Imitrex Stat Dose Refill Subcutaneous

Generic Name: sumatriptan (Subcutaneous route)

soo-ma-TRIP-tan

Commonly used brand name(s)

In the U.S.

• Alsuma


• Imitrex


• Imitrex Stat Dose Refill


• Sumavel DosePro

Available Dosage Forms:

• Kit


• Solution

Therapeutic Class: Antimigraine

Pharmacologic Class: Serotonin Receptor Agonist, 5-HT1

Uses For Imitrex Stat Dose Refill

Sumatriptan injection is used to treat acute migraine attacks and cluster headaches in adults. It does not prevent migraine attacks nor treat certain types of migraine headaches (e.g., hemiplegic or basilar type).

Many people find that their headaches go away completely after they use sumatriptan. Other people find that their headaches are much less painful, and that they are able to go back to their normal activities even though their headaches are not completely gone. Sumatriptan often relieves other symptoms that occur together with a migraine headache, such as nausea, vomiting, sensitivity to light, and sensitivity to sound.

Sumatriptan is not an ordinary pain reliever. It will not relieve any kind of pain other than migraine headaches. This medicine is usually used for people whose headaches are not relieved by acetaminophen, aspirin, or other pain relievers.

Sumatriptan has caused serious side effects in some people, especially people who have heart or blood vessel disease. Be sure that you discuss with your doctor the risks of using this medicine as well as the good that it can do.

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

Before Using Imitrex Stat Dose Refill

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 sumatriptan injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

Use of sumatriptan injection is not recommended in elderly patients with kidney problems, heart or blood vessel disease, or high blood pressure, and should not be used by elderly patients with liver problems.

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.

• Almotriptan


• Dihydroergotamine


• Eletriptan


• Ergoloid Mesylates


• Ergonovine


• Ergotamine


• Frovatriptan


• Methylergonovine


• Methysergide


• Naratriptan


• Rizatriptan


• Zolmitriptan

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.

• Citalopram


• Desvenlafaxine


• Dexfenfluramine


• Duloxetine


• Escitalopram


• Fluoxetine


• Fluvoxamine


• Milnacipran


• Paroxetine


• Reboxetine


• Sertraline


• Sibutramine


• St John's Wort


• Tapentadol


• Venlafaxine


• Vilazodone

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.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Bleeding problems or


• Blurred vision or


• CNS disorders or


• Kidney disease or


• Liver disease or


• Seizures or epilepsy, history of or


• Stomach or intestinal bleeding—Use with caution. May make these conditions worse.

• Cerebrovascular disease (e.g., stroke, transient ischemic attack), or history of or


• Heart attack, history of or


• Heart disease (e.g., angina) or


• Hemiplegic or basilar types of migraine or


• Hypertension (high blood pressure), uncontrolled or


• Ischemic bowel disease or


• Liver disease, severe—Should not be used in patients with these conditions.

• Coronary artery disease, history of or


• Diabetes or


• Hypercholesterolemia (high cholesterol in the blood) or


• Hypertension (high blood pressure), controlled or


• Obesity or


• Raynaud's syndrome—Use with caution. The chance of side effects may be increased. Heart or blood vessel disease sometimes do not cause any symptoms, so some people do not know that they have these problems. Before deciding whether you should use this medicine, your doctor may need to do some tests to make sure that you do not have any of these conditions.

Proper Use of sumatriptan

This section provides information on the proper use of a number of products that contain sumatriptan. It may not be specific to Imitrex Stat Dose Refill. Please read with care.

Do not use this medicine for a migraine or cluster headache that is different from your usual headaches. Instead, check with your doctor.

To relieve your migraine as soon as possible, use this medicine as soon as the headache pain begins. Even if you get warning signals of a coming migraine (an aura), you should wait until the headache pain starts before using sumatriptan. Using sumatriptan during the aura probably will not prevent the headache from occurring. However, even if you do not use sumatriptan until your migraine has been present for several hours, the medicine will still work.

Lying down in a quiet, dark room for a while after you use this medicine may help relieve your migraine.

If you feel much better after a dose of sumatriptan, but your headache comes back or gets worse after a while, wait at least 2 hours before using another dose. However, use this medicine only as directed by your doctor. Do not use more of it, and do not use it more often, than directed. Using too much sumatriptan may increase the chance of side effects. Do not use more than two doses in 24 hours.

This medicine is given as a shot under your skin (usually on the abdomen or stomach, thighs, or upper arms). Sumatriptan injection may sometimes be given at home to patients who do not need to be in a hospital or clinic. If you are using this medicine at home, your doctor or nurse will teach you how to prepare and inject the medicine. Be sure that you understand how to use the medicine.

If you use this medicine at home, you will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas. This will help prevent skin problems.

This medicine is available in 3 forms. You may use a single dose vial, prefilled syringe, or a prefilled autoinjector.

After you have finished injecting the medicine, be sure to follow the precautions in the patient directions about safely discarding the empty cartridge and the needle. Always return the empty cartridge and needle to their container before discarding them. Do not throw away the autoinjector unit, because refills are available.

This medicine comes with a patient information leaflet. Read and follow the instructions carefully. Ask your doctor if you have any questions.

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 injection dosage form:
  
  • For migraine or cluster headaches:
    
    • Adults—One 6-milligrams (mg) injected under the skin. One more 6-mg dose may be injected, if necessary, if the migraine comes back after being relieved. However, the second injection should not be given any sooner than 1 hour after the first one. Do not use more than two 6-mg injections in a 24-hour period (one day). However, some people may be directed to use no more than two 6-mg doses in a 48-hour period (two days).
    
    
    • Children—Use and dose must be determined by your doctor.
    
    
  
  

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.

Throw away used syringes or autoinjectors in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Precautions While Using Imitrex Stat Dose Refill

Check with your doctor if you have used this medicine and have not had good relief. Also, check with your doctor if your migraine or cluster headaches are worse, or if they are occurring more often, than before you started receiving this medicine.

Make sure your doctor knows if you are pregnant. Your doctor may want you to join a pregnancy registry for patients using this medicine.

This medicine may increase your risk of having a heart attack or stroke. This is more likely to occur if you already have a heart disease, if you smoke, if you are over 40, or if you have gone through menopause. People who use this medicine for a long time might also have a higher risk.

You should not receive this medicine if you have used an MAO inhibitor (MAOI) such as isocarboxacid (Marplan®), phenelzine (Nardil®), selegiline (Eldepryl®), or tranylcypromine (Parnate®) within the past two weeks. Do not use this medicine if you have taken other migraine medicines (e.g., almotriptan, frovatriptan, naratriptan, rizatriptan, zolmitriptan, Axert™, Frova®, Amerge®, Maxalt®, or Zomig®) or an ergotamine medicine (e.g., methysergide, D.H.E. 45®, or Migranal®) within the past 24 hours.

Make sure your doctor knows about all the other medicines you are using. Sumatriptan may cause a serious condition called serotonin syndrome when used with some medicines. This especially includes medicines used to treat depression, such as citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, olanzapine, paroxetine, sertraline, venlafaxine, Celexa®, Cymbalta®, Effexor®, Lexapro®, Luvox®, Paxil®, Prozac®, Sarafem®, Symbyax®, or Zoloft®. Check with your doctor first before taking any other medicines.

This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis requires immediate medical attention. The most serious signs of this reaction are very fast or irregular breathing, gasping for breath, wheezing, or fainting. Other signs may include changes in color of the skin of the face; very fast but irregular heartbeat or pulse; hive-like swellings on the skin; and puffiness or swellings of the eyelids or around the eyes. If these effects occur, get emergency help at once.

Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after your treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

Check with your doctor right away if you have chest discomfort, jaw or neck tightness after receiving this medicine. Also, tell your doctor if you have sudden or severe abdominal or stomach pain after using this medicine.

Drinking alcoholic beverages can make headaches worse or cause new headaches to occur. People who suffer from severe headaches should probably avoid alcoholic beverages, especially during a headache.

This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. If any of these side effects occur, do not drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert 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.

Imitrex Stat Dose Refill 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

• Blurred vision


• chest pain or discomfort


• chills


• confusion


• difficult or labored breathing


• dizziness


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


• fainting


• fast, pounding, or irregular heartbeat or pulse


• headache


• nervousness


• pounding in the ears


• shakiness in the legs, arms, hands, or feet


• shortness of breath


• slow or fast heartbeat


• sweating


• tight feeling in the head


• tightness or pressure in the chest


• trembling or shaking of the hands or feet


• unusual tiredness or weakness


• wheezing

Rare

• Black, tarry stools


• blood in the urine


• blood in the vomit


• burning while urinating


• cough


• decreased urination


• depression of the skin


• diarrhea


• dry mouth


• feeling of warmth or heat


• fever


• flushing or redness of the skin, especially on the face and neck


• general feeling of discomfort or illness


• inability to move the eyes


• inability to move the legs or arms


• increase in heart rate


• increased blinking or spasms of the eyelid


• increased sensitivity to pain


• increased sensitivity to touch


• indentation of the skin


• joint pain


• loss of appetite


• muscle aches and pains


• nausea and vomiting


• pain in the groin or genitals


• paleness of the skin


• paleness or cold feeling in the fingertips and toes


• paralysis of one side of the body


• rapid breathing


• runny nose


• severe or continuing stomach pain


• sharp back pain just below the ribs


• shivering


• sore throat


• sticking out of the tongue


• sunken eyes


• thirst


• tingling in the hands and feet


• tingling or pain in the fingers or toes when exposed to cold


• trouble with breathing, speaking, or swallowing


• trouble with sleeping


• uncontrolled twisting movements of the neck, trunk, arms, or legs


• unusual facial expressions


• wrinkled skin

Incidence not known

• Abdominal or stomach pain and tenderness


• agitation


• back, leg, or stomach pains


• bleeding gums


• blood in the stools


• bluish color of the fingernails, lips, skin, palms, or nail beds


• changes in skin color


• changes in vision


• coma


• depression


• difficulty with swallowing


• double vision


• general body swelling


• headache, sudden, severe, and continuing


• high fever


• hives


• hostility


• inability to speak


• irritability


• itching


• large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs


• lethargy


• loss of ability to use or understand speech or language


• loss of appetite


• loss of vision


• migraine headache


• muscle twitching


• noisy breathing


• nosebleeds


• overactive reflexes


• pain, tenderness, or swelling of the foot or leg


• pinpoint red spots on the skin


• poor coordination


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


• rapid weight gain


• rectal bleeding


• redness, soreness, or itching skin


• restlessness


• seizures


• severe or sudden headache


• slurred speech


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


• sores, welting, or blisters


• stupor


• swelling of the face, ankles, hands, feet, or lower legs


• swollen glands


• talking or acting with excitement you cannot control


• temporary blindness


• trembling or shaking


• twitching


• unexplained bleeding or bruising


• unusual bleeding or bruising


• unusually warm skin


• weakness in the arm or leg on one side of the body, sudden and severe


• weight loss


• yellowing of the eyes or skin

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:

More common

• Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site


• burning or tingling sensation


• drowsiness


• feeling of constant movement of self or surroundings


• feeling of warmth


• redness of the face, neck, arms, and occasionally, upper chest


• relaxed and calm


• sensation of spinning


• sleepiness

Less common

• Abdominal or stomach discomfort


• anxiety


• bad, unusual, or unpleasant (after) taste


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


• change in color vision


• change in taste


• difficulty seeing at night


• difficulty with moving


• discomfort in the jaw, nasal cavity, or throat


• false or unusual sense of well-being


• feeling strange


• heartburn


• increased sensitivity of the eyes to sunlight


• joint pain, stiffness, or swelling


• mental confusion


• muscle aching or cramping


• neck pain or stiffness


• red, sore eyes


• swollen joints


• tearing of the eyes


• thirst


• weakness

Rare

• Backache


• belching


• bloated or full feeling


• changes in patterns and rhythms of speech


• cramps


• dry heaves


• excess air or gas in the stomach or intestines


• extreme thirst


• heavy bleeding


• hiccups


• hunger


• increased thirst


• muscle tiredness


• muscle twitching or jerking


• pain


• passing gas


• reduced appetite


• rhythmic movement of muscles


• severe stomach pain with nausea and vomiting


• tenderness of the skin


• trouble with speaking

Incidence not known

• Deafness


• panic


• severe sunburn

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: Imitrex Stat Dose Refill Subcutaneous side effects (in more detail)

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

More Imitrex Stat Dose Refill Subcutaneous resources

• Imitrex Stat Dose Refill Subcutaneous Side Effects (in more detail)
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• Imitrex Stat Dose Refill Subcutaneous Support Group
• 104 Reviews for Imitrex Stat Dose Refill Subcutaneous - Add your own review/rating

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Cinolar

Generic Name: triamcinolone topical (trye am SIN oh lone)

Brand Names: Cinolar, Kenalog, Oralone, Pediaderm TA, Triamcinolone Acetonide in Absorbase, Trianex, Triderm

What is Cinolar (triamcinolone topical)?

Triamcinolone is a topical steroid. It reduces the actions of chemicals in the body that cause inflammation, redness, and swelling.

Triamcinolone topical is used to treat the inflammation caused by a number of conditions such as allergic reactions, eczema, and psoriasis. The dental paste form of triamcinolone is used to treat mouth ulcers.

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

What is the most important information I should know about Cinolar (triamcinolone topical)?

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

Do not cover treated skin areas with a bandage or other covering unless your doctor has told you to. If you are treating the diaper area of a baby, do not use plastic pants or tight-fitting diapers. Covering the skin that is treated with triamcinolone topical can increase the amount of the drug your skin absorbs, which may lead to unwanted side effects. Follow your doctor's instructions.

Avoid using this medication on your face, near your eyes, or on body areas where you have skin folds or thin skin.

Do not use this medication on a child without a doctor's advice. Children are more sensitive to the effects of triamcinolone topical.

Triamcinolone topical will not treat a bacterial, fungal, or viral skin infection.

Contact your doctor if your condition does not improve or if it gets worse after using this medication for several days.

What should I discuss with my healthcare provider before using Cinolar (triamcinolone topical)?

Do not use this medication if you are allergic to triamcinolone.

To make sure you can safely use triamcinolone topical, tell your doctor if you have any of these other conditions:

• 
  

  any skin infection, especially tuberculosis infection of the skin;

  
  


• 
  

  chicken pox or herpes infection (including cold sores);

  
  


• 
  

  diabetes; or

  
  


• 
  

  a stomach ulcer.

  
  

FDA pregnancy category C. It is not known whether triamcinolone topical 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 triamcinolone topical 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. Do not use this medication on a child without a doctor's advice. Children are more sensitive to the effects of triamcinolone topical.

How should I use Cinolar (triamcinolone topical)?

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

Triamcinolone topical will not treat a bacterial, fungal, or viral skin infection.

Wash your hands before and after each application, unless you are using triamcinolone topical to treat a hand condition.

Apply a small amount to the affected area and rub it gently into the skin.

Avoid using this medication on your face, near your eyes or mouth, or on body areas where you have skin folds or thin skin.

If you are using the dental paste, apply the medication in a thin layer, just enough to cover the mouth ulcer. The paste may stick better if you dry the mouth ulcer before applying the medication.

Do not cover treated skin areas with a bandage or other covering unless your doctor has told you to. If you are treating the diaper area of a baby, do not use plastic pants or tight-fitting diapers. Covering the skin that is treated with triamcinolone topical can increase the amount of the drug your skin absorbs, which may lead to unwanted side effects. Follow your doctor's instructions. Contact your doctor if your condition does not improve or if it gets worse after using this medication for several days. It is important to use triamcinolone topical regularly to get the most benefit. Store at room temperature away from moisture and heat.

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222, especially if anyone has accidentally swallowed this medicine. An overdose of triamcinolone topical applied to the skin is not expected to produce life-threatening symptoms.

What should I avoid while using Cinolar (triamcinolone topical)?

Avoid getting this medication in your eyes, mouth, and nose, or on your lips. If it does get into any of these areas, wash with water. Do not use triamcinolone topical on sunburned, windburned, irritated, or broken skin. Also avoid using this medication in open wounds.

Avoid using skin products that can cause irritation, such as harsh soaps or skin cleansers, or skin products with alcohol, spices, astringents, or lime. Avoid using other medications on the areas you treat with triamcinolone topical unless you doctor tells you to.

Cinolar (triamcinolone topical) 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. Stop using this medication and call your doctor at once if you have any of these signs that you may be absorbing triamcinolone topical through your skin or gums:

• 
  

  blurred vision, or seeing halos around lights;

  
  


• 
  

  uneven heartbeats;

  
  


• 
  

  mood changes;

  
  


• 
  

  sleep problems (insomnia);

  
  


• 
  

  weight gain, puffiness in your face; or

  
  


• 
  

  feeling tired.

  
  

Less serious side effects may include:

• 
  

  skin redness, burning, itching, or peeling;

  
  


• 
  

  thinning of your skin; or

  
  


• 
  

  blistering skin; or

  
  


• 
  

  stretch marks.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Cinolar (triamcinolone topical)?

It is not likely that other drugs you take orally or inject will have an effect on topically applied triamcinolone topical. But many drugs can interact with each other. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Cinolar resources

• Cinolar Side Effects (in more detail)
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Where can I get more information?

• Your pharmacist can provide more information about triamcinolone topical.

See also: Cinolar side effects (in more detail)

Inopil

Inopil may be available in the countries listed below.

Ingredient matches for Inopil

Indapamide

Indapamide is reported as an ingredient of Inopil in the following countries:

• Bangladesh

Perindopril

Perindopril is reported as an ingredient of Inopil in the following countries:

• Bangladesh

International Drug Name Search

Altazine Moisture Relief Eye Drops

Pronunciation: teh-trah-high-DRAHZ-ah-leen
Generic Name: Tetrahydrozoline
Brand Name: Examples include Altazine Moisture Relief and Visine

Altazine Moisture Relief Eye Drops are used for:

Relieving redness due to minor eye irritation.

Altazine Moisture Relief Eye Drops are a decongestant. It works by constricting swollen blood vessels in the eye, which reduces redness. Irritants cause blood vessels to swell.

Contact your doctor or health care provider immediately if any of these apply to you.

Do NOT use Altazine Moisture Relief Eye Drops if:

• you are allergic to any ingredient in Altazine Moisture Relief Eye Drops


• you are taking furazolidone or have taken a monoamine oxidase (MAO) inhibitor (eg, phenelzine) within the last 14 days

Contact your doctor or health care provider right away if any of these apply to you.

Before using Altazine Moisture Relief Eye Drops:

Some medical conditions may interact with Altazine Moisture Relief Eye Drops. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you have narrow-angle glaucoma, an overactive thyroid, or high blood pressure

Some MEDICINES MAY INTERACT with Altazine Moisture Relief Eye Drops. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Furazolidone and MAO inhibitors (eg, phenelzine) because side effects, such as headache, high blood pressure, and elevated body temperature, may occur


• Tricyclic antidepressants (eg, amitriptyline) because they may decrease Altazine Moisture Relief Eye Drops's effectiveness


• Bromocriptine or catechol-O-methyltransferase (COMT) inhibitors (eg, tolcapone, St. John's wort) because their actions and side effects may be increased by Altazine Moisture Relief Eye Drops

This may not be a complete list of all interactions that may occur. Ask your health care provider if Altazine Moisture Relief Eye Drops may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Altazine Moisture Relief Eye Drops:

Use Altazine Moisture Relief Eye Drops as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Altazine Moisture Relief Eye Drops are for use in the eye only. Avoid contact with mucous membranes.


• If you wear contact lenses, remove them before using Altazine Moisture Relief Eye Drops.


• To use Altazine Moisture Relief Eye Drops, wash your hands. Tilt your head back. Using your index finger, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close your eyes. Immediately use your finger to apply pressure to the inside corner of the eye and continue to apply pressure for 1 to 2 minutes after using the medicine. Do not blink.


• Remove excess medicine around your eye with a clean tissue, being careful not to touch your eye.


• Wash your hands to remove any medicine that may be on them. To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including your eye.


• Keep the container tightly closed.


• Do not use Altazine Moisture Relief Eye Drops if solution changes color or becomes cloudy.


• If you miss a dose of Altazine Moisture Relief Eye Drops and you are using it regularly, use it as soon as possible. If it is much more than 1 hour since your missed dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Altazine Moisture Relief Eye Drops.

Important safety information:

• Altazine Moisture Relief Eye Drops may cause blurred vision. Do not drive, operate machinery, or do anything else that could be dangerous unless you can see clearly.


• Do not use Altazine Moisture Relief Eye Drops for longer than 3 days without checking with your doctor.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Using too much of Altazine Moisture Relief Eye Drops may increase redness of the eye.


• Altazine Moisture Relief Eye Drops are not recommended for use in CHILDREN younger than 6 years of age. Safety and effectiveness in this age group have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Altazine Moisture Relief Eye Drops during pregnancy. It is unknown if Altazine Moisture Relief Eye Drops are excreted in breast milk. If you are or will be breast-feeding while you are using Altazine Moisture Relief Eye Drops, check with your doctor or pharmacist to discuss the risks to your baby.

Possible side effects of Altazine Moisture Relief Eye Drops:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurring, tearing, or stinging of the eye; dilation of pupils.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); change in vision; continued redness or irritation of the eye; eye pain; headache.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Altazine Moisture Relief side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Altazine Moisture Relief Eye Drops may be harmful if swallowed, especially in children.

Proper storage of Altazine Moisture Relief Eye Drops:

Store Altazine Moisture Relief Eye Drops at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Altazine Moisture Relief Eye Drops out of the reach of children and away from pets.

General information:

• If you have any questions about Altazine Moisture Relief Eye Drops, please talk with your doctor, pharmacist, or other health care provider.


• Altazine Moisture Relief Eye Drops are to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Altazine Moisture Relief Eye Drops. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Altazine Moisture Relief resources

• Altazine Moisture Relief Side Effects (in more detail)
• Altazine Moisture Relief Use in Pregnancy & Breastfeeding
• Altazine Moisture Relief Drug Interactions
• Altazine Moisture Relief Support Group
• 0 Reviews for Altazine Moisture Relief - Add your own review/rating

Compare Altazine Moisture Relief with other medications

• Eye Dryness/Redness

Angiomax

Generic Name: Bivalirudin
Class: Direct Thrombin Inhibitors
Chemical Name: d - Phenylalanyl - l - prolyl - l - arginyl - l - prolylglycylglycylglycylglycyl - l - asparaginylglycyl - l - α - aspartyl - l - phenylalanyl - l - α - glutamyl - l - α - glutamyl - l - isoleucyl - l - prolyl - l - α - glutamyl - l - α - glutamyl - l - tyrosyl - l - leucine
CAS Number: 128270-60-0

Special Alerts:

The Editors of AHFS Drug Information (AHFS DI) and AHFS DI Essentials wish to inform you of an error in the monographs for bivalirudin 20:12.04.12 that resulted from an error in one of the cited references, the American College of Chest Physicians (ACCP) guideline on treatment and prevention of heparin-induced thrombocytopenia (Warkentin TE, Greinacher A, Koster A et al. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians evidence-based clinical practice guidelines (8th ed). Chest. 2008; 133 (Suppl):340S-80S).^{10 25}

The error appears under the subhead Heparin-induced Thrombocytopenia in Patients Undergoing Cardiac Surgery, in Dosage and Administration. In the second sentence under this subhead, the statement should read:

“During cardiopulmonary bypass, initially, 1 mg/kg by direct IV injection followed by 2.5 mg/kg per hour by continuous IV infusion has been used;^{10 24} if needed, additional direct IV doses of 0.1–0.5 mg/kg have been given to maintain a 2.5-fold or greater prolongation of the baseline ACT.²⁴ ”

The originally stated dosage of 0.1–0.5 mg for additional direct IV doses of bivalirudin is incorrect.²⁵

The following reflects the corrected version of this information, incorporating the change noted above.

Introduction

Anticoagulant; synthetic peptide analog of hirudin, an anticoagulant polypeptide found in the saliva of the medicinal leech (Hirudo medicinalis).^{1 2 3 4 5 6}

Uses for Angiomax

Acute Ischemic Complications of Percutaneous Coronary Intervention

Used with aspirin to reduce the risk of acute ischemic complications (e.g., death, MI, need for urgent revascularization procedures) in patients with unstable angina or non-ST-segment-elevation MI (i.e., non-ST-segment-elevation acute coronary syndromes) undergoing PCI, including percutaneous transluminal coronary angioplasty (PTCA).^{1 8 9 11 15 17}

American College of Chest Physicians (ACCP) recommends anticoagulant therapy (e.g., heparin, low molecular weight heparin, bivalirudin, fondaparinux) for all patients presenting with non-ST-segment-elevation acute coronary syndromes.¹⁷ ACCP suggests the use of bivalirudin in combination with clopidogrel over heparin for initial antithrombotic therapy in patients at moderate to high risk for an ischemic event and who are scheduled for very early coronary angiography (within <6 hours).¹⁷

Efficacy in patients with non-ST-segment-elevation acute coronary syndromes undergoing PCI similar to that of high-dose heparin.^{1 5}

Used with aspirin and “provisional” treatment with a GP IIb/IIIa-receptor inhibitor in selected patients undergoing PCI who have complications (i.e., prolonged ischemia, decreased perfusion [TIMI grade 0–2 flow] or slow reflow, dissection with decreased perfusion, new or suspected thrombus, persistent residual stenosis, distal embolism, unplanned or suboptimal stenting, side branch closure, abrupt closure, or other clinical instability).^{1 8 11 14 17} Efficacy in such patients similar to that of heparin and routine treatment with a GP IIb/IIIa-receptor inhibitor.^{1 8 9 11 14 16 17}

ACC, AHA, and the Society for Cardiovascular Angiography and Interventions (SCAI) suggest bivalirudin as an alternative to heparin and a GP IIb/IIIa-receptor inhibitor in patients undergoing PCI who are at low risk for ischemic complications.¹⁵

ACCP recommends either bivalirudin and provisional treatment with a GP IIb/IIIa-receptor inhibitor or heparin and routine treatment with a GP IIb/IIIa-receptor inhibitor in patients with non-ST-segment-elevation acute coronary syndromes undergoing PCI who are at low to moderate risk for ischemic complications.¹⁷

Safety and efficacy not established in patients with acute coronary syndromes who are not undergoing PTCA or PCI.¹

Heparin-induced Thrombocytopenia in Patients Undergoing PCI

Used with aspirin in patients undergoing PCI who have, or are at risk for, heparin-induced thrombocytopenia (HIT).^{1 10 15}

ACC/AHA/SCAI recommend bivalirudin or argatroban and ACCP recommends bivalirudin, argatroban, or lepirudin as a substitute for unfractionated heparin or low molecular weight heparin in patients with HIT undergoing PCI.^{10 15}

ACCP suggests use of a nonheparin anticoagulant over continued therapy with unfractionated or low molecular weight heparin in patients with a history of HIT (antibody negative) who require cardiac catheterization or PCI.¹⁰

Heparin-induced Thrombocytopenia in Patients Undergoing Cardiac Surgery

Recommended as a substitute for heparin in patients with acute HIT (thrombocytopenic and HIT-antibody positive) who require cardiac surgery† (e.g., coronary artery bypass grafting [CABG]).^{10 24} ACCP recommends delaying surgery (if possible) until HIT antibodies are no longer detected or use of bivalirudin for intraoperative anticoagulation during cardiopulmonary bypass or “off-pump” cardiac surgery, provided special precautions to prevent blood stasis are followed.^{10 24 26} (See Patients with HIT Undergoing Cardiac Surgery under Cautions.)

Acute ST-Segment-Elevation MI

Used as an alternative to heparin in patients with acute ST-segment-elevation MI†.^{20 21 22} May be used in patients who have been pretreated with heparin and who are to undergo PCI; may also be used as an alternative to heparin in patients who have received fondaparinux in conjunction with a thrombolytic agent prior to PCI.²⁰

Angiomax Dosage and Administration

General

• 
  

  Manufacturer states that bivalirudin is intended for use concomitantly with aspirin 300–325 mg daily.¹ However, ACC/AHA/SCAI and ACCP recommend lower maintenance dosages of aspirin (e.g., 75–162 mg daily).^{15 17 18 19 20 21 23}

  
  

Administration

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by direct IV injection followed by IV infusion.¹ Do not administer IM.¹

Reconstitution

Reconstitute vial containing 250 mg of lyophilized bivalirudin with 5 mL of sterile water for injection (swirl gently) to provide a solution containing 50 mg/mL.¹

Discard any unused reconstituted solution.¹

Dilution

Dilute reconstituted solution in 50 mL of 5% dextrose or 0.9% sodium chloride injection to a final concentration of 5 mg/mL for direct IV injection and infusion.¹

For low-rate infusion, further dilute the 5-mg/mL solution in 500 mL of 5% dextrose or 0.9% sodium chloride injection to a final concentration of 0.5 mg/mL.^{1 7}

Dosage

Adults

Acute Ischemic Complications of PCI

IV

0.75 mg/kg (5-mg/mL solution) by direct IV injection immediately before PCI, followed by 1.75 mg/kg per hour (5-mg/mL solution) by continuous IV infusion for the duration of the procedure.¹ Obtain an activated clotting time (ACT) (as measured by a Hemochron device) 5 minutes after initial loading dose and administer an additional direct IV dose of 0.3 mg/kg if needed (e.g., if the ACT is <225 seconds).^{1 8}

May continue infusion for up to 4 hours after the procedure if necessary.¹ If needed, administer an additional IV infusion (0.5-mg/mL solution) at 0.2 mg/kg per hour for up to 20 hours.¹

Heparin-induced Thrombocytopenia in Patients Undergoing PCI

IV

0.75 mg/kg (5-mg/mL solution) by direct IV injection immediately before PCI, followed by 1.75 mg/kg per hour (5-mg/mL solution) by continuous IV infusion for the duration of the procedure.¹

May continue infusion for up to 4 hours after the procedure if necessary.¹ If needed, administer an additional IV infusion (0.5-mg/mL solution) at 0.2 mg/kg per hour for up to 20 hours.¹

Heparin-induced Thrombocytopenia in Patients Undergoing Cardiac Surgery†

IV

During “off-pump” cardiac surgery (i.e., without cardiopulmonary bypass), 0.75 mg/kg by direct IV injection, followed by 1.75 mg/kg per hour by continuous IV infusion to maintain an ACT >300 seconds has been used.^{10 26}

During cardiopulmonary bypass, initially, 1 mg/kg by direct IV injection followed by 2.5 mg/kg per hour by continuous IV infusion has been used;^{10 24} if needed, additional direct IV doses of 0.1–0.5 mg/kg have been given to maintain a 2.5-fold or greater prolongation of the baseline ACT.²⁴ In addition, 50 mg of bivalirudin is added to the recirculating priming fluid of the cardiopulmonary bypass circuit.^{10 24}

Acute ST-Segment-Elevation MI†

IV

0.25 mg/kg by direct IV injection followed by 0.5 mg/kg per hour by continuous IV infusion for the first 12 hours, then 0.25 mg/kg per hour for the subsequent 36 hours, has been used.^{21 22} Obtain aPTT 12 and 24 hours after the initial dosage; adjust dosage if needed.²¹

Special Populations

Renal Impairment

Reduction of the initial loading dose not necessary in patients with moderate to severe renal impairment.^{1 7} Closely monitor activated clotting time (ACT) in patients with renal impairment.¹ Reduce infusion rate to 1 mg/kg per hour in patients with severe renal impairment (Cl_cr <30 mL/minute).¹ In dialysis-dependent patients, reduce off-dialysis infusion rate to 0.25 mg/kg per hour.¹

Cautions for Angiomax

Contraindications

• 
  

  Active major bleeding.¹

  
  


• 
  

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

  
  

Warnings/Precautions

Warnings

Hematologic Effects

Possible bleeding, especially at site of arterial puncture.^{1 7} Unexplained decreases in hematocrit, hemoglobin, or BP may indicate hemorrhage.¹

Discontinue if severe hemorrhage occurs.¹ Use with caution in patients with an increased risk of hemorrhage.^{1 7}

Increased risk of potentially fatal thrombosis during vascular brachytherapy procedures; use caution.¹ Assess catheter function frequently by attempting to aspirate blood, and ensure patency by repeated flushing.¹ Minimize conditions promoting stasis within the catheter or circulatory system.^{1 10}

Sensitivity Reactions

Hypersensitivity

Positive bivalirudin antibody tests found rarely in clinical studies; however, no allergic or anaphylactic reactions reported.^{1 7}

General Precautions

Factors Increasing Risk of Hemorrhage

Increased risk of major bleeding events with concomitant heparin, warfarin, thrombolytic, or GP IIb/IIIa-receptor inhibitor therapy in clinical trials.¹ (See Common Adverse Effects and see Specific Drugs under Interactions.) No experience with concomitant administration of plasma expanders such as dextran.¹

Use with caution in patients with disease states associated with increased risk of hemorrhage.¹

Brachytherapy Procedures

Use with caution during vascular brachytherapy procedures because of an increased risk of potentially fatal thrombosis.¹

Patients with HIT Undergoing Cardiac Surgery

Possible formation of clots due to degradation of bivalirudin in areas of blood stasis; special maneuvers needed to avoid stasis within the cardiopulmonary bypass circuit during and after cardiac surgery.^{10 24 26} Avoid use of cardiotomy suction; also avoid use of patient blood to test graft patency or for cardioplegia solutions.^{10 24 26}

Specific Populations

Pregnancy

Category B.¹

Lactation

Not known whether bivalirudin is distributed into milk.¹ Use with caution.¹

Pediatric Use

Safety and efficacy not established in pediatric patients.¹

Geriatric Use

No substantial differences in safety or efficacy relative to younger adults.^{1 7}

Renal Impairment

Dosage reduction recommended in patients with moderate to severe renal impairment.¹ (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

Major hemorrhagic events less frequent with bivalirudin with or without provisional GP IIb/IIIa-receptor inhibitor therapy (2.3%) compared with unfractionated heparin and routine GP IIb/IIIa-receptor inhibitor therapy (4%).¹

Nonhemorrhagic effects in patients with unstable angina undergoing PTCA: Back pain,¹ pain (unspecified),¹ nausea,¹ headache,¹ hypotension,¹ injection site pain,¹ insomnia,¹ hypertension,¹ vomiting,¹ pelvic pain,¹ anxiety,¹ bradycardia,¹ dyspepsia,¹ abdominal pain,¹ fever,¹ nervousness,¹ urinary retention.¹

Nonhemorrhagic effects in patients undergoing PCI and receiving provisional therapy with a GP IIb/IIIa-receptor inhibitor: Back pain, angina pectoris,¹ pain (unspecified),¹ hypotension,¹ nausea,¹ injection site pain,¹ headache,¹ chest pain.¹

Interactions for Angiomax

Specific Drugs

Drug	Interaction	Comments
Aspirin	Increased risk of hemorrhage13
GP IIb/IIIa-receptor inhibitors	Increased risk of hemorrhage1
Heparin	Increased risk of hemorrhage1
Heparin, low molecular weight	No apparent pharmacodynamic interaction13	Limited data; safety and efficacy of combination therapy not established13
Plasma-volume expanders (e.g., dextran)	No experience with concomitant therapy1
Thrombolytic agents	Increased risk of hemorrhage1
Ticlopidine	No apparent pharmacodynamic interaction13	Limited data; safety and efficacy of combination therapy not established13
Warfarin	Increased risk of hemorrhage1

Angiomax Pharmacokinetics

Absorption

Onset

Immediate anticoagulant effect.¹

Duration

Effects are dose- and concentration-dependent and reversible; thrombin slowly cleaves the bivalirudin-Arg₃-Pro₄ bond, which results in recovery of the thrombin active site function.^{1 3 4} Coagulation times return to normal approximately 1–2 hours after cessation of infusion.^{1 7}

Distribution

Extent

Not known whether the drug is distributed into human milk.¹

Plasma Protein Binding

Does not bind to plasma proteins (other than thrombin).¹

Elimination

Metabolism

Cleared from the plasma by a combination of renal mechanisms and intracellular proteolysis.^{1 b}

Elimination Route

Approximately 20% of unchanged bivalirudin is cleared renally, and the remainder presumably undergoes intracellular proteolysis.^b

Half-life

22 minutes.¹

Special Populations

In patients with mild renal impairment (GFR of 60–89 mL/minute), half-life is 25 minutes.¹

In patients with moderate renal impairment (GFR of 30–59 mL/minute), half-life is 34 minutes.¹

In patients with severe renal impairment (GFR of 10–29 mL/minute), half-life is 57 minutes.¹

In dialysis-dependent patients, off-dialysis half-life is 3.5 hours.¹

Total body clearance reduced by about 20% in patients with moderate to severe renal impairment and by 80% in dialysis-dependent patients.¹

Approximately 25% of drug removed by hemodialysis.¹

Stability

Storage

Parenteral

Powder for Injection

20–25°C (may be exposed to 15–30°C).¹

Reconstituted solution (50 mg/mL) may be stored at 2–8°C for up to 24 hours.¹

Diluted IV solutions (0.5–5 mg/mL) are stable at room temperature for up to 24 hours.¹

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution Compatibility¹

Compatible
Dextrose 5% in water
Sodium chloride 0.9%

Drug Compatibility^HID

Y-Site CompatibilityHID

Compatible
Abciximab
Alfentanil HCl
Amikacin sulfate
Aminophylline
Ampicillin sodium
Ampicillin sodium-sulbactam sodium
Azithromycin
Aztreonam
Bretylium tosylate
Bumetanide
Butorphanol tartrate
Calcium gluconate
Cefazolin sodium
Cefepime HCl
Cefotaxime sodium
Cefoxitin sodium
Ceftazidime
Ceftizoxime sodium
Ceftriaxone sodium
Cefuroxime sodium
Cimetidine HCl
Ciprofloxacin
Clindamycin phosphate
Co-trimoxazole
Dexamethasone sodium phosphate
Digoxin
Diltiazem HCl
Diphenhydramine HCl
Dobutamine HCl
Dopamine HCl
Doxycycline hyclate
Droperidol
Enalaprilat
Ephedrine sulfate
Epinephrine HCl
Epoprostenol sodium
Eptifibatide
Erythromycin lactobionate
Esmolol HCl
Famotidine
Fentanyl citrate
Fluconazole
Furosemide
Gentamicin sulfate
Haloperidol lactate
Heparin sodium
Hydrocortisone sodium succinate
Hydromorphone HCl
Isoproterenol HCl
Labetalol HCl
Levofloxacin
Lidocaine HCl
Lorazepam
Magnesium sulfate
Mannitol
Meperidine HCl
Methylprednisolone sodium succinate
Metoclopramide HCl
Metronidazole
Midazolam HCl
Milrinone lactate
Morphine sulfate
Nalbuphine HCl
Nitroglycerin
Norepinephrine bitartrate
Phenylephrine HCl
Piperacillin sodium-tazobactam
Potassium chloride
Procainamide HCl
Promethazine HCL
Ranitidine HCl
Sodium bicarbonate
Sodium nitroprusside
Sufentanil citrate
Theophylline
Thiopental sodium
Ticarcillin disodium-clavulanate potassium
Tirofiban HCl
Tobramycin sulfate
Verapamil HCl
Warfarin sodium
Incompatible
Alteplase
Amiodarone HCl
Amphotericin B
Chlorpromazine HCl
Diazepam
Prochlorperazine edisylate
Reteplase
Vancomycin HCl

ActionsActions

• 
  

  Specific and reversible direct thrombin inhibitor that binds to circulating and clot-bound thrombin.^{1 2 3 4}

  
  


• 
  

  Inhibition of thrombin prevents various steps in the coagulation process (e.g., activation of factors V, VIII, and XIII; conversion of fibrinogen to fibrin; platelet activation and aggregation).^{1 2 3 4}

  
  


• 
  

  Prolongs activated clotting time (ACT), aPTT, thrombin time (TT), and PT.^{1 7}

  
  

Advice to Patients

• 
  

  Importance of patients reporting any signs of bleeding (e.g., bruising, petechiae, hematuria) to clinicians immediately.¹

  
  


• 
  

  Importance of patients informing clinicians of history of bleeding disorders or impaired renal function.¹

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

  
  


• 
  

  Importance of patients 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.

Bivalirudin

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	For injection, for IV infusion	250 mg	Angiomax	Medicines Company

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.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions March 25, 2011. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

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

References

1. The Medicines Company. Angiomax (bivalirudin) for injection prescribing information. Cambridge, MA; 2005 Dec 6.

2. Haines ST, Bussey HI. Thrombosis and the pharmacology of antithrombotic agents. Ann Pharmacother. 1995; 29:892-905. [IDIS 353388] [PubMed 8547739]

3. Stringer KA, Lindenfeld J. Hirudins: antithrombin anticoagulants. Ann Pharmacother. 1992; 26:1535-40. [IDIS 306624] [PubMed 1482812]

4. Bates SM, Weitz JI. Direct thrombin inhibitors for treatment of arterial thrombosis: potential differences between bivalirudin and hirudin. Am J Cardiol. 1998; 82:12-8P.

5. Bittl JA, Strony J, Brinker JA et al for the Hirulog Angioplasty Study investigators. Treatment with bivalirudin (hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. N Engl J Med. 1995; 333:764-9. [IDIS 353197] [PubMed 7643883]

6. Bittl JA, Feit F for Hirulog Angioplasty Study investigators. A randomized comparison of bivalirudin and heparin in patients undergoing coronary angioplasty for postinfarction angina. Am J Cardiol. 1998; 82:43-9P. [PubMed 9671007]

7. The Medicines Company, Cambridge, MA: Personal communication.

8. Lincoff AM, Bittl JA, Harrington RA et al. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. JAMA. 2003; 289:853-63. [IDIS 493155] [PubMed 12588269]

9. Saw J, Lincoff M, DeSmet W et al. Lack of clopidogrel pretreatment effect on the relative efficacy of bivalirudin with provisional glycoprotein IIb/IIIa blockade compared to heparin with routine glycoprotein IIb/IIIa blockade: a REPLACE-2 substudy. J Am Coll Cardiol. 2004; 44:1194-9. [IDIS 524399] [PubMed 15364319]

10. Warkentin TE, Greinacher A, Koster A et al. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians evidenced-based clinical practice guidelines (8th ed) Chest. 2008; 133 (Suppl):340S-80S

11. Popma JJ, Berger P, Ohman EM et al. Antithrombotic therapy in patients undergoing percutaneous coronary intervention. Chest. 2001; 119(Suppl):321S-36S.

12. Harrington RA, Becker RC, Ezekowitz M et al. Antithrombotic therapy in coronary artery disease. Chest. 2004; 126:513S-48S. [IDIS 523845] [PubMed 15383483]

13. The Medicines Company. Angiomax (bivalirudin) for injection prescribing information. Cambridge, MA; 2002 Jun 18.

14. Lincoff, AM, Kleiman NS, Kereiakes DJ et al. Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. JAMA. 2004; 292:696-703.

15. Smith SC, Feldman TE, Hirschfeld JW et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Revise the 2001 Guidelines for Percutaneous Coronary Intervention). 2005. Available at the American College of Cardiology web site.

16. Lansky AJ, Hochman JS, Ward PA et al. Percutaneous coronary intervention and adjunctive pharmacotherapy in women: a statement for healthcare professionals from the American Heart Association. Circulation. 2005; 111:940-5. [PubMed 15687113]

17. Harrington RA, Becker RC, Cannon CP et al. Antithrombotic therapy for non-ST-segment elevation acute coronary syndromes.American College of Chest Physicians evidenced-based clinical practice guidelines (8th ed). Chest. 2008; 133:670S-707S. [PubMed 18574276]

18. King SB, Smith SC, Hirshfeld JW et al. 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2008; 51:172-9. [PubMed 18191745]

19. Becker RC, Meade TW, Berger PB et al. The primary and secondary prevention of coronary artery disease: American College of Chest Physicians evidenced-based clinical practice guidelines (8th ed). Chest. 2008; 133 (Suppl): 776S-814S. [PubMed 18574278]

20. Antman EM, Hand M, Armstrong PW et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. J Am Coll Cardiol. 2008; 51:210-47. [PubMed 18191746]

21. Goodman SG, Menon V, Cannon CP et al. Acute ST-segment elevation myocardial infarction: American College of Chest Physicians evidenced-based clinical practice guidelines (8th ed). Chest. 2008; 133 (Suppl):708S-75S. [PubMed 18574277]

22. Schulman S, Beyth RJ, Kearon C et al. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians evidenced-based clinical practice guidelines (8th ed). Chest. 2008; 133 (Suppl):257S-98S. [PubMed 18574268]

23. Anderson JL, Adams CD, Antman EM et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction). Available at ACC website. Accessed 2008 Oct 15.

24. Koster A, Dyke CM, Aldea G et al. Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: results of the CHOOSE-ON trial. Ann Thorac Surg. 2007; 83:572-7.

25. Lewis SZ (American College of Chest Physicians, Northbrook, IL): Personal communication. 2011 Mar 15.

26. Dyke CM, Aldea G, Koster A et al. Off-pump coronary artery bypass with bivalirudin for patients with heparin-induced thrombocytopenia or antiplatelet factor four/heparin antibodies. Ann Thorac Surg. 2007; 84:836-40.

b. Robson R, White H, Aylward P et al. Bivalirudin pharmacokinetics and pharmacodynamics: effect of renal function, dose, and gender. Clin Pharmacol Ther. 2002; 71:433-39. [PubMed 12087346]

HID. Trissel LA. Handbook on injectable drugs. 14th ed; Bethesda, MD: American Society of Health-System Pharmacists; 2007:207-13.

More Angiomax resources

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

• Angiomax Prescribing Information (FDA)


• Angiomax MedFacts Consumer Leaflet (Wolters Kluwer)


• Angiomax Concise Consumer Information (Cerner Multum)


• Angiomax Advanced Consumer (Micromedex) - Includes Dosage Information


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Antivenin-Spider

Generic Name: antivenin (LATRODECTUS MACTANS) (Injection route)

an-tee-VEN-in (lat-roe-DEK-tus MAK-tans)

Commonly used brand name(s)

In the U.S.

• Antivenin-Spider

In Canada

• Antivenin

Available Dosage Forms:

• Powder for Solution


• Injectable

Therapeutic Class: Antivenom

Uses For Antivenin-Spider

Black widow spider antivenin belongs to a group of medicines known as immunizing agents. It is used to treat patients with serious symptoms caused by the bites of the black widow spider.

Black widow spider antivenin is to be used only by or under the supervision of a doctor.

Before Using Antivenin-Spider

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

Although there is no specific information comparing use of black widow spider antivenin in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does in adults.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of black widow spider antivenin in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults.

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 antivenin (latrodectus mactans)

This section provides information on the proper use of a number of products that contain antivenin (latrodectus mactans). It may not be specific to Antivenin-Spider. Please read with care.

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.

Antivenin-Spider 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:

• Difficulty in breathing or swallowing


• hives


• itching, especially of feet or hands


• reddening of skin, especially around ears


• swelling of eyes, face, or inside of nose


• unusual tiredness or weakness (sudden and severe)

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:

• Feeling of discomfort


• fever


• inflammation of joints


• itching


• muscle aches


• rash


• swollen lymph glands

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.

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

Tarsum Shampoo

Pronunciation: kohl tar/sal-ih-SILL-ik AS-id
Generic Name: Coal Tar/Salicylic Acid
Brand Name: Examples include Tarsum and X-Seb T Plus

Tarsum Shampoo is used for:

Relieving itching, flaking, irritation, redness, and scaling due to dandruff, seborrheic dermatitis, and psoriasis of the scalp. It may also be used for other conditions as determined by your doctor.

Tarsum Shampoo is a topical coal tar and salicylate combination. It works by causing the skin to swell, soften, and then slough or peel in areas where it is applied.

Do NOT use Tarsum Shampoo if:

• you are allergic to any ingredient in Tarsum Shampoo


• you are using prescription medicine or other treatments (eg, ultraviolet radiation therapy) to treat your condition, unless instructed by your doctor

Contact your doctor or health care provider right away if any of these apply to you.

Before using Tarsum Shampoo:

Some medical conditions may interact with Tarsum Shampoo. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you have had a severe allergic reaction (eg, severe rash, hives, difficulty breathing, dizziness) to aspirin or a nonsteroidal anti-inflammatory drug (NSAID) (eg, ibuprofen, naproxen, celecoxib)


• if you have liver or kidney problems, a skin infection, skin irritation, eczema, diabetes, or poor blood circulation

Some MEDICINES MAY INTERACT with Tarsum Shampoo. Because little, if any, of Tarsum Shampoo is absorbed into the blood, the risk of it interacting with another medicine is low.

This may not be a complete list of all interactions that may occur. Ask your health care provider if Tarsum Shampoo may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Tarsum Shampoo:

Use Tarsum Shampoo as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Shake well before each use.


• Wet hair and shampoo for a full 5 minutes. Rinse and repeat. Be sure to wash your hands after each use.


• If you miss a dose of Tarsum Shampoo, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Tarsum Shampoo.

Important safety information:

• Tarsum Shampoo is for external use only. Avoid getting Tarsum Shampoo in your eyes, nose, or mouth, or on the genitals. If contact with your eyes occurs, flush with water for 15 minutes. Do not inhale the vapors of Tarsum Shampoo.


• Overuse of topical products may worsen your condition.


• Do not use Tarsum Shampoo longer or more often than recommended by your doctor or on the package label.


• Check with your doctor before use if you have a condition that covers a large area of the body.


• Be sure to apply Tarsum Shampoo only to the affected area and not to normal healthy skin.


• Do not use Tarsum Shampoo on skin that is irritated, infected, or reddened.


• Do not use Tarsum Shampoo on open skin wounds, moles, birthmarks, genital warts, warts on the face, or warts growing hair.


• Do not use any other medicines or drying products on your skin unless your doctor instructs you otherwise.


• Tarsum Shampoo contains a salicylate, which has been linked to Reye syndrome. Do not use Tarsum Shampoo on children or teenagers during or after chickenpox, flu, or other viral infections without checking with your doctor or pharmacist.


• Tarsum Shampoo may cause increased sensitivity to the sun. Avoid exposure to the sun, sunlamps, or tanning booths until you know how you react to Tarsum Shampoo. Use a sunscreen or protective clothing if you must be outside for a prolonged period.


• Use Tarsum Shampoo with extreme caution in CHILDREN younger than 2 years of age. Safety and effectiveness in this age group have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Tarsum Shampoo during pregnancy. It is unknown if Tarsum Shampoo is excreted in breast milk. Do not breast-feed while you are using Tarsum Shampoo.

Possible side effects of Tarsum Shampoo:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Dry, peeling, red, or scaling skin.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); severe irritation.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Tarsum side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include agitation; diarrhea; dizziness; loss of appetite; loss of hearing; mental disturbances; nausea; rapid or difficult breathing; ringing in the ears; seizures; sluggishness; vomiting; yellowing of the skin or eyes.

Proper storage of Tarsum Shampoo:

Store Tarsum Shampoo at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not freeze. Do not store in the bathroom. Keep Tarsum Shampoo out of the reach of children and away from pets.

General information:

• If you have any questions about Tarsum Shampoo, please talk with your doctor, pharmacist, or other health care provider.


• Tarsum Shampoo is to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Tarsum Shampoo. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Tarsum resources

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

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