Lemsip Max Flu Lemon

1. Name Of The Medicinal Product

Lemsip Max Flu Lemon

2. Qualitative And Quantitative Composition

Active ingredients	mg/Sachet	Specification
Paracetamol	1000.00	Ph Eur
Pseudoephedrine hydrochloride*	60.00	BP

^*Equivalent to pseudoephedrine (base) 49.1 mg.

3. Pharmaceutical Form

Oral powder.

4. Clinical Particulars

4.1 Therapeutic Indications

For relief of the symptoms of heavy colds and influenza, including the relief of aches and pains, headache and sore throat, nasal congestion or a runny nose, pain and congestion of sinusitis, and lowering of temperature.

4.2 Posology And Method Of Administration

Oral administration after dissolution in water.

Adults and children over 12: One sachet dissolved by stirring in hot water and sweetened to taste.

The dose may be repeated in four to six hours.

No more than four doses should be taken in 24 hours.

Not to be given to children under 12.

There is no indication that dosage need be modified in the elderly.

4.3 Contraindications

Hypersensitivity to paracetamol, pseudoephedrine or any other ingredient

Severe coronary heart disease and cardiovascular disorders

Severe hypertension

Patients currently receiving or within two weeks of stopping therapy with monoamine oxidase inhibitors

4.4 Special Warnings And Precautions For Use

Use with caution in patients with hypertension, heart disease, diabetes, hyperthyroidism, hyperexcitability, phaeochromocytoma, prostatic enlargement or close angle glaucoma. Each sachet contains approximately 2.1 g of carbohydrate. Care is advised in the administration of paracetamol to patients with severe renal or severe hepatic impairment. The hazard of overdose is greater in those with non-cirrhotic alcoholic liver disease. Patients should be advised not to take other paracetamol-containing products concurrently.

Label warnings: Warning - Do not exceed the stated dose (panel). Keep out of the reach of children. Contains paracetamol (panel). If symptoms persist, consult your doctor. If you are pregnant or are being prescribed medicine by your doctor, seek his advice before taking this product. Total sugars 2.1 g. Contains aspartame. Do not take with any other paracetamol-containing products. Immediate medical advice should be sought in the event of an overdose, even if you feel well.

Leaflet: Immediate medical advice should be sought in the event of an overdose, even if you feel well, because of the risk of delayed, serious liver damage.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

Pseudoephedrine : Pseudoephedrine may adversely interact with antihypertensive agents or tricyclic antidepressants or other sympathomimetic agents, such as decongestants, appetite suppressants and amphetamine-like psychostimulants, to cause a rise in blood pressure. Pseudoephedrine may partially reverse the hypotensive action of drugs which interfere with sympathetic activity, such as bethanidine or methyldopa.

Paracetamol : Drugs which induce hepatic microsomal enzymes, such as alcohol, barbiturates, monoamine oxidase inhibitors and tricyclic antidepressants, may increase the hepatotoxicity of paracetamol, particularly after overdosage.

The speed of absorption of paracetamol may be increased by metoclopramide or domperidone and absorption reduced by cholestyramine. The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular daily use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.

4.6 Pregnancy And Lactation

Paracetamol

Epidemiological studies in human pregnancy have shown no ill-effects due to paracetamol used in the recommended dosage, but patients should follow the advice of their doctor regarding its use. Paracetamol is excreted in breast milk, but not in a clinically significant amount. Available published data do not contraindicate breast feeding.

Pseudoephedrine

Defective closure of the abdominal wall (gastroschisis) reported very rarely in newborns after first trimester exposure. The product should not be used in pregnancy unless considered essential by the physician. Pseudoephedrine is excreted in breast milk in small amounts, but the effect of this on breast-fed infants is not known. It has been estimated that 0.5-0.7% of a single dose of pseudoephedrine ingested by a mother will be excreted in the breast milk over 24 hours.

4.7 Effects On Ability To Drive And Use Machines

None known.

4.8 Undesirable Effects

Paracetamol

Adverse effects of paracetamol are rare, but hypersensitivity including skin rash may occur. There have been a few reports of blood dyscrasias including thrombocytopenia, leucopenia, pancytopenia, neutropenia and agranulocytosis, but these were not necessarily causally related to paracetamol.

Acute pancreatitis after ingestion of above normal amounts.

Pseudoephedrine

Adverse reactions due to pseudoephedrine are uncommon, but dry mouth, anorexia, urinary retention in men, skin rashes and symptoms of CNS excitation such as tension, restlessness, sleep disturbance or hallucinations may rarely occur.

4.9 Overdose

Liver damage is possible in adults who have taken 10 g or more of paracetamol. Ingestion of 5 g of more of paracetamol may lead to liver damage if the patient has risk factors (see below).

Risk factors

If the patient:

(a) Is on long-term treatment with carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St John's Wort or other drugs that induce liver enzymes.

Or

(b) Regularly consumes ethanol in excess of recommended amounts.

Or

(c) Is likely to be glutathione deplete, e.g. eating disorders, cystic fibrosis, HIV infection, starvation, cachexia.

Symptoms

Symptoms of paracetamol overdosage in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur. In severe poisoning, hepatic failure may progress to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema and death. Acute renal failure with acute tubular necrosis, strongly suggested by loin pain, haematuria and proteinuria, may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported.

Management

Immediate treatment is essential in the management of paracetamol overdose. Despite a lack of significant early symptoms, patients should be referred to hospital urgently for immediate medical attention. Symptoms may be limited to nausea or vomiting and may not reflect the severity of overdose or the risk of organ damage. Management should be in accordance with established treatment guidelines. See BNF overdose section.

Treatment with activated charcoal should be considered if the overdose has been taken within 1 hour. Plasma paracetamol concentration should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable). Treatment with N-acetylcysteine may be used up to 24 hours after ingestion of paracetamol, however, the maximum protective effect is obtained up to 8 hours post-ingestion. The effectiveness of the antidote declines sharply after this time. If required the patient should be given intravenous N-acetylcysteine, in line with the established dosage schedule. If vomiting is not a problem, oral methionine may be a suitable alternative for remote areas, outside hospital. Management of patients who present with serious hepatic dysfunction beyond 24 hours from ingestion should be discussed with the NPIS or a liver unit.

Caffeine: Symptoms - emesis and convulsions may occur. No specific antidote. However, treatment is usually fluid therapy. Fatal poisoning is rare. If symptoms become apparent or overdose is suspected, consult a doctor immediately.

Phenylephrine hydrochloride: Features of severe overdosage of phenylephrine include haemodynamic changes and cardiovascular collapse with respiratory depression. Treatment includes early gastric lavage and symptomatic and supportive measures. Hypertensive effects may be treated with an i.v. alpha-receptor blocking agent.

5. Pharmacological Properties

5.1 Pharmacodynamic Properties

Paracetamol: Paracetamol has both analgesic and antipyretic activity which is believed to be mediated principally through its inhibition of prostaglandin synthesis within the central nervous system.

Pseudoephedrine: Pseudoephedrine is an adrenergic agonist acting at both alpha- and beta- adrenoreceptors. It is reported to have less tachycardia and pressor activity and central nervous system effects that ephedrine. It is a recognised decongestant and acts by vasoconstriction to reduce oedema and nasal swelling.

The active ingredients are not known to cause sedation.

5.2 Pharmacokinetic Properties

Paracetamol: Paracetamol is absorbed rapidly and completely mainly from the small intestine producing peak plasma levels after 15-20 minutes following oral dosing. The systemic availability is subject to first-pass metabolism and varies with dose between 70% and 90%. The drug is rapidly and widely distributed throughout the body and is eliminated from plasma with a T½ of approximately 2 hours. The major metabolites are glucuronide and sulphate conjugates (>80%) which are excreted in urine.

Pseudoephedrine: Pseudoephedrine is rapidly and completely absorbed after oral administration, up to about 90% of a dose is excreted unchanged in the urine within 24 hours of dosing. The half life is between 5 and 8 hours but may be increased when the urine is alkaline and reduced when it is acid. Onset of nasal decongestant action occurs approximately 30 minutes after an oral dose of 60 mg and continues for at least 4 hours.

5.3 Preclinical Safety Data

No preclinical findings of relevance have been reported.

No Data Held

6. Pharmaceutical Particulars

6.1 List Of Excipients

Caster sugar, pulverised sucrose, citric acid, lemon flavour, saccharin sodium, aspartame, sodium citrate, ascorbic acid granular and curcumin.

6.2 Incompatibilities

None known.

6.3 Shelf Life

Three years.

6.4 Special Precautions For Storage

Store below 25°C.

6.5 Nature And Contents Of Container

Heat-sealed sachet of paper/polyethylene/aluminium foil/ionomer sealant laminate in an outer cardboard carton.

Pack sizes: 5, 10 and 16 sachets.

6.6 Special Precautions For Disposal And Other Handling

Oral administration after dissolution in water.

7. Marketing Authorisation Holder

Reckitt & Colman Products Limited

Dansom Lane

Hull, HU8 7DS

East Yorkshire

8. Marketing Authorisation Number(S)

PL 00063/0040.

9. Date Of First Authorisation/Renewal Of The Authorisation

13/03/2009

10. Date Of Revision Of The Text

08/07/2011

Physostigmine Salicylate

Class: Parasympathomimetic (Cholinergic) Agents
VA Class: AU300
CAS Number: 57-64-7
Brands: Antilirium

Introduction

Reversible anticholinesterase agent.^a

Uses for Physostigmine Salicylate

Reversal of Anticholinergic Effects

Carefully weigh risks and potential benefits of physostigmine therapy when making individual decisions about its use since serious adverse effects (including seizures and asystole) may occur with physostigmine therapy.^{109 148 149 150 151 152 153 156 157 158 159 a}

The manufacturers state that physostigmine is used to reverse CNS effects resulting from clinical or toxic dosages of drugs (e.g., some antihistamines, antimuscarinics, antiparkinsonian agents, phenothiazines) capable of producing anticholinergic syndrome^{148 149 a b} and from intoxication with certain plants (e.g., Atropa belladonna [deadly nightshade], Brugmansia species [angels’ trumpet], Datura stramonium [jimsonweed, thorn apple, locoweed], Lantana camara).^{139 148 149 a b} However, routine use not recommended because of potentially serious adverse effects (e.g., seizures, bronchospasm, bradycardia, asystole); many clinicians advise to reserve use for treatment of severe or life-threatening symptoms (e.g., extensive delirium or agitation, hallucinations, hyperthermia, severe sinus or supraventricular tachycardia, seizures) in patients who fail to respond to alternative therapy.^{139 140 141 142 143 144 147 148 149 150 151 152 a}

Has also been used successfully in the treatment of tricyclic antidepressant-induced anticholinergic toxicity,^{109 147 151 152 153 154 155 156 157 159 160} but currently is rarely used because of potentially serious adverse effects (seizures, bronchospasm, bradycardia, asystole).^{109 147 150 151 152 153 156 157 158 159} Precise role controversial; most clinicians advise against the routine use of physostigmine in tricyclic intoxication,^{109 147 151 152 153 154 155 156 157 158 159 161} and some clinicians recommend to reserve use only for life-threatening anticholinergic symptoms refractory to other treatment.^{109 153 157}

Treatment to reverse anticholinergic effects (e.g., delirium, prolonged somnolence) produced by atropine and/or scopolamine preanesthetic medications.^b

Alzheimer’s Disease

Has been used with variable results in the treatment of dementia of the Alzheimer’s type† (Alzheimer’s disease), alone or combined with lecithin.^{117 118 119 120 121 122 123 124 125 126 127 128 129 130 131}

HereditaryAtaxias

Has been used for the treatment of Friedreich’s ataxia and other hereditary ataxias† (spinocerebellar degenerations)^{135 136 137 138} (designated an orphan drug by FDA for these uses).¹³⁵

Physostigmine Salicylate Dosage and Administration

General

• 
  

  Atropine sulfate injection should always be readily available.¹⁴⁹ (See Cautions.)

  
  

Administration

Administer by slow IV injection or by IM injection;¹⁴⁹ has also been administered by sub-Q injection and orally†.^b

Oral Administration

Oral dosage form not currently commercially available.^b

IV Administration

Rate of Administration

Administer at a slow, controlled rate: ≤1 mg/minute in adults and ≤0.5 mg/minute in children.¹⁴⁹ (See Reversal of Anticholinergic Effects under Uses and also see Rapid IV Administration under Cautions.)

Dosage

Available as physostigmine salicylate; dosage expressed in terms of the salt.^{149 b}

Pediatric Patients

Reversal of Anticholinergic Effects

IV

Initially, 0.02 mg/kg;¹⁴⁹ if no response, repeat dose at 5- to 10-minute intervals until response occurs, adverse cholinergic effects develop, or a total dose of 2 mg has been administered.¹⁴⁹ Alternatively, 0.03 mg/kg or 0.9 mg/m², as necessary.^b

IM

Initially, 0.02 mg/kg;¹⁴⁹ if no response, repeat dose at 5- to 10-minute intervals until response occurs, adverse cholinergic effects develop, or a total dose of 2 mg has been administered.¹⁴⁹ Alternatively, 0.03 mg/kg or 0.9 mg/m², as necessary.^b

Adults

Reversal of Anticholinergic Effects

IV

Initially, 0.5–2 mg;^b may repeat dose every 20 minutes until response occurs or adverse cholinergic effects occur.^b If initial doses are effective, administer 1–4 mg, as necessary, at intervals (usually 30–60 minutes) as life-threatening signs (e.g., arrhythmias, seizures, deep coma) recur.^b

To reverse anticholinergic effects of atropine or scopolamine preanesthetic medications, administer a dose twice that of the anticholinergic drug, on a weight basis.^b

IM

Initially, 0.5–2 mg;^b may repeat dose every 20 minutes until response occurs or adverse cholinergic effects occur.^b If initial doses are effective, administer 1–4 mg, as necessary, at intervals (usually 30–60 minutes) as life-threatening signs (e.g., arrhythmias, seizures, deep coma) recur.^b

To reverse anticholinergic effects of atropine or scopolamine preanesthetic medications, administer a dose twice that of the anticholinergic drug, on a weight basis.^b

Alzheimer’s Disease†

Oral†

Usually has been initiated at dosage of 0.5 mg given every 2 hours 6 or 7 times daily until beneficial effect is achieved, intolerable adverse effects occur, or a maximum total daily dose of 16 mg is achieved.^{119 120 121 130}

Dosage of 2–2.5 mg every 2 hours 6 or 7 times daily also has been used.^{118 119 120 121 130}

Prescribing Limits

Pediatric Patients

Reversal of Anticholinergic Effects

IV

Maximum total dose of 2 mg.¹⁴⁹

IM

Maximum total dose of 2 mg.¹⁴⁹

Adults

Alzheimer’s Disease†

Oral†

Maximum 16 mg daily.¹²¹

Cautions for Physostigmine Salicylate

Contraindications

• 
  

  Asthma.^{149 b}

  
  


• 
  

  Gangrene.^{149 b}

  
  


• 
  

  Diabetes.^{149 b}

  
  


• 
  

  Cardiovascular disease.^{149 b}

  
  


• 
  

  Mechanical obstruction of the intestinal or urogenital tract.^{149 b}

  
  


• 
  

  Any vagotonic state.^{149 b}

  
  


• 
  

  Concomitant use of choline esters (e.g., methacholine, bethanechol) or depolarizing neuromuscular blocking agents (e.g., succinylcholine).^{149 b}

  
  


• 
  

  Known hypersensitivity to physostigmine or any ingredient in the formulation.

  
  

Warnings/Precautions

Warnings

Cholinergic Crisis

Overdosage may result in cholinergic crisis (e.g., excessive salivation and sweating, miosis, nausea, vomiting, diarrhea, bradycardia or tachycardia, hypotension or hypertension, confusion, seizures, coma, severe muscle weakness, paralysis).^{149 b} If overdosage occurs, mechanical ventilation with repeated bronchial aspiration and IV atropine are recommended.^{149 b}

Rapid IV Administration

Possible bradycardia, hypersalivation leading to respiratory problems, and/or seizures associated with rapid IV administration; asystole also has been reported.^{148 149 150 151 a} Administer at a slow controlled rate.¹⁴⁹ (See IV Administration under Dosage and Administration.)

Parasympathetic Stimulation

Discontinue therapy if excessive salivation, vomiting, urination, or defecation occurs.^{149 b} Reduce dosage if excessive sweating or nausea occurs.^{149 b} Atropine sulfate injection should always be readily available.¹⁴⁹ Observe patient for evidence of bronchial constriction; perform cardiac monitoring.^{141 142 144}

Sensitivity Reactions

Sulfite Sensitivity

Injections may contain sulfites, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.¹⁴⁹

General Precautions

Concomitant Diseases

Use with caution in patients with epilepsy, parkinsonian syndrome, or bradycardia.^b

Specific Populations

Pregnancy

Category C.^c

Lactation

Safety not established in nursing women.¹⁴⁹

Pediatric Use

Reserve use for life-threatening situations only.^b

Common Adverse Effects

Nausea,¹⁴⁹ vomiting,¹⁴⁹ epigastric pain,^b miosis,^b salivation,¹⁴⁹ sweating,^b lacrimation,^b dyspnea,^b bronchospasm.^b

Physostigmine Salicylate Pharmacokinetics

Absorption

Bioavailability

Readily absorbed from the GI tract, mucous membranes, and subcutaneous tissue.^b

Following oral administration (oral dosage form not currently commercially available), physostigmine may undergo saturable metabolism prior to reaching the systemic circulation.^{100 101 102 103}

Onset

Following parenteral administration, 3–8 minutes.^b

Duration

Following parenteral administration, 30 minutes to 5 hours.^b

Distribution

Extent

Widely distributed throughout the body;^b readily penetrates the blood-brain barrier.^{149 b}

Elimination

Metabolism

Metabolized via hydrolysis by cholinesterases.^b

Elimination Route

Not fully elucidated; very small amounts excreted in urine.^b

Half-life

15–40 minutes.^{100 101}

Stability

Storage

Parenteral

Injection

15–30°C.^{149 b}

ActionsActions

• 
  

  Inhibits acetylcholinesterase and prolongs and exaggerates the central and peripheral effects of acetylcholine.^{149 b}

  
  


• 
  

  Produces generalized cholinergic responses including miosis, increased tonus of intestinal musculature, constriction of bronchi, and stimulation of secretion by salivary and sweat glands.^b

  
  


• 
  

  At sufficiently high dosage, directly blocks action at autonomic ganglia, causes muscle fasciculation and, ultimately, depolarization block.^b

  
  


• 
  

  Some evidence that physostigmine may potentiate cholinergic mechanisms involved in memory storage and may improve short-term memory.^b

  
  

Advice to Patients

• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹⁴⁹

  
  


• 
  

  Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.¹⁴⁹

  
  


• 
  

  Importance of informing patients of other important precautionary information.¹⁴⁹ (See Cautions.)

  
  

Preparations

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

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

Physostigmine Salicylate

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Bulk	Powder*
Parenteral	Injection	1 mg/mL*	Physostigmine Salicylate Injection	Akorn

Disclaimer

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

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

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions April 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

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

References

Only references cited for selected revisions after 1984 are available electronically.

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147. Woolf AD, Erdman AR, Nelson LS et al. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2007; 45:203-33.

148. Taylor Pharmaceuticals. Physostigmine salicylate injection prescribing information. Decatur, IL; 2006 Mar.

149. Forest Pharmaceuticals. Antilirium (physostigmine salicylate) injection prescribing information. In: Physicians' desk reference. 52nd ed. Montvale, NJ: Medical Economics Company Inc; 1998:944-5.

150. Pentel P, Peterson CD. Asystole complicating physostigmine treatment of tricyclic antidepressant overdose. Ann Emerg Med. 1980; 9:588-90. [PubMed 7001962]

151. Suchard JR. Assessing physostigmine's contraindication in cyclic antidepressant ingestions. J Emerg Med. 2003; 25:185-91. [PubMed 12902007]

152. Pentel PR, Benowitz NL. Tricyclic antidepressant poisoning: management of arrhythmias. Med Toxicol. 1986; 1:101-21. [IDIS 221648] [PubMed 3784839]

153. Crome P. Poisoning due to tricyclic antidepressant overdosage: clinical presentation and treatment. Med Toxicol. 1986; 1:261-85. [IDIS 222612] [PubMed 3537621]

154. Marshall JB, Forker AD. Cardiovascular effects of tricyclic antidepressant drugs: therapeutic usage, overdose, and management of complications. Am Heart J. 1982; 103:401-14. [IDIS 145664] [PubMed 7039280]

155. Jackson JE, Bressler R. Prescribing tricyclic antidepressants. Part III: management of overdose. Drug Therapy. 1982; 12:175-89.

156. Goldfrank LR, Lewin NA, Flomenbaum NE et al. Psychotropics: antidepressants: tricyclics, tetracyclics, monoamine oxidase inhibitors, and others. In: Goldfrank LR, Flomenbaum NE, Lewin NA et al, eds. Goldfrank’s toxicologic emergencies. 3rd ed. Norwalk, CT: Appleton-Century-Crofts; 1986:351-9.

157. Braden NJ, Jackson JE, Walson PD. Tricyclic antidepressant overdose. Ped Clin North Am. 1986; 33:287-98.

158. The American Heart Association. Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005; 112(Suppl I): IV1-211. [PubMed 16314375]

159. Newton RW. Physostigmine salicylate in the treatment of tricyclic antidepressant overdosage. JAMA. 1975; 231:941-3. [PubMed 1173100]

160. Holinger PC, Klawans HL. Reversal of tricyclic-overdosage-induced central anticholnegic syndrome by physostigmine. Am J Psychiatry. 1976; 133:1018-23. [PubMed 961921]

161. Hollister LE. Drug therapy: tricyclic antidepressants (second of two parts). N Engl J Med. 1978; 299:1168-72. [PubMed 703806]

a. Forest Pharmaceuticals. Antilirium (physostigmine salicylate) injection prescribing information. In: Physicians' desk reference. 53rd ed. Montvale, NJ: Medical Economics Company Inc; 1999:1018.

b. AHFS Drug Information 2008. McEvoy GK, ed. Physostigmine salicylate. Bethesda, MD: American Society of Health-System Pharmacists; 2007: 1284-6.

c. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1998:866-7.

More Physostigmine Salicylate resources

• Physostigmine Salicylate Use in Pregnancy & Breastfeeding
• Physostigmine Salicylate Drug Interactions
• Physostigmine Salicylate Support Group
• 0 Reviews for Physostigmine Salicylate - Add your own review/rating

• physostigmine Ophthalmic Advanced Consumer (Micromedex) - Includes Dosage Information

Compare Physostigmine Salicylate with other medications

• Anticholinergic Syndrome

Huntington's Disease Medications

Definition of Huntington's Disease: Huntington's disease is a disorder passed down through families in which nerve cells in the brain waste away, or degenerate.

Drugs associated with Huntington's Disease

The following drugs and medications are in some way related to, or used in the treatment of Huntington's Disease. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

Learn more about Huntington's Disease

Medical Encyclopedia:

• Huntington's disease

Harvard Health Guide:

• Symptoms and treatment for Huntington's Disease (Chorea)

Drug List:

Kemstro

Lioresal

Xenazine

Limbrel 250

Generic Name: bioflavonoids and zinc glycinate (BYE oh FLAV oh noids and ZINK GLYE sin ate)

Brand Names: Limbrel250, Limbrel500

What is Limbrel 250 (bioflavonoids and zinc glycinate)?

Bioflavonoids and zinc glycinate is a medical food. It works by reducing swelling and providing pain relief.

Bioflavonoids and zinc glycinate is used in the dietary management of osteoarthritis symptoms, such as swelling, stiffness, and joint discomfort.

Bioflavonoids and zinc glycinate may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Limbrel 250 (bioflavonoids and zinc glycinate)?

You should not use bioflavonoids and zinc glycinate if you are allergic to any type of flavonoid or foods such as colored fruits and vegetables, dark chocolate, tea (especially green tea), red wine, or Brazil nuts.

Before taking bioflavonoids and zinc glycinate, tell your doctor about all of your medical conditions. Also tell your doctor if you are pregnant or breast-feeding.

Do not give this medication to anyone under 18 years old without medical advice.

Tell your doctor about all other medicines you use, especially a blood thinner such as warfarin (Coumadin, Jantoven).

You must remain under the care of a doctor while you are using bioflavonoids and zinc glycinate. Visit your doctor regularly.

What should I discuss with my healthcare provider before taking Limbrel 250 (bioflavonoids and zinc glycinate)?

You should not use bioflavonoids and zinc glycinate if you are allergic to any type of flavonoid or foods such as colored fruits and vegetables, dark chocolate, tea (especially green tea), red wine, or Brazil nuts.

Before taking bioflavonoids and zinc glycinate, tell your doctor about all of your medical conditions.

It is not known whether bioflavonoids and zinc glycinate will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether bioflavonoids and zinc glycinate passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to anyone under 18 years old without medical advice.

How should I take Limbrel 250 (bioflavonoids and zinc glycinate)?

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.

You must remain under the care of a doctor while you are using bioflavonoids and zinc glycinate. Visit your doctor regularly.

Bioflavonoids and zinc glycinate is usually taken once every 12 hours. Follow your doctor's instructions.

Bioflavonoids and zinc glycinate works best if you take it with a meal or within 1 hour before or after a meal. However, you may take bioflavonoids and zinc glycinate with or without food. Store at room temperature away from moisture, heat, and light.

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 while taking Limbrel 250 (bioflavonoids and zinc glycinate)?

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

Limbrel 250 (bioflavonoids and zinc glycinate) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using bioflavonoids and zinc glycinate and call your doctor at once if you have a serious side effect such as:

• 
  

  confusion, headache, anxiety, feeling restless;

  
  


• 
  

  fever, cough, rapid heart rate, feeling short of breath;

  
  


• 
  

  blue lips or fingernails, weak or shallow breathing;

  
  


• 
  

  feeling like you might pass out;

  
  


• 
  

  bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  
  


• 
  

  skin rash, bruising, severe tingling, numbness, pain, muscle weakness; or

  
  


• 
  

  nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

  
  

Less serious side effects may include:

• 
  

  mild nausea;

  
  


• 
  

  diarrhea; or

  
  


• 
  

  gas.

  
  

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 Limbrel 250 (bioflavonoids and zinc glycinate)?

Tell your doctor about all other medicines you use, especially a blood thinner such as warfarin (Coumadin, Jantoven).

There may be other drugs that can interact with bioflavonoids and zinc glycinate. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

More Limbrel 250 resources

• Limbrel 250 Drug Interactions
• Limbrel 250 Support Group
• 0 Reviews for Limbrel 250 - Add your own review/rating

Compare Limbrel 250 with other medications

• Osteoarthritis

Where can I get more information?

• Your pharmacist can provide more information about bioflavonoids and zinc glycinate.

AlleRx

Generic Name: chlorpheniramine and phenylephrine (KLOR fen IR a meen and FEN il EFF rin)

Brand Names: Actifed Cold & Allergy, Allan Tannate Pediatric, Allerest PE, AlleRx, BP Allergy JR, C Phen, Cardec, Ceron, Chlor-Mes Jr, ChlorTan D, Cold & Allergy Relief, CP Dec, Dallergy Drops, Dallergy-JR, Dec-Chlorphen, Ed A-Hist, Ed ChlorPed D, Histadec, Nasohist Pediatric, NoHist, Ny-Tannic, PD-Hist D, PD-Hist D Drops, PediaTan D, Phenchlor Tannate Pediatric, R-Tanna, Relera, Rinate Pediatric, Rondec, Rondex, Rynatan, Rynatan Pediatric, Sildec-PE, Sinus & Allergy Maximum Strength, Sinus & Allergy PE, Sonahist, Sudafed PE Sinus & Allergy, Tanahist-D, Triaminic Cold & Allergy

What is AlleRx (chlorpheniramine and phenylephrine)?

Chlorpheniramine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose.

Phenylephrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).

The combination of chlorpheniramine and phenylephrine is used to treat symptoms of the common cold or seasonal allergies, including sneezing, runny or stuffy nose, and itchy, watery eyes.

Chlorpheniramine and phenylephrine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about AlleRx (chlorpheniramine and phenylephrine)?

There are many brands and forms of this medication available and not all brands are listed on this leaflet.

Do not use chlorpheniramine and phenylephrine if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects. You should not use this medication if you are allergic to chlorpheniramine or phenylephrine, or if you have severe high blood pressure or coronary artery disease, narrow-angle glaucoma, a stomach ulcer, or if you are unable to urinate.

Do not use this medication during an asthma attack.

This medication 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 chlorpheniramine and phenylephrine. Older adults may be more likely to have side effects from this medicine. Do not give this medication to a child younger than 4 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.

Talk with your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever with a headache, cough, or skin rash.

What should I discuss with my healthcare provider before taking AlleRx (chlorpheniramine and phenylephrine)?

Do not use chlorpheniramine and phenylephrine if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects. You should not use this medication if you are allergic to chlorpheniramine or phenylephrine, or if you have:

• 
  

  severe or uncontrolled high blood pressure;

  
  


• 
  

  severe coronary artery disease;

  
  


• 
  

  narrow angle glaucoma;

  
  


• 
  

  a stomach ulcer;

  
  


• 
  

  if you are unable to urinate; or

  
  


• 
  

  if you are having an asthma attack.

  
  

Ask a doctor or pharmacist if it is safe for you to take this medication if you have:

• kidney disease;


• liver disease;


• 
  

  diabetes;

  
  


• 
  

  glaucoma;

  
  


• 
  

  circulation problems;

  
  


• 
  

  heart disease or high blood pressure;

  
  


• 
  

  overactive thyroid;

  
  


• 
  

  a seizure disorder such as epilepsy;

  
  


• 
  

  asthma, emphysema or chronic bronchitis; or

  
  


• 
  

  urination problems or an enlarged prostate.

  
  

It is not known whether chlorpheniramine and phenylephrine is harmful to an unborn baby. Do not take this medication with a doctor's advice if you are pregnant. It is not known whether chlorpheniramine and phenylephrine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more likely to have side effects from this medicine.

Artificially sweetened liquid cold medicine may contain phenylalanine. If you have phenylketonuria (PKU), check the medication label to see if the product contains phenylalanine.

How should I take AlleRx (chlorpheniramine and phenylephrine)?

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. Cold medicine is usually taken only for a short time until your symptoms clear up.

Do not give this medication to a child younger than 4 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. Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

The chewable tablet must be chewed before swallowing.

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

Talk with your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever with a headache, cough, or skin rash.

This medication can cause unusual results with allergy skin tests. Tell any doctor who treats you that you are taking an antihistamine.

If you need surgery, tell the surgeon ahead of time if you have taken a cold medicine within the past few days.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Since cold medicine is taken as needed, you may not be on a dosing schedule. If you are taking the medication regularly, 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 some of the serious side effects listed in this medication guide.

What should I avoid while taking AlleRx (chlorpheniramine and phenylephrine)?

This medication 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 chlorpheniramine and phenylephrine. Ask a doctor or pharmacist before using any other cold, allergy, or sleep medicine. Chlorpheniramine and phenylephrine are contained in many combination medicines. Taking certain products together can cause you to get too much of a certain drug. Check the label to see if a medicine contains an antihistamine or decongestant.

Avoid taking this medication if you also take diet pills, caffeine pills, or other stimulants (such as ADHD medications). Taking a stimulant together with a decongestant can increase your risk of unpleasant side effects.

AlleRx (chlorpheniramine and phenylephrine) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:

• 
  

  fast or pounding heartbeats;

  
  


• 
  

  confusion, hallucinations, unusual thoughts or behavior;

  
  


• 
  

  severe dizziness, anxiety, restless feeling, nervousness;

  
  


• 
  

  urinating less than usual or not at all;

  
  


• 
  

  easy bruising or bleeding, unusual weakness; or

  
  


• 
  

  seizure (black-out or convulsions).

  
  

Less serious side effects may include:

• 
  

  blurred vision;

  
  


• 
  

  dry nose or mouth;

  
  


• 
  

  nausea, stomach pain, constipation, loss of appetite;

  
  


• 
  

  dizziness, drowsiness;

  
  


• 
  

  problems with memory or concentration;

  
  


• 
  

  ringing in your ears; or

  
  


• 
  

  feeling restless or excited (especially in children).

  
  

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 AlleRx (chlorpheniramine and phenylephrine)?

Before using this medication, tell your doctor if you regularly use other medicines that make you sleepy (such as other cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by chlorpheniramine.

Tell your doctor about all other medications you use, especially:

• 
  

  mecamylamine (Inversine);

  
  


• 
  

  methyldopa (Aldomet);

  
  


• 
  

  reserpine;

  
  


• 
  

  a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others;

  
  


• 
  

  a barbiturate such as butabarbital (Butisol), secobarbital (Seconal), pentobarbital (Nembutal), or phenobarbital (Solfoton); or

  
  


• 
  

  an antidepressant such as amitriptyline (Elavil, Vanatrip), doxepin (Sinequan), nortriptyline (Pamelor), and others.

  
  

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

More AlleRx resources

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

• AlleRx Suspension MedFacts Consumer Leaflet (Wolters Kluwer)


• Cardec Drops MedFacts Consumer Leaflet (Wolters Kluwer)


• Dallergy-JR Sustained-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)


• Ny-Tannic MedFacts Consumer Leaflet (Wolters Kluwer)


• Relera Controlled-Release Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Rondec MedFacts Consumer Leaflet (Wolters Kluwer)


• Rynatan Prescribing Information (FDA)


• Sonahist Prescribing Information (FDA)

Compare AlleRx with other medications

• Cold Symptoms
• Hay Fever

Where can I get more information?

• Your pharmacist can provide more information about chlorpheniramine and phenylephrine.

See also: AlleRx side effects (in more detail)

furosemide Injection

fure-OH-se-mide

Available Dosage Forms:

• Solution

Therapeutic Class: Cardiovascular Agent

Pharmacologic Class: Diuretic, Loop

Uses For furosemide

Furosemide injection is used to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease (cirrhosis), kidney disease, or other medical conditions.

Furosemide belongs to a group of medicines called loop diuretics or "water pills". It works by acting on the kidneys to increase the flow of urine.

furosemide is to be given only by or under the direct supervision of a doctor.

Before Using furosemide

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

Allergies

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

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of furosemide injection in children. However, premature babies are more likely to have unwanted effects (e.g., kidney stones, hearing problems), which may require caution in patients receiving furosemide injection.

Geriatric

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

Pregnancy

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

Breast Feeding

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

Interactions with Medicines

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

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

• Amikacin


• Arsenic Trioxide


• Bepridil


• Chloral Hydrate


• Cisplatin


• Digitoxin


• Dofetilide


• Droperidol


• Ethacrynic Acid


• Gentamicin


• Kanamycin


• Ketanserin


• Levomethadyl


• Lithium


• Metolazone


• Neomycin


• Netilmicin


• Sotalol


• Streptomycin


• Tobramycin

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

• Alacepril


• Apazone


• Aspirin


• Benazepril


• Bromfenac


• Captopril


• Celecoxib


• Cephaloridine


• Cilazapril


• Clofibrate


• Cyclosporine


• Delapril


• Dibekacin


• Diclofenac


• Diflunisal


• Digoxin


• Enalaprilat


• Enalapril Maleate


• Etodolac


• Fenoprofen


• Fludrocortisone


• Flurbiprofen


• Fosinopril


• Germanium


• Ginseng


• Gossypol


• Ibuprofen


• Ibuprofen Lysine


• Imidapril


• Indomethacin


• Ketoprofen


• Ketorolac


• Licorice


• Lisinopril


• Magnesium Salicylate


• Meclofenamate


• Mefenamic Acid


• Meloxicam


• Moexipril


• Nabumetone


• Naproxen


• Nepafenac


• Oxaprozin


• Pancuronium


• Pentopril


• Perindopril


• Piroxicam


• Quinapril


• Ramipril


• Salicylic Acid


• Salsalate


• Spirapril


• Sulindac


• Temocapril


• Tolmetin


• Trandolapril


• Tubocurarine


• Vecuronium


• Zofenopril

Interactions with Food/Tobacco/Alcohol

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

Other Medical Problems

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

• Allergy to sulfa drugs (such as sulfamethoxazole, sulfasalazine, sulfisoxazole, Azulfidine®, Bactrim®, Gantrisin®, or Septra®) or


• Bladder problem with urinating or


• Blood or bone marrow problems or


• Dehydration or


• Electrolyte imbalance (e.g., low sodium, calcium, magnesium, or potassium in the blood) or


• Enlarged prostate or


• Gout or


• Hearing problems or


• Hyperuricemia (high uric acid in the blood) or


• Hypovolemia (low blood volume) or


• Liver disease, severe (e.g., cirrhosis, hepatic coma) or


• Systemic lupus erythematosus (SLE) or


• Tinnitus (ringing in the ears) or


• Trouble urinating—Use with caution. May make these conditions worse.

• Anuria (not able to pass urine)—Should not be used in patients with this condition.

• Diabetes—furosemide may increase the amount of sugar in the blood.

• Hypertension (high blood pressure)—Your dose of antihypertensive medicines may need to be adjusted to prevent your blood pressure from falling too low.

• Hypoproteinemia (low protein in the blood) from a kidney problem or


• Radiocontrast nephropathy (kidney problem), history of—May cause side effects to become worse.

• Kidney disease, severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of furosemide

A nurse or other trained health professional will give you or your child furosemide in a hospital. furosemide is given as a shot into a muscle or a vein.

Your doctor will give you a few doses of furosemide until your condition improves, and then switch you or your child to an oral medicine that works the same way. If you have any concerns about this, talk to your doctor.

Precautions While Using furosemide

It is very important that your doctor check you or your child closely while you are receiving furosemide. This is to make sure furosemide is working properly. Blood or urine tests may be needed to check for unwanted effects.

Using furosemide while you are pregnant may cause your unborn baby to be bigger than normal. If you think you have become pregnant while using furosemide, tell your doctor right away.

furosemide may cause you or your child to lose more potassium from your body than normal (hypokalemia). This is more likely to occur if you have liver disease (e.g., cirrhosis), or if you are using furosemide together with steroids (cortisone-like medicines), adrenocorticotropic hormone (ACTH), large amounts of licorice, or laxatives for a long time. Tell your doctor if you become sick with severe or continuing nausea, vomiting, or diarrhea, and drink fluids to prevent getting dehydrated. Check with your doctor right away if you have one or more of these symptoms: dry mouth; increased thirst; muscle cramps; or nausea or vomiting.

Stop using furosemide and check with your doctor right away if you or your child have a sudden decrease in hearing or loss of hearing. You may also have dizziness or ringing in the ears with the hearing problem. Tell your doctor if you have dizziness or lightheadedness; a feeling of constant movement of self or surroundings; or a sensation of spinning.

Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help. If the problem continues or gets worse, check with your doctor.

furosemide may cause an increase in blood sugar levels. If you or your child are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.

furosemide may make your skin more sensitive to sunlight. Use a sunscreen, hat, and protective clothing when you are outdoors. Avoid sunlamps and tanning beds.

Make sure any doctor or dentist who treats you knows that you are using furosemide. furosemide may affect the results of certain medical tests.

Do not take other medicines unless they have been discussed with your doctor. This especially includes prescription or nonprescription (over-the-counter) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.

furosemide Side Effects

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

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

Rare

• Chest pain


• chills


• cough or hoarseness


• fever


• general feeling of tiredness or weakness


• headache


• lower back or side pain


• painful or difficult urination


• shortness of breath


• sore throat


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


• swollen or painful glands


• tightness in the chest


• unusual bleeding or bruising


• unusual tiredness or weakness


• wheezing

Incidence not known

• Back or leg pains


• black, tarry stools


• bladder spasm


• bleeding gums


• blistering, peeling, or loosening of the skin


• bloating


• bloody or cloudy urine


• blurred vision


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


• changes in the skin color, pain, tenderness, or swelling of foot or leg


• clay-colored stools


• cold sweats


• confusion


• constipation


• continuing ringing or buzzing or other unexplained noise in the ears


• coughing up blood


• cracks in the skin


• darkened urine


• diarrhea


• difficulty with breathing or swallowing


• dizziness


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


• dry mouth


• fast heartbeat


• fever with or without chills


• flushed, dry skin


• fruit-like breath odor


• general body swelling


• greatly decreased frequency of urination or amount of urine


• hearing loss


• hives


• increased hunger


• increased thirst


• increased urination


• indigestion


• itching


• joint stiffness or swelling


• loss of appetite


• loss of heat from the body


• nausea or vomiting


• nosebleeds


• pain in the joints or muscles


• pain where a shot was given


• pains in the stomach, side, or abdomen, possibly radiating to the back


• pale skin


• pinpoint red spots on the skin


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


• red, irritated eyes


• red, swollen skin


• scaly skin


• severe abdominal or stomach pain


• skin rash


• stomach cramps


• sugar in the urine


• sweating


• swelling of the feet or lower legs


• troubled breathing with exertion


• unpleasant breath odor


• unusual weight loss


• vomiting of blood


• yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

• Decreased urination


• drowsiness


• fainting


• increase in heart rate


• irregular heartbeat


• irritability


• muscle cramps


• numbness, tingling, pain, or weakness in the hands, feet, or lips


• rapid breathing


• seizures


• sunken eyes


• thirst


• trembling


• weak pulse


• weakness and heaviness of the legs


• wrinkled skin

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

Incidence not known

• Feeling of constant movement of self or surroundings


• hives or welts


• increased sensitivity of the skin to sunlight


• muscle spasm


• redness or other discoloration of the skin


• restlessness


• sensation of spinning


• severe sunburn


• weakness

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

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

See also: furosemide Injection side effects (in more detail)

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

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

More furosemide Injection resources

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

Compare furosemide Injection with other medications

• Ascites
• Edema
• Heart Failure
• High Blood Pressure
• Hypercalcemia
• Nonobstructive Oliguria
• Oliguria
• Pulmonary Edema
• Renal Failure
• Renal Transplant

mesalamine

Generic Name: mesalamine (oral) (me SAL a meen)

Brand Names: Apriso, Asacol, Asacol HD, Lialda, Pentasa

What is mesalamine oral?

Mesalamine affects a substance in the body that causes inflammation, tissue damage, and diarrhea.

Mesalamine is used to treat ulcerative colitis, proctitis, and proctosigmoiditis. Mesalamine is also used to prevent the symptoms of ulcerative colitis from recurring.

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

What is the most important information I should know about mesalamine oral?

You should not use this medication if you are allergic to mesalamine or to aspirin or other salicylates (such as Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others). Before you take mesalamine, tell your doctor if you have kidney or liver disease, a stomach condition called pyloric stenosis, a heart condition such as congestive heart failure, or a history of allergy to sulfasalazine (Azulfidine). Do not crush, break, or chew a mesalamine tablet or capsule. Swallow the pill whole. It is specially formulated to release the medicine after it has passed through your stomach into your intestines.

Call your doctor if you find undissolved tablets in your stool.

Stop using mesalamine and call your doctor at once if you have severe stomach pain, cramping, fever, headache, and bloody diarrhea.

What should I discuss with my healthcare provider before taking mesalamine oral?

You should not use this medication if you are allergic to mesalamine or to aspirin or other salicylates (such as Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others).

To make sure you can safely take mesalamine, tell your doctor if you have any of these other conditions:

• 
  

  a stomach condition called pyloric stenosis;

  
  


• 
  

  a history of allergy to sulfasalazine (Azulfidine);

  
  


• 
  

  a heart condition such as congestive heart failure;

  
  


• 
  

  kidney disease; or

  
  


• 
  

  liver disease.

  
  

FDA pregnancy category C. It is not known whether mesalamine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Mesalamine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take mesalamine oral?

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

Take mesalamine with a full glass of water.

Mesalamine can usually be taken with or without food. Follow your doctor's instructions.

Mesalamine extended-release capsules (Lialda) should be taken with a meal. Do not crush, break, or chew a mesalamine tablet or capsule. Swallow the pill whole.

The extended-release capsule is specially formulated to release the medicine after it has passed through your stomach into your intestines. Breaking the pill may cause the drug to be released too early in the digestive tract.

The enteric-coated tablet has a special coating to protect your stomach. Breaking the pill could damage this coating.

Call your doctor if you find undissolved tablets in your stool.

Store at room temperature away from moisture and heat.

See also: Mesalamine dosage (in more detail)

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 ringing in your ears, dizziness, headache, confusion, drowsiness, sweating, shortness of breath, vomiting, and diarrhea.

What should I avoid while taking mesalamine oral?

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

Mesalamine oral side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking mesalamine and call your doctor at once if you have a serious side effect such as:

• 
  

  severe stomach pain, cramping, fever, headache, and bloody diarrhea.

  
  

Less serious side effects may include:

• 
  

  mild nausea, vomiting, stomach cramps, diarrhea, gas;

  
  


• 
  

  fever, sore throat, or other flu symptoms;

  
  


• 
  

  constipation;

  
  


• 
  

  headache or dizziness;

  
  


• 
  

  tired feeling; or

  
  


• 
  

  skin rash.

  
  

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.

Mesalamine Dosing Information

Usual Adult Dose for Ulcerative Colitis -- Active:

Oral:
Asacol (R): 800 mg orally 3 times a day for the treatment of mildly to moderately active ulcerative colitis
Asacol HD (R): 1600 mg orally 3 times a day for the treatment of moderately active ulcerative colitis
Lialda (R): 2.4 to 4.8 g orally once a day for the induction of remission of mildly to moderately active ulcerative colitis
Pentasa (R): 1 g orally 4 times a day for the treatment and induction of remission of mildly to moderately active ulcerative colitis

Rectal:
Suspension enema: 4 g rectally once a day at bedtime for the treatment of active mild to moderate distal ulcerative colitis, proctosigmoiditis, or proctitis

Usual Adult Dose for Ulcerative Colitis -- Maintenance:

Maintenance of remission of ulcerative colitis:
Apriso (TM): 1.5 g orally once a day in the morning
Asacol (R): 1.6 g/day orally in divided doses
Lialda (R): 2.4 g orally once a day
Pentasa (R): 1 g orally 4 times a day

Usual Adult Dose for Ulcerative Proctitis:

Suppository: 1 g rectally once a day at bedtime for the treatment of active ulcerative proctitis

Usual Adult Dose for Crohn's Disease -- Maintenance:

Mildly to moderately active Crohn's disease: 500 mg to 1 g orally 4 times a day as Pentasa (R)

What other drugs will affect mesalamine oral?

Tell your doctor about all other medicines you use, especially:

• 
  

  azathioprine (Imuran) or mercaptopurine (Purinethol);

  
  


• 
  

  pentamidine (Nebupent, Pentam);

  
  


• 
  

  tacrolimus (Prograf);

  
  


• 
  

  amphotericin B (Fungizone, AmBisome, Amphotec, Abelcet);

  
  


• 
  

  antibiotics such as capreomycin (Capastat), rifampin (Rifadin, Rimactane, Rifater), vancomycin (Vancocin, Vancoled);

  
  


• 
  

  antiviral medicines such as acyclovir (Zovirax), adefovir (Hepsera), cidofovir (Vistide), or foscarnet (Foscavir);

  
  


• 
  

  cancer medicine such as aldesleukin (Proleukin), carmustine (BiCNU, Gliadel), cisplatin (Platinol), ifosfamide (Ifex), oxaliplatin (Eloxatin), streptozocin (Zanosar), or tretinoin (Vesanoid); or

  
  


• 
  

  aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), diclofenac (Voltaren), etodolac (Lodine), indomethacin, nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.

  
  

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

More mesalamine resources

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

• mesalamine Advanced Consumer (Micromedex) - Includes Dosage Information


• Mesalamine Monograph (AHFS DI)


• Mesalamine Prescribing Information (FDA)


• Mesalamine Controlled-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)


• Apriso Prescribing Information (FDA)


• Apriso Consumer Overview


• Apriso Extended-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)


• Asacol Prescribing Information (FDA)


• Asacol Consumer Overview


• Asacol Delayed-Release Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Asacol HD Delayed-Release Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Asacol HD Prescribing Information (FDA)


• Canasa Suppositories MedFacts Consumer Leaflet (Wolters Kluwer)


• Canasa Oral, Rectal Advanced Consumer (Micromedex) - Includes Dosage Information


• Canasa Prescribing Information (FDA)


• Lialda Prescribing Information (FDA)


• Lialda Consumer Overview


• Pentasa Prescribing Information (FDA)


• Pentasa Consumer Overview


• Rowasa Prescribing Information (FDA)


• Rowasa Enema MedFacts Consumer Leaflet (Wolters Kluwer)


• Rowasa Advanced Consumer (Micromedex) - Includes Dosage Information


• sfRowasa Prescribing Information (FDA)

Compare mesalamine with other medications

• Crohn's Disease
• Crohn's Disease, Maintenance
• Inflammatory Bowel Disease
• Lymphocytic Colitis
• Ulcerative Colitis
• Ulcerative Colitis, Active
• Ulcerative Colitis, Maintenance
• Ulcerative Proctitis

Where can I get more information?

• Your pharmacist can provide more information about mesalamine.

See also: mesalamine side effects (in more detail)