Before Taking SUSTIVA:

What should I tell my doctor before I start SUSTIVA?

• Inform your doctor about any past or present medical problems, including liver disease, hepatitis, allergies, severe kidney failure, seizures or mental illness.
• Inform your doctor if you have ever had a previous life-threatening skin reaction (e.g. Stevens-Johnson syndrome).
• Inform your doctor about any medications (prescription and nonprescription), herbal products, vitamins, nutritional supplements that you are currently taking or are planning to take.
• Also inform your doctor about any recreational (street, illicit) drugs that you are currently taking or are planning to take. The effect of combining recreational (street, illicit) drugs or alcohol with SUSTIVA has not been studied. Because they may interact with each other, speak with your doctor or other health care provider before you combine these drugs.

What should I consider concerning contraception, pregnancy, or breast-feeding?

• Tell your doctor if you are pregnant or planning to become pregnant. Birth defects have been reported in the offsprings of animals and women treated with SUSTIVA during pregnancy. It is not known whether SUSTIVA caused these defects. Women should not become pregnant while taking SUSTIVA and for 12 weeks after stopping it. If you are pregnant, you should take SUSTIVA only if you and your doctor decide that the possible benefit to you is greater than the possible risk to your fetus. If you take SUSTIVAwhile you are pregnant, talk to your doctor about how you can be included in the antiretroviral pregnancy registry.
• Tell your doctor if you are breastfeeding or planning to breastfeed. It is currently recommended that HIV-infected women should not breastfeed. Discuss this with your doctor.
• A reliable form of barrier contraception must always be used even if you or your partner are using other methods of contraception such as the pill or other hormonal therapy (e.g., implants, injections). SUSTIVA may remain in your blood for a time after therapy is stopped. Therefore, you should continue use of a reliable form of contraception for 12 weeks after stopping treatment with SUSTIVA.

Can children take SUSTIVA?

• SUSTIVA has not been studied in children below 3 years of age.
• SUSTIVA can be taken by children 3 years or older and who are able to swallow capsules. Your child's doctor will determine the right dose based on your child's weight.

Do not drive or operate machinery until you have determined your response to SUSTIVA, as this may make you sleepy or dizzy.

• SUSTIVA, like all medications, affects different people in different ways. Any medication may have unintended or unwanted effects, so-called side effects. Some people may develop side effects, others may not.
• The most notable side effects of SUSTIVA are rash and nervous system symptoms that include dizziness, insomnia (difficulty falling asleep), drowsiness, reduced ability to concentrate, and abnormal dreaming. These side effects are generally mild to moderate and tend to disappear after you have taken SUSTIVA for a few weeks. Decreasing the dose does not seem to help and is not recommended.
• Some of these side effects such as dizziness will likely be less noticeable if you take SUSTIVA before going to bed. Be sure to tell your doctor if any of these side effects continue or if they bother you.
• A small number of patients have had severe depression, strange thoughts, or angry behavior. Some patients have had thoughts of suicide and a few patients have actually committed suicide. These problems tend to occur more often in patients with a history of mental illness. You should contact your doctor immediately if you think you are having these symptoms, so your doctor can decide whether you should continue to take SUSTIVA.
• Dizziness, trouble concentrating, and drowsiness have been reported with SUSTIVA. If you notice any of these symptoms you should avoid potentially hazardous tasks such as driving or operating machinery.
• You should consult your doctor if you have a rash since some rashes may be serious. However, most cases of rash disappear without any change in your treatment.
• Rash seems to be more common in children than in adults treated with SUSTIVA.
• Changes in body fat have been seen in some patients taking antiretroviral therapy. These changes may include increased amount 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.
• Some patients taking SUSTIVA have experienced serious liver problems including liver failure resulting in transplantation or death. Most of these serious side effects occurred in patients with a chronic liver disease such as a hepatitis infection, but there have also been a few reports in patients without any existing liver disease.
• 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 straight away.

Other side effects:

• Other common side effects that have been reported include tiredness, nausea, diarrhea and headache. These may be from SUSTIVA or from other medications that you are taking.
• Tell your doctor or other health care provider if you notice these or any other side effects not mentioned in the pamphlet that continue or if they bother you.

Remember do not stop taking SUSTIVA without speaking to your doctor first. He or she may be able to help you manage these side effects without stopping your anti-HIV medications.

Drugs that may interact with SUSTIVA:

SUSTIVA may affect the dosing of other medications including ones for treating HIV infection. For this reason it is very important to:

• Let all health care providers know that you are taking SUSTIVA.
• Inform your doctor and pharmacist about all medications that you are currently taking including those obtained over-the-counter without a prescription and complementary medications (vitamins, nutritional supplements, etc.) and herbal products, particularly St. John's wort.
• Consult your doctor or pharmacist before you start any new medication.
• Consult your doctor or pharmacist before you stop any medications that you are currently taking.

Bring all your medications when you see your doctor. Or make a list of their names, how much you take, and how often you take them. This will give your doctor a complete picture of the medications you are taking. Then he or she can decide the best approach for your situation.

You must not take the following medications if you are taking SUSTIVA. Taking these medications with SUSTIVA could create the potential for serious and/or life-threatening side effects:

CISAPRIDE

MIDAZOLAM

TRIAZOLAM (e.g, HALCION)

ERGOT MEDICATIONS (e.g, CAFERGOT)

PIMOZIDE (e.g, ORAP)

1. JOHN’S WORT (Hypericum perforatum): You must not take products containing St. John’s wort (Hypericum perforatum) with SUSTIVA as this may stop SUSTIVA from working properly and may lead to resistance to SUSTIVA or resistance to the class of non-nucleoside reverse transcriptase inhibitors (NNRTIs).

The following drugs may interact with SUSTIVA and your doctor will determine whether they can be used or not or may make dosage changes for SUSTIVA or the other product, or substitute other products, as indicated below:

• SUSTIVA may be taken with many of the medications commonly used in people with HIV infection. These include the protease inhibitors, such as nelfinavir (Viracept) and indinavir (Crixivan), and nucleoside analogue reverse transcriptase inhibitors (NRTIs).
• Use of SUSTIVA with saquinavir (Invirase) is not recommended if you are taking saquinavir as your only protease inhibitor.
• VORICONAZOLE (VFEND) should not be taken at standard doses with SUSTIVA since it may lose its effect or increase the chance of side effects from SUSTIVA. Some doses of voriconazole can be taken at the same time as a lower dose of SUSTIVA, but your doctor will decide if this is appropriate.
• Tegretol (carbamazepine), Sporanox (itraconazole), Posanol (posaconazole) and REYATAZ (atazanavir sulfate), if this is not the first time you are receiving treatment for your HIV infection, may need to be replaced with another medicine when taken with SUSTIVA.
• SUSTIVA reduces the blood levels of clarithromycin (Biaxin) and is associated with a higher incidence of rash; your doctor may consider giving you an alternative antibiotic.
• If you are taking SUSTIVA and REYATAZ (atazanavir sulfate), you should also be taking Norvir (ritonavir).
• SUSTIVA reduces exposure of Galexos (simeprevir) and coadministration is not recommended; your doctor should consider alternatives.
• Antimalarials such as atovaquone/proguanil, when taken with SUSTIVA, may reduce the amount of atovaquone/proguanil in your blood which may reduce the antimalarial activity of these medicines. Atovaquone/proguanil should not be taken with SUSTIVA; your doctor should consider alternatives to these antimalarial medicines.

The following medicine should not be taken with SUSTIVA since it contains efavirenz, the active ingredient in SUSTIVA:

• ATRIPLA (efavirenz, emtricitabine, tenofovir disoproxil fumarate) unless your doctor decides a dose adjustment is needed (e.g., with rifampin).
• Your doctor may need to adjust the dose of either SUSTIVA or the following medications when taken with SUSTIVA:
  • Crixivan (indinavir)
  • Methadone
  • Zoloft (sertraline)
  • Wellbutrin SR, Wellbutrin XL, or Zyban (bupropion)
  • Kaletra (lopinavir/ritonavir): Lopinavir and ritonavir combination should not be taken once daily with SUSTIVA. Your doctor may suggest an alternate dosing regimen.
  • Celsentri (maraviroc)
  • Mycobutin (rifabutin)
  • The cholesterol-lowering medicines Lipitor (atorvastatin), Pravachol (pravastatin), and Zocor (simvastatin)
  • Rifadin (rifampin) or the rifampin-containing medicines Rofact and Rifater
  • Calcium channel blockers such as Cardizem or Tiazac (diltiazem), Covera HS, Isoptin SR or Tarka (verapamil), and others
  • Immunosuppressants such as Neoral (cyclosporin), Advagraf or Prograf (tacrolimus), Rapamune or Torisel (sirolimus)
  • Hepatitis C antiviral agents such as Victrelis (boceprevir) and Incivek (telaprevir)
  • Antimalarials such as Coartem‡ and Riamet‡ (artemether/lumefantrine)
• The effect of combining alcohol or recreational (street, illicit) drugs with SUSTIVA has not been studied. Because they may interact with each other, speak with your doctor or other health care provider before you combine these drugs.

Usual dose:

• The dose of SUSTIVA for adults and children weighing more than 40 kg (88 lbs) is 600 mg once-a-day (three 200 mg capsules taken together OR one 600 mg tablet).
• The dose for children weighing 40 kg or less is determined by the weight of the child and is taken once daily. SUSTIVA capsules should only be administered to children if they have the ability to reliably swallow capsules.
• You should take SUSTIVA on an empty stomach, preferably at bedtime. Taking SUSTIVA with food increases the level of efavirenz in the blood and may increase the possibility of side effects.
• Your doctor or pharmacist will give you instructions for proper dosage.

What should I remember to do or avoid while taking SUSTIVA?

• Swallow SUSTIVA with water.
• Do not chew the capsules or tablets.
• Taking SUSTIVA at bedtime may improve the tolerability of the nervous system side effects.
• It is important to take SUSTIVA as your doctor prescribes. Do not change the dose on your own.
• SUSTIVA should not be used alone to treat HIV. SUSTIVA should always be taken with other anti-HIV medications in order to prevent the virus from becoming resistant to your drug treatment.
• You should not stop taking SUSTIVA without first consulting with your doctor.
• If you are unsure of what to do or need help in planning the best times to take your medications, ask your doctor or other health care provider.
• If you think it would be useful, ask a friend or family member to remind you to take your medications.
• When your SUSTIVA supply starts to run low, get more from your doctor or pharmacist. This is very important because the amount of virus may start to increase if SUSTIVA is stopped for even a short time. The virus may then become harder to treat.
• Remember, SUSTIVA has been prescribed just for you. Never give your medications to others to try.
• Do not use your current supply of SUSTIVA after the end of the month and year shown by the “expiry date” on the bottle.

Overdose:

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

Missed dose:

• If you forget to take SUSTIVA, do not double your next dose. Take the missed dose as soon as possible, and then carry on with your regular dosing schedule.
• Try not to miss a dose. With anti-HIV medications, missing doses or not taking them properly may allow the amount of HIV in your body to increase. HIV may then become resistant. This means that the virus changes or mutates causing a medication to lose its effect.

Serious Warnings and Precautions

Drugs that may interact with NIASPAN FCT (extended-release niacin) include: statins (HMG-CoA reductase inhibitors-drugs which reduce serum cholesterol), vasoactive drugs (drugs which affect blood vessels e.g., some blood pressure medications, nitrates), acetylsalicylic acid, bile-acid sequestrants (drugs which prevent cholesterol reabsorption), anticoagulant drugs (drugs which prevent blood clotting), alcohol, hot drinks, vitamins or other nutritional supplements containing large doses of niacin (>100 mg) or related compounds such as nicotinamide.

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.

Take this medicine with a full glass of water.

Do not crush, chew, or break the extended-release tablet. Swallow the pill whole. Breaking or crushing the pill may cause too much of the drug to be released at one time.

NORFLEX is only part of a complete program of treatment that may also include rest, physical therapy, or other pain relief measures. Follow your doctor's instructions.

NORFLEX may be habit-forming and should be used only by the person it was prescribed for. NORFLEX 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.

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

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

Overdose symptoms may include blurred vision, fast heart rate, confusion, weak or shallow breathing, cold or clammy skin, feeling like you might pass out, or seizure (convulsions).

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.

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

• fast, pounding, or uneven heartbeats;
• confusion, anxiety, agitation, tremors, hallucinations;
• seizure (convulsions); or
• urinating less than usual or not at all.

Less serious side effects may include:

• dry mouth or throat;
• blurred vision, dilated pupils;
• headache;
• drowsiness, dizziness;
• nausea, vomiting, constipation; or
• weakness.

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

Do not crush, chew, or break the extended-release tablet. Swallow the pill whole. Breaking or crushing the pill may cause too much of the drug to be released at one time.

NORFLEX may be habit-forming and should be used only by the person it was prescribed for. NORFLEX 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.

NORFLEX can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol, which can increase some of the side effects of NORFLEX.

Do not take this medication if you are allergic to NORFLEX, or if you have:

• problems with urination;
• enlarged prostate;
• glaucoma;
• a blockage in your stomach or intestines;
• trouble swallowing; or
• myasthenia gravis.

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

• heart disease;
• a heart rhythm disorder; or
• coronary artery disease.

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

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 NORFLEX 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.

NORFLEX can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol, which can increase some of the side effects of NORFLEX.

Cold or allergy medicine, narcotic pain medicine, sleeping pills, and medicine for seizures, depression or anxiety can add to sleepiness caused by NORFLEX. Tell your doctor if you regularly use any of these medicines, or any other muscle relaxer.

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

• atropine (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm-Scop);
• bronchodilators such as ipratroprium (Atrovent) or tiotropium (Spiriva);
• glycopyrrolate (Robinul);
• mepenzolate (Cantil);
• bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare); or
• irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin, and others), or propantheline (Pro-Banthine).

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

Some medicines can interact with NIMOTOP and should not be used at the same time. Tell your doctor about all your medications and any you start or stop using during treatment with NIMOTOP.

NIMOTOP can lower your blood pressure. Call your doctor at once if you feel like you might pass out.

The liquid from a NIMOTOP capsule should never be injected through a needle into the body, or dangerously low blood pressure may result. NIMOTOP gel capsules are to be taken by mouth only.

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

Some medicines can interact with NIMOTOP and should not be used at the same time. Your doctor may need to change your treatment plan if you use any of the following drugs:

• conivaptan;
• imatinib;
• nefazodone;
• an antibiotic--clarithromycin, telithromycin;
• antifungal medication--itraconazole, ketoconazole, posaconazole, voriconazole;
• heart medication--nicardipine, quinidine;
• hepatitis C medications--boceprevir, telaprevir; or
• HIV/AIDS medication--atazanavir, cobicistat, delavirdine, fosamprenavir, indinavir, nelfinavir, ritonavir, saquinavir.

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

• cirrhosis or other liver disease;
• heart disease; or
• high or low blood pressure.

FDA pregnancy category C. It is not known whether NIMOTOP 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 NIMOTOP passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

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:

• a light-headed feeling, like you might pass out;
• easy bruising or bleeding;
• fast or slow heart rate; or
• swelling in your ankles or feet.

Common side effects may include:

• nausea, diarrhea, upset stomach;
• headache; or
• mild rash.

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

Grapefruit and grapefruit juice may interact with NIMOTOP and lead to potentially dangerous effects. Avoid the use of grapefruit products while taking NIMOTOP.

Drinking alcohol can increase certain side effects of NIMOTOP.

Many drugs can interact with NIMOTOP. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with NIMOTOP, especially:

• St. John's wort;
• seizure medication--carbamazepine, fosphenytoin, phenobarbital, phenytoin, and others;
• sildenafil (Viagra) and other erectile dysfunction medicines; or
• tuberculosis medications.

This list is not complete and many other drugs can interact with NIMOTOP. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take NIMOTOP on an empty stomach, at least 1 hour before or 2 hours after a meal.

Take this medicine with a full glass of water. Swallow the capsule whole.

Measure liquid medicine with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

If the person taking NIMOTOP cannot swallow the capsule, the medicine from inside the capsule can be given through an in-place nasogastric tube (through the nose and into the stomach). Use a needle to make a hole in each end of the capsule, and squeeze the medicine out into an oral syringe or other syringe to which a needle cannot be attached. Empty the syringe into the nasogastric tube and wash it down with 30 milliliters of normal saline.

The medicine placed into a syringe should never be injected through a needle into the body, or dangerously low blood pressure may result. NIMOTOP gel capsules are to be taken by mouth only.

Your blood pressure will need to be checked often. Your liver function may also need to be tested.

You should not stop using NIMOTOP suddenly. Stopping suddenly may make your condition worse.

Store at room temperature away from moisture, heat, and light. Do not freeze. Keep each capsule in the original package until you are ready to take one.

Seek emergency medical attention or call the Poison Help line.

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

BEFORE you use NITOMAN tell your doctor or pharmacist if you:

• have a current episode of depression or suicidal thoughts
• are taking any prescription or over-the-counter medications, or are planning on taking any prescription or over-the-counter medications during your therapy
• have liver problems
• have heart disease including irregular heart beat
• have or have had breast cancer
• have or have had pituitary tumours
• have Parkinson's disease
• drink alcohol. It is best not to drink alcohol while taking NITOMAN
• are pregnant, or thinking about becoming pregnant, or are breastfeeding

Depression:

NITOMAN may cause depression in some patients. You and people close to you should watch for symptoms of depression (see table Serious Side Effects, How Often They Happen and What to Do About Them below) and report to your doctor immediately should they occur.

Driving vehicles or using machinery:

NITOMAN may cause drowsiness and low blood pressure. Driving, operating machinery, or performing other hazardous tasks should be avoided until the effect of NITOMAN is known.

Trouble swallowing:

NITOMAN may increase the chance that you will have trouble swallowing. Contact your doctor if this happens.

Irregular heartbeat:

NITOMAN may cause changes in the electrical currents in your heart. Although these changes may be small, it may increase the risk of arrhythmias (irregular heart beats), especially if used in combination with other drugs that have the same effect, or if you already have certain heart conditions. If you feel a change in your heart beat, if you feel dizzy or faint, you should seek immediate medical attention.

Like all medications, NITOMAN may cause some side effects. You may not experience any of them. However, some may be serious. Some of these side effects may be dose related. Consult your doctor if you experience these or other side effects, as the dose of NITOMAN may have to be adjusted.

The most common side effects of NITOMAN are:

• Signs and symptoms of Parkinsonism, such as tremors, difficulty starting or controlling movement, body stiffness, decrease in facial expressions, difficulty keeping your balance, speech problems, etc.
• Drowsiness, fatigue, weakness
• Depression
• Anxiety, nervousness
• Insomnia
• Restlessness, unable to sit or stand still
• Drooling
• Irritability, agitation
• Nausea, vomiting, stomach pain
• Confusion, disorientation
• Low blood pressure
• Dizziness

You should tell your doctor if you are taking or have recently taken any medications (prescription, non-prescription or natural herbal) especially:

• monoamine oxidase (MAO) inhibitor antidepressants (e.g. phenelzine sulphate, moclobemide)
• antidepressants such as fluoxetine, paroxetine, quinidine, duloxetine, sertraline
• antipsychotics such as thioridazine, chlorpromazine
• medicines for Parkinson's Disease such as levodopa, amantadine or orphenadrine
• neuroleptic drugs such as haloperidol, chlorpromazine, metoclopramide
• reserpine

You should consult your doctor before you start any new medicines or before you stop or change doses of any other medicine you are taking while taking NITOMAN.

Usual dose:

How to take NITOMAN:

Adults:

Take NITOMAN exactly as prescribed by your doctor.

• An initial starting dose of 12.5 mg two to three times a day is recommended. To obtain a 12.5 mg dose, the scored 25 mg tablet must be split with a pill cutter.
• This can be increased by 12.5 mg a day weekly until the maximal tolerated and effective dose is reached.
• In most cases the maximal tolerated dose will be 25 mg three times a day. In some cases higher doses may be prescribed.
• You should talk to your doctor before you stop taking your medication on your own. If you miss a dose and it is time or almost time for your next dose, take only the next scheduled dose and do not take 2 doses at once. If you miss several days contact your doctor as you may have to start with lower doses.

Elderly and Debilitated Patients:

• Reduced initial and maintenance doses should be used. Your doctor will choose the appropriate dose.

Chlidren:

• Your doctor will decide the best dose.

Remember: This medicine has been prescribed only for you. Do not give it to anybody else, as they may experience undesirable effects, which may be serious.

Overdose:

The signs and symptoms of overdose may include drowsiness, sweating, low blood pressure, and feeling cold.

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.