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Friday, 16 March 2012

Inderal

Generic Name: propranolol (Oral route)

proe-PRAN-oh-lol

Oral route(Capsule, Extended Release)

Reports of exacerbation of angina and myocardial infarction have been noted following abrupt discontinuance of propranolol. When discontinuance of propranolol is planned, dosage should be gradually reduced over at least a few weeks, and the patient should be cautioned against interruption or cessation of therapy. If propranolol therapy is interrupted and exacerbation of angina occurs, reinstitution of propranolol and management of angina is advised. Since coronary artery disease may be unrecognized, it may be prudent to follow the above advice in patients considered at risk of having occult atherosclerotic heart disease who are given propranolol for other indications .

Commonly used brand name(s)

In the U.S.

Inderal

Inderal LA

InnoPran XL

Propranolol HCl Intensol

Available Dosage Forms:

Tablet

Capsule, Extended Release

Solution

Therapeutic Class: Cardiovascular Agent

Pharmacologic Class: Beta-Adrenergic Blocker, Nonselective

Uses For Inderal

Propranolol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Propranolol is also used to treat severe chest pain (angina), migraine headaches, or hypertrophic subaortic stenosis (thickened heart muscle).

This medicine may also be used to treat irregular heartbeats, tremors, or pheochromocytoma (adrenal gland tumor). It may also be used to reduce the risk of death in patients who have heart attacks.

This medicine is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

This medicine is available only with your doctor's prescription.

Before Using Inderal

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of propranolol capsules, extended-release capsules, and tablets in the pediatric population. Safety and efficacy have not been established.

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of propranolol oral solution in children.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of propranolol in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving propranolol.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Thioridazine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol

Amiodarone

Arformoterol

Bambuterol

Bitolterol

Broxaterol

Bupivacaine

Clenbuterol

Clonidine

Colterol

Diatrizoate

Diltiazem

Dronedarone

Epinephrine

Fenoldopam

Fenoterol

Formoterol

Haloperidol

Hexoprenaline

Indacaterol

Isoetharine

Levalbuterol

Lidocaine

Mefloquine

Mepivacaine

Metaproterenol

Pirbuterol

Prilocaine

Procaterol

Reproterol

Rimiterol

Ritodrine

Salmeterol

Terbutaline

Tretoquinol

Tulobuterol

Verapamil

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose

Aceclofenac

Acemetacin

Acetohexamide

Alclofenac

Alfuzosin

Aluminum Carbonate, Basic

Aluminum Hydroxide

Aluminum Phosphate

Amlodipine

Apazone

Arbutamine

Benfluorex

Benoxaprofen

Bromfenac

Bufexamac

Bunazosin

Calcium Carbonate

Carprofen

Chlorpromazine

Chlorpropamide

Cimetidine

Clometacin

Clonixin

Dexketoprofen

Diclofenac

Diflunisal

Digoxin

Dihydroergotamine

Dihydroxyaluminum Aminoacetate

Dihydroxyaluminum Sodium Carbonate

Dipyrone

Disopyramide

Doxazosin

Droxicam

Ergotamine

Etodolac

Etofenamate

Felbinac

Felodipine

Fenbufen

Fenoprofen

Fentiazac

Flecainide

Floctafenine

Flufenamic Acid

Flurbiprofen

Fluvoxamine

Gliclazide

Glimepiride

Glipizide

Gliquidone

Glyburide

Guar Gum

Guggul

Ibuprofen

Indomethacin

Indoprofen

Insulin

Insulin Aspart, Recombinant

Insulin Glulisine

Insulin Lispro, Recombinant

Isoxicam

Ketoprofen

Ketorolac

Lacidipine

Lercanidipine

Lornoxicam

Magaldrate

Manidipine

Meclofenamate

Mefenamic Acid

Meloxicam

Metformin

Mibefradil

Miglitol

Moxisylyte

Nabumetone

Naproxen

Nicardipine

Nifedipine

Niflumic Acid

Nilvadipine

Nimesulide

Nimodipine

Nisoldipine

Nitrendipine

Oxaprozin

Oxyphenbutazone

Phenoxybenzamine

Phentolamine

Phenylbutazone

Phenylephrine

Piperine

Pirazolac

Piroxicam

Pirprofen

Pranidipine

Prazosin

Propoxyphene

Propyphenazone

Proquazone

Quinidine

Repaglinide

Rifapentine

Rizatriptan

Sertraline

St John's Wort

Sulindac

Suprofen

Tamsulosin

Tenidap

Tenoxicam

Terazosin

Tiaprofenic Acid

Tolazamide

Tolbutamide

Tolmetin

Trimazosin

Troglitazone

Tubocurarine

Urapidil

Zileuton

Zomepirac

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Proper Use of propranolol

This section provides information on the proper use of a number of products that contain propranolol. It may not be specific to Inderal. Please read with care.

Your doctor will tell you how much of this medicine to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to.

In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

Swallow the long-acting oral capsules whole. Do not chew, crush, or open them.

Propranolol extended-release capsules should be taken at bedtime (10 p.m.). This medicine may be taken with or without food. However, you should take it the same way each time.

Measure the concentrated oral solution, Intensol™ with the dropper that comes with the medicine. You may mix the concentrated solution with water, juice, soda, applesauce, or pudding to make it easier to swallow, then take the mixture right away.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For acute heart attack:
- For oral dosage form (solution):
  - Adults—180 to 240 milligrams (mg) per day, given in divided doses.
  - Children—Dose is based on body weight and must be determined by your doctor.
- For oral dosage form (tablets):
  - Adults—At first, 40 milligrams (mg) three times a day. Your doctor may increase your dose if needed.
  - Children—Use and dose must be determined by your doctor.

For adrenal gland tumor (pheochromocytoma):
- For oral dosage form (solution):
  - Adults—60 milligrams (mg) per day, given in divided doses for 3 days before having surgery. In patients who cannot have surgery, the usual dose is 30 mg per day, given in divided doses.
  - Children—Dose is based on body weight and must be determined by your doctor.
- For oral dosage form (tablets):
  - Adults—60 milligrams (mg) per day, given in divided doses for 3 days before having surgery. In patients who cannot have surgery, the usual dose is 30 mg per day, given in divided doses.
  - Children—Use and dose must be determined by your doctor.

For chest pain (angina):
- For oral dosage form (long-acting oral capsules):
  - Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose if needed.
  - Children—Use and dose must be determined by your doctor.
- For oral dosage form (solution):
  - Adults—80 to 320 milligrams (mg) per day, given in divided doses.
  - Children—Dose is based on body weight and must be determined by your doctor.
- For oral dosage form (tablets):
  - Adults—80 to 320 milligrams (mg) per day, given in divided doses.
  - Children—Use and dose must be determined by your doctor.

For high blood pressure (hypertension):
- For oral dosage form (extended-release capsules):
  - Adults—At first, 80 milligrams (mg) once a day, given at bedtime. Your doctor may increase your dose if needed.
  - Children—Use and dose must be determined by your doctor.
- For oral dosage form (long-acting oral capsules):
  - Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose if needed.
  - Children—Use and dose must be determined by your doctor.
- For oral dosage form (solution):
  - Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose if needed.
  - Children—Dose is based on body weight and must be determined by your doctor.
- For oral dosage form (tablets):
  - Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose if needed.
  - Children—Use and dose must be determined by your doctor.

For hypertrophic subaortic stenosis (thickened heart muscle):
- For oral dosage form (long-acting oral capsules):
  - Adults—80 to 160 milligrams (mg) once a day.
  - Children—Use and dose must be determined by your doctor.
- For oral dosage form (solution):
  - Adults—20 to 40 milligrams (mg) three or four times a day, given before meals and at bedtime.
  - Children—Dose is based on body weight and must be determined by your doctor.
- For oral dosage form (tablets):
  - Adults—20 to 40 milligrams (mg) three or four times a day, given before meals and at bedtime.
  - Children—Use and dose must be determined by your doctor.

For irregular heartbeats:
- For oral dosage form (solution):
  - Adults—10 to 30 milligrams (mg) three or four times a day, given before meals and at bedtime.
  - Children—Dose is based on body weight and must be determined by your doctor.
- For oral dosage form (tablets):
  - Adults—10 to 30 milligrams (mg) three or four times a day, given before meals and at bedtime.
  - Children—Use and dose must be determined by your doctor.

For migraine headaches:
- For oral dosage form (long-acting oral capsules):
  - Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose if needed.
  - Children—Use and dose must be determined by your doctor.
- For oral dosage form (solution):
  - Adults—At first, 80 milligrams (mg) per day, given in divided doses. Your doctor may increase your dose if needed.
  - Children—Dose is based on body weight and must be determined by your doctor.
- For oral dosage form (tablets):
  - Adults—At first, 80 milligrams (mg) per day, given in divided doses. Your doctor may increase your dose if needed.
  - Children—Use and dose must be determined by your doctor.

For tremors:
- For oral dosage form (solution):
  - Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose if needed.
  - Children—Dose is based on body weight and must be determined by your doctor.
- For oral dosage form (tablets):
  - Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose if needed.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using Inderal

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects. .

Propranolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing.

This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

Make sure any doctor or dentist who treats you knows that you are using this medicine. Do not stop taking this medicine before surgery without your doctor's approval.

This medicine may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking propranolol.

Do not interrupt or stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth while you are using this medicine.

Serious skin reactions can occur during treatment with this medicine. Check with your doctor right away if you have any of the following symptoms while taking this medicine: blistering, peeling, or loosening of the skin; chills; cough; diarrhea; fever; itching; joint or muscle pain; red skin lesions; sore throat; sores, ulcers, or white spots in your mouth or lips; or unusual tiredness or weakness.

Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.

Propranolol will add to the effects of alcohol and other central nervous system (CNS) depressants. CNS depressants are medicines that slow down the nervous system and may cause drowsiness. Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates or medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Inderal Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

Abdominal or stomach pain and tenderness

black, tarry stools

blistering, peeling, or loosening of the skin

blood in the urine

bloody nose

bloody stools

blurred or loss of vision

body aches or pain

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

chest pain or discomfort

confusion about identity, place, and time

congestion

constipation

cough

cracks in the skin

crying

decreased awareness or responsiveness

decreased urine output

depersonalization

diarrhea

difficulty with breathing or swallowing

difficulty with swallowing

dilated neck veins

disturbed color perception

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

double vision

dryness or soreness of the throat

dysphoria

euphoria

extreme fatigue

fast, pounding, slow, or irregular heartbeat

fever and chills

general feeling of discomfort, illness, or weakness

hair loss

halos around lights

headaches

heavier menstrual periods

hives

hoarseness

irregular breathing

itching

lightheadedness, dizziness, or fainting

loss of heat from the body

mental depression

mimicry of speech or movements

muscle or joint pain

mutism

nausea

negativism

night blindness

noisy breathing

overbright appearance of lights

paleness or cold feeling in the fingertips and toes

paranoia

peculiar postures or movements, mannerisms, or grimacing

pinpoint red or purple spots on the skin

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

quick to react or overreact emotionally

rapidly changing moods

rectal bleeding

red skin lesions, often with a purple center

red, irritated eyes

red, swollen skin

reddening of the skin, especially around the ears

runny nose

scaly skin

seeing, hearing, or feeling things that are not there

severe sleepiness

short-term memory loss

shortness of breath

skin irritation or rash, including rash that looks like psoriasis

skin rash

sores, ulcers, or white spots in the mouth or on the lips

sweating

swelling of the eyes, face, fingers, feet, or lower legs

swollen glands

tender, swollen glands in the neck

tightness in the chest

tingling or pain in fingers or toes when exposed to cold

trouble with swallowing

troubled breathing

tunnel vision

unusual bleeding or bruising

unusual tiredness or weakness

voice changes

vomiting

weight gain

wheezing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

Dry eyes

heartburn

loss of strength or energy

muscle weakness

pain or discomfort in the chest, upper stomach, or throat

sleeplessness

stomach cramps

trouble sleeping

unable to sleep

unusual drowsiness, dullness, or feeling of sluggishness

vivid dreams

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Inderal side effects (in more detail)

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More Inderal resources

Inderal Side Effects (in more detail)
Inderal Use in Pregnancy & Breastfeeding
Drug Images
Inderal Drug Interactions
Inderal Support Group
32 Reviews for Inderal - Add your own review/rating

Inderal Prescribing Information (FDA)

Inderal MedFacts Consumer Leaflet (Wolters Kluwer)

Inderal Consumer Overview

Propranolol Prescribing Information (FDA)

Propranolol MedFacts Consumer Leaflet (Wolters Kluwer)

Inderal LA Sustained-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)

Inderal LA Prescribing Information (FDA)

InnoPran XL Sustained-Release Bead Capsules MedFacts Consumer Leaflet (Wolters Kluwer)

InnoPran XL Prescribing Information (FDA)

Propranolol Hydrochloride Monograph (AHFS DI)

Compare Inderal with other medications

Angina
Aortic Stenosis
Arrhythmia
Benign Essential Tremor
Heart Attack
Hemangioma
High Blood Pressure
Migraine Prevention
Mitral Valve Prolapse
Performance Anxiety
Pheochromocytoma
Thyrotoxicosis

Nizoral Topical

Generic Name: ketoconazole (Topical route)

kee-toe-KON-a-zole

Commonly used brand name(s)

In the U.S.

Extina

Nizoral

Nizoral A-D

Xolegel

In Canada

Ketoderm

Available Dosage Forms:

Shampoo

Foam

Gel/Jelly

Solution

Cream

Therapeutic Class: Antifungal

Chemical Class: Imidazole

Uses For Nizoral

Ketoconazole is used to treat infections caused by a fungus or yeast. It works by killing the fungus or yeast or preventing its growth.

Ketoconazole cream is used to treat:

Athlete's foot (tinea pedis; ringworm of the foot);

Ringworm of the body (tinea corporis);

Ringworm of the groin (tinea cruris; jock itch);

Seborrheic dermatitis;

"Sun fungus" (tinea versicolor; pityriasis versicolor); and

Yeast infection of the skin (cutaneous candidiasis).

Ketoconazole foam or gel is used to treat seborrheic dermatitis (scaly areas on your skin or scalp).

Ketoconazole 1% shampoo is used to treat dandruff.

Ketoconazole 2% shampoo is used to treat "sun fungus" (tinea versicolor; pityriasis versicolor).

This medicine may also be used for other fungus infections of the skin as determined by your doctor.

Most forms of this medicine are available only with your doctor's prescription. Some forms are available without a prescription. However, your doctor may have special instructions on the proper use for your medical condition.

Before Using Nizoral

Allergies

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of ketoconazole topical in children younger than 12 years of age. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of ketoconazole topical in the elderly. However, some elderly patients may be more sensitive to the side effects of this medicine.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use of ketoconazole

This section provides information on the proper use of a number of products that contain ketoconazole. It may not be specific to Nizoral. Please read with care.

It is very important that you use this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may cause unwanted side effects or skin irritation.

This medicine is for use on the skin only. Do not get it in your eyes, nose, mouth, or vagina. Do not use it on skin areas that have cuts, scrapes, or burns. If it does get on these areas, rinse it off right away with water.

For patients using the cream:

Apply enough cream to cover the affected and surrounding skin areas, and rub in gently.

To help clear up your infection completely, it is very important that you keep using the cream for the full time of treatment, even if your symptoms begin to clear up after a few days. Since fungus or yeast infections may be very slow to clear up, you may have to continue using this medicine every day for up to several weeks. If you stop using this medicine too soon, your symptoms may return. Do not miss any doses.

For patients using the foam:

Wash your hands before and after using this medicine.

Do not spray the foam directly on your hand because it will begin to melt as soon as it touches your skin. Instead, spray the foam into the cap of the medicine can or other cool surface. Then dip your fingertips into the foam to pick up small amounts of the medicine, and apply to the affected skin areas. Gently massage the foam into your skin until it disappears.

If you are treating skin areas with hair, such as your scalp, move any hair away so the foam can be applied directly to the affected skin.

This medicine is flammable. Do not use it near heat, an open flame, or while smoking. Do not puncture, break, or burn the medicine can.

For patients using the gel:

Wash your hands before and after using this medicine.

Apply enough ketoconazole gel to cover the affected and surrounding skin areas, and rub in gently with your fingertips.

After applying this medicine, do not wash the affected area for at least 3 hours.

Cosmetics (makeup or sunscreens) may be used on the treated skin areas no sooner than 20 minutes after this medicine is applied.

This medicine may be flammable. Do not use it near heat, an open flame, or while smoking.

For patients using the 1% shampoo:

Wet your hair and scalp well with water.

Apply enough shampoo to work up a good lather and gently massage it over your entire scalp.

Rinse your hair and scalp with warm water.

Repeat application.

Rinse your hair and scalp well with warm water, and dry your hair.

For patients using the 2% shampoo:

Wet your hair and scalp well with water.

Apply the shampoo to the skin of the affected area and a wide margin surrounding this area.

Work up a good lather and leave it in place for 5 minutes.

Rinse your hair and scalp well with warm water, and dry your hair.

Dosing

For cream dosage form:
- For cutaneous candidiasis, tinea corporis, tinea cruris, tinea pedis, or pityriasis versicolor:
  - Adults—Apply to the affected area of the skin and the surrounding area once a day.
  - Children—Use and dose must be determined by your doctor.
- For seborrheic dermatitis:
  - Adults—Apply to the affected area of the skin and the surrounding area two times per day.
  - Children—Use and dose must be determined by your doctor.

For foam dosage form:
- For seborrheic dermatitis:
  - Adults—Apply to the affected area of the skin and the surrounding area two times per day for 4 weeks.
  - Children—Use and dose must be determined by your doctor.

For gel dosage form:
- For seborrheic dermatitis:
  - Adults, teenagers, and children 12 years of age and older—Apply to the affected area of the skin and the surrounding area once a day for 2 weeks.
  - Children younger than 12 years of age—Use and dose must be determined by your doctor.

For 1% shampoo dosage form:
- For dandruff:
  - Adults—Use every 3 or 4 days for up to 8 weeks. Then use only as needed to keep dandruff under control.
  - Children—Use and dose must be determined by your doctor.

For 2% shampoo dosage form:
- For pityriasis versicolor:
  - Adults—Use once.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using Nizoral

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and check you for any problems or unwanted effects that may be caused by this medicine.

Do not use this medicine for a skin problem that has not been checked by your doctor.

If your skin problem does not improve within 2 weeks for cutaneous candidiasis, pityriasis versicolor, tinea corporis, or tinea cruris; or 4 weeks for seborrheic dermatitis; or 4 to 6 weeks for tinea pedis, or if it becomes worse, check with your doctor.

Good health habits are also required for patients using the cream form of this medicine to help clear up your infection completely and to help make sure it does not return.

For patients using the cream for athlete's foot (tinea pedis; ringworm of the foot), the following instructions will help keep the feet cool and dry:

Avoid wearing socks made from wool or synthetic materials (e.g., rayon or nylon). Instead, wear clean, cotton socks and change them daily or more often if your feet sweat a lot.

Wear sandals or well-ventilated shoes (e.g., shoes with holes).

Use a bland, absorbent powder (e.g., talcum powder) or an antifungal powder between the toes, on the feet, and in socks and shoes one or two times a day. It is best to use the powder between the times you use the cream.

If you have any questions about these instructions, check with your doctor.

For patients using the cream for ringworm of the groin (tinea cruris; jock itch), the following instructions will help reduce chafing and irritation and will also help keep the groin area cool and dry:

Avoid wearing underwear that is tight-fitting or made from synthetic materials (e.g., rayon or nylon). Instead, wear loose-fitting, cotton underwear.

Use a bland, absorbent powder (e.g., talcum powder) or an antifungal powder on the skin. It is best to use the powder between the times you use ketoconazole cream.

If you have any questions about these instructions, check with your doctor.

The foam form of this medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Tell your doctor if you have the following symptoms while using the ketoconazole 2% shampoo: hair discoloration, abnormal hair texture, removal of the curl from permanently waved hair, hair loss, itching, burning sensation of the skin, or blistering, peeling, or redness of the skin.

Stop using this medicine and check with your doctor right away if you or your child have a skin rash, burning, stinging, swelling, or irritation on the skin.

Nizoral Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common—For cream, shampoo, foam, or gel

Itching, stinging, burning, or irritation not present before use of this medicine

Rare—For cream, foam, or gel

Acne

bleeding from sore in the mouth

blistering, crusting, irritation, itching, or reddening of the skin

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

cracked, dry, or scaly skin

discoloration of the fingernails or toenails

dizziness

eye dryness, irritation, or swelling

red rash with watery, yellow-colored, or pus filled blisters with or without thick yellow to honey-colored crusts

skin dryness, pain, rash, redness, or swelling

sore in the mouth or on the gums

swelling of the face

Rare—For shampoo

Hair loss and irritation

Incidence not known—For gel

Pain

Incidence not known—For shampoo

Blistering, burning, crusting, dryness, or flaking of the skin

burning sensation of the skin

burning, itching, redness, skin rash, swelling, or soreness at the application site

discoloration of the hair

dry skin

fast heartbeat

fever

hives

hoarseness

irritation

itching, scaling, severe redness, or soreness of the skin

joint pain, stiffness, or swelling

rash

shortness of breath

swelling of the eyelids, face, lips, hands, or feet

thinning of the hair

tightness in the chest

troubled breathing or swallowing

wheezing

Less common—For shampoo or gel

Dryness or oiliness of the hair and scalp

headache

Rare—For shampoo

Abnormal hair texture

mild dryness of the skin

scalp pustules

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Nizoral Topical side effects (in more detail)

Compare Nizoral Topical with other medications

Cutaneous Candidiasis
Dandruff
Seborrheic Dermatitis
Tinea Corporis
Tinea Cruris
Tinea Pedis
Tinea Versicolor

Tuesday, 13 March 2012

Feldene

Generic Name: Piroxicam
Class: Other Nonsteroidal Anti-inflammatory Agents
VA Class: MS120
Chemical Name: 4-Hydroxy-2-methyl-N2-pyridinyl-2H-1,2-benzothiazine-3-carboxamide 1,1-dioxide
Molecular Formula: C₁₅H₁₃N₃O₄S
CAS Number: 36322-90-4

Cardiovascular Risk

Possible increased risk of serious (sometimes fatal) cardiovascular thrombotic events (e.g., MI, stroke).¹ Risk may increase with duration of use.¹ Individuals with cardiovascular disease or risk factors for cardiovascular disease may be at increased risk.¹ (See Cardiovascular Effects under Cautions.)

Contraindicated for the treatment of pain in the setting of CABG surgery.¹

GI Risk

Increased risk of serious (sometimes fatal) GI events (e.g., bleeding, ulceration, perforation of the stomach or intestine).¹ Serious GI events can occur at any time and may not be preceded by warning signs and symptoms.¹ Geriatric individuals are at greater risk for serious GI events.¹ (See GI Effects under Cautions.)

Introduction

Prototypical NSAIA; an oxicam derivative.¹ ² ³ ⁴

Uses for Feldene

Consider potential benefits and risks of piroxicam therapy as well as alternative therapies before initiating therapy with the drug.¹ Use lowest possible effective dosage and shortest duration of therapy consistent with patient's treatment goals.¹

Inflammatory Diseases

Symptomatic treatment of rheumatoid arthritis and osteoarthritis.¹

Has been used for the symptomatic relief of acute gouty arthritis†² ³⁸ and ankylosing spondylitis†;² ⁴⁰ has also been used for symptomatic treatment of acute musculoskeletal disorders†.² ³

Pain

Has been used for symptomatic relief of postoperative†² or postpartum pain†.² ³

Dysmenorrhea

Has been used for the management of dysmenorrhea†.⁴¹

Feldene Dosage and Administration

General

Consider potential benefits and risks of piroxicam therapy as well as alternative therapies before initiating therapy with the drug.¹

Administration

Oral Administration

Administered orally, usually as a single daily dose.¹ May be administered in divided doses daily.¹

Dosage

To minimize the potential risk of adverse cardiovascular and/or GI events, use lowest effective dosage and shortest duration of therapy consistent with patient's treatment goals.¹ Adjust dosage based on individual requirements and response; attempt to titrate to lowest effective dosage.¹

Adults

Inflammatory Diseases

Osteoarthritis or Rheumatoid Arthritis

Oral

Initially, 20 mg daily.¹ Adjust dosage based on response and tolerance; 30 or 40 mg daily may be required for maintenance therapy, ² although 20 mg daily is usually adequate.¹ ²

Prescribing Limits

Adults

Inflammatory Diseases

Oral

Dosages >20 mg daily associated with increased frequency of adverse GI effects.¹ ² ³

Special Populations

Hepatic Impairment

Inflammatory Diseases

Oral

Dosage reduction may be required.¹

Cautions for Feldene

Contraindications

Known hypersensitivity to piroxicam or any ingredient in the formulation. ¹

History of asthma, urticaria, or other sensitivity reaction precipitated by aspirin or other NSAIAs.¹

Treatment of perioperative pain in the setting of CABG surgery.¹

Warnings/Precautions

Warnings

Cardiovascular Effects

Selective COX-2 inhibitors have been associated with increased risk of cardiovascular events (e.g., MI, stroke) in certain situations.¹¹² Several prototypical NSAIAs also have been associated with increased risk of cardiovascular events.¹¹⁵ ¹¹⁶ ¹¹⁷ Current evidence (based on limited data from observational studies) suggests that use of piroxicam is not associated with increased cardiovascular risk.¹¹⁵

Use NSAIAs with caution and careful monitoring (e.g., monitor for development of cardiovascular events), and at the lowest effective dose for the shortest duration necessary.¹

Short-term use to relieve acute pain, especially at low dosages, does not appear to be associated with increased risk of serious cardiovascular events (except immediately following CABG surgery).¹¹²

No consistent evidence that concomitant use of low-dose aspirin mitigates the increased risk of serious adverse cardiovascular events associated with NSAIAs.¹ (See Specific Drugs under Interactions.)

Hypertension and worsening of preexisting hypertension reported; either event may contribute to the increased incidence of cardiovascular events.¹ Use with caution in patients with hypertension; monitor BP.¹ Impaired response to certain diuretics may occur.¹ (See Specific Drugs under Interactions.)

Fluid retention and edema reported.¹ Caution in patients with fluid retention or heart failure.¹

GI Effects

Serious GI toxicity (e.g., bleeding, ulceration, perforation) can occur with or without warning symptoms; increased risk in those with a history of GI bleeding or ulceration, geriatric patients, smokers, those with alcohol dependence, and those in poor general health.¹ ⁹⁴ ¹⁰² ¹⁰⁹

For patients at high risk for complications from NSAIA-induced GI ulceration (e.g., bleeding, perforation), consider concomitant use of misoprostol;¹⁶ ⁴⁷ ⁶⁸ ⁹⁴ ¹⁰² alternatively, consider concomitant use of a proton-pump inhibitor (e.g., omeprazole)¹⁶ ⁶⁸ ⁹⁴ or use of an NSAIA that is a selective inhibitor of COX-2 (e.g., celecoxib).¹⁶

Renal Effects

Direct renal injury, including renal papillary necrosis, reported in patients receiving long-term NSAIA therapy.¹

Potential for overt renal decompensation.¹ ³¹ ⁴⁸ ⁴⁹ ⁵⁰ ⁶⁵ Increased risk of renal toxicity in patients with renal or hepatic impairment or heart failure, in geriatric patients, in patients with volume depletion, and in those receiving a diuretic, ACE inhibitor, or angiotensin II receptor antagonist.¹ ³¹ ⁴⁸ ⁶⁵ ¹¹⁴ (See Renal Impairment under Cautions.)

Sensitivity Reactions

Hypersensitivity Reactions

Anaphylactoid reactions reported. ¹

Immediate medical intervention and discontinuance for anaphylaxis.¹

Avoid in patients with aspirin triad (aspirin sensitivity, asthma, nasal polyps); caution in patients with asthma.¹

Dermatologic Reactions

Serious skin reactions (e.g., exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis) reported; can occur without warning.¹ Discontinue at first appearance of rash or any other sign of hypersensitivity (e.g., blisters, fever, pruritus).¹

General Precautions

Hepatic Effects

Severe reactions including jaundice, fatal fulminant hepatitis, liver necrosis, and hepatic failure (sometimes fatal) reported rarely with NSAIAs. ¹

Elevations of serum ALT or AST reported.¹

Monitor for symptoms and/or signs suggesting liver dysfunction; monitor abnormal liver function test results.¹ Discontinue if signs or symptoms of liver disease or systemic manifestations (e.g., eosinophilia, rash) occur or if liver function test abnormalities persist or worsen.¹

Hematologic Effects

Anemia reported rarely.¹ Determine hemoglobin concentration or hematocrit in patients receiving long-term therapy if signs or symptoms of anemia occur.¹

May inhibit platelet aggregation and prolong bleeding time. ¹

Ocular Effects

Visual disturbances reported; ophthalmic evaluation recommended if visual changes occur. ¹

Other Precautions

Not a substitute for corticosteroid therapy; not effective in the management of adrenal insufficiency.¹

May mask certain signs of infection.¹

Obtain CBC and chemistry profile periodically during long-term use.¹

Specific Populations

Pregnancy

Category C.¹ Avoid use in third trimester because of possible premature closure of the ductus arteriosus.¹

Lactation

Distributed into milk in humans; use not recommended.¹

Pediatric Use

Safety and efficacy not established.¹

Geriatric Use

Caution advised.¹ Geriatric adults appear to tolerate NSAIA-induced adverse effects less well than younger individuals.⁹⁶ Fatal adverse GI effects reported more frequently in geriatric patients than younger adults.⁹⁶

Consider lowest effective dosage for the shortest possible duration.¹

Hepatic Impairment

Monitor closely.¹ (See Hepatic Impairment under Dosage and Administration.)

Renal Impairment

Use not recommended in patients with advanced renal disease; close monitoring of renal function advised if used.¹

Common Adverse Effects

Dyspepsia, nausea, diarrhea, constipation, rash, dizziness, headache, edema, tinnitus.¹

Interactions for Feldene

Protein-bound Drugs

Pharmacokinetic interaction possible with other highly protein-bound drugs; monitor patient; dosage adjustment may be needed.¹

Specific Drugs

Drug	Interaction	Comments
ACE inhibitors	Reduced BP response to ACE inhibitor¹	Monitor BP¹
Angiotensin II receptor antagonists	Reduced BP response to angiotensin II receptor antagonist¹¹⁸	Monitor BP¹¹⁸
Antacids (magnesium- or aluminum-containing)	Pharmacokinetic interaction unlikely¹ ¹³
Anticoagulants (warfarin)	Possible bleeding complications¹	Use with caution;¹ ³⁷ ⁹⁷ monitor PT; adjust anticoagulant dosage as needed¹ ⁹⁷
Diuretics (furosemide, thiazides)	Reduced natriuretic effects¹ ⁹⁸	Monitor for diuretic efficacy and renal failure¹
Lithium	Increased plasma lithium concentrations¹ ⁷² ⁷³ ⁷⁴ ⁷⁵ ⁷⁶ ⁷⁷ ⁷⁸ ⁷⁹	Monitor plasma lithium concentrations when initiating or discontinuing piroxicam;¹ ⁷² ⁷³ ⁷⁶ ⁷⁷ ⁷⁹ monitor for lithium toxicity²⁹ ⁷² ⁷³ ⁷⁶
Methotrexate	Increased plasma methotrexate concentrations,¹ ¹⁰⁰ particularly with high methotrexate dosage⁹⁹ ¹⁰⁰	Use with caution¹
NSAIAs	NSAIAs including aspirin: Increased risk of GI ulceration and other complications ¹ Aspirin: No consistent evidence that use of low-dose aspirin mitigates the increased risk of serious cardiovascular events associated with NSAIAs¹¹² Decreased plasma piroxicam concentrations with concomitant use of 20 mg piroxicam and 3.9 g aspirin daily ¹	Concomitant use not recommended¹
Thrombolytic agents (streptokinase)	Possible bleeding complications²⁶	Use with caution²⁶

Feldene Pharmacokinetics

Absorption

Bioavailability

Well absorbed following oral administration;¹ ³ peak plasma concentrations usually attained within 3 to 5 hours.¹

Food

Decreases rate but not extent of absorption.² ¹² ²⁸

Distribution

Extent

Distributed into synovial fluid.³

Distributed into human milk.¹ ⁴³ ⁹⁵

May accumulate slowly in cartilage.² ⁵

Plasma Protein Binding

99.3%.³ ¹³

Elimination

Metabolism

Extensively metabolized,² principally by hydroxylation and glucuronide conjugation of the hydroxy metabolite.¹ ²⁸

Elimination Route

Excreted principally in urine and feces, ¹ with urinary excretion approximately twice the fecal excretion.¹ Excreted principally as metabolites; <5% excreted unchanged.¹ ²⁸

Half-life

50 hours¹ (range: 14–158 hours).² ¹³

Stability

Storage

Oral

Capsules

Tight, light-resistant containers³⁴ ³⁵ at <30°C.³⁴ ³⁶

ActionsActions

Inhibits cyclooxygenase-1 (COX-1) and COX-2.⁸⁸ ⁸⁹ ⁹⁰ ⁹¹ ⁹² ⁹³

Pharmacologic actions similar to those of other prototypical NSAIAs;² ⁴ exhibits anti-inflammatory, analgesic, and antipyretic activity.¹ ² ⁴

Advice to Patients

Importance of reading the medication guide for NSAIAs that is provided to the patient each time the drug is dispensed.¹

Risk of serious cardiovascular events with long-term use.¹

Risk of GI bleeding and ulceration.¹

Risk of serious skin reactions.¹ Risk of anaphylactoid and other sensitivity reactions.¹

Risk of hepatotoxicity.¹

Importance of notifying clinician if signs and symptoms of a cardiovascular event (chest pain, dyspnea, weakness, slurred speech) occur.¹

Importance of notifying clinician if signs and symptoms of GI ulceration or bleeding, unexplained weight gain, or edema develops.¹

Importance of discontinuing piroxicam and contacting clinician if rash or other signs of hypersensitivity (blisters, fever, pruritus) develop.¹ Importance of seeking immediate medical attention if an anaphylactic reaction occurs.¹

Importance of discontinuing therapy and contacting clinician immediately if signs and symptoms of hepatotoxicity (nausea, fatigue, lethargy, pruritus, jaundice, upper right quadrant tenderness, flu-like symptoms) occur.¹

Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹ Importance of avoiding piroxicam in late pregnancy (third trimester).¹

Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant diseases.¹

Importance of informing patients of other important precautionary information.¹ (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Piroxicam
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Capsules	10 mg*	Feldene	Pfizer
		20 mg*	Feldene	Pfizer

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Feldene 20MG Capsules (PFIZER U.S.): 30/$145.98 or 90/$429.95

Piroxicam 10MG Capsules (NOSTRUM LABORATORIES): 30/$39.99 or 60/$69.98

Piroxicam 20MG Capsules (TEVA PHARMACEUTICALS USA): 30/$89.99 or 60/$159.97

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

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Friday, 16 March 2012

Inderal

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Tuesday, 13 March 2012

Feldene

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