication

Before staring COMPAZINE, tell your doctor about any prescription, non-prescription, over-the-counter (OTC), illegal and recreational drugs, herbal remedies, nutritional and dietary supplements, and all other drugs and treatments you're taking.

COMPAZINE and Drug Interactions

If you are taking any of the following medications while taking COMPAZINE, your doctor will watch closely to guard against interactions:

•Thiazide diuretics, such as hydrochlorothiazide (Microzide) or chlorothiazide (Diuril). These can lower blood pressure too much when taken with COMPAZINE.

•Oral anticoagulants such as warfarin (Coumadin) can work less effectively when taken with COMPAZINE.

•Anticonvulsant medications (anti-epileptic drugs) may need to be dose-adjusted.

COMPAZINE and Alcohol

COMPAZINE may intensify or lengthen the effects of alcohol. Ask your doctor about using alcohol while taking COMPAZINE.

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Sinemet CR (Carbidopa/Levodopa)

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Sinemet CR

Carbidopa, Levodopa

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Sinemet CR (Carbidopa-Levodopa) Medication Information

Uses

Sinemet CR is dopamine synthetic that is used to treat Parkinson’s disease and parkinsonism. 

Dosage

The tablets are available in several different strengths:

  • 25-100 mg
  • 50-200 mg

Side Effects

The most common side effects of Sinemet CR include:

  • Abdominal pain
  • Changes in blood pressure
  • Heartburn
  • Weight loss
  • Somnolence
  • Anxiety
  • Gait abnormalities
  • Memory impairment
  • Rash 

Speak with your doctor for a full list of side effects that apply to you if you are taking Sinemet.

Precautions

Sinemet can affect multiple organ systems, so it is recommended that liver, heart and kidney function be monitored along with blood count regularly during treatment.

Patients with wide-angle glaucoma should use caution when being treated with Sinemet.

Dopamine agents like Sinemet can cause somnolence, so patients should be monitored during their initial treatment. 

Interactions

The most common drug interaction with Sinemet CR included:

  • Antihypertensives
  • MAOIs
  • TCAs
  • Phenothiazine
  • Butyrophenones
  • Risperidone
  • Metoclopramide 

Speak with your doctor for more information and before starting a new medication with Sinemet. 

Storage

Store below 86ºF. Store Sinemet in a tightly closed container. 

Pharmacist Tips

  • Sinemet can affect several organ systems, so monitoring blood work during treatment is important.
  • If you have a dose adjustment to Sinemet CR you will need to be monitored closely. 
  • Sinemet should be given as a whole or half tablet. 

Sinemet CR FAQs

What is the best way to take Sinemet?

It is generally recommended that Sinemet be taken on an empty stomach. 

 

What are the symptoms of too much Sinemet?

Some symptoms of taking too much Sinemet include dizziness, agitation, and irregular heartbeat.

 

What foods should I avoid with Sinemet?

Foods that are high in protein, fiber, or fat can decrease drug absorption. 

 

How quickly will Sinemet take effect?

The ingredients in Sinemet CR will be released over 4-6 hours. 

 

Does Sinemet help with walking?

Sinemet has been found to help with freezing, but it will not help with balance. 

 

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Reference:

Sinemet CR {package insert}. Princeton, NJ: Bristol-Myers Squibb.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/019856s025lbl.pdf

PharmD Medical Writer

Author: Dr. Larisa Roybal, PharmD

Dr. Roybal is a board-certified pharmacotherapy specialist who has practiced in both ambulatory and acute care settings. Her pharmacy interests include oncology and general inpatient pharmacy.

Sinemet (Carbidopa/Levodopa)

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Sinemet

Levodopa, Carbidopa

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Sinemet (Carbidopa/Levodopa) Dosage and Side Effects

SINEMET is used to treat the symptoms of Parkinson's disease. SINEMET is a combination of levodopa, the metabolic precursor of dopamine, and carbidopa, an aromatic amino acid decarboxylase inhibitor.

Proper Use of this medication

Usual dose:

The dosage of SINEMET is variable and your physician will adjust it according to the severity of your disease and your response to treatment.

SINEMET is an immediate-release formulation of levodopa-carbidopa that is designed to begin release of ingredients within 30 minutes. For best results take SINEMET every day. It is important to carefully follow your physician's advice on how much SINEMET to take and how often to take it. Promptly inform your physician of any change in your condition such as nausea or abnormal movements, as this may require an adjustment in your prescription.

Do not change the dose regimen prescribed by your physician and do not add any additional antiparkinson medications, including other levodopa-carbidopa preparations, without first consulting your physician.

Do not stop taking this medicine abruptly or lower the dosage without checking with your physician. If you suddenly stop or reduce your dosage you may experience the following symptoms: stiff muscles, high temperature (fever) and mental changes.

Overdose:

In case of an overdose, contact your physician immediately so that medical attention may be given promptly.

For management of a suspected drug overdose, contact your regional Poison Control Centre.

Missed dose:

Try to take SINEMET as prescribed. However, if you have missed a dose, take it as soon as you remember. If it is almost time to take your next tablet, do not take the missed tablet, but resume your normal schedule.

Side Effects

SINEMET is generally well tolerated. Like any other medicine, however, SINEMET may have unintended or undesirable effects, so called side-effects.

Very rare but serious side effects that have been reported include sudden sleep onset episodes.

Certain side effects that have been reported with SINEMET may affect some patients' ability to drive or operate machinery.

SINEMET can cause somnolence (excessive drowsiness) and sudden sleep onset episodes. Therefore you must refrain from driving or engaging in activities where impaired alertness may put yourself or others at risk of injury or death (e.g. operating machines) until such recurrent episodes and somnolence have resolved.

The most frequent side effects are: abnormal movements including twitching or spasms (which may or may not resemble your Parkinson's symptoms), and nausea.

Other possible side effects include: mental changes, dream abnormalities, hair loss, diarrhea, dizziness, vomiting, loss of appetite, and slow movement. Occasionally, dark colour (red, brown or black) may appear in your saliva, urine or sweat after you take SINEMET.

Warnings and Precautions

Serious Warnings and Precautions

Some people feel sleepy, drowsy, or, rarely, may suddenly fall asleep without warning (i.e. without feeling sleepy or drowsy) when taking SINEMET. During treatment with SINEMET take special care when you drive or operate a machine. If you experience excessive drowsiness or a sudden sleep onset episode, refrain from driving and operating machines, and contact your physician.

Studies of people with Parkinson's disease show that they may be at an increased risk of developing melanoma, a form of skin cancer, when compared to people without Parkinson's disease. It is not known if this problem is associated with Parkinson's disease or the drugs used to treat Parkinson's disease. Therefore, patients treated with SINEMET should have periodic skin examinations.

BEFORE taking SINEMET, tell your physician or pharmacist if you:

  • have or have had any medical conditions including: allergies; depression or mental disturbances; lung, kidney, liver, heart or hormonal problems; skin cancer or suspicious skin lesions; ulcer in your gut (called “duodenal” or “peptic ulcer”); convulsions/seizures; or glaucoma
  • have previously been treated with levodopa
  • are pregnant or plan to become pregnant
  • are breastfeeding or wish to breastfeed
  • are going to have an operation that requires general anesthesia
  • drive or operate machinery

Tell your doctor if you or your family member/caregiver notices you are developing urges to gamble, increased sexual urges, excessive eating or spending, and/or other intense urges that could harm yourself or others. These behaviors are called impulse control disorders. Your doctor may need to review your treatments.

It is not recommended to use SINEMET while you are pregnant or breast-feeding.

It is not known what effect SINEMET may have on human pregnancy. Levodopa, one of the components of SINEMET, is passed into human milk. If you are pregnant, may become pregnant or intend to breast-feed, tell your physician, who will help you weigh the benefits of the drug for you against possible risks to your baby.

As you improve on SINEMET, you may increase your physical activity gradually and with caution related to any other medical conditions you may have.

SINEMET should not be given to children under 18 years of age.

Interactions with this medication

Although SINEMET can generally be given with other medicines, there are exceptions. Tell your physician about all medicines you are taking or plan to take, including those obtained without a prescription.

It is particularly important to tell your physician if you are taking:

  • antihypertensive drugs (used to treat elevated blood pressure)
  • some medications used to treat psychiatric conditions or mental depression (including phenothiazines, butyrophenones, risperidone, selegiline, tricyclic antidepressants and monoamine oxidase inhibitors)
  • tetrabenazine (medication used to treat conditions related to involuntary movements such as Huntingtons Disease)
  • phenytoin (anti-epileptic medication)
  • papaverine (medication for intestinal spasms)
  • isoniazid (medication to treat tuberculosis)
  • metoclopramide (for nausea and vomiting)
  • iron salts (such as multivitamins tablets) which may reduce the amount of carbidopa and/or levodopa available to the body

A change in diet to foods that are high in protein (such as meat, fish, dairy products, seeds and nuts) may delay the absorption of levodopa and SINEMET may not work as well as it should.

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