What is lisinopril? Lisinopril is an ACE inhibitor. ACE stands for angiotensin converting enzyme. Lisinopril is used to treat high blood pressure (hypertension) in adults and children who are at least 6 years old. Lisinopril is also used to treat congestive heart failure in adults, or to improve survival after a heart attack. Warnings Do not use lisinopril if you are pregnant. It could harm the unborn baby. Stop using this medicine and tell your doctor right away if you become pregnant. You should not use this medicine if you have ever had angioedema. Do not take lisinopril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto). If you have diabetes, do not use lisinopril together with any medication that contains aliskiren (such as Amturnide, Tekturna, Tekamlo). You may also need to avoid taking lisinopril with aliskiren if you have kidney disease. Before taking this medicine You should not use lisinopril if you are allergic to it, or if you: have a history of angioedema; recently took a heart medicine called sacubitril; or are allergic to any other ACE inhibitor, such as benazepril, captopril, enalapril, fosinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril. Do not take lisinopril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto). If you have diabetes, do not use lisinopril together with any medication that contains aliskiren (such as Tekturna or Tekamlo). You may also need to avoid taking lisinopril with aliskiren if you have kidney disease. To make sure this medicine is safe for you, tell your doctor if you have ever had: kidney disease (or if you are on dialysis); liver disease; or high levels of potassium in your blood. Do not use lisinopril if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. This medicine can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking this medicine. It is not known whether lisinopril passes into breast milk or if it could harm a nursing baby. You should not breastfeed while using this medicine. How should I take lisinopril? Take lisinopril exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended. Drink plenty of water each day while you are taking this medicine. Lisinopril can be taken with or without food. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. Your blood pressure will need to be checked often. Your kidney function and electrolytes may also need to be checked. Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medicine. This can lead to very low blood pressure, electrolyte disorders, or kidney failure while you are taking lisinopril. If you need surgery, tell the surgeon ahead of time that you are using lisinopril. If you have high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. Store at room temperature away from moisture and heat. Do not freeze the oral liquid. Dosing information Usual Adult Dose for Hypertension: Initial dose: 10 mg orally once a day; 5 mg orally once a day Maintenance dose: 20 to 40 mg orally once a day Maximum dose: 80 mg orally once a day Comments: -The initial dose is 5 mg orally once a day in patients receiving a diuretic. -The 80 mg dose is used but does not appear to give greater effect. -If blood pressure is not controlled with lisinopril alone, a low dose of a diuretic may be added (e.g., hydrochlorothiazide, 12.5 mg). After the addition of a diuretic, it may be possible to reduce the dose of lisinopril. Usual Adult Dose for Congestive Heart Failure: Initial dose: 2.5 to 5 mg orally once a day Maintenance dose: Dosage should be increased as tolerated Maximum dose: 40 mg orally once a day Comments: -The diuretic dose may need to be adjusted to help minimize hypovolemia, which may contribute to hypotension. The appearance of hypotension after the initial dose of lisinopril does not preclude subsequent careful dose titration with the drug. Usual Adult Dose for Myocardial Infarction: Initial dose: 5 mg orally (within 24 hours of the onset of acute myocardial infarction) Subsequent doses: 5 mg orally after 24 hours, then 10 mg orally after 48 hours. Maintenance dose: 10 mg orally once a day. Dosing should continue for at least 6 weeks. Comments: -Therapy should be initiated at 2.5 mg in patients with a low systolic blood pressure (less than or equal to 120 mm Hg and greater than 100 mmHg) during the first 3 days after the infarct. If prolonged hypotension occurs (systolic blood pressure less than 90 mmHg for more than 1 hour) therapy should be withdrawn. Usual Adult Dose for Diabetic Nephropathy: Initial dose: 10 to 20 mg orally once a day Maintenance dose: 20 to 40 mg orally once a day Dosage may be titrated upward every 3 days Comments: -Not an approved indication. Usual Geriatric Dose for Hypertension: Initial dose: 2.5 to 5 mg orally once a day Maintenance dose: Dosages should be increased at 2.5 mg to 5 mg per day at 1 to 2 week intervals. Maximum dose: 40 mg orally once a day Usual Pediatric Dose for Hypertension: Pediatric patients greater than or equal to 6 years of age: Initial dose: 0.07 mg/kg orally once a day (Maximum initial dose is 5 mg once a day) Maintenance dose: Dosage should be adjusted according to blood pressure response at 1 to 2 week intervals. Maximum dose: Doses above 0.61 mg/kg or greater than 40 mg have not been studied in pediatric patients Comments: -This drug is not recommended in pediatric patients less than 6 years old or in pediatric patients with glomerular filtration rate less than 30 mL/min.   What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What to avoid Drinking alcohol can further lower your blood pressure and may increase certain side effects of lisinopril. Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Lisinopril can decrease sweating and you may be more prone to heat stroke. Do not use potassium supplements or salt substitutes while taking this medicine, unless your doctor has told you to. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall. Lisinopril side effects Get emergency medical help if you have signs of an allergic reaction to lisinopril: hives; severe stomach pain, difficult breathing; swelling of your face, lips, tongue, or throat. You may be more likely to have an allergic reaction if you are African-American. Call your doctor at once if you have: a light-headed feeling, like you might pass out; fever, sore throat; high potassium - nausea, weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement; kidney problems - little or no urination, swelling in your feet or ankles, feeling tired or short of breath; or liver problems - nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes). Common lisinopril side effects may include: headache, dizziness; cough; or chest pain. 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 lisinopril? Tell your doctor about all your current medicines and any you start or stop using, especially: a diuretic or "water pill"; lithium; gold injections to treat arthritis; insulin or oral diabetes medicine; a potassium supplement; medicine to prevent organ transplant rejection - everolimus, sirolimus, tacrolimus, temsirolimus; or NSAIDs (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others. This list is not complete. Other drugs may interact with lisinopril, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

What is hydrochlorothiazide and lisinopril? Hydrochlorothiazide is a thiazide diuretic (water pill). Lisinopril is in an ACE inhibitor (ACE stands for angiotensin converting enzyme). Hydrochlorothiazide and lisinopril is a combination medicine used to treat hypertension (high blood pressure). Lowering blood pressure may lower your risk of a stroke or heart attack. Hydrochlorothiazide and lisinopril may also be used for purposes not listed in this medication guide. Warnings Do not use if you are pregnant. If you become pregnant, stop taking hydrochlorothiazide and lisinopril and tell your doctor right away. You should not use this medicine if you have ever had angioedema, if you are unable to urinate, or if you are allergic to sulfa drugs or to any ACE inhibitor. Do not take hydrochlorothiazide and lisinopril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto). If you have diabetes, do not use hydrochlorothiazide and lisinopril together with any medication that contains aliskiren (a blood pressure medicine). Before taking this medicine You should not use this medicine if you are allergic to hydrochlorothiazide or lisinopril, or if: you have hereditary angioedema; you are unable to urinate; you recently took a heart medicine called sacubitril; you have an allergy to sulfa drugs; or you have ever had a severe allergic reaction to any ACE inhibitor (benazepril, captopril, enalapril, fosinopril, moexipril, perindopril, quinapril, ramipril, trandolapril). Do not take hydrochlorothiazide and lisinopril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto). If you have diabetes, do not use hydrochlorothiazide and lisinopril together with any medication that contains aliskiren (a blood pressure medicine). You may also need to avoid taking hydrochlorothiazide and lisinopril with aliskiren if you have kidney disease. Tell your doctor if you have ever had: kidney disease (or if you are on dialysis); cirrhosis or other liver disease; glaucoma; heart disease or congestive heart failure; asthma or allergies; gout; lupus; an allergy to sulfa drugs or penicillin; or if you are on a low-salt diet. Do not use if you are pregnant. Stop using the medicine and tell your doctor right away if you become pregnant. Lisinopril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. You should not breastfeed while using hydrochlorothiazide and lisinopril. Hydrochlorothiazide and lisinopril is not approved for use by anyone younger than 18 years old. How should I take hydrochlorothiazide and lisinopril? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking hydrochlorothiazide and lisinopril. This can lead to very low blood pressure, electrolyte disorders, or kidney failure. Your blood pressure will need to be checked often, and you may need occasional blood tests. If you need surgery, tell your surgeon you currently use this medicine. Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. Store at room temperature away from moisture, heat, and light. What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking hydrochlorothiazide and lisinopril? Hydrochlorothiazide may increase your risk of skin cancer. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Your doctor may want you to have skin examinations on a regular basis. Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and lisinopril. Do not use potassium supplements or salt substitutes while you are taking this medicine, unless your doctor has told you to. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough. Hydrochlorothiazide and lisinopril side effects Get emergency medical help if you have signs of an allergic reaction: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat. You may be more likely to have an allergic reaction if you are African-American. Call your doctor at once if you have: a light-headed feeling, like you might pass out; eye pain, vision problems; little or no urination; weakness, drowsiness, or feeling restless; fever, chills, sore throat, mouth sores, trouble swallowing; jaundice (yellowing of the skin or eyes); high potassium--nausea, tingly feeling, chest pain, irregular heartbeats, loss of movement; low potassium--leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling; or low sodium--headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady. Common side effects may include: cough; headache; dizziness; or tired feeling. 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.   Hydrochlorothiazide and lisinopril dosing information Usual Adult Dose for Hypertension: Initial dose: Hydrochlorothiazide 12.5 mg-Lisinopril 10 to 20 mg orally once a day, depending on the current monotherapy dose Maximum dose: Hydrochlorothiazide 50 mg-Lisinopril 80 mg per day Comments: -May increase dose every 2 to 3 weeks. -If blood pressure is controlled with monotherapy hydrochlorothiazide 25 mg per day, but significant potassium loss occurs, then similar or greater blood pressure control without electrolyte disturbance may be achieved with hydrochlorothiazide 12.5 mg-lisinopril 10 mg orally once a day.   What other drugs will affect hydrochlorothiazide and lisinopril? Tell your doctor about all your other medicines, especially: any other blood pressure medication; lithium; everolimus, sirolimus, temsirolimus; or NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others. This list is not complete. Other drugs may affect hydrochlorothiazide and lisinopril, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.  

What is lithium? Lithium affects the flow of sodium through nerve and muscle cells in the body. Sodium affects excitation or mania. Lithium a mood stabilizer that is a used to treat or control the manic episodes of bipolar disorder (manic depression). Manic symptoms include hyperactivity, rushed speech, poor judgment, reduced need for sleep, aggression, and anger. Lithium also helps to prevent or lessen the intensity of manic episodes. Lithium is for use in adults and children at least 7 years old. Warnings Do not use lithium without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Lithium toxicity can cause death. Lithium is a medicine with a narrow range of safety and toxicity can occur if you take only slightly more than a recommended dose. Stop using lithium and call your doctor right away if you have symptoms of lithium toxicity: muscle weakness, twitching, drowsiness, feeling light-headed, mood changes, blurred vision, ringing in your ears, irregular heartbeats, confusion, slurred speech, clumsiness. trouble breathing, or seizures. Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Drink extra fluids to keep from getting dehydrated while you are taking this medication. Tell your doctor if you have been sweating excessively, or if you are sick with fever, vomiting, or diarrhea. Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough. Lithium can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Before taking this medicine You should not use lithium if you are allergic to it. To make sure this medicine is safe for you, tell your doctor if you have ever had: breathing problems; heart disease; kidney disease; a thyroid disorder; an abnormal electrocardiograph or ECG (sometimes called an EKG); fainting spells; or a family member who died before age 45. Some medicines can interact with lithium and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications. It is not known whether lithium will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. You should not breast-feed while using this medicine. Lithium is not approved for use by anyone younger than 7 years old. How should I take lithium? Take lithium exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Never use lithium in larger amounts, or for longer than prescribed. Overdose can occur if you take only slightly more than a recommended dose. Swallow the tablet whole and do not crush, chew, or break it. Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Call your doctor if you are sick with a fever and vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking lithium, which may affect your dose needs. Do not change your dose or medication schedule without your doctor's advice. Drink extra fluids each day to prevent dehydration. It may take up to 3 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not begin to improve after 1 week of treatment. You may need frequent blood tests. If you need surgery, tell the surgeon ahead of time that you are using this medicine. Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use. Dosing information Usual Adult Dose for Mania: Acute Control: -Usual dose: 1800 mg/day -Extended release formulations: 900 mg orally in the morning and at nighttime -Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime Long-term Control: -Maintenance dose: 900 to 1200 mg/day -Extended release formulations: 600 mg orally in the morning and at nighttime -Regular release formulations: 300 mg orally 3 to 4 times a day Uses: -Treatment of manic episodes of bipolar disorder -Maintenance treatment for individuals with bipolar disorder Usual Adult Dose for Bipolar Disorder: Acute Control: -Usual dose: 1800 mg/day -Extended release formulations: 900 mg orally in the morning and at nighttime -Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime Long-term Control: -Maintenance dose: 900 to 1200 mg/day -Extended release formulations: 600 mg orally in the morning and at nighttime -Regular release formulations: 300 mg orally 3 to 4 times a day Uses: -Treatment of manic episodes of bipolar disorder -Maintenance treatment for individuals with bipolar disorder Usual Pediatric Dose for Mania: 12 years and older: Acute Control: -Usual dose: 1800 mg/day -Extended release formulations: 900 mg orally in the morning and at nighttime -Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime Long-term Control: -Maintenance dose: 900 to 1200 mg/day -Extended release formulations: 600 mg orally in the morning and at nighttime -Regular release formulations: 300 mg orally 3 to 4 times a day Uses: -Treatment of manic episodes of bipolar disorder -Maintenance treatment for individuals with bipolar disorder Usual Pediatric Dose for Bipolar Disorder: 12 years and older: Acute Control: -Usual dose: 1800 mg/day -Extended release formulations: 900 mg orally in the morning and at nighttime -Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime Long-term Control: -Maintenance dose: 900 to 1200 mg/day -Extended release formulations: 600 mg orally in the morning and at nighttime -Regular release formulations: 300 mg orally 3 to 4 times a day Uses: -Treatment of manic episodes of bipolar disorder -Maintenance treatment for individuals with bipolar disorder   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Stop taking lithium and seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Early signs of toxicity include: vomiting, diarrhea, drowsiness, muscle weakness, or loss of coordination. What to avoid Avoid driving or hazardous activity until you know how lithium will affect you. Your reactions could be impaired. Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough. Do not change the amount of salt you consume in your diet. Changing your salt intake could change the amount of lithium in your blood. Lithium side effects Get emergency medical help if you have signs of an allergic reaction to lithium: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Too much lithium in your body can cause death. Lithium toxicity can occur if you take only slightly more than a recommended dose. Stop using this medicine and call your doctor right away if you have symptoms of lithium toxicity: muscle weakness, twitching, drowsiness, feeling light-headed, mood changes, blurred vision, ringing in your ears, irregular heartbeats, confusion, slurred speech, clumsiness, trouble breathing, or seizures. Call your doctor at once if you have: a light-headed feeling, like you might pass out; shortness of breath; fever, increased thirst or urination; weakness, dizziness or spinning sensation; memory problems, hallucinations; problems with balance or muscle movement; loss of bowel or bladder control; a seizure (blackout or convulsions); low sodium level - headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady; thyroid problems - weight gain or loss, muscle pain, tremors, feeling hot or cold, changes in your skin or hair, sweating, feeling weak or tired, fast or pounding heartbeats, increased bowel movements, feeling anxious or agitated; dehydration symptoms - feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin; or increased pressure inside the skull -severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes. Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea. Common lithium side effects may include: dizziness, drowsiness; tremors in your hands; trouble walking; dry mouth, increased thirst or urination; nausea, vomiting, loss of appetite; rash; or blurred vision. 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 lithium? Tell your doctor about all your current medicines. Many drugs can affect lithium, especially: buspirone; fentanyl; St. John's wort; tramadol; a "triptan" migraine headache medicine; tryptophan; an antidepressant or antipsychotic medication; or a MAO inhibitor - isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others. This list is not complete and many other drugs may interact with lithium. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Lithium Carbonate ER Tablets  Lithium Carbonate Extended-Release Tablets USP, contain lithium carbonate USP, a white, crystalline powder with molecular formula Li 2CO 3 and molecular weight 73.89 g/mol. Lithium is an element of the alkali‑metal group with atomic number 3, atomic weight 6.94 and an emission line at 671 nm on the flame photometer. Lithium Carbonate Extended-Release Tablets USP Each off-white to pale yellow, circular, beveled edged, biconvex uncoated tablets with ‘224’ debossed on one side, ‘G’ and a break line debossed on the other side, contains lithium carbonate, 450 mg. Inactive ingredients consist of ferric oxide yellow, hypromellose, magnesium stearate, microcrystalline cellulose, sodium alginate, sodium starch glycolate and talc. Product meets USP Dissolution Test 2. Lithium Carbonate Extended-Release Tablets USP, 450 mg are designed to release a portion of the dose initially and the remainder gradually; the release pattern of the controlled release tablets reduces the variability in lithium blood levels seen with the immediate release dosage forms. Lithium Carbonate ER Tablets - Clinical Pharmacology Preclinical studies have shown that lithium alters sodium transport in nerve and muscle cells and effects a shift toward intraneuronal metabolism of catecholamines, but the specific biochemical mechanism of lithium action in mania is unknown. Indications and Usage for Lithium Carbonate ER Tablets Lithium Carbonate Extended-Release Tablets are indicated in the treatment of manic episodes of manic-depressive illness. Maintenance therapy prevents or diminishes the intensity of subsequent episodes in those manic-depressive patients with a history of mania. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, elation, poor judgment, aggressiveness and possibly hostility. When given to a patient experiencing a manic episode, Lithium Carbonate Extended-Release Tablets may produce a normalization of symptomatology within 1 to 3 weeks. Warnings Lithium Toxicity The toxic concentrations for lithium (≥1.5 mEq/L) are close to the therapeutic range (0.8 to 1.2 mEq/L). Some patients abnormally sensitive to lithium may exhibit toxic signs at serum concentrations that are considered within the therapeutic range [see BOXED WARNING, DOSAGE AND ADMINISTRATION]. Lithium may take up to 24 hours to distribute into brain tissue, so occurrence of acute toxicity symptoms may be delayed. Neurological signs of lithium toxicity range from mild neurological adverse reactions such as fine tremor, lightheadedness, lack of coordination, and weakness; to moderate manifestations like giddiness, apathy, drowsiness, hyperreflexia, muscle twitching, ataxia, blurred vision, tinnitus, and slurred speech; and severe manifestations such as clonus, confusion, seizure, coma, and death. In rare cases, neurological sequelae may persist despite discontinuing lithium treatment and may be associated with cerebellar atrophy. Cardiac manifestations involve electrocardiographic changes, such as prolonged QT interval, ST and T-wave changes and myocarditis. Renal manifestations include urine concentrating defect, nephrogenic diabetes insipidus, and renal failure. Respiratory manifestations include dyspnea, aspiration pneumonia, and respiratory failure. Gastrointestinal manifestations include nausea, vomiting, diarrhea, and bloating. No specific antidote for lithium poisoning is known [see OVERDOSAGE]. The risk of lithium toxicity is increased by: Recent onset of concurrent febrile illness Concomitant administration of drugs which increase lithium serum concentrations by pharmacokinetic interactions or drugs affecting kidney function [see PRECAUTIONS-DRUG INTERACTIONS] Acute ingestion Impaired renal function Volume depletion or dehydration Significant cardiovascular disease Changes in electrolyte concentrations (especially sodium and potassium)

What is loratadine? Loratadine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Loratadine is used to treat sneezing, runny nose, watery eyes, hives, skin rash, hay fever, itching, and other cold or allergy symptoms. Loratadine is also used to treat skin hives and itching in people with chronic skin reactions Warnings You should not take this medication if you are allergic to loratadine or to desloratadine (Clarinex). Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use. Some chewable dosage forms of loratadine may contain phenylalanine. Talk to your doctor before using these forms of loratadine if you have phenylketonuria (PKU). Ask a doctor or pharmacist before taking this medicine if you have liver or kidney disease. Before taking this medicine Ask a doctor or pharmacist if loratadine is safe to use if you have ever had: kidney disease; or liver disease. The disintegrating tablet may contain phenylalanine and could be harmful if you have phenylketonuria (PKU). Ask a doctor before using this medicine if you are pregnant or breastfeeding. Do not give this medicine to a child younger than 2 years old without medical advice. How should I take loratadine? Use loratadine exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Cold or allergy medicine is usually taken only for a short time until your symptoms clear up. Do not give this medicine to a child younger than 2 years old. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children. Loratadine is usually taken once per day. Follow your doctor's instructions. Do not crush, chew, or break the regular tablet. Swallow the pill whole. A child's dose is based on age and some forms of loratadine are not for use in children younger than 6 years old. Carefully follow the dosing instructions provided with this medicine. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. The chewable tablet must be chewed before you swallow it. To take the orally disintegrating tablet (Claritin RediTab, Alavert): Keep the tablet in its blister pack until you are ready to take it. Open the package and peel back the foil. Do not push a tablet through the foil or you may damage the tablet. Use dry hands to remove the tablet and place it in your mouth. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. If desired, you may drink liquid to help swallow the dissolved tablet. Call your doctor if your symptoms do not improve, or if they get worse. Store at room temperature away from moisture and heat. Loratadine side effects Get emergency medical help if you have signs of an allergic reaction to loratadine: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using this medicine and call your doctor at once if you have: fast or uneven heart rate; severe headache; or a light-headed feeling, like you might pass out; Common loratadine side effects may include: headache; feeling tired or drowsy; stomach pain, vomiting; dry mouth; or feeling nervous or hyperactive. 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.   Dosing information Usual Adult Dose for Allergic Rhinitis: 10 mg orally once a day -Maximum dose: 10 mg/day Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat) Usual Adult Dose for Urticaria: 10 mg orally once a day -Maximum dose: 10 mg/day Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat) Usual Pediatric Dose for Allergic Rhinitis: 2 to 5 years: 5 mg orally once a day -Maximum dose: 5 mg/day 6 years and older: 10 mg orally once a day -Maximum dose: 10 mg/day Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat) Usual Pediatric Dose for Urticaria: 2 to 5 years: 5 mg orally once a day -Maximum dose: 5 mg/day 6 years and older: 10 mg orally once a day -Maximum dose: 10 mg/day Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat)   What other drugs will affect loratadine? Other drugs may interact with loratadine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

What is loratadine? Loratadine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Loratadine is used to treat sneezing, runny nose, watery eyes, hives, skin rash, hay fever, itching, and other cold or allergy symptoms. Loratadine is also used to treat skin hives and itching in people with chronic skin reactions Warnings You should not take this medication if you are allergic to loratadine or to desloratadine (Clarinex). Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use. Some chewable dosage forms of loratadine may contain phenylalanine. Talk to your doctor before using these forms of loratadine if you have phenylketonuria (PKU). Ask a doctor or pharmacist before taking this medicine if you have liver or kidney disease. Before taking this medicine Ask a doctor or pharmacist if loratadine is safe to use if you have ever had: kidney disease; or liver disease. The disintegrating tablet may contain phenylalanine and could be harmful if you have phenylketonuria (PKU). Ask a doctor before using this medicine if you are pregnant or breastfeeding. Do not give this medicine to a child younger than 2 years old without medical advice. How should I take loratadine? Use loratadine exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Cold or allergy medicine is usually taken only for a short time until your symptoms clear up. Do not give this medicine to a child younger than 2 years old. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children. Loratadine is usually taken once per day. Follow your doctor's instructions. Do not crush, chew, or break the regular tablet. Swallow the pill whole. A child's dose is based on age and some forms of loratadine are not for use in children younger than 6 years old. Carefully follow the dosing instructions provided with this medicine. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. The chewable tablet must be chewed before you swallow it. To take the orally disintegrating tablet (Claritin RediTab, Alavert): Keep the tablet in its blister pack until you are ready to take it. Open the package and peel back the foil. Do not push a tablet through the foil or you may damage the tablet. Use dry hands to remove the tablet and place it in your mouth. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. If desired, you may drink liquid to help swallow the dissolved tablet. Call your doctor if your symptoms do not improve, or if they get worse. Store at room temperature away from moisture and heat. Loratadine side effects Get emergency medical help if you have signs of an allergic reaction to loratadine: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using this medicine and call your doctor at once if you have: fast or uneven heart rate; severe headache; or a light-headed feeling, like you might pass out; Common loratadine side effects may include: headache; feeling tired or drowsy; stomach pain, vomiting; dry mouth; or feeling nervous or hyperactive. 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.   Dosing information Usual Adult Dose for Allergic Rhinitis: 10 mg orally once a day -Maximum dose: 10 mg/day Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat) Usual Adult Dose for Urticaria: 10 mg orally once a day -Maximum dose: 10 mg/day Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat) Usual Pediatric Dose for Allergic Rhinitis: 2 to 5 years: 5 mg orally once a day -Maximum dose: 5 mg/day 6 years and older: 10 mg orally once a day -Maximum dose: 10 mg/day Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat) Usual Pediatric Dose for Urticaria: 2 to 5 years: 5 mg orally once a day -Maximum dose: 5 mg/day 6 years and older: 10 mg orally once a day -Maximum dose: 10 mg/day Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat)   What other drugs will affect loratadine? Other drugs may interact with loratadine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

What is lorazepam? Lorazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen) It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain. Lorazepam is used to treat anxiety disorders. It is dangerous to purchase lorazepam on the Internet or outside the United States. The sale and distribution of medicines outside the U.S. does not comply with safe-use regulations of the Food and Drug Administration (FDA). These medications may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Warnings Lorazepam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. These effects can be fatal. MISUSE OF LORAZEPAM CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep this medicine where others cannot get to it. Lorazepam may be habit-forming and should be used only by the person it was prescribed for. This medicine should never be shared with another person, especially someone who has a history of drug abuse or addiction. Do not stop using lorazepam without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. Some withdrawal symptoms may last up to 12 months or longer. Get medical help right away if you stop using lorazepam and have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, or thoughts about suicide. Do not use lorazepam if you are pregnant. This medicine can cause birth defects or life-threatening withdrawal symptoms in a newborn. You should not use this medicine if you have narrow-angle glaucoma, severe respiratory insufficiency, myasthenia gravis, or if you are allergic to Valium or a similar medicine. Before taking this medicine You should not use lorazepam if you have: narrow-angle glaucoma; or a history of allergic reaction to any benzodiazepine (lorazepam, alprazolam, diazepam, Valium, Xanax, Versed, Klonopin, and others). To make sure lorazepam is safe for you, tell your doctor if you have ever had: asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder; drug or alcohol addiction; depression, mood problems, or suicidal thoughts or behavior; kidney or liver disease; seizures; or an allergy to aspirin or yellow food dye. Tell your doctor if you are pregnant or plan to become pregnant. If you use lorazepam during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks. You should not breastfeed while you are taking lorazepam. If you do breastfeed, tell your doctor if you notice drowsiness, feeding problems, or slow weight gain in the nursing baby. Lorazepam is not approved for use by anyone younger than 12 years old. Extended-release lorazepam should not be used by anyone younger than 18 years old. How should I take lorazepam? Take lorazepam exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides or instruction sheets. Never use lorazepam in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of lorazepam. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it. Selling or giving away this medicine is against the law. Measure the oral concentrate (liquid) with the supplied measuring device (not a kitchen spoon). Mix the liquid with water, juice, soda, or soft food such as applesauce or pudding. Swallow this mixture right away. Swallow the extended-release capsule whole and do not crush, chew, break, or open it. If you cannot swallow a capsule whole, open it and mix the medicine with applesauce. Swallow the mixture right away without chewing. Then drink a glass of water. Do not stop using lorazepam without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. Store tightly closed at room temperature, away from moisture and heat. Store the liquid form of lorazepam in the refrigerator. Throw away any liquid not used within 90 days. Keep your medicine in a place where no one can use it improperly. Dosing information Usual Adult Dose for Anxiety: ORAL: Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day Maintenance dose: 1 to 2 mg orally 2 to 3 times a day. Usual Adult Dose for Light Anesthesia: INJECTION: IM: 0.05 mg/kg IM ONCE -Maximum dose: 4 mg IV: 2 mg total OR 0.044 mg/kg IV ONCE, whichever is smaller Comments: -Doses of other injectable central-nervous-system depressant drugs should be reduced. -Narcotic analgesics should be administered at their usual preoperative time. -IV: The recommended dose of 2 mg (OR 0.44 mg/kg, whichever is smaller) should not ordinarily be exceeded in patients over 50 years of age. -IV: Doses up to 0.05 mg/kg (4 mg maximum) may be administered. -IM: For optimum effect, this route should be administered at least 2 hours before the anticipated operative procedure. -IV: For optimum effect, this route should be administered 15 to 20 minutes before the anticipated operative procedure. Use: As a preanesthetic medication to produce sedation (sleepiness or drowsiness), relieve anxiety, and decrease the ability to recall events related to the day of surgery Usual Adult Dose for Status Epilepticus: INJECTION: 4 mg IV given at a rate of 2 mg/min; may repeat the dose in 10 to 15 minutes -Maximum total dose: 8 mg Comments : -Vital signs should be monitored, an unobstructed airway should be maintained, and artificial ventilation equipment should be available. -When an intravenous port is not available, the IM route may prove useful. Use: Treatment of status epilepticus Usual Adult Dose for Insomnia: ORAL: 2 to 4 mg orally once a day at bedtime Comments: -The dosage should be increased gradually when needed to help avoid adverse effects. -Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months). Use: Management of insomnia due to anxiety of transient situational stress Usual Geriatric Dose for Anxiety: ORAL: Older or debilitated patients: -Initial dose: 1 to 2 mg orally per day, given in divided doses Comments: -The dosage should be increased gradually when needed to help avoid adverse effects. Usual Pediatric Dose for Anxiety: ORAL: 12 years or older: -Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day -Maintenance dose: 1 to 2 mg orally 2 to 3 times a day -The daily dosage may vary from 1 to 10 mg/day. -The dosage should be increased gradually when needed to help avoid adverse effects. -When higher dosage is indicated, the evening dose should be increased before the daytime doses. -Use of anxiolytic agents is typically not needed to treat anxiety/tension associated with the stress of everyday life. -Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months). Uses: -Management of anxiety disorders -Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms Usual Pediatric Dose for Insomnia: ORAL: 12 years or older: 2 to 4 mg orally once a day at bedtime Comments: -For debilitated patients, an initial dosage of 1 to 2 mg/day in divided doses is recommended. -The dosage should be increased gradually when needed to help avoid adverse effects. -Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months). Use: Management of insomnia   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of lorazepam can be fatal if you take it with alcohol, opioid medicine, or other drugs that cause drowsiness or slow your breathing. Overdose symptoms may include severe drowsiness, confusion, slurred speech, feeling restless, muscle weakness, loss of balance or coordination, feeling light-headed, slow heartbeats, weak or shallow breathing, or coma. What should I avoid while taking lorazepam? Avoid drinking alcohol. Dangerous side effects or death could occur. Avoid driving or hazardous activity until you know how lorazepam will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Lorazepam side effects Get emergency medical help if you have signs of an allergic reaction to lorazepam: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Lorazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. Call your doctor at once if you have: severe drowsiness; unusual changes in mood or behavior, being agitated or talkative; sudden restless feeling or excitement; thoughts of suicide or hurting yourself; confusion, aggression, hallucinations; sleep problems; vision changes; or dark urine, or jaundice (yellowing of the skin or eyes). Drowsiness or dizziness may last longer in older adults. Use caution to avoid falling or accidental injury. Common lorazepam side effects may include: dizziness, drowsiness; weakness; or feeling unsteady. After you stop using lorazepam, get medical help right away if you have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, suicidal thoughts or actions. Some withdrawal symptoms may last up to 12 months or longer after stopping this medicine suddenly. Tell your doctor if you have ongoing anxiety, depression, problems with memory or thinking, trouble sleeping, ringing in your ears, a burning or prickly feeling, or a crawling sensation under your skin. 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 is losartan? Losartan belongs to a group of drugs called angiotensin II receptor antagonists. It keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow. Losartan is used to treat high blood pressure (hypertension). It is also used to lower the risk of stroke in certain people with heart disease. Losartan is used to slow long-term kidney damage in people with type 2 diabetes who also have high blood pressure. Warnings Do not use losartan if you are pregnant. Stop using and tell your doctor right away if you become pregnant. This medicine can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control. You should not use this medication if you are allergic to losartan. If you have diabetes, do not use losartan together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo, Valturna). In extremely rare cases, losartan can cause a condition that results in the breakdown of skeletal muscle tissue, potentially leading to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness especially if you also have fever, unusual tiredness, and dark colored urine. Before taking this medicine If you have diabetes, do not use losartan together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo, Valturna). You may also need to avoid taking this medicine with aliskiren if you have kidney disease. To make sure this medicine is safe for you, tell your doctor if you have: kidney disease; liver disease; congestive heart failure; an electrolyte imbalance (such as low levels of potassium in your blood); or if you are dehydrated. Do not use if you are pregnant. Stop using and tell your doctor right away if you become pregnant. Losartan can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control. It is not known whether losartan passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine. How should I take losartan? Take losartan exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended. You may take losartan with or without food. Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medication, which can lead to severely low blood pressure or a serious electrolyte imbalance. Your blood pressure will need to be checked often. Visit your doctor regularly. It may take 3 to 6 weeks of using losartan before your blood pressure goes down somewhat. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 3 weeks of treatment. If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. Store at room temperature away from moisture, heat, and light. Dosing information Usual Adult Dose for Diabetic Nephropathy: Initial dose: 50 mg orally once a day. Maintenance dose: 25 to 100 mg orally in 1 to 2 divided doses. Usual Adult Dose for Hypertension: Initial dose: 50 mg orally once a day. Maintenance dose: 25 to 100 mg orally in 1 to 2 divided doses.   What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid? Drinking alcohol can further lower your blood pressure and may increase certain side effects of losartan. Do not use potassium supplements or salt substitutes while you are taking this medicine, unless your doctor has told you to. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall. Losartan side effects Get emergency medical help if you have any of these signs of an allergic reaction to losartan: hives; difficult breathing; swelling of your face, lips, tongue, or throat. In extremely rare cases, losartan can cause a condition that results in the breakdown of skeletal muscle tissue, leading to potential kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness especially if you also have fever, unusual tiredness, and dark colored urine. Call your doctor at once if you have: a feeling that you might pass out; pain or burning when you urinate; pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; wheezing, chest pain; drowsiness, confusion, mood changes, increased thirst, loss of appetite, nausea and vomiting; swelling, weight gain, feeling short of breath, urinating less than usual or not at all; or high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling). Common losartan side effects may include: cold or flu symptoms such as stuffy nose, sneezing, sore throat, fever; dry cough; muscle cramps; pain in your legs or back; stomach pain, diarrhea; headache, dizziness; tired feeling; or sleep problems (insomnia). 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 losartan? Tell your doctor about all medicines you use, and those you start or stop using during your treatment with losartan, especially: a diuretic or "water pill"; other blood pressure medications; lithium; celecoxib; or aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others. This list is not complete. Other drugs may interact with losartan, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

What is hydrochlorothiazide and losartan? Hydrochlorothiazide is a diuretic (water pill). Losartan is an angiotensin II receptor antagonist (sometimes called an ARB blocker). Hydrochlorothiazide and losartan is a combination medicine used to treat high blood pressure (hypertension). It is also used to lower the risk of stroke in certain people with heart disease. Hydrochlorothiazide and losartan may also be used for purposes not listed in this medication guide. Warnings You should not use hydrochlorothiazide and losartan if you are unable to urinate. Do not use if you are pregnant. Stop using the medicine and tell your doctor right away if you become pregnant. If you have diabetes, do not use hydrochlorothiazide and losartan together with any medication that contains aliskiren (a blood pressure medicine). Before taking this medicine You should not use this medicine if you are allergic to hydrochlorothiazide or losartan, if you are unable to urinate. If you have diabetes, do not use hydrochlorothiazide and losartan together with any medication that contains aliskiren (a blood pressure medicine). You may also need to avoid taking hydrochlorothiazide and losartan with aliskiren if you have kidney disease. Tell your doctor if you have ever had: lupus; liver or kidney disease; asthma or allergies; diabetes; gout; congestive heart failure; glaucoma; low or high levels of potassium in your blood; high cholesterol or triglyceride levels; or an allergy to penicillin or sulfa drugs. Do not use if you are pregnant. Stop using the medicine and tell your doctor right away if you become pregnant. Hydrochlorothiazide and losartan can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. You should not breastfeed while using this medicine. Hydrochlorothiazide and losartan is not approved for use by anyone younger than 18 years old. How should I take hydrochlorothiazide and losartan? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Your blood pressure will need to be checked often. Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking hydrochlorothiazide and losartan. This can lead to very low blood pressure, a serious electrolyte imbalance, or kidney failure. If you need surgery or medical tests, tell the surgeon ahead of time that you are using hydrochlorothiazide and losartan. If you have high blood pressure, keep using this medicine even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life. Store at room temperature away from moisture, heat, and light. What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking hydrochlorothiazide and losartan? Hydrochlorothiazide may increase your risk of skin cancer. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Your doctor may want you to have skin examinations on a regular basis. Do not use potassium supplements or salt substitutes, unless your doctor has told you to. Drinking alcohol can further lower your blood pressure and may cause side effects. Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Hydrochlorothiazide and losartan side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have: a light-headed feeling, like you might pass out; irregular heartbeats; eye pain, vision problems; kidney problems--little or no urination, rapid weight gain, swelling in your hands, feet, or ankles; new or worsening symptoms of lupus--joint pain, and a skin rash on your cheeks or arms that worsens in sunlight; or signs of an electrolyte imbalance--increased thirst or urination, confusion, vomiting, constipation, muscle pain, leg cramps, irregular heartbeats, numbness or tingling, severe weakness, loss of movement, feeling jittery or unsteady. Common side effects may include: dizziness; back pain; or cold symptoms such as stuffy nose, sneezing, sore throat. 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.   Hydrochlorothiazide and losartan dosing information Usual Adult Dose for Hypertension: HYPERTENSION: Hydrochlorothiazide 12.5 to 25 mg-Losartan 50 to 100 mg orally once a day Maximum dose: Hydrochlorothiazide 25 mg-Losartan 100 mg orally once a day Comments: -A patient whose blood pressure is not adequately controlled with hydrochlorothiazide or losartan monotherapy may be switched to hydrochlorothiazide 12.5 mg-losartan 50 mg orally once a day. -May increase dose if blood pressure remains uncontrolled after about 3 weeks. Use: Treatment of hypertension. This drug is not indicated for initial therapy except when hypertension is severe enough that the benefit of achieving prompt blood pressure control exceeds the risk of initiating combination therapy. SEVERE HYPERTENSION: Initial treatment: Hydrochlorothiazide 12.5 mg-Losartan 50 mg orally once a day; if blood pressure remains uncontrolled after 2 to 4 weeks, may initiate maximum dose. Maximum dose: Hydrochlorothiazide 25 mg-Losartan 100 mg orally once a day HYPERTENSION WITH LEFT VENTRICULAR HYPERTROPHY: Initial therapy: Losartan monotherapy; if blood pressure remains uncontrolled, may initiate this drug. Add-on therapy: Hydrochlorothiazide 12.5 mg-Losartan 50 mg orally once a day; if blood pressure remains uncontrolled, initiate hydrochlorothiazide 12.5 mg-losartan 100 mg orally once a day, followed by hydrochlorothiazide 25 mg-losartan 100 mg orally once a day, if needed. Use: To reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy, but there is evidence that this benefit does not apply to Black patients.   What other drugs will affect hydrochlorothiazide and losartan? If you also take cholestyramine or colestipol, take your hydrochlorothiazide and losartan dose 4 hours before or 4 to 6 hours after you take the other medicine. Tell your doctor about all your other medicines, especially: a diuretic or "water pill"; other blood pressure medications; lithium; or NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others. This list is not complete. Other drugs may affect hydrochlorothiazide and losartan, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

What is lovastatin? Lovastatin is used together with diet to lower blood levels of "bad" cholesterol (low-density lipoprotein, or LDL), to increase levels of "good" cholesterol (high-density lipoprotein, or HDL), and to lower triglycerides (a type of fat in the blood). Lovastatin is used to lower the risk of stroke, heart attack, and other heart complications in adults with diabetes, coronary heart disease, or other risk factors. Lovastatin may also be used for purposes not listed in this medication guide. Warnings You should not take lovastatin if you have active liver disease, or if you are pregnant or breastfeeding. Tell your doctor about all your current medicines and any you start or stop using. Many drugs can interact, and some drugs should not be used together. Stop taking lovastatin and tell your doctor at once if you become pregnant. Before taking this medicine You should not use lovastatin if you are allergic to it, or if: you are pregnant or breastfeeding; or you have active liver disease. Many drugs can interact and cause dangerous effects. Some drugs should not be used together with lovastatin. Your doctor may change your treatment plan if you also use: nefazodone; an antibiotic--clarithromycin, erythromycin, telithromycin; antifungal medicine--itraconazole, ketoconazole, posaconazole, voriconazole; or antiviral medicine to treat HIV or hepatitis C--boceprevir, cobicistat, dasabuvir, elvitegravir, indinavir, lopinavir/ritonavir, nelfinavir, ombitasvir, paritaprevir saquinavir, telaprevir, tipranavir. Tell your doctor if you have ever had: liver disease; muscle pain or weakness; kidney disease; a thyroid disorder; or if you drink large amounts of alcohol. Lovastatin can cause the breakdown of muscle tissue, which can lead to kidney failure. This happens more often in older adults or people who have kidney disease or poorly controlled hypothyroidism (underactive thyroid). Do not use if you are pregnant. This medicine can harm an unborn baby. Use effective birth control to prevent pregnancy. Stop taking this medicine and tell your doctor at once if you become pregnant. Do not breastfeed while using this medicine. Lovastatin is not approved for use by anyone younger than 18 years old. How should I take lovastatin? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Swallow the tablet whole and do not crush, chew, or break it. It may take up to 4 weeks before your cholesterol levels improve, and you may need frequent blood tests. Even if you have no symptoms, tests can help your doctor determine if lovastatin is effective. You may need to stop using lovastatin for a short time if you have surgery or a medical emergency. Do not stop taking this medicine unless your doctor tells you to. Lovastatin is only part of a complete treatment program that may also include diet, exercise, and weight control. Follow your doctor's instructions very closely. Store at room temperature away from moisture, heat, and light.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking lovastatin? Avoid eating foods high in fat or cholesterol, or lovastatin will not be as effective. Avoid drinking alcohol. It can raise triglyceride levels and may increase your risk of liver damage. Grapefruit may interact with lovastatin and lead to unwanted side effects. Avoid the use of grapefruit products. Lovastatin side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Lovastatin can cause the breakdown of muscle tissue, which can lead to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness especially if you also have fever, unusual tiredness, or dark colored urine. Also call your doctor at once if you have: muscle weakness in your hips, shoulders, neck, and back; trouble lifting your arms, trouble climbing or standing; kidney problems--little or no urination, swelling in your feet or ankles, feeling tired or short of breath; or liver problems--loss of appetite, stomach pain (upper right side), tiredness, dark urine, jaundice (yellowing of the skin or eyes). Common side effects may include: infections; headache; or accidental injury. 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 lovastatin? Some drugs can increase your risk of serious muscle problems if you take them together with lovastatin. Your doctor may need to change your treatment plan if you use any of the following drugs: cyclosporine; danazol; gemfibrozil, fenofibric acid, fenofibrate; or medicines that contain niacin (Advicor, Niaspan, Niacor, Simcor, Slo-Niacin, and others). This list is not complete and many other drugs may affect lovastatin. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

What is loxapine? Loxapine is an antipsychotic medication that is used to treat schizophrenia. Loxapine may also be used for purposes not listed in this medication guide. Warnings You should not use loxapine if you have decreased alertness caused by taking certain medications or drinking alcohol. Loxapine is not approved for use in older adults with dementia-related psychosis. Before taking this medicine You should not use loxapine if you are allergic to loxapine or amoxapine, or if you have decreased alertness caused by taking certain medications or drinking alcohol. Loxapine may increase the risk of death in older adults with dementia-related psychosis and is not approved for this use. Tell your doctor if you have ever had: epilepsy or other seizure disorder; low white blood cell (WBC) counts; glaucoma; urination problems; blockage in your digestive tract (stomach or intestines); Parkinson's disease; heart disease; or breast cancer. Tell your doctor if you are pregnant or you get pregnant. Using antipsychotic medication during the last 3 months of pregnancy may cause breathing problems, feeding problems, or withdrawal symptoms in the newborn. You should not breastfeed while using loxapine. How should I take loxapine? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. You may not start feeling better right away when you start taking loxapine. Call your doctor if your symptoms do not improve, or if they get worse while using loxapine. Store at room temperature away from moisture, heat, and light. What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include weak or shallow breathing, fainting, or seizure (convulsions). What should I avoid while taking loxapine? Avoid driving or operating machinery until you know how loxapine will affect you. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Dizziness or severe drowsiness can cause falls, fractures, or other injuries. Avoid drinking alcohol. Dangerous side effects could occur. Avoid becoming overheated or dehydrated during exercise and in hot weather. Loxapine can decrease perspiration and you may be more prone to heat stroke. Loxapine side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. High doses or long-term use of loxapine can cause a serious movement disorder that may not be reversible. The longer you use loxapine, the more likely you are to develop this disorder, especially if you are a woman or an older adult. Call your doctor at once if you have: uncontrolled muscle movements in your arms or legs, or your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); fast heart rate; a light-headed feeling, like you might pass out; confusion, slurred speech; agitation, trouble sleeping; seizure (convulsions); little or no urinating; severe constipation; low white blood cell counts--fever, chills, mouth sores, skin sores, sore throat, cough, trouble breathing, feeling light-headed; or severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out. Common side effects may include: dizziness, problems with balance or walking; swelling in your face; itching or rash; tremors, muscle twitching or stiffness; numbness, weakness; blurred vision; feeling restless or agitated; nausea, vomiting, constipation; dry mouth, stuffy nose; or insomnia. 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.   Loxapine dosing information Usual Adult Dose for Schizophrenia: Initial Dose: 10 mg orally twice a day -Initial doses of up to 50 mg a day may be needed in severely disturbed patients Titrate rapidly over the first 7 to 10 days until symptoms are effectively controlled Maintenance Dose: 60 mg to 100 mg daily in divided doses, 2 to 4 times a day Maximum dose: 250 mg/day Comments: -Daily dosage should be adjusted to the individual patient's needs based on severity of symptoms and previous antipsychotic drug response. -Usual therapeutic and maintenance range is 60 to 100 mg daily; however, some patients may respond to lower, and others higher, doses. -For maintenance therapy, 20 to 60 mg has been satisfactory for a majority of patients. Use: For the treatment of schizophrenia Usual Adult Dose for Agitated State: 10 mg by oral inhalation once within a 24-hour period Comments: -To mitigate the risk of bronchospasm, all patients must undergo screening and examination prior to administration. -This drug must be administered by a healthcare professional only in an enrolled healthcare facility. Use: For the acute treatment of agitation associated with schizophrenia or bipolar I disorder   What other drugs will affect loxapine? Taking loxapine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures. Other drugs may affect loxapine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

What is magnesium oxide? Magnesium is a naturally occurring mineral. Magnesium is important for many systems in the body especially the muscles and nerves. Magnesium oxide is used as a supplement to maintain adequate magnesium in the body. Magnesium oxide is also used as an antacid to treat indigestion, or as a laxative to relieve occasional constipation. Magnesium oxide may also be used for purposes not listed in this medication guide. Warnings Before you take magnesium oxide, tell your doctor about all your medical conditions or allergies, and all the medicines you are using. Also make sure your doctor knows if you are pregnant or breast-feeding. In some cases, you may not be able to take magnesium oxide, or you may need a dose adjustment or special precautions. Before taking this medicine You should not use magnesium oxide if you are allergic to it. Ask a doctor or pharmacist if it is safe for you to use magnesium oxide if you have other medical conditions, especially: kidney disease; heart disease; nausea, vomiting; a blockage in your intestines; low levels of calcium in your blood; or a sudden change in bowel habits for 2 weeks or longer. It is not known whether magnesium oxide will harm an unborn baby. Ask a doctor before using this medicine if you are pregnant. It is not known whether magnesium oxide passes into breast milk or if it could affect a nursing baby. Ask a doctor before using this medicine if you are breast-feeding. Do not give this medicine to a child without medical advice. Magnesium oxide should not be given to a child younger than 6 years old. How should I take magnesium oxide? Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Take this medicine with a full glass of water. When using this medicine as a laxative, it may be best to take your dose at bedtime. Magnesium oxide may be taken with food if it upsets your stomach. Call your doctor if your symptoms do not improve after 7 days of treatment, or if symptoms get worse. Store at room temperature away from moisture and heat.   What happens if I miss a dose? Since magnesium oxide is sometimes used when needed, you may not be on a dosing schedule. If you are on a schedule, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, weakness, breathing problems, slow reflexes, weak pulse, extreme drowsiness, and feeling dizzy or light-headed. What should I avoid while taking magnesium oxide? Magnesium oxide can make it harder for your body to absorb other medicines you take by mouth. Avoid taking other medicines within 2 hours before or 2 hours after you take magnesium oxide. You may need to wait 4 hours to take your other medicines after taking magnesium oxide. Ask your doctor how to best schedule your medications. Magnesium oxide side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using magnesium oxide and call your doctor at once if you have: rectal bleeding; coughing up blood or vomit that looks like coffee grounds; bloody or tarry stools; or no bowel movement after using magnesium oxide as a laxative. Common side effects may include: diarrhea; or upset stomach. 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 magnesium oxide? Ask a doctor or pharmacist if it is safe for you to take magnesium oxide if you are also using any of the following drugs: an antibiotic; a diuretic or "water pill"; penicillamine; a blood thinner--warfarin, Coumadin, Jantoven; or medicine to treat osteoporosis or Paget's disease--alendronate, ibandronate, risedronate, Fosamax, Boniva, Actonel, and others. This list is not complete. Other drugs may interact with magnesium oxide, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

What is medroxyprogesterone? Medroxyprogesterone is a progestin (a form of progesterone), a female hormone that helps regulate ovulation (the release of an egg from an ovary) and menstrual periods. Medroxyprogesterone is used to treat conditions such as absent or irregular menstrual periods, or abnormal uterine bleeding. Medroxyprogesterone is also used to decrease the risk of endometrial hyperplasia (a condition that may lead to uterine cancer) while taking estrogens. Medroxyprogesterone is also used to prevent overgrowth in the lining of the uterus in postmenopausal women who are receiving estrogen hormone replacement therapy Warnings You should not use medroxyprogesterone if you are pregnant, or if you have liver disease, a hormone-related cancer such as breast or uterine cancer, a history of stroke or blood clot, or abnormal vaginal bleeding that has not been checked by a doctor. Medroxyprogesterone should not be used to prevent heart disease, stroke, or dementia. This medicine may actually increase your risk of developing these conditions. Long-term use of medroxyprogesterone may increase your risk of breast cancer, heart attack, stroke, or blood clot. Talk with your doctor about your individual risk. Before taking this medicine You should not use this medicine if you are allergic to medroxyprogesterone, or if you have: abnormal vaginal bleeding that has not been checked by a doctor; liver disease; a history of heart attack, stroke, or blood clot; or a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina. Medroxyprogesterone may cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant. Medroxyprogesterone should not be used to prevent heart disease, stroke, or dementia. This medicine may actually increase your risk of developing these conditions. To make sure medroxyprogesterone is safe for you, tell your doctor if you have: heart problems; liver problems; asthma; migraine headaches; a thyroid disorder; endometriosis (severe pelvic pain); jaundice caused by pregnancy or birth control pills; kidney disease; high or low blood levels of calcium; a seizure; diabetes; or lupus. Using this medicine can increase your risk of blood clots, stroke, or heart attack, especially if you have high blood pressure, diabetes, high cholesterol, if you are overweight, or if you smoke. Long-term use of medroxyprogesterone may increase your risk of cancer of the breast, uterus, or ovaries. Talk with your doctor about this risk. Do not breastfeed. How should I take medroxyprogesterone? Take medroxyprogesterone exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Medroxyprogesterone is usually given for only a few days in a row each month. Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using this medicine. If you need major surgery or will be on long-term bed rest, you may need to stop using medroxyprogesterone for a short time. This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using medroxyprogesterone. Store at room temperature away from moisture and heat. Dosing information Usual Adult Dose for Endometrial Hyperplasia -- Prophylaxis: Oral tablets: 5 or 10 mg daily for 12 to 14 consecutive days per month, in postmenopausal women receiving daily 0.625 mg conjugated estrogens, either beginning on the 1st day of the cycle or the 16 th day of the cycle Comments: -Postmenopausal woman with a uterus taking estrogens should also initiate progestin therapy to reduce the risk of endometrial cancer. -Use of estrogen, alone or in combination with a progestin, should be with the lowest effective dose and for the shortest duration. Starting dose should be the lowest. -Periodically re-evaluation (e.g., 3 to 6 month intervals) to determine if treatment is still necessary is recommended. -In women with uterus, endometrial sampling should be undertaken to rule out malignancy in cases of undiagnosed persistent or recurring abnormal vaginal bleeding. Use: Prevention of endometrial hyperplasia in non-hysterectomized postmenopausal women who are receiving daily oral conjugated estrogens 0.625 mg tablets Usual Adult Dose for Abnormal Uterine Bleeding: Oral tablets: -5 or 10 mg daily for 5 to 10 days, beginning on the 16 th or 21 st day of the menstrual cycle -Dose to produce an optimum secretory transformation of an endometrium that has been adequately primed with either endogenous or exogenous estrogen: 10 mg daily for 10 days beginning on the 16 th day of the cycle Comments: -Withdrawal bleeding usually occurs within 3 to 7 days after discontinuing therapy with the oral tablets. -Patients with a past history of recurrent episodes of abnormal uterine bleeding may benefit from planned menstrual cycling with the oral tablets. Use: Abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as fibroids or uterine cancer Usual Adult Dose for Amenorrhea: Oral tablets: -5 or 10 mg daily for 5 to 10 days Dose for inducing an optimum secretory transformation of an endometrium that has been adequately primed with either endogenous or exogenous estrogen: -10 mg daily for 10 day Comments: -Therapy may be started at any time. -Withdrawal bleeding usually occurs within 3 to 7 days after discontinuing therapy with this drug. Use: Treatment of secondary amenorrhea due to hormonal imbalance in the absence of organic pathology, such as fibroids or uterine cancer   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking medroxyprogesterone? Avoid smoking while you are taking medroxyprogesterone. Smoking greatly increases your risk of blood clots. Medroxyprogesterone side effects Get emergency medical help if you have signs of an allergic reaction to medroxyprogesterone: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using this medicine and call your doctor at once if you have: signs of a stroke - sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance; signs of a blood clot - sudden vision loss, stabbing chest pain, feeling short of breath, coughing up blood, pain or warmth in one or both legs; heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; liver problems - loss of appetite, upper stomach pain, tiredness, fever, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); unusual vaginal bleeding; confusion, memory problems; a breast lump; or symptoms of depression - sleep problems, weakness, tired feeling, mood changes. Common medroxyprogesterone side effects may include: spotting or breakthrough bleeding; changes in your menstrual periods; vaginal itching or discharge; headache, dizziness, feeling nervous or depressed; breast tenderness or discharge; stomach discomfort, bloating, nausea, vomiting; itching, rash, acne, hair growth, hair loss; premenstrual type symptoms (bloating, fluid retention, mood changes); weight gain; bruising or swelling of your veins; tiredness, trouble sleeping; or vision changes and difficulty wearing contact lenses. 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 medroxyprogesterone? Other drugs may interact with medroxyprogesterone, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.

What is Melatonin? Melatonin is the natural hormone your body secretes that helps to maintain your wake-sleep cycle (also called “biological clock”). Melatonin is also made synthetically and available without a prescription as an over-the-counter (OTC) dietary supplement in the U.S. Melatonin is most commonly used to: help decrease jet lag adjust sleep cycles in the blind (non 24-Hour Sleep Wake Disorder, or Non-24) treat shift-work sleep disorders in people with alternating work schedules for general insomnias The wake-sleep cycle is the process of sleep and wakefulness; in humans this averages 8 hours of nighttime sleep and 16 hours of daytime activity. Supplemental Melatonin has been suggested to have many uses, from sleep disorders to cancer treatment, but adequate studies are lacking for many uses. It has been widely studied for treatment of jet lag and other sleep disorders. Endogenous melatonin release (made by our bodies) is increased each day in response to darkness, peaking between 11PM and 3AM at roughly 200 picograms (pg) per mL. Nighttime levels are roughly 10 times higher than in the daytime. Levels fall sharply before daylight, and are barely detectable in the daylight hours. The rise and fall in endogenous levels signal wake and sleep times, known as our circadian rhythm. Natural melatonin production starts from the amino acid tryptophan, with serotonin as an intermediary, and then is released to the receptors in the brain, eye and other areas to help control the sleep quality and wake cycles. The half-life is short, roughly 20 to 50 minutes. It is metabolized (broken down) by the CYP450 enzyme system in the liver and then excreted in the urine or feces. Shorter periods of production occur in the summer with longer days, and more prolonged periods of production occur in the winter. Light at night (such as from smartphones or the TV) blocks production and can lead to sleep disturbances. Age also suppresses the levels of nighttime melatonin that are released, which may contribute to the problem of insomnia and early awakening often seen in older adults. How Does Melatonin Work? Natural melatonin is a highly lipid soluble hormone produced in the pineal gland in the brain. It is synthesized from the amino acid tryptophan and then released into the blood and cerebrospinal fluid, crossing the blood-brain barrier. It sends messages to the receptor agonist in the brain and other areas of the body to help control the sleep and wake cycles. Does melatonin help you sleep? When taken as a supplement, its function is to mimic the effects of the natural sleep hormone. Drowsiness generally occurs within 30 minutes after taking a dose. Taking supplemental melatonin for sleep before bedtime may not be the best strategy for all sleep disorders. Ask your doctor about the best method of dosing. This medication does not work for everyone. Is Melatonin a Hormone? Exogenous melatonin is a natural hormone when produced in the body (the endogenous hormone). It is not a vitamin. Melatonin supplements (exogenous hormone) are made synthetically and all products and strengths on the U.S. market are available without a prescription at the pharmacy, nutrition stores, and other retail shops. Before Taking This Medicine Do not use melatonin if you are allergic to it. Before using this medication, talk to your healthcare provider. You may not be able to use this medication if you have certain medical conditions, such as: diabetes depression a bleeding or blood clotting disorder such as hemophilia taking a blood thinner like warfarin high or low blood pressure epilepsy or other seizure disorder if you are using any medicine to prevent organ transplant rejection an autoimmune condition using other sedatives or tranquilizers It is not known whether this medication will harm an unborn baby. Do not use this product without medical advice if you are pregnant. High doses of this medicine may affect ovulation, making it difficult for you to get pregnant. It is not known whether melatonin passes into breast milk or if it could harm a nursing baby. Do not use this product without medical advice if you are breast-feeding a baby. Do not give any herbal/health supplement to a child without medical advice. Melatonin Dosage Melatonin is considered an effective treatment for jet lag and can aid sleep during times when you would not normally be awake. Effective starting doses of melatonin for jet lag range from 0.3 to 0.5 mg. One milligram tablets can be cut in half to achieve a 0.5 mg dose of melatonin if smaller doses are not available for purchase. Higher doses are commonly marketed in the U.S. (up to 10 mg), but higher doses may be associated with more side effects such as headache, next day grogginess, or vivid dreams. Side effects of melatonin may be worse in older adults. Always start with the lowest dose. According to a Cochrane review, doses over 5 mg appear to be no more effective than lower doses. Higher doses may result in excessively high levels of physiologic melatonin. How to Use Melatonin for Jet Lag? Jet lag is an air travel problem that causes difficulty in sleeping, fatigue, trouble concentrating, constipation, and other symptoms. Jet lag is much more likely if you cross over several time zones, and can worsen the more time zones you cross. Effective starting doses for jet lag range from 0.3 to 0.5 mg. Smaller doses may work for some while others may need a higher dose. It may be more difficult to fly east, when time is lost, rather than to fly west, when you gain it back. High doses, such as 20 mg pills are available for purchase on the Internet, but such high doses are not normally recommended or needed, and may greatly increase side effects. Eastbound: If you are traveling east, say from the US to Europe, take supplemental melatonin for sleep after dark, 30 minutes before bedtime in the new time zone or if you are on the plane. Then take it for the next 4 nights in the new time zone, after dark, 30 minutes before bedtime. If you are still feeling drowsy the day after using this medication, try a lower dose. Westbound: If you are heading west, for example, from the US to Australia, a dose is not needed for your first travel night, but you then may take it for the next 4 nights in the new time zone, after dark, 30 minutes before bedtime. Melatonin may not always be needed for westbound travel. Given enough time (usually 3 to 5 days), jet lag will usually resolve on its own, but this is not always optimal when traveling. Other Uses How to Take for Primary Sleep Disorders (Insomnia): Dosage: Take 0.1 mg to 0.5 mg thirty minutes before bedtime. Studies suggest supplemental melatonin for primary sleep disorders may be effective in promoting but not maintaining sleep (early morning awakening). How to Take for Shift-Work Sleep Disorders Dosage: Take 1 to 3 mg thirty minutes prior to the desired onset of daytime sleep; melatonin may NOT lead to improved alertness during the nighttime work shift. How to Take for Delayed Sleep-Wake Phase Disorder Delayed sleep-wake phase disorder (DSWPD) most often occurs in adolescents, possibly due to reduced production and melatonin deficiency at this age. Sleep onset is delayed by 3 to 6 hours compared with conventional bedtimes (10 to 11 pm). DSWPD can negatively affect school performance, daily activities, and lead to morning drowsiness which can be dangerous for teen drivers. Any sleep disorder in an adolescent should be evaluated by a physician. Dosage: No consensus is available for dosing in DSWPS. Some clinicians recommend 3 to 5 mg taken in the early evening, at least 1.5 hours before the desired bedtime. Bright light therapy and behavioral management may enhance results. Be aware drowsiness may occur after the melatonin dose, so avoid hazardous activities such as driving. How to Take for Non-24-Hour Sleep Wake Disorder (Non-24) More than 70% of people who are totally blind have Non-24, a circadian rhythm disorder. For people who are totally blind, there are no light cues to help reset the biological clock. The sleep time and wake up time of people who have Non-24-Hour Sleep Wake Disorder shifts a little later every day. Sleep times go in and out of alignment compared to a normal sleep-wake phase. Extra minutes add up each day by day and disrupt the normal wake-sleep pattern. Use of melatonin in Non-24 is to aid in stimulation to reset the biological clock with one long sleep time at night and one long awake time during the day. Dosage: Studies on people who are the blind suggest 0.5 mg/day, taken either at a fixed time before bed or one hour before bedtime. Hetlioz, a prescription-only melatonin agonist is approved for use in Non-24-Hour Sleep Wake Disorder in adults and for the treatment of Nighttime Sleep Disturbances in Smith-Magenis Syndrome (SMS) in patients 3 years of age and older. Hetlioz (tasimelteon) Rozerem (ramelteon), also a melatonin agonist, has been approved to treat insomnia characterized by difficulty with sleep onset in adults. Hetlioz (tasimelteon) Rozerem (ramelteon) Fast-dissolving Tablets Some melatonin tablets are available in fast-dissolving formulations in the U.S. To take the orally disintegrating tablet: Use dry hands to remove the tablet and place it in your mouth. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. If desired, you may drink liquid to help swallow the dissolved tablet. Call your doctor if the condition you are treating with this medication does not improve, or if it gets worse while using this product. Store at room temperature away from moisture and heat. Melatonin for Children Parents may consider using melatonin to help their child who has a trouble falling asleep. Only use this medication for your child under the care of a pediatrician or other medical sleep specialist. Insomnia or other sleeping disorders in children should always be evaluated by a medical professional. Melatonin should not be used as a substitute for good sleep hygiene and consistent bedtime routines in children. According to Yale sleep specialist Dr. Craig Canapari, use of this medication results in less difficulty with falling asleep, earlier time of sleep onset, and more sleep at night. Products containing lower-dose melatonin for kids do exist on the U.S. market. Long-term use of this medication has not been studied in clinical trials for children and possible side effects with prolonged use are not known. The use of melatonin in children with autism spectrum disorder or attention-deficit hyperactivity disorder should involve behavioral interventions and should be directed by a physician. Delayed sleep phase disorder often occurs in teenagers and young adults, possibly due to alterations in endogenous production. Sleep onset is delayed by 3 to 6 hours compared with normal bedtime hours of 10 to 11 PM. Maintaining a consistent bedtime free of electronics for at least one hour prior to bedtime is especially important for insomnia in children and adolescents. Melatonin Side Effects in Children The most common melatonin side effect in children is morning drowsiness. Other common side effects in children include: Bedwetting Headache Dizziness Nausea Diarrhea Possible increased risk for seizures in children with severe neurological disorders. Dietary melatonin supplements can still have drug interactions or health risks if you have certain medical conditions, upcoming surgery, or other health concerns. What to avoid Avoid driving or operating machinery for at least 4 hours after taking melatonin, or until the drowsy effects are no longer present. Avoid using this medication with other prescription medications, over-the-counter drugs, or dietary supplements without asking your doctor, pharmacist or other healthcare provider. Avoid alcohol while taking this medication. Avoid coffee, tea, cola, energy drinks, or other products that contain caffeine, as it may counteract the effects of the melatonin. What Happens if I Miss a Dose? If you miss taking a dose there is no cause for concern, but melatonin may impair your thinking and reaction time. If you will be driving or doing any hazardous activity, skip your dose as melatonin can cause drowsiness. Otherwise, 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 or double your dose to make up the missed medication. Can You Overdose? Melatonin is thought to be very safe in the short-term with a low risk for overdose. If you suspect an overdose or serious adverse effects or allergic reactions, seek emergency medical attention from your health care provider or call the Poison Help Line at 1-800-222-1222. Is Melatonin Safe? Melatonin is a relatively safe supplement when used in the short-term, and melatonin side effects are uncommon. Its safety in the long-term has not been determined in randomized, controlled studies. In general this medication appears to be relatively nontoxic, even at higher doses such as 3 to 5 mg once a day. Some people can have side effects from melatonin that may include: daytime drowsiness, dizziness, weakness, or confusion vivid dreams, nightmares feeling depressed, anxious, irritable headache loss of appetite, diarrhea, nausea, stomach pain blood pressure changes joint or back pain elevated risk for seizures Higher external doses(>1 mg to 10 mg) can worsen side effects like daytime drowsiness, impaired physical or mental ability, low body temperature, and elevated prolactin levels. Related: Melatonin: Worth Losing Sleep Over? Melatonin and Pregnancy Most dietary supplements like melatonin have not been studied in pregnant women, during breastfeeding, or in children. Seek advice from your healthcare provider before using any dietary supplement if you are pregnant, nursing, or considering the use of this product in a child under 18 years of age. Melatonin Drug Interactions Some important drug interactions can occur with melatonin even though it is a dietary supplement. Always review for drug, food and disease interactions with your healthcare provider anytime you start, or even stop, a medication. Always tell your doctor and pharmacist about all of the medications you take, including prescription drugs, over-the-counter medicines, vitamins and herbal supplements. Do not stop using any medications without first talking to your doctor. Talk to your doctor before using melatonin if you take the blood thinner warfarin. Melatonin has been reported to increase the effects of warfarin in some patients. This is not a complete list of drug interactions that may occur with melatonin. Melatonin drug interactions (more detail) Is Melatonin Approved by the FDA? Melatonin is not approved by the FDA for any use. It falls under the FDA’s Dietary Health and Education Act as a dietary supplement. Dietary supplements may include vitamins, minerals, amino acids, and herbs or botanicals, plus other substances used to supplement the diet. As with other dietary supplements, melatonin isn't approved by the Food and Drug Administration (FDA) for safety or effectiveness. Manufacturers must notify FDA about new ingredients prior to marketing. After the supplement is on the market, the FDA will monitor adverse event/s that are reported to them by the manufacturer, consumers or health care professionals. If a manufacturer makes an unproven health claim or if the supplement is found to be unsafe the FDA can remove the OTC from the market. Avoid buying dietary supplements from the Internet and from online pharmacies whose authenticity you cannot verify. It is important to remember that an OTC label that says “natural” supplement does not always mean it’s “safe” for consumption. Formulations that are United States Pharmacopeial (USP) Convention Verified can be considered most reliable in this regard; the label “USP” is found on the outside of the bottle. For example, all Nature Made products are verified by the USP. The safest way to purchase drugs online is through pharmacies accredited by the Verification of Internet Pharmacy Practice Sites (VIPPS) programs. Do Electronic Devices Alter Melatonin Levels? Light at night blocks the production of melatonin, and this has been shown to cause sleep disturbances in people who use electronics that emit light at night. Researchers have found that light from electronic devices can block the release of natural hormone melatonin at night. The effect was most significant for younger children, with nighttime levels reduced by up to 37 percent in certain cases. This can also be problematic for children between ages 9 and 16. Studies show that light after dark lowers melatonin levels which may lead to difficulty in initiating sleep. Electronic light-emitting devices such as the television, laptops, smartphones and tablets often find their way into the bedroom at night, or are used after dark. Children should not have electronics, including TVs, in their bedroom at bedtime and everyone should avoid use of light-emitting devices and screen time at least one hour before bedtime. Melatonin Reviews and Studies For Primary Sleep Disorders Researchers have conducted many studies on melatonin supplements for various health conditions. Most studies have been conducted in sleep disorders, such as jet lag, shift work sleep disorders, delayed sleep phase disorder, and insomnia. Studies are often not consistent in their results and questions still remain about its usefulness, dosage, length of treatment and long-term safety for some sleep conditions. Melatonin can be effective for jet lag for many people when dosed at the appropriate time. Studes measuring the effectiveness of melatonin for the treatment of insomnia show a slight reduction in the amount of time needed to fall asleep, but melatonin may not increase the overall quality of sleep. This medication does appear to be safe for short-term use for primary insomnia (less than three months). For Other Conditions Multiple areas for melatonin use have been investigated, but not all uses may be accepted or have adequate research to determine appropriate clinical use. These include: Cancer Boost the immune system Sunburn Irritable Bowel Syndrome (IBS) Fibromyalgia Systemic sclerosis Antioxidant and free radical scavenger Alzheimer’s disease Ocular diseases Sleep aid for children with autism spectrum disorder or attention deficit hyperactivity disorder (ADHD) Amyotrophic lateral sclerosis (ALS) Nighttime blood pressure control Seasonal affective disorder (SAD) How Does Melatonin Come at the Store? In the U.S., melatonin pills can be purchased without a prescription in the pharmacy, grocery, or health food store. Pill strengths range from 1 milligram (mg) to 10 mg, but you should always start with the lowest dose to judge its effects. Some experts suggest to start with 0.3 to 0.5 mg thirty minutes before bedtime, instead of the higher doses. Cut a 1-mg immediate release tablet in half to get a 0.5 mg dose if lower doses are not available; don’t do this with time release products. Also, don't drink alcohol with the time-release preparation, as it can disrupt the time-release mechanism. Does Food Contain Melatonin? A study published in Food and Nutrition Research notes that certain food products do contain various amounts of melatonin as measured by immunological and chromatographic laboratory techniques. How consumption of these various foods might affect endogenous production sleep or was not evaluated: Tomatoes Walnuts Rice/barley cereal Strawberries, tart cherries Olive oil Wine, beer Cow’s milk  

What is meloxicam? Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. Meloxicam is used to treat pain or inflammation caused by rheumatoid arthritis and osteoarthritis in adults. Meloxicam is also used to treat juvenile rheumatoid arthritis in children who are at least 2 years old. The Anjeso brand of meloxicam is used to treat moderate to severe pain in adults. Vivlodex is for use only in adults. Qmiiz is for adults and children weighing at least 132 pounds (60 kilograms). Warnings Meloxicam can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance. Meloxicam may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults. Call your doctor at once if you have symptoms of stomach bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. Avoid smoking and drinking alcohol as they also increase your risk of stomach bleeding. Ask a doctor or pharmacist before using any other cold, allergy, or pain medicine. Medicines similar to meloxicam are contained in many combination medicines. Check the label to see if a medicine contains an NSAID (non-steroidal anti-inflammatory drug) such as aspirin, ibuprofen, ketoprofen, or naproxen. Meloxicam can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Even people without heart disease or risk factors could have a stroke or heart attack while taking this medicine. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Meloxicam may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using this medicine, especially in older adults. You should not use meloxicam if you are allergic to it, or if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID. To make sure this medicine is safe for you, tell your doctor if you have: heart disease, high blood pressure, high cholesterol, diabetes, or if you smoke; a history of heart attack, stroke, or blood clot; a history of stomach ulcers or bleeding; asthma; kidney disease (or if you are on dialysis); liver disease; or fluid retention. If you are pregnant, you should not take meloxicam unless your doctor tells you to. Taking a NSAID during the last 20 weeks of pregnancy can cause serious heart or kidney problems in the unborn baby and possible complications with your pregnancy. Meloxicam may cause a delay in ovulation (the release of an egg from an ovary). You should not take this medicine if you are undergoing fertility treatment, or are otherwise trying to get pregnant. Meloxicam can pass into breast milk and may harm a nursing baby. Talk to your doctor before breastfeeding while using this medicine. Meloxicam is not FDA approved for use by anyone younger than 2 years old. How should I take meloxicam? Take meloxicam exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger amounts or for longer than recommended. Use the lowest dose that is effective in treating your condition. Meloxicam oral is taken by mouth. The injection is given as an infusion into a vein. A healthcare provider will give you this injection. You may take the oral medicine with or without food. Remove an orally disintegrating tablet from the package only when you are ready to take the medicine. Place the tablet in your mouth and allow it to dissolve, without chewing. Swallow several times as the tablet dissolves. Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the form and strength your doctor prescribes. Meloxicam doses are based on weight (especially in children and teenagers). Your dose needs may change if you gain or lose weight. If you use this medicine long-term, you may need frequent medical tests. Store meloxicam tablets or capsules at room temperature, away from moisture and heat. Keep the bottle tightly closed when not in use.   What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What to avoid Avoid alcohol. Heavy drinking can increase your risk of stomach bleeding. Avoid taking aspirin while you are taking meloxicam, unless your doctor tells you to. Ask a doctor or pharmacist before using other medicines for pain, fever, swelling, or cold/flu symptoms. They may contain ingredients similar to meloxicam (such as aspirin, ibuprofen, ketoprofen, or naproxen). Meloxicam side effects Get emergency medical help if you have signs of an allergic reaction to meloxicam: sneezing, runny or stuffy nose; wheezing or trouble breathing; hives; swelling of your face, lips, tongue, or throat. Get emergency medical help if you have signs of a heart attack or stroke: chest pain spreading to your jaw or shoulder, sudden numbness or weakness on one side of the body, slurred speech, feeling short of breath. Stop using this medicine and call your doctor at once if you have: the first sign of any skin rash, no matter how mild; shortness of breath (even with mild exertion); swelling or rapid weight gain; signs of stomach bleeding - bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds; liver problems - nausea, upper stomach pain, itching, tired feeling, flu-like symptoms, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); kidney problems - little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath; low red blood cells (anemia) - pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. Common meloxicam side effects may include: upset stomach, nausea, vomiting, heartburn; diarrhea, constipation, gas; dizziness; or cold symptoms, flu symptoms. 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 meloxicam? Ask your doctor before using meloxicam if you take an antidepressant such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed easily. Tell your doctor about all your current medicines and any you start or stop using, especially: cyclosporine; lithium; methotrexate; sodium polystyrene sulfonate (Kayexalate); a blood thinner (warfarin, Coumadin, Jantoven); heart or blood pressure medication, including a diuretic or "water pill" and ACE inhibitors; or steroid medicine (such as prednisone). This list is not complete. Other drugs may interact with meloxicam, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

What is memantine? Memantine reduces the actions of chemicals in the brain that may contribute to the symptoms of Alzheimer's disease. Memantine is used to treat moderate to severe dementia of the Alzheimer's type. Memantine may also be used for purposes not listed in this medication guide. Warnings Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use. Before taking this medicine You should not use memantine if you are allergic to it. To make sure memantine is safe for you, tell your doctor if you have: epilepsy or other seizure disorder; liver disease; kidney disease; urination problems; or a bladder or kidney infection. memantine is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether memantine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby. How should I take memantine? Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended. Memantine can be taken with or without food. Do not crush, chew, break, or open an extended-release capsule. Swallow it whole. To make swallowing easier, you may open the extended-release capsule and sprinkle the medicine into a spoonful of applesauce. Swallow right away without chewing. Do not save the mixture for later use.   Measure liquid medicine (oral solution) with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. Do not mix the oral solution with any other liquids. Rinse the empty oral syringe with clean water and allow it to air dry after every use. Use memantine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. Your doctor will need to check your progress while you are using memantine. Store memantine at room temperature away from moisture and heat. Keep the liquid medicine bottle tightly closed with the cap provided. Do not store the bottle with the oral syringe in it. Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions. What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. If you miss doses or forget to take your medicine for several days, call your doctor before starting the medicine again. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking memantine? Memantine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Memantine side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have: severe headache, blurred vision, pounding in your neck or ears; seizure (convulsions); or unusual changes in mood or behavior. Common side effects may include: diarrhea; dizziness; or headache. 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.   Memantine dosing information Usual Adult Dose for Alzheimer's Disease: IMMEDIATE-RELEASE: Week 1: 5 mg orally once a day. Week 2: 10 mg orally/day (Administer 5 mg twice a day.) Week 3: 15 mg orally/day (Administer 5 mg and 10 mg as separate doses.) Week 4/Maintenance Dose: 20 mg orally/day (Administer 10 mg twice a day.) EXTENDED-RELEASE: -Initial Dose: 7 mg orally once a day. -Maintenance and Maximum Dose: 28 mg orally once a day; increase the initial dose in 7 mg increments to the recommended maintenance dose. Comments: The minimum recommended interval between dose increases is one week; only increase dosage if the previous dose has been well tolerated. Use: Treatment of moderate to severe dementia of the Alzheimer's type.  

What is meprobamate? Meprobamate is used short-term to treat anxiety. Meprobamate may also be used for purposes not listed in this medication guide. Warnings Use only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies. Before taking this medicine You should not use meprobamate if you are allergic to it, or if you have: porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system); or an allergy to carisoprodol, mebutamate, tybamate, or carbromal. Tell your doctor if you have ever had: epilepsy or other seizure disorder; kidney disease; liver disease; or alcoholism or drug addiction. May harm an unborn baby. Tell your doctor if you are pregnant or if you become pregnant. Ask a doctor if it is safe to breastfeed while using meprobamate. Not approved for use by anyone younger than 6 years old. How should I take meprobamate? Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed. Meprobamate may be habit-forming. Misuse can cause addiction, overdose, or death. Never share this medicine with another person. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law. Your doctor will need to check your progress on a regular basis. You may have withdrawal symptoms if you stop using meprobamate suddenly after using it long term or at high doses. Ask your doctor before stopping the medicine. Store tightly closed at room temperature, away from moisture and heat. Keep your medicine in a place where no one can use it improperly. What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal. Overdose symptoms may include extreme drowsiness or dizziness, loss of coordination, slurred speech, weak or shallow breathing, fainting, or coma. What should I avoid while taking meprobamate? Drinking alcohol with meprobamate can cause side effects. Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired. Meprobamate side effects Get emergency medical help if you have signs of an allergic reaction (hives, fever, chills, wheezing, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling). Call your doctor at once if you have: feelings of extreme happiness, feeling restless or excited; thoughts about suicide or hurting yourself; fast or pounding heartbeats; a light-headed feeling, like you might pass out; swelling in your hands, ankles, or feet; a red, itchy rash (may be only in your groin area); unusual bruising; or sudden fever, chills, sore throat, weakness. Common side effects may include: drowsiness, weakness; problems with balance or muscle movement; headache, dizziness; bruising; numbness or tingling; blurred vision; or nausea, vomiting, diarrhea. 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.   Meprobamate dosing information Usual Adult Dose for Anxiety: 1200 to 1600 mg orally divided in 3 or 4 doses Maximum dose: 2400 mg per day Comments: -The lowest effective dose should be used in order to limit oversedation. -The effectiveness beyond 4 months has not been assessed. Uses: Management of anxiety disorders or for the short-term relief of anxiety symptoms. Usual Pediatric Dose for Anxiety: Age: 6 to 12 years: 200 to 600 mg orally divided in 2 or 3 doses Age: 13 years or older: 1200 to 1600 mg orally divided in 3 or 4 doses Maximum dose: 2400 mg per day Comments: -The lowest effective dose should be used in order to limit oversedation. -The effectiveness beyond 4 months has not been assessed. Uses: Management of anxiety disorders or for the short-term relief of anxiety symptoms   What other drugs will affect meprobamate? Using meprobamate with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures. Other drugs may affect meprobamate, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.

What is mesalamine? Mesalamine is used to treat mild to moderate ulcerative colitis. Mesalamine is also used to prevent the symptoms of ulcerative colitis from recurring. Some brands of mesalamine are for use only in adults, and some brands are for use in children who are at least 5 years old. Mesalamine may also be used for purposes not listed in this medication guide. Warnings Stop using mesalamine and call your doctor at once if you have severe stomach pain, stomach cramping, bloody diarrhea (may occur with fever, headache, and skin rash). Before taking this medicine You should not use mesalamine if you are allergic to mesalamine, aspirin, sulfasalazine, or salicylates (such as Disalcid, Doans Pills, Dolobid, Kaopectate, Nuprin Backache, Pepto-Bismol, Tricosal, Trilisate, and others). Tell your doctor if you have ever had: a kidney stone or kidney disease; liver disease; a blockage in your stomach or intestines (such as pyloric stenosis); or a skin condition such as eczema. Some forms of mesalamine contain phenylalanine. Tell your doctor if you have phenylketonuria (PKU). Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether mesalamine will harm an unborn baby. However, having untreated or uncontrolled ulcerative colitis during pregnancy may cause complications such as low birth weight or premature birth. The benefit of treating ulcerative colitis may outweigh any risks to the baby. It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. If you are breastfeeding, tell your doctor if you notice diarrhea in the nursing baby. Do not give this medicine to a child without medical advice. Some brands of mesalamine are not approved for use in anyone younger than 18 years old. Delzicol should not be given to a child younger than 5 years old. How should I take mesalamine? Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed. This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using mesalamine. Take Asacol HD on an empty stomach, at least 1 hour before or 2 hours after a meal. Lialda should be taken with a meal. You may take Apriso with or without food. Drink plenty of liquids to help prevent kidney stones. Other brands of mesalamine can be taken with or without food. Follow your doctor's instructions or the directions on your medicine label. Swallow the capsule or tablet whole and do not crush, chew, or break it. Tell your doctor if you have trouble swallowing the pill. If you cannot swallow a Pentasa capsule whole, open it and sprinkle the medicine into a spoonful of yogurt or applesauce. Swallow the mixture right away without chewing. Do not save it for later use. Tell your doctor if you find undissolved mesalamine tablets in your stool. Call your doctor if your ulcerative colitis symptoms do not improve, or if they get worse. This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using mesalamine. You may need frequent blood tests to check your blood cells or kidney function. Store at room temperature away from moisture and heat.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking mesalamine? If you have a skin condition such as eczema, mesalamine could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Ask your doctor before using an antacid, and use only the type your doctor recommends. Some antacids can make it harder for your body to absorb mesalamine. Mesalamine side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using mesalamine and call your doctor at once if you have: severe stomach pain, stomach cramping, bloody diarrhea; fever, headache, general ill feeling; rash, itching, eye redness; bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds; low white blood cell counts--fever, chills, mouth sores, skin sores, sore throat, cough, feeling light-headed, trouble breathing; signs of a kidney stone--severe pain in your side and back, frequent need to urinate, foul-smelling urine, dark or cloudy urine; kidney problems--increased or decreased urination, swelling, weight gain; or liver problems--loss of appetite, upper stomach pain, tiredness, easy bruising or bleeding, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes). Low white blood cell counts may be more likely in older adults. Common side effects may include: burping, constipation, nausea, vomiting, stomach pain, diarrhea, gas; dizziness; cold symptoms such as stuffy nose, sneezing, sore throat; back pain; headache; rash; or abnormal liver function tests. 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 mesalamine?   Mesalamine can harm your kidneys, especially if you also use certain medicines for infections, cancer, osteoporosis, organ transplant rejection, bowel disorders, high blood pressure, or pain or arthritis (including Advil, Motrin, and Aleve). Tell your doctor about all your other medicines, especially: azathioprine or 6-mercaptopurine. This list is not complete. Other drugs may affect mesalamine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

What is metformin? Metformin is an oral diabetes medicine that helps control blood sugar levels. Metformin is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. Metformin is sometimes used together with insulin or other medications, but it is not for treating type 1 diabetes. Metformin is also used off-label to treat polycystic ovary syndrome (PCOS). Warnings You should not use metformin if you have severe kidney disease, metabolic acidosis, or diabetic ketoacidosis (call your doctor for treatment). If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you may need to temporarily stop taking metformin. Though extremely rare, you may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. Call your doctor or get emergency medical help if you have unusual muscle pain, trouble breathing, stomach pain, dizziness, feeling cold, or feeling very weak or tired. Before taking this medicine You should not use metformin if you are allergic to it, or if you have: severe kidney disease; or metabolic acidosis or diabetic ketoacidosis (call your doctor for treatment). If you need to have surgery or any type of x-ray or CT scan using a dye that is injected into your veins, you may need to temporarily stop taking metformin. Be sure your caregivers know ahead of time that you are using this medication. Tell your doctor if you have ever had: kidney disease (your kidney function may need to be checked before you take this medicine); high ketone levels in your blood or urine; heart disease, congestive heart failure; liver disease; or if you also use insulin, or other oral diabetes medications. You may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. This may be more likely if you have other medical conditions, a severe infection, chronic alcoholism, or if you are 65 or older. Ask your doctor about your risk. Follow your doctor's instructions about using metformin if you are pregnant or you become pregnant. Controlling diabetes is very important during pregnancy, and having high blood sugar may cause complications in both the mother and the baby. Tell your doctor if you become pregnant while taking metformin. Metformin may stimulate ovulation in a premenopausal woman and may increase the risk of unintended pregnancy. Talk to your doctor about your risk. You should not breastfeed while using this medicine. Metformin should not be given to a child younger than 10 years old. Some forms of metformin are not approved for use by anyone younger than 18 years old. How should I take metformin? Take metformin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Take metformin with a meal, unless your doctor tells you otherwise. Some forms of metformin are taken only once daily with the evening meal. Follow your doctor's instructions. Do not crush, chew, or break an extended-release tablet. Swallow it whole. Measure liquid medicine carefully. Shake the oral suspension before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Some tablets are made with a shell that is not absorbed or melted in the body. Part of this shell may appear in your stool. This is normal and will not make the medicine less effective. You may have low blood sugar (hypoglycemia) and feel very hungry, dizzy, irritable, confused, anxious, or shaky. To quickly treat hypoglycemia, eat or drink a fast-acting source of sugar (fruit juice, hard candy, crackers, raisins, or non-diet soda). Your doctor may prescribe a glucagon injection kit in case you have severe hypoglycemia. Be sure your family or close friends know how to give you this injection in an emergency. Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule. Metformin is only part of a complete treatment program that may also include diet, exercise, weight control, regular blood sugar testing, and special medical care. Follow your doctor's instructions very closely. Store at room temperature away from moisture, heat, and light. Your doctor may have you take extra vitamin B12 while you are taking this medicine. Take only the amount of vitamin B12 that your doctor has prescribed.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can cause severe hypoglycemia or lactic acidosis. What to avoid Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis. Metformin side effects Get emergency medical help if you have signs of an allergic reaction to metformin: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Some people using this medicine develop lactic acidosis, which can be fatal. Get emergency medical help if you have even mild symptoms such as: unusual muscle pain; feeling cold; trouble breathing; feeling dizzy, light-headed, tired, or very weak; stomach pain, vomiting; or slow or irregular heart rate. Common metformin side effects may include: low blood sugar; nausea, upset stomach; or diarrhea. 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 metformin? Many drugs can interact with metformin, making it less effective or increasing your risk of lactic acidosis. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

What is metformin? Metformin is an oral diabetes medicine that helps control blood sugar levels. Metformin is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. Metformin is sometimes used together with insulin or other medications, but it is not for treating type 1 diabetes. Metformin is also used off-label to treat polycystic ovary syndrome (PCOS). Warnings You should not use metformin if you have severe kidney disease, metabolic acidosis, or diabetic ketoacidosis (call your doctor for treatment). If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you may need to temporarily stop taking metformin. Though extremely rare, you may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. Call your doctor or get emergency medical help if you have unusual muscle pain, trouble breathing, stomach pain, dizziness, feeling cold, or feeling very weak or tired. Before taking this medicine You should not use metformin if you are allergic to it, or if you have: severe kidney disease; or metabolic acidosis or diabetic ketoacidosis (call your doctor for treatment). If you need to have surgery or any type of x-ray or CT scan using a dye that is injected into your veins, you may need to temporarily stop taking metformin. Be sure your caregivers know ahead of time that you are using this medication. Tell your doctor if you have ever had: kidney disease (your kidney function may need to be checked before you take this medicine); high ketone levels in your blood or urine; heart disease, congestive heart failure; liver disease; or if you also use insulin, or other oral diabetes medications. You may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. This may be more likely if you have other medical conditions, a severe infection, chronic alcoholism, or if you are 65 or older. Ask your doctor about your risk. Follow your doctor's instructions about using metformin if you are pregnant or you become pregnant. Controlling diabetes is very important during pregnancy, and having high blood sugar may cause complications in both the mother and the baby. Tell your doctor if you become pregnant while taking metformin. Metformin may stimulate ovulation in a premenopausal woman and may increase the risk of unintended pregnancy. Talk to your doctor about your risk. You should not breastfeed while using this medicine. Metformin should not be given to a child younger than 10 years old. Some forms of metformin are not approved for use by anyone younger than 18 years old. How should I take metformin? Take metformin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Take metformin with a meal, unless your doctor tells you otherwise. Some forms of metformin are taken only once daily with the evening meal. Follow your doctor's instructions. Do not crush, chew, or break an extended-release tablet. Swallow it whole. Measure liquid medicine carefully. Shake the oral suspension before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Some tablets are made with a shell that is not absorbed or melted in the body. Part of this shell may appear in your stool. This is normal and will not make the medicine less effective. You may have low blood sugar (hypoglycemia) and feel very hungry, dizzy, irritable, confused, anxious, or shaky. To quickly treat hypoglycemia, eat or drink a fast-acting source of sugar (fruit juice, hard candy, crackers, raisins, or non-diet soda). Your doctor may prescribe a glucagon injection kit in case you have severe hypoglycemia. Be sure your family or close friends know how to give you this injection in an emergency. Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule. Metformin is only part of a complete treatment program that may also include diet, exercise, weight control, regular blood sugar testing, and special medical care. Follow your doctor's instructions very closely. Store at room temperature away from moisture, heat, and light. Your doctor may have you take extra vitamin B12 while you are taking this medicine. Take only the amount of vitamin B12 that your doctor has prescribed.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can cause severe hypoglycemia or lactic acidosis. What to avoid Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis. Metformin side effects Get emergency medical help if you have signs of an allergic reaction to metformin: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Some people using this medicine develop lactic acidosis, which can be fatal. Get emergency medical help if you have even mild symptoms such as: unusual muscle pain; feeling cold; trouble breathing; feeling dizzy, light-headed, tired, or very weak; stomach pain, vomiting; or slow or irregular heart rate. Common metformin side effects may include: low blood sugar; nausea, upset stomach; or diarrhea. 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 metformin? Many drugs can interact with metformin, making it less effective or increasing your risk of lactic acidosis. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

What is metformin? Metformin is an oral diabetes medicine that helps control blood sugar levels. Metformin is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. Metformin is sometimes used together with insulin or other medications, but it is not for treating type 1 diabetes. Metformin is also used off-label to treat polycystic ovary syndrome (PCOS). Warnings You should not use metformin if you have severe kidney disease, metabolic acidosis, or diabetic ketoacidosis (call your doctor for treatment). If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you may need to temporarily stop taking metformin. Though extremely rare, you may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. Call your doctor or get emergency medical help if you have unusual muscle pain, trouble breathing, stomach pain, dizziness, feeling cold, or feeling very weak or tired. Before taking this medicine You should not use metformin if you are allergic to it, or if you have: severe kidney disease; or metabolic acidosis or diabetic ketoacidosis (call your doctor for treatment). If you need to have surgery or any type of x-ray or CT scan using a dye that is injected into your veins, you may need to temporarily stop taking metformin. Be sure your caregivers know ahead of time that you are using this medication. Tell your doctor if you have ever had: kidney disease (your kidney function may need to be checked before you take this medicine); high ketone levels in your blood or urine; heart disease, congestive heart failure; liver disease; or if you also use insulin, or other oral diabetes medications. You may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. This may be more likely if you have other medical conditions, a severe infection, chronic alcoholism, or if you are 65 or older. Ask your doctor about your risk. Follow your doctor's instructions about using metformin if you are pregnant or you become pregnant. Controlling diabetes is very important during pregnancy, and having high blood sugar may cause complications in both the mother and the baby. Tell your doctor if you become pregnant while taking metformin. Metformin may stimulate ovulation in a premenopausal woman and may increase the risk of unintended pregnancy. Talk to your doctor about your risk. You should not breastfeed while using this medicine. Metformin should not be given to a child younger than 10 years old. Some forms of metformin are not approved for use by anyone younger than 18 years old. How should I take metformin? Take metformin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Take metformin with a meal, unless your doctor tells you otherwise. Some forms of metformin are taken only once daily with the evening meal. Follow your doctor's instructions. Do not crush, chew, or break an extended-release tablet. Swallow it whole. Measure liquid medicine carefully. Shake the oral suspension before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Some tablets are made with a shell that is not absorbed or melted in the body. Part of this shell may appear in your stool. This is normal and will not make the medicine less effective. You may have low blood sugar (hypoglycemia) and feel very hungry, dizzy, irritable, confused, anxious, or shaky. To quickly treat hypoglycemia, eat or drink a fast-acting source of sugar (fruit juice, hard candy, crackers, raisins, or non-diet soda). Your doctor may prescribe a glucagon injection kit in case you have severe hypoglycemia. Be sure your family or close friends know how to give you this injection in an emergency. Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule. Metformin is only part of a complete treatment program that may also include diet, exercise, weight control, regular blood sugar testing, and special medical care. Follow your doctor's instructions very closely. Store at room temperature away from moisture, heat, and light. Your doctor may have you take extra vitamin B12 while you are taking this medicine. Take only the amount of vitamin B12 that your doctor has prescribed.   What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can cause severe hypoglycemia or lactic acidosis. What to avoid Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis. Metformin side effects Get emergency medical help if you have signs of an allergic reaction to metformin: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Some people using this medicine develop lactic acidosis, which can be fatal. Get emergency medical help if you have even mild symptoms such as: unusual muscle pain; feeling cold; trouble breathing; feeling dizzy, light-headed, tired, or very weak; stomach pain, vomiting; or slow or irregular heart rate. Common metformin side effects may include: low blood sugar; nausea, upset stomach; or diarrhea. 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 metformin? Many drugs can interact with metformin, making it less effective or increasing your risk of lactic acidosis. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

What is methimazole? Methimazole prevents the thyroid gland from producing too much thyroid hormone. Methimazole is used to treat hyperthyroidism (overactive thyroid). It is also used before thyroid surgery or radioactive iodine treatment. Methimazole may also be used for purposes not listed in this medication guide. Warnings You should not breast-feed while using methimazole. Before taking this medicine You should not use methimazole if you are allergic to it, or: if you are pregnant or breast-feeding. To make sure methimazole is safe for you, tell your doctor if you have: liver disease; a blood cell disorder; or a weak immune system. Using methimazole during pregnancy could harm the unborn baby. Tell your doctor if you are pregnant or if you become pregnant while using this medicine. Methimazole can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine. Do not give this medicine to a child without medical advice. How should I take methimazole? Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not use methimazole in larger or smaller amounts or for longer than recommended. Methimazole is usually taken every 8 hours. Take your doses at regular intervals to keep a steady amount of the drug in your body at all times. If a child is using this medicine, tell your doctor if the child has any changes in weight. Methimazole doses are based on weight in children, and any changes may affect your child's dose. Methimazole can lower blood cells that help your body fight infections and help your blood to clot. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Your blood may need to be tested often. Use methimazole regularly to get the most benefit, even if you feel fine or have no symptoms of hyperthyroidism. Get your prescription refilled before you run out of medicine completely. If you need surgery, tell the surgeon ahead of time that you are using methimazole. Store at room temperature away from moisture and heat. What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, upset stomach, headache, joint pain, fever, itching, swelling, or pale skin and easy bruising or bleeding. What should I avoid while taking methimazole? Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection. Methimazole side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Serious and sometimes fatal infections may occur during treatment with methimazole. Stop using methimazole and call your doctor right away if you have signs of infection such as: sudden weakness or ill feeling, fever, chills, sore throat, cold or flu symptoms; painful mouth sores, pain when swallowing, red or swollen gums; or pale skin, easy bruising, unusual bleeding. Call your doctor at once if you have: swollen glands in your neck or jaw; or liver problems--nausea, upper stomach pain, itching, tiredness, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes). Common side effects may include: nausea, vomiting, upset stomach; headache, dizziness, drowsiness; numbness or tingly feeling; rash, itching, skin discoloration; muscle or joint pain; hair loss; or decreased sense of taste. 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.   Methimazole dosing information Usual Adult Dose for Hyperthyroidism: Initial dose: Mild hyperthyroidism: 15 mg orally per day Moderately severe hyperthyroidism: 30 to 40 mg orally per day Severe hyperthyroidism: 60 mg orally per day Maintenance dose: 5 to 15 mg orally per day Comments: Daily doses are usually given in 3 divided doses at approximately 8 hour intervals Uses: -For the treatment of Graves' disease with hyperthyroidism or toxic multinodular goiter in whom surgery or radioactive iodine therapy is not an appropriate treatment option. -To ameliorate symptoms of hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy. Usual Pediatric Dose for Hyperthyroidism: Initial dose: 0.4 mg/kg orally per day Maintenance dose: 0.2 mg/kg orally per day (approximately half the initial dose) Comments: Daily doses are usually given in 3 divided doses at approximately 8 hour intervals   What other drugs will affect methimazole? Tell your doctor about all your current medicines and any you start or stop using, especially: digoxin, digitalis, theophylline; a blood thinner--warfarin, Coumadin, Jantoven; or a beta blocker--atenolol, carvedilol, labetalol, metoprolol, nadolol, propranolol, sotalol, and others. This list is not complete. Other drugs may interact with methimazole, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

What is methocarbamol? Methocarbamol is a muscle relaxer. It works by blocking nerve impulses (or pain sensations) that are sent to your brain. Methocarbamol is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury. Methocarbamol injection is sometimes used in the treatment of tetanus, (lockjaw) which causes painful tightening of the muscles. Warnings You should not use this medication if you are allergic to methocarbamol. Before using methocarbamol, tell your doctor if you have myasthenia gravis. You may need to reduce your dose after the first 2 or 3 days of treatment. Follow your doctor's instructions regarding the number of tablets you take each day. Methocarbamol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Drinking alcohol can increase certain side effects of this medicine. Before taking this medicine You should not use methocarbamol if you are allergic to it. To make sure this medicine is safe for you, tell your doctor if you have: kidney disease; a seizure; or myasthenia gravis. Methocarbamol may harm an unborn baby. Use effective birth control to prevent pregnancy, and tell your doctor if you become pregnant. It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. Methocarbamol is not approved for use by anyone younger than 16 years old unless to treat tetanus. Methocarbamol pregnancy and breastfeeding warnings (more detail) How should I use methocarbamol? Take methocarbamol exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Methocarbamol is only part of a complete treatment program that may also include rest, physical therapy, or other pain relief measures. Methocarbamol oral is taken by mouth. You may need to reduce your dose after the first 2 or 3 days of treatment. Carefully follow your doctor's dosing instructions. Methocarbamol injection is injected into a muscle or given as an infusion into a vein. A healthcare provider will give you this injection. The injection is usually given as a single dose before you start taking the oral form. Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when methocarbamol is injected. This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using this medicine. Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use. Dosing information Usual Adult Dose for Muscle Spasm: ORAL: Initial Dose: 1500 mg orally 4 times a day -Doses of 6000 mg per day are generally used for the first 48 to 72 hours -In severe cases, doses up to 8000 mg per day may be used Maintenance dose: 500 mg tablets: 1000 mg orally 4 times a day 750 mg Tablets: 750 mg orally every 4 hours OR 1500 mg orally 3 times a day PARENTERAL: -For the relief of moderate symptoms: 1 g IV or IM once, then switch to oral -For relief of severe symptoms or postoperative conditions: 1 g IV or IM every 8 hours Maximum Dose: 3 g in 24-hours Maximum Duration: 3 consecutive days; may repeat after a drug-free interval of 48 hours Comments: -Higher doses are recommended in the first 48 to 72 hours of treatment, then doses can usually be reduced to approximately 4000 mg per day. -Oral tablets should be administered whenever feasible; IV/IM therapy should not be administered for more than 3 consecutive days without a drug-free interval of 48 hours. Use: As an adjunct to rest and physical therapy for the relief of discomfort associated with acute, painful musculoskeletal conditions. Usual Adult Dose for Tetanus: Initial dose: 1 to 2 g IV followed by an additional 1 to 2 g via IV infusion Maximal Initial Dose: 3 g Repeat initial IV dose every 6 hours until NG tube or oral therapy is possible Once NG tube is in place, may crush tablets, suspend in water or saline and administer through tube -Total oral doses of up to 24 g may be needed based on patient response Comments: -There is clinical evidence to suggest this drug may have a beneficial effect in the control of the neuromuscular manifestations of tetanus. -This drug should not replace the usual procedure of debridement, tetanus antitoxin, penicillin, tracheotomy, attention to fluid balance, and supportive care; if used, this drug should be added to the regimen as soon as possible. Use: To control the neuromuscular manifestations of tetanus. Usual Pediatric Dose for Tetanus: Initial dose: 15 mg/kg or 500 mg/m2 IV; repeat initial dose every 6 hours as needed Maximum dose: 1.8 g/m2/day IV for 3 consecutive days Maintenance dose: May be given by injection into tubing or by IV infusion with an appropriate quantity of fluid Comments: -There is clinical evidence to suggest this drug may have a beneficial effect in the control of the neuromuscular manifestations of tetanus. -This drug should not replace the usual procedure of debridement, tetanus antitoxin, penicillin, tracheotomy, attention to fluid balance, and supportive care; if used, this drug should be added to the regimen as soon as possible. Use: To control the neuromuscular manifestations of tetanus. What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. Detailed Methocarbamol dosage information What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, extreme drowsiness, fainting, seizure, or coma. What to avoid Avoid driving or hazardous activity until you know how methocarbamol will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Drinking alcohol with this medicine can cause side effects. Methocarbamol side effects Get emergency medical help if you have signs of an allergic reaction to methocarbamol: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using methocarbamol and call your doctor at once if you have: a light-headed feeling, like you might pass out; slow heartbeats; a seizure; jaundice (yellowing of your skin or eyes); or pain, bruising, swelling, or skin changes where the injection was given. Common methocarbamol side effects may include: headache, dizziness, drowsiness; fever; confusion, problems with memory; nausea, vomiting, upset stomach; blurred vision, double vision; flushing (warmth, redness, or tingly feeling); sleep problems (insomnia); or lack of coordination.    

What is methotrexate? Methotrexate interferes with the growth of certain cells of the body, especially cells that reproduce quickly, such as cancer cells, bone marrow cells, and skin cells. Methotrexate is used to treat leukemia and certain types of cancer of the breast, skin, head and neck, lung, or uterus. Methotrexate is also used to treat severe psoriasis and rheumatoid arthritis in adults. It is also used to treat active polyarticular-course juvenile rheumatoid arthritis in children. Methotrexate is sometimes given when other medicines have not been effective. Warnings Methotrexate may cause injury or death to an unborn baby and should not be used during pregnancy to treat arthritis or psoriasis. Methotrexate is sometimes used to treat cancer during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant. Do not use this medicine to treat psoriasis or rheumatoid arthritis if you have low blood cell counts, a weak immune system, alcoholism or chronic liver disease, or if you are breastfeeding. YOU MAY NOT NEED TO TAKE METHOTREXATE EVERY DAY. Some people have died after incorrectly taking methotrexate every day. You must use the correct dose for your condition. Methotrexate can cause serious or fatal side effects. Tell your doctor if you have diarrhea, mouth sores, cough, shortness of breath, upper stomach pain, dark urine, numbness or tingling, muscle weakness, confusion, seizure, or skin rash that spreads and causes blistering and peeling. Before taking this medicine You should not use methotrexate if you are allergic to it. You may not be able to take this medicine if you have: alcoholism, cirrhosis, or chronic liver disease; low blood cell counts; a weak immune system or bone marrow disorder; or if you are pregnant or breastfeeding. Methotrexate is sometimes used to treat cancer in people who have a condition listed above. Your doctor will decide if this treatment is right for you. To make sure this medicine is safe for you, tell your doctor if you have ever had: liver problems, especially fluid in your stomach (ascites); kidney disease; lung problems, especially fluid in the lungs (pleural effusion); radiation treatments; or a stomach ulcer or ulcerative colitis. Tell your doctor if you are pregnant or plan to become pregnant. Methotrexate may cause injury or death to an unborn baby and should not be used during pregnancy to treat arthritis or psoriasis. However, methotrexate is sometimes used to treat cancer during pregnancy. Methotrexate can harm an unborn baby if the mother or the father is using this medicine. If you are a woman, you may need to have a negative pregnancy test before starting this treatment. Use effective birth control to prevent pregnancy while you are using methotrexate and for at least 6 months after your last dose. If you are a man, use effective birth control if your sex partner is able to get pregnant. Keep using birth control for at least 3 months after your last dose. Tell your doctor right away if a pregnancy occurs while either the mother or the father is using methotrexate. This medicine may affect fertility (ability to have children) in both men and women. However, it is important to use birth control to prevent pregnancy because methotrexate may harm the baby if a pregnancy does occur. Do not breastfeed while using this medicine, and for at least 1 week after your last dose. Do not give this medicine to a child without the advice of a doctor. How should I take methotrexate? YOU MAY NOT NEED TO TAKE METHOTREXATE EVERY DAY. This medicine is sometimes taken only once per week, or 2 to 4 times per week. Some conditions are treated daily for just a few days followed by a rest period of 1 week or longer before taking the medicine again. You must use the correct dose. Some people have died after incorrectly taking methotrexate every day. Take methotrexate exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets. Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Methotrexate can be toxic to your organs, and may lower your blood cell counts. You will need frequent medical tests, and you may need an occasional liver biopsy or chest X-ray. Your cancer treatments may be delayed based on the results. If you need to be sedated for dental work, tell your dentist you currently use methotrexate. Store methotrexate at room temperature away from moisture, heat, and light. You may store Xatmep in a refrigerator or at room temperature. Avoid freezing or high heat. Throw away any unused Xatmep after 60 days if kept at room temperature.   What happens if I miss a dose? Call your doctor for instructions if you miss a dose of methotrexate. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of methotrexate can be fatal. Overdose symptoms may include bruising or unusual bleeding, mouth sores, vomiting, little or no urination, bloody or tarry stools, or coughing up blood or vomit that looks like coffee grounds. What to avoid Avoid drinking alcohol. It may increase your risk of liver damage. Do not receive a "live" vaccine while using methotrexate, or you could develop a serious infection. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine. Methotrexate could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Methotrexate side effects Get emergency medical help if you have signs of an allergic reaction to methotrexate: (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling). Methotrexate can cause serious or fatal side effects. Call your doctor at once if you have: sudden chest pain, wheezing, dry cough, cough with mucus, chest pain, feeling short of breath; fever, chills, swollen lymph glands, night sweats, weight loss; blisters or ulcers in your mouth, red or swollen gums, trouble swallowing; vomiting, diarrhea, blood in your urine or stools; skin changes such as redness, warmth, swelling, or oozing; low blood cell counts - fever, chills, tiredness, mouth sores, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath; kidney problems - little or no urination, swelling in your feet or ankles; liver problems - swelling around your midsection, right-sided upper stomach pain, nausea, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes); nerve problems - confusion, weakness, drowsiness, coordination problems, feeling irritable, headache, neck stiffness, vision problems, loss of movement in any part of your body, seizure; or signs of tumor cell breakdown - tiredness, weakness, muscle cramps, nausea, vomiting, diarrhea, fast or slow heart rate, tingling in your hands and feet or around your mouth. Common methotrexate side effects may include: fever, chills, tiredness, not feeling well; low blood cell counts; mouth sores; nausea, stomach pain; abnormal liver function tests; hair loss; burning skin lesions; or being more sensitive to light. 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 methotrexate? Tell your doctor about all your other medicines, especially: an antibiotic or sulfa drug; folic acid; mercaptopurine; theophylline; NSAIDs> (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; stomach acid reducers - esomeprazole, lansoprazole, omeprazole, pantoprazole, Nexium, Prilosec, Protonix, and others. Many drugs can interact with methotrexate. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.