Verapamil

Pronunciation: ver-AP-a-mil
Generic Name: Verapamil
Brand Name: Calan

Verapamil is used for:

Treating supraventricular tachycardia, a rhythm disturbance of the heart. It is also used for controlling heart rate response to other rhythm disturbances, specifically atrial fibrillation and atrial flutter. It may also be used for other conditions as determined by your doctor.

Verapamil is a calcium channel blocker. It works by slowing the electrical conduction in the heart, slowing heart rate, and/or normalizing heart rhythm.

Do NOT use Verapamil if:

• you are allergic to any ingredient in Verapamil


• you have certain heart problems (eg, left ventricular dysfunction, sick sinus syndrome, second- or third-degree heart block and do not have a pacemaker), very low blood pressure, or moderate to severe congestive heart failure (CHF)


• you have atrial fibrillation or flutter and a pre-excitation syndrome (extra conduction pathway in the heart), such as Wolff-Parkinson-White (WPW) syndrome or Lown-Ganong-Levine (LGL) syndrome


• you have shock due to serious heart problems


• you are taking dofetilide, or you have taken disopyramide within the past 48 hours

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

Before using Verapamil:

Some medical conditions may interact with Verapamil. 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 heart failure or a recent heart attack with lung congestion, low blood pressure, or heart problems (eg, a very slow heart rate, heart block, heart valve disease)


• if you have kidney or liver problems, muscular dystrophy, or a neuromuscular disease


• if you are taking another blood pressure medicine or you are being treated for cancer

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

• Beta-blockers (eg, propranolol), clonidine, disopyramide, ketolides (eg, telithromycin), macrolides (eg, erythromycin), or ritonavir because they may increase the risk of Verapamil's side effects


• Phenobarbital, rifampin, or St. John's wort because they may decrease Verapamil's effectiveness


• Aldosterone blockers (eg, eplerenone), aspirin, carbamazepine, colchicine, cyclosporine, digoxin, dofetilide, doxorubicin, dronedarone, eletriptan, erythromycin, everolimus, flecainide, HMG-CoA reductase inhibitors (eg, lovastatin, simvastatin), lithium, narcotic pain relievers (eg, fentanyl), paclitaxel, quinazolines (eg, terazosin), quinidine, ranolazine, theophyllines, or tolvaptan because the risk of their side effects may be increased by Verapamil

This may not be a complete list of all interactions that may occur. Ask your health care provider if Verapamil 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 Verapamil:

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

• Verapamil is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Verapamil at home, a health care provider will teach you how to use it. Be sure you understand how to use Verapamil. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.


• Do not use Verapamil if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.


• Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.


• If you miss a dose of Verapamil, take 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 take 2 doses at once.

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

Important safety information:

• Verapamil may cause dizziness. This effect may be worse if you take it with alcohol or certain medicines. Use Verapamil with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Verapamil; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.


• Verapamil may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.


• Tell your doctor or dentist that you take Verapamil before you receive any medical or dental care, emergency care, or surgery.


• Lab tests, including liver function, kidney function, complete blood cell counts, electrocardiogram (ECG), and blood pressure, may be performed while you use Verapamil. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.


• Use Verapamil with caution in the ELDERLY; they may be more sensitive to its effects.


• Verapamil should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Verapamil while you are pregnant. Verapamil is found in breast milk. If you are or will be breast-feeding while you use Verapamil, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Verapamil:

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:

Dizziness; fatigue; headache; lightheadedness; mild pain, redness, or swelling at the injection site.

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); chest pain; fainting; lightheadedness, especially when standing; severe dizziness; shortness of breath; swelling of the feet or hands; symptoms of liver problems (eg, yellowing of the skin or eyes, dark urine, pale stools, severe or persistent stomach pain, fever, general feeling of being unwell); unusually fast, slow, or irregular heartbeat.

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: Verapamil 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 decreased mental status; dizziness; loss of consciousness; shortness of breath; slow or irregular heartbeat.

Proper storage of Verapamil:

Store the undiluted solution of Verapamil at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Because the product does not contain a preservative, any unused portion should be discarded. Verapamil is stable for 24 hours when added to compatible intravenous (IV) solutions at 77 degrees F (25 degrees C). Protect from heat, light, and moisture. Keep Verapamil out of the reach of children and away from pets.

General information:

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


• Verapamil 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 Verapamil. 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 Verapamil resources

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

• Verapamil Prescribing Information (FDA)


• verapamil Concise Consumer Information (Cerner Multum)


• verapamil Advanced Consumer (Micromedex) - Includes Dosage Information


• Calan Prescribing Information (FDA)


• Calan SR Prescribing Information (FDA)


• Covera-HS Prescribing Information (FDA)


• Isoptin Concise Consumer Information (Cerner Multum)


• Isoptin SR Prescribing Information (FDA)


• Verapamil Hydrochloride Monograph (AHFS DI)


• Verelan Prescribing Information (FDA)


• Verelan PM Prescribing Information (FDA)

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hepatitis A pediatric vaccine

Generic Name: hepatitis A pediatric vaccine (HEP a TYE tis)

Brand Names: Havrix Pediatric, Vaqta Pediatric

What is hepatitis A pediatric vaccine?

Hepatitis is a serious disease caused by a virus. Hepatitis A is spread through contact with the stool (bowel movements) of a person infected with the hepatitis A virus. This usually occurs by eating food or drinking water that has become contaminated as a result of handling by an infected person.

Hepatitis causes inflammation of the liver, vomiting, and jaundice (yellowing of the skin or eyes). Hepatitis can lead to liver cancer, cirrhosis, or death.

The hepatitis A pediatric vaccine is used to help prevent this disease in children. The vaccine works by exposing your child to a small amount of the virus, which causes the body to develop immunity to the disease. This vaccine will not treat an active infection that has already developed in the body.

Vaccination with hepatitis A pediatric vaccine is recommended for all children between the ages of 12 months and 23 months, and in children and adults who travel in certain areas of the world where hepatitis A is a common disease.

Other risk factors for hepatitis in children include: receiving treatment for hemophilia or other bleeding disorders, or being in an area where there has been an outbreak of hepatitis A.

Like any vaccine, the hepatitis A pediatric vaccine may not provide protection from disease in every person.

What is the most important information I should know about this vaccine?

Hepatitis A pediatric vaccine will not protect your child against infection with hepatitis B, C, and E, or other viruses that affect the liver. It may also not protect a child from hepatitis A if the child is already infected with the virus, even if the child does not yet show symptoms.

The hepatitis A pediatric vaccine is given in a series of 2 shots. The first shot is usually given when the child is between 12 and 23 months old. The booster shot is then given 6 months later. Your child's individual booster schedule may be different from these guidelines. Follow your doctor's instructions or the schedule recommended by the health department of the state you live in.

Vaccination with hepatitis A vaccine is recommended for all children between the ages of 12 months and 23 months, and in children who travel in certain areas of the world where hepatitis A is a common disease.

Other risk factors for hepatitis in children include: receiving treatment for hemophilia or other bleeding disorders, or being in an area where there has been an outbreak of hepatitis A.

Be sure your child receives all recommended doses of this vaccine. If your child does not receive the full series of vaccines, he or she may not be fully protected against the disease.

Your child can still receive a vaccine if he or she has a cold or fever. In the case of a more severe illness with a fever or any type of infection, wait until the child gets better before receiving this vaccine.

Your child should not receive a booster vaccine if he or she had a life-threatening allergic reaction after the first shot.

Keep track of any and all side effects your child has after receiving this vaccine. When the child receives a booster dose, you will need to tell the doctor if the previous shots caused any side effects.

Becoming infected with hepatitis A is much more dangerous to your child's health than receiving the vaccine to protect against it. Like any medicine, this vaccine can cause side effects, but the risk of serious side effects is extremely low.

What should I discuss with my healthcare provider before receiving this vaccine?

Hepatitis A pediatric vaccine will not protect your child against infection with hepatitis B, C, and E, or other viruses that affect the liver. It may also not protect against hepatitis A if the child is already infected with the virus, even if he or she does not yet show symptoms.

Your child should not receive this vaccine if he or she has ever had a life-threatening allergic reaction to any vaccine containing hepatitis A, or if the child has received cancer chemotherapy or radiation treatment in the past 3 months.

Before receiving this vaccine, tell the doctor if your child has:

• 
  

  a bleeding or blood clotting disorder such as hemophilia or easy bruising;

  
  


• 
  

  a history of seizures;

  
  


• 
  

  a neurologic disorder or disease affecting the brain;

  
  


• 
  

  an allergy to latex rubber;

  
  


• 
  

  a weak immune system caused by disease, bone marrow transplant, or by using certain medicines or receiving cancer treatments; or

  
  


• 
  

  if the child is taking a blood thinner such as warfarin (Coumadin).

  
  

Your child can still receive a vaccine if he or she has a cold or fever. In the case of a more severe illness with a fever or any type of infection, wait until the child gets better before receiving this vaccine.

How is this vaccine given?

This vaccine is given as an injection (shot) into a muscle. Your child will receive this injection in a doctor's office or other clinic setting.

The hepatitis A pediatric vaccine is given in a series of 2 shots. The first shot is usually given when the child is between 12 and 23 months old. The booster shot is then given 6 months later. Your child's individual booster schedule may be different from these guidelines. Follow your doctor's instructions or the schedule recommended by the health department of the state you live in.

To prevent hepatitis A while traveling, the child should receive this vaccine at least 2 weeks before the trip. Your child's doctor will determine the best dosing schedule for your situation.

Your doctor may recommend treating fever and pain with an aspirin-free pain reliever such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil, and others) when the shot is given and for the next 24 hours. Follow the label directions or your doctor's instructions about how much of this medicine to give your child.

It is especially important to prevent fever from occurring in a child who has a seizure disorder such as epilepsy.

What happens if I miss a dose?

Contact your doctor if you will miss a booster dose or if you get behind schedule. The next dose should be given as soon as possible. There is no need to start over.

Be sure your child receives all recommended doses of this vaccine. If your child does not receive the full series of vaccines, he or she may not be fully protected against the disease.

What happens if I overdose?

An overdose of this vaccine is unlikely to occur.

What should I avoid before or after receiving this vaccine?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Hepatitis A pediatric vaccine side effects

Your child should not receive a booster vaccine if he or she had a life-threatening allergic reaction after the first shot. Keep track of any and all side effects your child has after receiving this vaccine. When the child receives a booster dose, you will need to tell the doctor if the previous shots caused any side effects.

Becoming infected with hepatitis A is much more dangerous to your child's health than receiving the vaccine to protect against it. Like any medicine, this vaccine can cause side effects, but the risk of serious side effects is extremely low.

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

Call your doctor at once if the child has any of these serious side effects:

• 
  

  extreme drowsiness, fainting;

  
  


• 
  

  fussiness, irritability, crying for an hour or longer;

  
  


• 
  

  seizure (black-out or convulsions); or

  
  


• 
  

  high fever (within a few hours or a few days after the vaccine).

  
  

Less serious side effects include:

• 
  

  mild fever;

  
  


• 
  

  mild fussiness or crying;

  
  


• 
  

  headache;

  
  


• 
  

  dizziness, tired feeling;

  
  


• 
  

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

  
  


• 
  

  joint pain;

  
  


• 
  

  sore throat; or

  
  


• 
  

  swelling, redness, or a hard lump where the shot was given.

  
  

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 vaccine side effects to the US Department of Health and Human Services at 1-800-822-7967.

Hepatitis A pediatric vaccine Dosing Information

Usual Pediatric Dose for Hepatitis A Prophylaxis:

1 years to 18 years:
hepatitis A pediatric vaccine 720 units/0.5 mL intramuscular suspension:
720 units/0.5 mL intramuscularly followed by 720 units/0.5 mL intramuscularly given anytime between 6 to 12 months after primary course.

-OR-

hepatitis A pediatric vaccine 25 units/0.5 mL intramuscular suspension:
25 units/0.5 mL intramuscularly followed by 25 units/0.5 mL intramuscularly given anytime between 6 to 12 months after primary course.

What other drugs will affect hepatitis A pediatric vaccine?

Before receiving this vaccine, tell the doctor about all other vaccines your child has recently received.

Also tell the doctor if your child has received drugs or treatments in the past 2 weeks that can weaken the immune system, including:

• 
  

  an oral, nasal, inhaled, or injectable steroid medicine;

  
  


• 
  

  medications to treat psoriasis, rheumatoid arthritis, or other autoimmune disorders, such as azathioprine (Imuran), efalizumab (Raptiva), etanercept (Enbrel), leflunomide (Arava), and others; or

  
  


• 
  

  medicines to treat or prevent organ transplant rejection, such as basiliximab (Simulect), cyclosporine (Sandimmune, Neoral, Gengraf), muromonab-CD3 (Orthoclone), mycophenolate mofetil (CellCept), sirolimus (Rapamune), or tacrolimus (Prograf).

  
  

If your child is using any of these medications, he or she may not be able to receive the vaccine, or may need to wait until the other treatments are finished.

This list is not complete and other drugs may interact with this vaccine. Tell your doctor about all medications your child receives. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More hepatitis A pediatric vaccine resources

• Hepatitis A pediatric vaccine Drug Interactions
• Hepatitis A pediatric vaccine Support Group
• 0 Reviews for Hepatitis A pediatric vaccine - Add your own review/rating

• Havrix Pediatric Advanced Consumer (Micromedex) - Includes Dosage Information

Compare hepatitis A pediatric vaccine with other medications

• Hepatitis A Prophylaxis

Where can I get more information?

• Your doctor or pharmacist can provide more information about this vaccine. Additional information is available from your local health department or the Centers for Disease Control and Prevention.

Flunisolide eent

Class: Corticosteroids
ATC Class: R01AD
VA Class: RE101
Chemical Name: 6α,11β,16α) - 6 - fluoro - 11,21 - dihydroxy - 16,17 - [(1 - methylethylidene)bis(oxy)] - pregna - 1,4 - diene - 3,20 - dione hemihydrate
Molecular Formula: C₂₄H₃₁FO₆•½H₂O
CAS Number: 77326-96-6

Introduction

Synthetic fluorinated corticosteroid.^a

Uses for Flunisolide

Seasonal and Perennial Rhinitis

Symptomatic treatment of seasonal or perennial rhinitis^{a b} when conventional therapy with antihistamines or decongestants is ineffective or produces intolerable adverse effects.^b

Generally provides symptomatic relief of watery rhinorrhea, nasal congestion, sneezing, postnasal drip, and pharyngeal itching;^b generally does not relieve symptoms of conjunctivitis or those involving the lower respiratory tract^b

Appears to provide greater symptomatic relief in allergic rhinitis than in nonallergic rhinitis^b

Serious Otitis Media

Has been used intranasally for the treatment of serous otitis media† (eustachian tube dysfunction, middle ear effusion) in children. ^b

Corticosteroid-dependent Asthma

Although orally inhaled flunisolide is used for the treatment of asthma, the nasal solution is not recommended for this purpose, since the safety of polyethylene glycol in the vehicle of the nasal solution has not been established for this route of administration.^b

Flunisolide Dosage and Administration

Administration

Intranasal Administration

Administer by nasal inhalation using a special nasal inhaler.

Avoid contact with the eyes.^a

Poor clinical response can result from improper drug administration techniques, poor drug penetration (secondary to marked nasal congestion, presence of nasal polyps, or symptoms originating in the nasal sinuses), or localized infections of the nasal mucosa.^b

Clear nasal passages prior to administration.^b If nasal passages are blocked, a topical nasal decongestant can be administered 5–15 minutes before intranasal administration during the first 2–3 days of therapy to ensure adequate penetration of the drug and prevent loss from the nasal passages via excess secretions.^b

Prior to initial use, the nasal inhaler must be assembled and primed.^b

After assembly is complete, tilt the head slightly forward, insert the spray tip into one nostril, and point the tip toward the inflamed nasal turbinates and away from the nasal septum.^b

Pump the drug into one nostril while holding the other nostril closed and concurrently inspire through the nose.^b Repeat procedure for the other nostril.^b

Advise patients to cleanse the nasal adapter and/or pump in warm water if the holes in the device become clogged.^b If the nasal inhaler is disassembled for any reason (including the cleansing procedure) or not used for 5 days or longer, it must be primed again prior to use.^b

Dosage

After priming, nasal inhaler delivers about 25 mcg of flunisolide per metered spray and about 200 metered sprays per 25-mL container.^a

Adjust dosage according to individual requirements and response.^{a b}

Therapeutic effects of intranasal corticosteroids, unlike those of decongestants, are not immediate.^b This should be explained to the patient in advance to ensure compliance and continuation of the prescribed treatment regimen.^b

Symptomatic relief is usually evident within 2–3 days of continuous therapy; however, occasionally, up to 2–3 weeks may be required for optimum effectiveness.^b

Generally assess response to the initial dosage 4–7 days after starting therapy; about two-thirds will experience some relief within this time period.^b

Once symptoms of seasonal or perennial rhinitis have been controlled, gradually reduce dosage to the lowest effective level.^b

Discontinue intranasal flunisolide in patients who do not experience clinically important benefit within 3 weeks of initiating therapy.^b

Pediatric Patients

Seasonal Rhinitis

Intranasal Inhalation

Children 6–14 years of age: 1 spray (25 mcg) in each nostril 3 times daily or 2 sprays (50 mcg) in each nostril twice daily (total dose: 150–200 mcg/day).^{a b}

Perennial Rhinitis

Intranasal Inhalation

Children 6–14 years of age: 1 spray (25 mcg) in each nostril 3 times daily or 2 sprays (50 mcg) in each nostril twice daily (total dose 150–200 mcg/day).^b

Adults

Seasonal Rhinitis

Intranasal Inhalation

Usual initial dose is 50 mcg (2 sprays) in each nostril twice daily.^{a b} When necessary, increase to 50 mcg (2 sprays) in each nostril 3 times daily.^{a b}

Maintenance: 25 mcg (1 spray) in each nostril daily (50 mcg total) may be sufficient.^{a b}

Perennial Rhinitis

Intranasal Inhalation

Usual initial dose is 50 mcg (2 sprays) in each nostril twice daily.^{a b} When necessary, increase to 50 mcg (2 sprays) in each nostril 3 times daily.^{a b}

Maintenance: 25 mcg (1 spray) in each nostril daily (50 mcg total) may be sufficient.^{a b}

Prescribing Limits

No evidence that higher than recommended dosages or increased frequency of administration is beneficial.^b

Exceeding the maximum recommended daily dosage may only increase the risk of adverse systemic effects (e.g., HPA-axis suppression, Cushing’s syndrome).^b

Pediatric Patients

Seasonal Rhinitis

Intranasal Inhalation

Children 6-14 years of age: daily dosage should not exceed 100 mcg (4 sprays) in each nostril (200 mcg total).^{a b}

Perennial Rhinitis

Intranasal Inhalation

Children 6-14 years of age: daily dosage should not exceed 100 mcg (4 sprays) in each nostril (200 mcg total).^{a b}

Adults

Seasonal Rhinitis

Intranasal Inhalation

Daily dosage should not exceed 200 mcg (8 sprays) in each nostril (400 mcg total).^{a b}

Perennial Rhinitis

Intranasal Inhalation

Daily dosage should not exceed 200 mcg (8 sprays) in each nostril (400 mcg total).^{a b}

Special Populations

Hepatic Impairment

No specific dosage recommendations for hepatic impairment.^a

Renal Impairment

No specific dosage recommendations for renal impairment.^a

Geriatric Patients

No specific geriatric dosage recommendations.^a

Cautions for Flunisolide

Contraindications

• 
  

  Known hypersensitivity to flunisolide or any ingredient in the formulation.^{a b}

  
  


• 
  

  Do not use in the presence of untreated localized nasal mucosa infections.^a

  
  

Warnings/Precautions

Warnings

Withdrawal of Systemic Corticosteroid Therapy

Patients being switched from prolonged systemic corticosteroids to intranasal therapy should be monitored carefully since corticosteroid withdrawal symptoms (e.g., joint pain, muscular pain, lassitude, depression), acute adrenal insufficiency, and/or severe symptomatic exacerbation of asthma or other clinical conditions may occur.^{a b}

Systemic corticosteroid dosage should be tapered, and patients should be carefully monitored during dosage reduction.^b

Infection, Trauma, or Surgery

Use cautiously, if at all, in patients with clinical tuberculosis or asymptomatic Mycobacterium tuberculosis infections; untreated fungal, bacterial, or systemic viral or ocular herpes simplex infections; or septal ulcers, trauma, or surgery in the nasal region.^{a b}

Hypothalamic-Pituitary-Adrenal (HPA) Axis Suppression

Avoid higher than recommended dosages since suppression of HPA function may occur.^b

Immunosuppression

Although risk with intranasal use is unknown, consider the possibility that corticosteroid-induced immunosuppression could occur.^a Avoid exposure to varicella and measles in previously unexposed patients.^a

General Precautions

Systemic Corticosteroid Effects

Excessive intranasal dosages or use in patients who are particularly sensitive to corticosteroid effects may cause systemic corticosteroid effects (e.g., Cushing’s syndrome, adrenal suppression).^{a b}

Nasopharyngeal Effects

Temporary or permanent loss of smell may occur.^a

Rarely, localized candidal infections of the nose and/or pharynx.^{a b} Treat suspected local infection appropriately^{a b} ; may require discontinuance of flunisolide therapy.^{a b}

Rarely, nasal septal perforations.^a

Avoid use until healing occurs in patients with recurrent epistaxis, recent nasal septal ulcers, nasal surgery, or nasal trauma.^a

Oral Effects

Temporary or permanent loss of taste may occur.^a

Specific Populations

Pregnancy

Category C.^a

Lactation

Other corticosteroids known to be distributed into milk.^{a b} Caution if used in nursing women.^{a b}

May cause adverse effects (e.g., growth suppression) in nursing infants if distributed.^b

Pediatric Use

May be a useful therapeutic alternative to oral corticosteroids in children ≥6 years of age with seasonal or perennial allergic rhinitis, since intranasal administration is associated with a decreased risk of adverse systemic effects.^b

Intranasal corticosteroids may reduce growth velocity in pediatric patients.^{a b}

Safety and efficacy haven’t been established in children < 6 months of age.^a

Common Adverse Effects

Mild, transient nasal burning and stinging,^{a b} aftertaste,^{a b} nasal congestion,^{a b} epistaxis,^{a b} headache,^{a b} watery eyes,^{a b} nausea,^{a b} vomiting,^{a b} abdominal bloating,^b upper respiratory tract infection,^pdh cold symptoms.^pdh

Interactions for Flunisolide

No reports to date of clinically important drug interactions.^b

Drugs Affecting Hepatic Microsomal Enzymes

Phenobarbital and other agents that induce hepatic microsomal enzymes may enhance the metabolism of corticosteroids.^b

Flunisolide Pharmacokinetics

Absorption

Bioavailability

About 50% of a nasally inhaled dose is absorbed systemically.^b

Onset

Symptomatic relief usually is evident within 2–3 days of continuous therapy but may take up to 2–3 weeks.^b

Distribution

Extent

Placental distribution in humans is unknown, but flunisolide apparently crosses the placenta in animals.^b

Distribution into milk unknown, but other corticosteroids are distributed.^{a b}

Plasma Protein Binding

At a plasma concentration of 1–20,000 ng/mL, about 50% bound to plasma albumin.^b No binding to glucocorticosteroid binding globulin.^b

Elimination

Metabolism

Metabolized via the liver.^b

Elimination Route

Excretion pathway is unknown when inhaled; however, when given systemically, metabolites are excreted in roughly equal portions in feces and urine.^pdh

Drug absorbed via nasopharyngeal mucosa bypasses extensive first-pass hepatic metabolism.^b

Half-life

Plasma half-life: 1–2 hours.^a

Stability

Storage

Solutions

Tight, light-resistant container at 15–30°C.^{a b c}

Discard opened containers after 3 months.^{a b}

ActionsActions

• 
  

  Potent glucocorticoid and weak mineralocorticoid effects.^b

  
  


• 
  

  Local anti-inflammatory and vasoconstrictor effects;^b topical potency similar to triamcinolone acetonide.^b

  
  


• 
  

  May reduce the number of mediator cells (basophil leukocytes and mast cells) at the epithelial level, number of eosinophils, sensitivity of sensory nerves to mechanical stimuli, secretory response to cholinergic receptor stimulation, and fibroblast activity.^b

  
  


• 
  

  May inhibit capillary dilation and permeability.^b

  
  


• 
  

  May stabilize lysosomal membranes and subsequently prevent the release of proteolytic enzymes.^b

  
  

Advice to Patients

• 
  

  Proper techniques for assembly and priming of nasal spray pump and for administration of the nasal solution.^{a b} Importance of not administering the entire dose (i.e., 4 sprays) into a single nostril.^{a b} Give patients a copy of the manufacturer’s patient instructions.^{a b}

  
  


• 
  

  Advise patients that opened containers of flunisolide nasal solution should be discarded after 3 months.^b

  
  


• 
  

  Advise patients that effects are not immediate; full benefit requires regular use and usually can be achieved in several days.^a

  
  


• 
  

  Importance of taking as directed.^a

  
  


• 
  

  Importance of informing clinician if no improvement is seen within 3 weeks or if the condition worsens.^a

  
  


• 
  

  Importance of not increasing dosage unless directed by a clinician.^a

  
  


• 
  

  Importance of advising clinician if sneezing or nasal irritation occurs.^a

  
  


• 
  

  Advise that concomitant nasal decongestants and/or oral antihistamines may be needed until effects of flunisolide are optimal.^a

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.^{a b}

  
  


• 
  

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

  
  


• 
  

  Importance of informing patients of other important precautionary information.^{a b} (See Cautions.)

  
  

Preparations

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

Flunisolide

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Nasal	Solution	25 mcg/metered spray	Flunisolide Spray	Bausch & Lomb

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.

Flunisolide 0.025% Solution (RISING PHARMACEUTICALS): 25/$49.99 or 75/$145.97

Flunisolide 29MCG/ACT Solution (APOTEX): 25/$45.99 or 75/$129.97

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.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions April 2010. 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

a. Bausch & Lomb Pharmaceuticals, Inc. Flunisolide Nasal Solution prescribing information. Tampa, FL: 2000 August.

b. AHFS Drug Information 2004. McEvoy, GK, ed. Flunisolide. Bethesda, MD: American Society of Health-System Pharmacists; 2004:2666-2669.

c. The United States pharmacopeia, 27rd rev, and The national formulary, 22th ed. Rockville, MD: The United States Pharmacopeial Convention, Inc; 2000:806.

pdh. Schilling McCann JA, Publisher. Pharmacists drug handbook. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins and American Society of Health-System Pharmacists; 2003.

More Flunisolide eent resources

• Flunisolide eent Use in Pregnancy & Breastfeeding
• Flunisolide eent Support Group
• 2 Reviews for Flunisolide eent - Add your own review/rating

Compare Flunisolide eent with other medications

• Hay Fever

Elocon Cream

1. Name Of The Medicinal Product

Elocon Cream

2. Qualitative And Quantitative Composition

Mometasone Furoate 0.1% w/w

Propylene glycol stearate 8.0% w/w

Stearyl alcohol 68.5-74.5 %w/w

3. Pharmaceutical Form

Cream

4. Clinical Particulars

4.1 Therapeutic Indications

Elocon Cream is indicated for the treatment of inflammatory and pruritic manifestations of psoriasis (excluding widespread plaque psoriasis) and atopic dermatitis.

4.2 Posology And Method Of Administration

Adults, including elderly patients and Children : A thin film of Elocon Cream should be applied to the affected areas of skin once daily.

Use of topical corticosteroids in children or on the face should be limited to the least amount compatible with an effective therapeutic regimen and duration of treatment should be no more than 5 days.

4.3 Contraindications

Elocon is contraindicated in facial rosacea, acne vulgaris, perioral dermatitis, perianal and genital pruritis, napkin eruptions, bacterial (e.g. impetigo), viral (e.g. herpes simplex, herpes zoster and chickenpox) and fungal (e.g. candida or dermatophyte) infections, varicella, tuberculosis, syphilis or post-vaccine reactions. Elocon should not be used in patients who are sensitive to mometasone furoate or to other corticosteroids.

4.4 Special Warnings And Precautions For Use

If irritation or sensitisation develop with the use of Elocon, treatment should be withdrawn and appropriate therapy instituted.

Should an infection develop, use of an appropriate antifungal or antibacterial agent should be instituted. If a favourable response does not occur promptly, the corticosteroid should be discontinued until the infection is adequately controlled.

Local and systemic toxicity is common especially following long continued use on large areas of damaged skin, in flexures and with polythene occlusion. If used in childhood, or on the face, courses should be limited to 5 days and occlusion should not be used. Long term continuous therapy should be avoided in all patients irrespective of age.

Topical steroids may be hazardous in psoriasis for a number of reasons including rebound relapses following development of tolerance, risk of centralised pustular psoriasis and development of local or systemic toxicity due to impaired barrier function of the skin. If used in psoriasis careful patient supervision is important.

ELOCON Cream contains propylene glycol which may cause skin irritation. ELOCON Cream contains stearyl alcohol which may cause local skin reactions (e.g. contact dermatitis).

Elocon topical preparations are not for ophthalmic use.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

None stated

4.6 Pregnancy And Lactation

There is inadequate evidence of safety in human pregnancy. Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate and intra-uterine growth retardation. There may therefore be a very small risk of such effects in the human foetus.

It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Elocon should be administered to nursing mothers only after careful consideration of the benefit/risk relationship.

4.7 Effects On Ability To Drive And Use Machines

None stated.

4.8 Undesirable Effects

Local adverse reactions occasionally reported with Elocon include paresthesia, folliculitis, burning, pruritis, tingling, stinging, application site reactions, allergic contact dermatitis, hypopigmentation, hypertrichosis, secondary infection, furunculosis, striae, acneiform reactions and signs of skin atrophy.

Local adverse reactions reported infrequently with topical dermatalogic corticosteroids include: skin dryness, irritation, perioral dermatitis, maceration of the skin and miliaria.

Paediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced hypothalamic-pituitary-adrenal axis suppression and Cushing's syndrome than mature patients because of a larger skin surface area to body weight ratio.

Chronic corticosteroids therapy may interfere with the growth and development of children.

4.9 Overdose

None stated.

5. Pharmacological Properties

5.1 Pharmacodynamic Properties

Mometasone furoate exhibits marked anti-inflammatory activity and marked anti-psoriatic activity in standard animal predictive models.

In the croton oil assay in mice, mometasone was equipotent to betamethasone valerate after single application and about 8 times as potent after five applications.

In guinea pigs, mometasone was approximately twice as potent as betamethasone valerate in reducing m.ovalis-induced epidermal acanthosis (i.e. anti-psoriatic activity) after 14 applications.

5.2 Pharmacokinetic Properties

Pharmacokinetic studies have indicated that systemic absorption following topical application of mometasone furoate cream 0.1% is minimal, approximately 0.4% of the applied dose in man, the majority of which is excreted within 72 hours following application. Characterisation of metabolites was not feasible owing to the small amounts present in plasma and excreta.

5.3 Preclinical Safety Data

There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.

6. Pharmaceutical Particulars

6.1 List Of Excipients

Hexylene glycol

phosphoric acid

propylene glycolstearate

stearyl alcohol and ceteareth-20

titanium dioxide

aluminium starch octenylsuccinate

white beeswax

white soft paraffin

purified water

6.2 Incompatibilities

None Known

6.3 Shelf Life

36 months

6.4 Special Precautions For Storage

Store between 2 and 30°C.

6.5 Nature And Contents Of Container

5, 15, 30, 45 and 100gm aluminium tubes with low density polyethylene cap or laminated tubes with high density polyethylene head and polypropylene cap.

6.6 Special Precautions For Disposal And Other Handling

Not applicable

7. Marketing Authorisation Holder

Merck Sharp & Dohme Limited

Hertford Road

Hoddesdon

Hertfordshire

EN11 9BU

UK

8. Marketing Authorisation Number(S)

PL 00025/0577

9. Date Of First Authorisation/Renewal Of The Authorisation

19 November 1991 / 15 April 2002

10. Date Of Revision Of The Text

22 December 2010

11. LEGAL CATEGORY

Prescription Only Medicine

© Merck Sharp & Dohme Limited 2011. All rights reserved.

Elocon-C/UK/12-10/2

triamcinolone Injection

trye-am-SIN-oh-lone

Commonly used brand name(s)

In the U.S.

• Aristocort


• Aristocort Forte


• Aristospan


• Clinacort


• Kenalog-10


• Kenalog-40


• Triamcot


• Triam-Forte


• Triesense

Available Dosage Forms:

• Suspension

Therapeutic Class: Endocrine-Metabolic Agent

Pharmacologic Class: Adrenal Glucocorticoid

Uses For triamcinolone

Triamcinolone injection is used to treat inflammation (swelling), allergic reactions, certain types of arthritis, gout, skin diseases, and many other medical problems. It is given to patients who are not able to take medicines by the mouth. triamcinolone is a corticosteroid (cortisone-like medicine or steroid).

triamcinolone is to be administered only by or under the immediate supervision of your doctor.

Before Using triamcinolone

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 triamcinolone, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to triamcinolone 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 performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of triamcinolone injection in the pediatric population. However, because of triamcinolone's toxicity, it should be used with caution especially in premature babies.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of triamcinolone injection in the elderly.

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. When you are receiving triamcinolone, 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 triamcinolone 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.

• Rotavirus Vaccine, Live

Using triamcinolone 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.

• Aldesleukin


• Quetiapine

Using triamcinolone 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.

• Alatrofloxacin


• Alcuronium


• Aspirin


• Atracurium


• Balofloxacin


• Cinoxacin


• Ciprofloxacin


• Clinafloxacin


• Enoxacin


• Fleroxacin


• Flumequine


• Gallamine


• Gemifloxacin


• Grepafloxacin


• Hexafluorenium


• Itraconazole


• Levofloxacin


• Licorice


• Lomefloxacin


• Metocurine


• Moxifloxacin


• Norfloxacin


• Ofloxacin


• Pefloxacin


• Phenytoin


• Primidone


• Prulifloxacin


• Rosoxacin


• Rufloxacin


• Saiboku-To


• Sparfloxacin


• Temafloxacin


• Tosufloxacin


• Trovafloxacin Mesylate

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 triamcinolone. Make sure you tell your doctor if you have any other medical problems, especially:

• Bone problems (e.g., osteoporosis) or


• Cataracts or


• Cirrhosis (liver problem) or


• Congestive heart failure or


• Depression or


• Emotional problems or


• Glaucoma or


• Heart attack, recent or


• Heart disease or


• Hypertension (high blood pressure) or


• Intracranial hypertension (increased pressure in the head) or


• Kaposi's sarcoma or


• Kidney disease, severe or


• Mental illness or


• Myasthenia gravis (severe muscle weakness) or


• Stomach or bowel problems (e.g., diverticulitis, ulcers, ulcerative colitis) or


• Thyroid problems—Use with caution. May make these conditions worse.

• Brain injury, traumatic or


• Cerebral malaria or


• Herpes infection of the eye or


• Idiopathic thrombocytopenic purpura (low platelet count)—Should not be used in patients with this condition.

• Infection (bacteria, virus, fungus, parasite, or protozoa)—May decrease your body's ability to fight infection.

• Tuberculosis infection, inactive—Should be treated first before starting therapy with triamcinolone.

Proper Use of triamcinolone

A nurse or other trained health professional will give you triamcinolone. You may also be taught how to give your medicine at home. triamcinolone is given as a shot into one of your muscles, a joint, or a spot on your skin called a lesion.

Precautions While Using triamcinolone

Your doctor will check your progress closely while you or your child are receiving triamcinolone. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to receive it.

triamcinolone contains benzyl alcohol which may cause serious reactions (e.g., gasping syndrome, low blood pressure, and metabolic acidosis) to newborn or premature infants. Discuss this with your doctor if you are concerned.

triamcinolone 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 or your child have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth after receiving triamcinolone.

Let your doctor know if you or your child have any events causing unusual stress or anxiety in your life. Your doctor may give you oral corticosteroids.

triamcinolone may cause fluid retention (edema) in some patients. Carefully follow your doctor's instructions about any special diet (especially on salt intake).

Using too much of triamcinolone or using it for a long time may increase your risk of having adrenal gland problems. The risk is greater for children and for patients who use large amounts for a long time. Talk to your doctor if you have more than one of these symptoms while you are using triamcinolone: blurred vision; dizziness or fainting; a fast, pounding, or uneven heartbeat; increased thirst or urination; irritability; or unusual tiredness or weakness.

It may be easier for you to get an infection while you or your child are receiving triamcinolone. Avoid crowded places or being near people who are sick. If you are exposed to chicken pox or measles, tell your doctor right away.

Tell your doctor if you or your child have recently spent time in a tropical climate or have unexplained diarrhea before receiving triamcinolone.

Talk with your doctor before getting flu shots or other vaccines while you or your child are receiving triamcinolone because there are certain vaccines that you should not receive.

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

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

Do not stop using triamcinolone without checking first with your doctor. Your doctor may want you or your child to gradually reduce the amount you are using before stopping it completely

triamcinolone may cause slow growth. If your child is using triamcinolone, the doctor will need to keep track of your child's height and weight to make sure that your child is growing properly.

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.

triamcinolone 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 or nurse immediately if any of the following side effects occur:

More common

• Aggression


• agitation


• anxiety


• blurred vision


• decrease in the amount of urine


• dizziness


• fast, slow, pounding, or irregular heartbeat or pulse


• headache


• irritability


• mental depression


• mood changes


• nervousness


• noisy, rattling breathing


• numbness or tingling in the arms or legs


• pounding in the ears


• shortness of breath


• swelling of the fingers, hands, feet, or lower legs


• trouble thinking, speaking, or walking


• troubled breathing at rest


• weight gain

Incidence not known

• Abdominal cramping and/or burning (severe)


• abdominal pain


• backache


• bloody, black, or tarry stools


• cough or hoarseness


• darkening of skin


• decreased vision


• diarrhea


• dry mouth


• eye pain


• eye tearing


• facial hair growth in females


• fainting


• fatigue


• fever or chills


• flushed, dry skin


• fractures


• fruit-like breath odor


• full or round face, neck, or trunk


• heartburn and/or indigestion (severe and continuous)


• increased hunger


• increased thirst


• increased urination


• loss of appetite


• loss of sexual desire or ability


• lower back or side pain


• menstrual irregularities


• muscle pain or tenderness


• muscle wasting or weakness


• nausea


• pain in back, ribs, arms, or legs


• painful or difficult urination


• skin rash


• sleeplessness


• sweating


• trouble healing


• trouble sleeping


• unexplained weight loss


• unusual tiredness or weakness


• vision changes


• vomiting


• vomiting of material that looks like coffee grounds

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

• Blemishes on the skin


• bruising


• dry, scaly skin


• feeling of constant movement of self or surroundings


• full or bloated feeling


• increased appetite


• increased hair growth on the face, forehead, back, arms, and legs


• large, flat, blue, or purplish patches in the skin


• pimples


• pitting or depression of the skin at the injection site


• reddish purple lines on the arms, face, legs, trunk, or groin


• redness of the skin


• redness, swelling, tenderness, or pain at the injection site


• sensation of spinning


• small, red, or purple spots on the skin


• thin, fragile, or shiny skin


• thinning of the scalp hair

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.

More triamcinolone Injection resources

• Triamcinolone Injection Use in Pregnancy & Breastfeeding
• Drug Images
• Triamcinolone Injection Drug Interactions
• Triamcinolone Injection Support Group
• 24 Reviews for Triamcinolone Injection - Add your own review/rating

Compare triamcinolone Injection with other medications

• Adrenocortical Insufficiency
• Allergic Reactions
• Alopecia
• Ankylosing Spondylitis
• Asthma
• Berylliosis
• Bursitis
• Chorioditis
• Chorioretinitis
• Conjunctivitis
• Dermal Necrosis, Prophylaxis
• Dermatitis
• Dermatological Disorders
• Erythroblastopenia
• Frozen Shoulder
• Gouty Arthritis
• Hay Fever
• Heart Failure
• Hemolytic Anemia
• Idiopathic Thrombocytopenic Purpura
• Iridocyclitis
• Iritis
• Keloids
• Keratitis
• Leukemia
• Lichen Planus
• Lichen Sclerosus
• Lichen Simplex Chronicus
• Loeffler's Syndrome
• Meningitis
• Nephrotic Syndrome
• Neuritis
• Osteoarthritis
• Pityriasis rubra pilaris
• Psoriasis
• Psoriatic Arthritis
• Rheumatoid Arthritis
• Sarcoidosis
• Synovitis
• Systemic Lupus Erythematosus
• Thrombocytopenia Idiopathic
• Uveitis

P-A-C

Pronunciation: AS-pir-in/cah-FEEN
Generic Name: Aspirin/Caffeine
Brand Name: Examples include Anacin and P-A-C

P-A-C is used for:

Treating pain including, headache, muscle aches, sprains, tooth extraction and toothache, menstrual cramps, arthritis and rheumatism, and pain and fever of the common cold. It may also be used for other conditions as determined by your doctor.

P-A-C is a combination salicylate and stimulant. It works by blocking several different chemical processes within the body that cause pain, inflammation, and fever. It also reduces the tendency for blood to clot.

Do NOT use P-A-C if:

• you are allergic to any ingredient in P-A-C


• you are a child or teenager with influenza (flu) or chickenpox


• you have bleeding problems such as hemophilia, von Willebrand disease, or low blood platelets, or you have active severe bleeding


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


• you are taking anticoagulants (eg, heparin, warfarin) or methotrexate

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

Before using P-A-C:

Some medical conditions may interact with P-A-C. 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 alcoholism or if you consume 3 or more alcohol-containing drinks every day


• if you have asthma, bleeding or clotting problems, growths in the nose (nasal polyps), kidney or liver problems, stomach or intestinal problems (eg, ulcer, inflammation), heart problems, heartburn, upset stomach, stomach pain, hives, influenza (flu) or chickenpox, or vitamin K deficiency


• if you have anxiety, trouble sleeping, or heart problems


• if you are a child with a stroke, a weakened blood vessel (cerebral aneurysm) or bleeding in the brain, rheumatic disease (eg, rheumatoid arthritis), or Kawasaki syndrome (a rare inflammation causing heart problems in children)

Some MEDICINES MAY INTERACT with P-A-C. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Carbonic anhydrase inhibitors (eg, acetazolamide) because they may decrease P-A-C's effectiveness


• Anticoagulants (eg, heparin, warfarin), clopidogrel, or NSAIDs (eg, ibuprofen, celecoxib) because the risk of their side effects, including risk of bleeding, may be increased by P-A-C


• Quinolones (eg, ciprofloxacin) because side effects, such as problems sleeping, nervousness, jitteriness, or anxiety, may occur


• Insulin or oral antidiabetics (eg, glyburide, nateglinide) because the risk of their side effects, including low blood sugar (eg, hunger, shakiness or weakness, dizziness, headache, sweating), may be increased by P-A-C


• Methotrexate, theophylline, or valproic acid because the risk of their actions and side effects may be increased by P-A-C


• Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), probenecid, or sulfinpyrazone because their effectiveness may be decreased by P-A-C

This may not be a complete list of all interactions that may occur. Ask your health care provider if P-A-C 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 P-A-C:

Use P-A-C as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take P-A-C by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Taking it with food may not decrease the risk of stomach or bowel problems (eg, bleeding, ulcers) that may occur while taking P-A-C.


• Take P-A-C with a full glass of water (8 oz/240 mL). Do not lie down for 30 minutes after taking P-A-C.


• Use P-A-C exactly as directed on the package, unless instructed differently by your doctor. If you are taking P-A-C without a prescription, follow any warnings and precautions on the label.


• If you miss a dose of P-A-C and you are taking it regularly, take 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 take 2 doses at once.

Ask your health care provider any questions you may have about how to use P-A-C.

Important safety information:

• P-A-C may cause dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use P-A-C with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Avoid large amounts of food or drink that have caffeine (eg, coffee, tea, cocoa, cola, chocolate). This includes any medicines that contain caffeine.


• P-A-C has aspirin in it. Before you start any new medicine, check the label to see if it has aspirin in it too. If it does or if you are not sure, check with your doctor or pharmacist.


• Talk to your doctor before you take P-A-C or other pain relievers/fever reducers if you drink more than 3 drinks with alcohol per day. Serious stomach ulcers or bleeding can occur with the use of P-A-C. Taking it in high doses or for a long time, smoking, or drinking alcohol increases the risk of these side effects. Taking P-A-C with food will NOT reduce the risk of these effects. Contact your doctor or emergency room at once if you develop severe stomach or back pain; black, tarry stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling.


• Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. Taking more than the recommended dose or taking P-A-C regularly may be habit-forming.


• P-A-C may reduce the number of clot-forming cells (platelets) in your blood. To prevent bleeding, avoid situations in which bruising or injury may occur. Report any unusual bleeding, bruising, blood in stools, or dark, tarry stools to your doctor.


• Aspirin has been linked to a serious illness called Reye syndrome. Do not give P-A-C to a child or teenager who has the flu, chickenpox, or a viral infection. Contact your doctor with any questions or concerns.


• Diabetes patients - P-A-C may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.


• If P-A-C has a strong vinegar-like smell upon opening, do not use. It means the medicine is breaking down. Throw the bottle away safely and out of the reach of children; contact your pharmacist and replace.


• Tell your doctor or dentist that you take P-A-C before you receive any medical or dental care, emergency care, or surgery.


• Do not take P-A-C for at least 7 days after any surgery unless directed by your health care provider.


• Do not take P-A-C for more than 10 days for pain or for more than 3 days for fever unless directed to do so by your health care provider.


• Different brands of P-A-C may have different dosing instructions for CHILDREN. Follow the dosing instructions on the package labeling. If your doctor has given you instructions, follow those. If you are unsure of the dose to give a child, check with your doctor or pharmacist.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using P-A-C while you are pregnant. P-A-C is not recommended during the last 3 months (third trimester) of pregnancy because it may cause harm to the fetus. P-A-C is found in breast milk. If you are or will be breast-feeding while you use P-A-C, check with your doctor. Discuss any possible risks to your baby.

Some people who use P-A-C for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction.

If you stop taking P-A-C suddenly, you may have WITHDRAWAL symptoms including dizziness, headache, unusual tiredness, irritability, muscle tension, and nausea.

Possible side effects of P-A-C:

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:

Dizziness; heartburn; irritability; nausea; nervousness; upset stomach.

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); black or bloody stools; confusion; diarrhea; drowsiness; hearing loss; ringing in the ears; severe or persistent dizziness; severe or persistent stomach pain or heartburn; shakiness; trouble sleeping; vomiting.

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: P-A-C 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 ( http://www.aapcc.org), or emergency room immediately. Symptoms may include agitation; anxiety; confusion; fever; hearing loss; lethargy; lightheadedness, especially upon standing; muscle twitching; nausea; rapid breathing; rapid or irregular heartbeat; ringing in the ears; seizures; shortness of breath; stomach pain; trouble sleeping; vomiting.

Proper storage of P-A-C:

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

General information:

• If you have any questions about P-A-C, please talk with your doctor, pharmacist, or other health care provider.


• P-A-C 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 P-A-C. 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 P-A-C resources

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

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