DRUG CLASS AND MECHANISM: Clopidogrel bisulfate is an anti-platelet drug, that is, a drug that inhibits the ability of platelets to clump together as part of a blood clot. It is similar to ticlopidine (Ticlid) in chemical structure and in the way it works. Unlike ticlopidine, clopidogrel bisulfate does not cause serious reductions of white cells in the blood and, therefore, routine blood testing to determine if the white blood cell count is low is not necessary during treatment. The risk of heart attacks and strokes (which usually are caused by blood clots) is increased in patients with a recent history of stroke or heart attack and patients with peripheral vascular disease. (Peripheral vascular disease is the same as atherosclerotic arterial disease or "hardening" of the arteries in which the arteries become narrowed. It frequently occurs in the legs and often causes claudication or pain in the legs upon walking). Clopidogrel bisulfate is used to reduce the risk of heart attacks and strokes in these patients. Clopidogrel bisulfate was approved by the FDA in 1997.
GENERIC AVAILABLE: no
PRESCRIPTION: yes
PREPARATIONS: Tablets: 75mg.
STORAGE: Tablets should be stored at room temperature, 15-30°C (59-86°F).
PRESCRIBED FOR: Clopidogrel is used to prevent strokes and heart attacks in persons who are at high risk. In one large study, clopidogrel bisulfate was more effective than aspirin in reducing heart attacks. The frequency of side effects of clopidogrel bisulfate was similar to aspirin; however, stomach and intestinal bleeding probably occurs less often with clopidogrel bisulfate than with aspirin.
DOSING: Clopidogrel bisulfate usually is taken once daily. It can be taken with or without food.
DRUG INTERACTIONS: The combination of clopidogrel with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin; Advil; Nuprin), naproxen (Naprosyn, Aleve), diclofenac (Voltaren), etodolac (Lodine), nabumetone (Relafen), fenoprofen (Nalfon), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis; Oruvail), oxaprozin (), piroxicam (Feldene), sulindac (Clinoril), tolmetin (Tolectin), and mefenamic acid (Ponstel) may increase the risk of stomach and intestinal bleeding.
At high concentrations in the blood, clopidogrel inhibits the activity of the enzyme which metabolizes (eliminates) warfarin (Coumadin), a "blood thinner". This could lead to an increase in levels of warfarin and increase the risk of bleeding due to over-thinning of the blood. To date there have been no reports of an important interaction in humans between warfarin and clopidogrel. Nonetheless, because warfarin increases the risk of bleeding, blood tests to measure the degree to which the blood is anti-coagulated or thinned (prothrombin time; INR) may be ordered to assess the degree of blood-thinning when warfarin and clopidogrel are used together. The same enzyme also is responsible for the metabolism of phenytoin (Dilantin), tamoxifen (Nolvadex), tolbutamide (Orinase), torsemide (Demadex), and fluvastatin (Lescol). Although important interactions between clopidogrel and these drugs are unlikely, interactions should be looked for carefully.
SIDE EFFECTS: The tolerability of clopidogrel is similar to that of aspirin. Diarrhea, rash, or itching occurs in approximately 1 in 20 persons taking clopidogrel. Abdominal pain also occurs in about 1 in 20 persons, but it is less frequent than with aspirin.
Ticlopidine (Ticlid) is an antiplatelet medication quite similar to clopidogrel. It has been associated with a severe reduction in white blood cell count in between 0.8% and 1% of persons. The risk of this dangerous side effect with clopidogrel is about 0.04%, much less than with ticlopidine but twice that of aspirin
Clopidogrel rarely causes a condition called thrombotic thrombocytopenic purpura (TTP) in one out of every 250,000 people. TTP is a serious condition in which blood clots form throughout the body. Blood platelets, which participate in clotting, are consumed, and the result can be bleeding because enough platelets are no longer left to allow blood to clot normally. For comparison, the related drug, ticlodipine (Ticlid), causes TTP 17-50 times more frequently than clopidogrel.
DRUG CLASS AND MECHANISM: Losartan is an oral medication that belongs to a class of drugs called angiotensin receptor blockers (ARBs). Other ARBs include irbesartan (Avapro), valsartan (Diovan), and candesartan (Atacand). Angiotensin, formed in the blood by the action of angiotensin converting enzyme (ACE), is a powerful chemical that attaches to angiotensin receptors found in many tissues but primarily on smooth muscle cells of blood vessels. Angiotensin’s attachment to the receptors causes the blood vessels to narrow (vasoconstrict) which leads to an increase in blood pressure (hypertension). Losartan (more specifically, the chemical formed when the liver converts the inactive losartan into an active chemical) blocks the angiotensin receptor. By blocking the action of angiotensin, losartan dilates blood vessels and thereby reduces blood pressure. Losartan was approved by the FDA in April, 1995.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 25, 50 and 100 mg
STORAGE: Tablets should be stored at room temperature in a tightly closed, light resistant container.
PRESCRIBED FOR: Losartan is used for treating hypertension, left ventricular hypertrophy (increase in muscle) and diabetic nephropathy (kidney disease). It may be used alone or in combination with other drugs.
DOSING: The usual starting dose of losartan for adults is 50 mg daily. The maximum dose is 100 mg daily. The total daily dose may be divided and administered twice daily. Losartan may be given with or without food.
The starting dose of losartan for pediatric patients 6 years of age or older is 0.7 mg/kg up to 50 mg once daily. Doses more than 1.4 mg/kg or 100 mg daily have not been evaluated in pediatric patients.
DRUG INTERACTIONS: Inhibitors of cytochrome P450 enzymes such as fluconazole (Diflucan) reduced the formation of the active drug metabolite in laboratory studies. Therefore, caution should be used when adding losartan in a patient taking Nizoral, as reduced activity of losartan may occur.
Losartan may increase levels of blood potassium which can lead to serious heart problems (arrhythmias). Therefore, concomitant use of other substances that increase blood—such as potassium-sparing diuretics (e.g., spironolactone, triamterene, and amiloride), potassium supplements, or salt substitutes containing potassium--may lead to dangerous increases in serum potassium.
The antihypertensive effect of losartan may be reduced by nonsteroidal antiinflammatory drugs (e.g., indomethacin, ibuprofen, aspirin , and naproxen).
SIDE EFFECTS: In clinical studies the overall incidence of side effects was similar to placebo. Side effects reported included diarrhea, muscle cramps, dizziness, insomnia, and nasal congestion. Losartan also may cause a persistent cough, increase serum potassium, and angioedema. Losartan may reduce kidney function in some patients and should not be used by patients who have bilateral renal artery stenosis (narrowing of both arteries going to the kidneys). Rare cases of rhabdomyolysis (muscle breakdown) have been reported.
DRUG CLASS AND MECHANISM: Simvastatin is a cholesterol- lowering medicine. It inhibits the production of cholesterol by the liver. It lowers overall blood cholesterol as well as blood LDL cholesterol levels. LDL cholesterol is believed to be the "bad" cholesterol that is primarily responsible for the development of coronary artery disease. Lowering LDL cholesterol levels retards progression and may even reverse coronary artery disease.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: tablets: 5 mg,10 mg, 20 mg, 40 mg
STORAGE: Tablets should be stored at room temperature in a tightly closed container.
PRESCRIBED FOR: High blood cholesterol is first treated with exercise, weight loss, and a diet low in cholesterol and saturated fats. When these measures fail, cholesterol-lowering medications such as simvastatin can be added. The National Cholesterol Education Program (NCEP) has published treatment guidelines for use of these medications. These treatment guidelines take into account the level of LDL cholesterol as well as the presence of other risk factors such as diabetes, hypertension, cigarette smoking, low HDL cholesterol level, and family history of early coronary heart disease. The effectiveness of the medication in lowering cholesterol is dose related. Blood cholesterol determinations are performed in regular intervals during treatment so that dosage adjustments can be made.
DOSING: May be taken on an empty or full stomach.
DRUG INTERACTIONS: Simvastatin is generally well- tolerated. The medication should be used with caution in patients with alcohol or other liver diseases. Persistently abnormal liver tests during treatment are rare, but may lead to a discontinuation of the medication. Rare cases of muscle inflammation (myositis) and breakdown have been reported with simvastatin. Muscle breakdown causes the release of muscle protein (myoglobin) into the blood and kidney tubules, resulting in acute kidney failure. The risk of muscle breakdown is increased when simvastatin is given together with other medications such as cyclosporine (Sandimmune), gemfibrozil (Lopid), erythromycin and nicotinic acid. Simvastatin may interact with cholestyramine (Questran), warfarin (Coumadin), and cimetidine (Tagamet) to alter the blood levels of these medicines. When Coumadin is given together with simvastatin, blood clotting times require monitoring to avoid excessive blood thinning and bleeding. Simvastatin should not be used in children. Simvastatin is not habit forming.
SIDE EFFECTS: Simvastatin is generally well-tolerated and side effects are rare. Minor side effects include constipation, diarrhea, fatigue, gas, heartburn, and headache. Major side effects include abdominal pain or cramps, blurred vision, dizziness, easy bruising or bleeding, itching, muscle pain or cramps, rash, and yellowing of the skin or eyes.
DRUG CLASS AND MECHANISM: Sibutramine is a medication that assists with weight-loss by altering neurotransmitters within the brain. Neurotransmitters are chemicals that are produced and released by nerves in order to communicate with other nerves. Released neurotransmitters may attach to other nerves or they may be taken up again by the nerves that release them, a process termed reuptake. Sibutramine blocks the reuptake of the neurotransmitters dopamine, norepinephrine, and serotonin. Blocking the reuptake of neurotransmitters alters the balance of neurotransmitters within the nerve cells and thereby affect nerve function and interaction.
Patients taking sibutramine may achieve a 5-10% reduction from their baseline weight. Additionally, sibutramine-assisted weight loss has been accompanied by improvement in blood lipids (e.g, cholesterol). Sibutramine was approved by the FDA in 1997.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Capsules: 5mg (blue and yellow); 10mg (blue and white); 15mg (white and yellow)
STORAGE: Capsules should be stored at 25°C (77°F). Brief periods at higher or lower temperatures, i.e., 15-30°C (59-86°F) are permitted. The medication should be stored in a tight, light-resistant container. The capsules should be protected from heat and moisture.
PRESCRIBED FOR: Sibutramine is used for weight loss in conjunction with a low calorie diet. Specific populations for whom the medication is recommended are those with an initial body mass index of more than 30 kg/m2 (27 mg/m2 if they also have other risk factors such as diabetes mellitus, high cholesterol or hypertension).
DOSING: Sibutramine is taken once daily, generally in the morning. Therapy usually is started with one 10mg tablet per day. The dose may be increased to 15mg by the physician after several weeks to achieve the desired effect. Doses of up to 60mg have been studied. Sibutramine may be taken with or without food.
DRUG INTERACTIONS: Sibutramine must be converted in the liver to its active form. This conversion is inhibited by ketoconazole (Nizoral), cimetidine (Tagamet) and erythromycin (Erytab, Eryc, Ilosone), and use of these drugs can result in decreased conversion and effectiveness of sibutramine. Several other drugs may have a similar effect. These other drugs include clarithromycin (Biaxin), danazol (Danocrine), diltiazem (Cardizem, Tiazac, Dilacor), fluconazole (Diflucan), fluoxetine (Prozac), itraconazole (Sporanox), propoxyphene (Darvon), troleandomycin (Tao) and verapamil (Verelan, Covera, Calan, Isoptin).
SIDE EFFECTS: In general, sibutramine is well-tolerated. The most common side effects have been constipation, inability to sleep, headache, and dry mouth. Other side effects include abdominal pain, acne, rash, chest pain, anxiety, joint pain, back pain, excitation, depression, sweating, dizziness, drowsiness, changes in taste, irregular or painful menstrual periods, flu-like syndrome, increased cough, muscle pain, nausea, vomiting, neck pain, nervousness, palpitations, tingling of the extremities, sore throat, and sinus congestion.
DRUG CLASS AND MECHANISM: Orlistat is a drug that promotes loss of weight by preventing the digestion and absorption of fat in food. In the intestine, an enzyme called lipase (produced primarily by the pancreas) breaks apart fat in food so that it can be absorbed into the body. Orlistat blocks the action of lipase and thereby prevents the breakup and absorption of fat. Orlistat blocks absorption of about 25% of the fat in a meal. The unabsorbed fat is excreted in the stool. The FDA approved Orlistat by prescription in 1999. alli, a lower dose formulation of orlistat, was approved for purchase without a prescription "over the counter" in 2007.
PRESCRIPTION: Orlistat yes, alli no
GENERIC AVAILABLE: No
PREPARATIONS: Capsules: 60 mg (alli), 120 mg (Xenical)
STORAGE: Capsules should be stored at room temperature, 15–30°C (59–86°F)
PRESCRIBED FOR: Orlistat is combined with a reduced–calorie diet to promote weight loss. Orlistat also may be used to prevent weight gain after weight has been lost. Candidates for treatment with orlistat are patients who are obese with a body mass index (a measure of obesity) of more than 30 kg/m2. Candidates also include patients with a body mass index of between 27 and 30 kg/m2 if other risk factors for arteriosclerosis are present such as high blood pressure, diabetes, and elevated blood cholesterol or triglycerides. Based on several scientific studies, the average weight loss that is achieved when orlistat is taken as recommended for six months to one year is 12.4 to 13.4 pounds.
DOSING: The recommended prescription dose for Xenical is one capsule (120 mg) three times daily. The recommended dose for alli is 60 mg three times daily. Orlistat should be taken one hour after or during a meal containing about 15 mg of fat. Meals without fat do not require orlistat. No additional benefit has been shown when orlistat was taken in doses greater than 120 mg. Patients should eat a nutritionally balanced, reduced calorie diet that contains approximately 30% of calories from fat. alli includes an individually tailored online weight loss support program.
DRUG INTERACTIONS: The blood thinning effect of warfarin (Coumadin) depends on the amount of vitamin K in the body, and vitamin K is one of the vitamins that binds to fat. Patients receiving warfarin who begin orlistat should have their blood clotting monitored closely because the orlistat may cause levels of vitamin K to decline. This will increase the effects of warfarin and lead to abnormal bleeding from the warfarin. There is no evidence that a deficiency of vitamin K occurs in patients who are taking orlistat.
Orlistat may reduce the absorption and blood levels of cyclosporine (Sandimmune) when both drugs are administered together. Therefore, cyclosporine should be administered two hours before or after orlistat, and more frequent monitoring of cyclosporine levels may be needed.
SIDE EFFECTS: The most common side effects of orlistat are oily spotting on underwear, flatulence, urgent bowel movements, fatty or oily stools, increased number of bowel movements, abdominal pain or discomfort, and inability to control stool (incontinence). Between 1 in 250 and 1 in 70 patients experienced one or more of these symptoms in the first year. Generally, the side effects occurred within three months of starting therapy. In about 50% of patients, the side effects resolved within one to four weeks, but the effects in some patients lasted six months or longer. To reduce the occurrence of these side effects, meals should contain no more than 30% fat because it is the unabsorbed fat that causes most of the symptoms. alli causes fewer side effects because it contains half the dose of prescription–strength orlistat. Patients receiving orlistat with a history of oxalate kidney stones may develop increased levels of oxalate in their urine, which may increase the risk of kidney stones.
GENERIC NAME: rimonabant
DRUG CLASS AND MECHANISM: Generic Acomplia medicine inhibits the working of CB-1 receptor present on the surface of every cell of the human body. Hunger signal are transmitted to the brain by the CB-1 receptors. Generic Acomplia helps to cure the abnormality in this signaling and the diet becomes balanced.
The feeling of uncontrolled urge for food will disappear after taking Generic Acomplia pill, even if your best dish is placed in your front.
Also Generic Acomplia has shown some effectiveness in suppressing tobacco addiction, because it is the same CB-1 receptor that is responsible for increasing the body’s affinity towards tobacco.
GENERIC AVAILABLE:Yes
PRESCRIPTION:Yes
PREPARATIONS: Capsules: 20mg
STORAGE: Capsules should be stored at 25°C (77°F). Brief periods at higher or lower temperatures, i.e., 15-30°C (59-86°F) are permitted. The medication should be stored in a tight, light-resistant container. The capsules should be protected from heat and moisture.
PRESCRIBED FOR: Acomplia is an anorectic anti-obesity drug (causes a reduction in appetite) that is used to help weight loss. Acomplia can also help redunce tobacco dependcy in smokers, helping people to quit smoking.
DOSING: Patients are usually prescribed daily dose of 20 mg of Rimonabant which should be in blend with a low-calorie diet and regular fitness regime to get superior weight loss results. Pill should be swallowed with a full glass of weather and not chewed. Rimonabant should be taken prior to breakfast once a day.
DRUG INTERACTIONS: Rimonabant is metabolized by both CYP3A and amidohydrolase (predominantly hepatic) pathways in vitro. Co-administration of CYP3A4 inhibitors will lead to increased exposure of rimonabant. Co-administration of CYP3A4 inducers is expected to reduce the exposure of rimonabant.
DRUG CLASS AND MECHANISM: Esomeprazole is in a class of drugs called proton pump inhibitors (PPIs) which block the production of acid by the stomach. Other drugs in the same class include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix). Chemically, esomeprazole is very similar to omeprazole. Proton pump inhibitors are used for the treatment of conditions such as stomach and duodenal ulcers, gastroesophageal reflux disease (GERD) and the Zollinger-Ellison syndrome which all are caused by stomach acid. Esomeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal. Esomeprazole was approved by the FDA in February, 2001.
GENERIC: No
PRESCRIPTION: Yes
PREPARATIONS: Capsules: 20 and 40 mg. Intravenous: 20 and 40 mg.
STORAGE: Store at room temperature, 15-30°C (59-86°F) in a tightly closed container.
PRESCRIBED FOR: Esomeprazole is approved for the treatment of gastroesophageal reflux disease (GERD) and in combination with amoxicillin and clarithromycin (Biaxin) for the treatment of patients with ulcers and H. pylori infection. Since it is very similar to omeprazole, it also is likely that it will be used for the treatment of Zollinger-Ellison syndrome.
DOSING: For GERD, 20 or 40 mg of esomeprazole is given once daily for 4-8 weeks.
For the treatment of H. pylori, 40 mg is administered once daily in combination with amoxicillin and clarithromycin for 10 days.
Esomeprazole capsules should be administered one hour before meals, swallowed whole and should not be crushed or chewed. Patients with difficulty swallowing can open the capsule and mix the pellets with applesauce. The applesauce should not be hot and the pellets should not be chewed or crushed.
DRUG INTERACTIONS: Esomeprazole potentially can increase the concentration in blood of diazepam (Valium) by decreasing the elimination of diazepam in the liver. Esomeprazole may have fewer drug interactions than omeprazole.
The absorption of certain drugs may be affected by stomach acidity. Therefore, esomeprazole and other PPIs that reduce stomach acid also reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole or increased digoxin toxicity, respectively.
SIDE EFFECTS: Esomeprazole, like other PPIs, is well-tolerated. The most common side effects are diarrhea, nausea, vomiting, headaches, rash and dizziness. Nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps and water retention occur infrequently.
DRUG CLASS AND MECHANISM: Pantoprazole is in a class of drugs called proton pump inhibitors (PPI) which block the production of acid by the stomach. Other drugs in the same class include lansoprazole (Prevacid), omeprazole (Prilosec) and rabeprazole (Aciphex). Proton pump inhibitors are used for the treatment of conditions such as ulcers, gastroesophageal reflux disease (GERD) and Zollinger-Ellison Syndrome that are caused by stomach acid. Pantoprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Tablets: 40 mg . An intravenous form of pantoprazole is expected soon.
STORAGE: Store at room temperature, 15-30°C (59-86°F). Keep away from moisture.
PRESCRIBED FOR: Although pantoprazole is approved for the treatment of gastroesophageal reflux disease (GERD), like other PPI's it also is used for treating ulcers of the stomach and duodenum, and the Zollinger-Ellison Syndrome.
DOSING: For GERD the recommended dose for adults is 40 mg daily for 4-8 weeks.
It generally is recommended that tablets be taken approximately 30 minutes prior to meals for maximal effectiveness. Tablets should be swallowed whole and should not be crushed, split or chewed.
DRUG INTERACTIONS: Pantoprazole is less likely than omeprazole to interact with other drugs.
The absorption of certain drugs may be affected by stomach acidity, and, as a result, pantoprazole and other PPIs that reduce stomach acid also reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole or increased digoxin toxicity, respectively.
SIDE EFFECTS: Pantoprazole like other PPIs is well-tolerated. The most common side effects are diarrhea, nausea, vomiting, constipation, rash and headaches. Dizziness, nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps and water retention rarely occur.
DRUG CLASS AND MECHANISM: Rabeprazole is an oral drug that is used for the treatment of conditions caused by acid. It is in a class of drugs called proton pump inhibitors or PPIs which block the production of acid by the stomach. Other drugs in the same class include lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and esomeprazole (Nexium). PPIs are used for the treatment of acid-caused conditions such as stomach and duodenal ulcers, gastroesophageal reflux disease (GERD) and Zollinger-Ellison Syndrome. Rabeprazole, like other PPIs, blocks the enzyme in the wall of the stomach that makes and secretes acid into the stomach. By blocking the enzyme, the secretion of acid into the stomach is decreased, and this allows ulcers in the stomach and esophagus to heal.
GENERIC AVAILABLE: No.
PRESCRIPTION: Yes.
PREPARATIONS: Tablets: 20 mg
STORAGE: Store at room temperature, 15-30°C (59-86°F). Keep away from moisture.
PRESCRIBED FOR: Rabeprazole is used for treating ulcers of the stomach and duodenum, erosive or ulcerative gastroesophageal reflux disease (GERD) and Zollinger-Ellison Syndrome (in which there is overproduction of acid caused by tumors). It also is used with antibiotics for eradicating Helicobacter pylori infections of the stomach that, along with acid, are responsible for many ulcers.
DOSING: For healing ulcerative or erosive GERD, the recommended dose for adults is 20 mg daily for 4-8 weeks. If healing does not occur after 8 weeks, another 8 week course may be considered. The recommended maintenance dose is 20 mg daily. Heartburn due to GERD is treated with 20 mg daily for 4 weeks and an additional 4 weeks if symptoms do not resolve. Ulcers are treated with 20 mg daily for 4 weeks. For the management of Zollinger-Ellison Syndrome, the starting dose for adults is 60 mg daily, and the dose is adjusted based on improvement in symptoms, healing of ulcers, or the effectiveness of acid suppression. Doses of 100 mg per day and 60 mg twice daily have been used in some patients with Zollinger-Ellison Syndrome. The regimen for eradication of Helicobacter pylori is rabeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1000 mg all given twice daily (morning and evening) for 7 days.
Tablets should be swallowed whole and should not be crushed, split or chewed. Rabeprazole can be taken with or without meals since food has little effect on its absorption.
DRUG INTERACTIONS: There have been reports of an increase in the effect of the blood thinner, warfarin, by rabeprazole which theoretically could lead to increased bleeding. Patients taking warfarin should be monitored more frequently if the begin taking rabeprazole.
Rabeprazole may reduce the elimination of cyclosporin in the liver, thereby increasing cyclosporin levels in the blood and potentially lead to cyclosporin toxicity.
The absorption of certain drugs may be affected by changes in stomach acidity. Rabeprazole and other PPIs that reduce stomach acid reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole or increased digoxin toxicity, respectively.
SIDE EFFECTS: Rabeprazole like other PPIs has few side effects. The most common side effects are diarrhea, nausea, vomiting, constipation, rash and headaches. Dizziness, nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps and water retention rarely occur.
DRUG CLASS AND MECHANISM: Histamine is a chemical made by the body that stimulates cells lining the stomach to produce acid. Famotidine belongs to a class of medications called H2-blockers that blocks the action of histamine on stomach cells, thus reducing production of acid by the stomach. Other H2 blockers include cimetidine (Tagamet), ranitidine (Zantac), and nizatidine (Axid). Famotidine was approved by the FDA in November, 1986.
PRESCRIPTION: Yes.
GENERIC AVAILABLE: Yes.
PREPARATIONS: Tablets: 10, 20, and 40 mg. Suspension: 40 mg per 5 ml teaspoon. Injection: 10 mg/ml and 20 mg/50 ml.
STORAGE: Tablets and suspension should be stored at room temperature, 15 -30°C (59-86°F). Injection should be stored between 2-8°C (36-46°F).
PRESCRIBED FOR: Famotidine blocks the action of histamine on stomach cells, and reduces stomach acid production. Famotidine is useful in promoting the healing of stomach and duodenal ulcers and in reducing ulcer pain. Famotidine has been effective in preventing recurrence of ulcers when given in low doses for prolonged periods of time. Famotidine also is used for treating heartburn and in healing ulceration and inflammation of the esophagus (esophagitis) resulting from acid (gastroesophageal reflux disease or GERD). High doses are used for treating conditions in which there are marked increases in acid secretion such as Zollinger-Ellison syndrome.
DOSING: The recommended adult oral dose for treating duodenal ulcers is 40 mg once daily at bedtime or 20 mg twice daily. Most patients heal their ulcers within 4 weeks. The regimen for maintenance therapy after the ulcers are healed is 20 mg once a day at bedtime.
The recommended adult oral dose for treating gastric ulcer is 40 mg once a day at bedtime, and esophagitis is treated with 20-40 mg twice daily for 6-12 weeks. Zollinger-Ellison syndrome is treated with 20 mg every 6 hours.
Heartburn due to GERD is treated with 10-20 mg daily.
DRUG INTERACTIONS: No important drug interactions with famotidine have been identified.
SIDE EFFECTS: Side effects of famotidine are rare. Minor side effects include constipation, diarrhea, fatigue, headache, insomnia, muscle pain, nausea, and vomiting. Major side effects include agitation, anemia, confusion, depression, easy bruising or bleeding, hallucinations, hair loss, irregular heartbeat, rash, visual changes, and yellowing of the skin or eyes (jaundice).
DRUG CLASS AND MECHANISM: Histamine is a natural chemical that stimulates the stomach cells to produce acid. Ranitidine belongs to a class of medications, called H2-blockers, that block the action of histamine on stomach cells, thus reducing stomach acid production.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: Tablets (150 mg, 300 mg), Capsules (150 mg, 300 mg);
Syrup (15 mg/ml)
STORAGE: Should be stored at room temperature in a tightly closed container.
PRESCRIBED FOR: Ranitidine blocks the action of histamine on stomach cells, and reduces stomach acid production. Ranitidine is useful in promoting healing of stomach and duodenal ulcers, and in reducing ulcer pain. Ranitidine has been effective in preventing ulcer recurrence when given in low doses for prolonged periods of time. In doses higher than that used in ulcer treatment, ranitidine has been helpful in treating heartburn and in healing ulcer and inflammation of the esophagus resulting from acid reflux (reflux esophagitis).
DOSING: May be taken with or without food. Since ranitidine is excreted by the kidney and metabolized by the liver, dosages of ranitidine need to be lowered in patients with significantly abnormal liver or kidney function.
DRUG INTERACTIONS: Antacids may decrease the absorption of ranitidine. Safety of ranitidine in children has not been established. Ranitidine is not habit forming. Ranitidine can interfere with the metabolism of alcohol. Patients taking ranitidine who drink alcohol may have elevated blood alcohol levels.
SIDE EFFECTS: Minor side effects include constipation, diarrhea, fatigue, headache, insomnia, muscle pain, nausea, and vomiting. Major side effects are rare; they include: agitation, anemia, confusion, depression, easy bruising or bleeding, hallucinations, hair loss, irregular heartbeat, rash, visual changes, and yellowing of the skin or eyes.
DRUG CLASS AND MECHANISM: Cimetidine belongs to a class of medications called histamine H2-antagonists. Histamine is a natural chemical that stimulates stomach cells to produce acid. Histamine H2-antagonists inhibit the action of histamine on the acid-producing cells of the stomach and reduce stomach acid. Cimetidine was approved by the FDA in 1977.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 200, 300, 400, and 800 mg. Liquid: 300 mg/5 mL. Injection: 150 mg/mL.
STORAGE: Store at room temperature 15-30°C (59-86°F).
PRESCRIBED FOR: Cimetidine is used for the treatment of duodenal ulcers, active gastric ulcers, gastroesophageal reflux disease (GERD), pathological hypersecretory conditions (e.g., Zollinger Ellison syndrome), heartburn and the prevention of gastrointestinal bleeding.
DOSING:
DRUG INTERACTIONS: Cimetidine may increase the blood levels of several drugs by reducing their elimination by the liver. This interaction may occur between cimetidine and warfarin (Coumadin), a commonly used blood thinning agent. Patients taking both medications should have frequent blood monitoring to avoid accumulation of high levels of warfarin leading to excessive blood thinning and bleeding. Cimetidine also may increase the blood levels phenytoin, theophylline, lidocaine, amiodarone, metronidazole, loratadine, calcium channel blockers (e.g., diltiazem, felodipine, nifedipine), bupropion, carbamazepine and fluvastatin. Because cimetidine reduces stomach acid, it may reduce the absorption of drugs (e.g., ketoconazole) that are best absorbed in acidic conditions. Such drugs should be administered at least 2 hours before the administration of cimetidine.
SIDE EFFECTS: Side effects due to cimetidine are rare and generally reversible once the medication is stopped. Minor side effects include constipation, diarrhea, fatigue, headache, insomnia, muscle pain, nausea, and vomiting. Major side effects include confusion and hallucinations (usually in elderly or critically ill patients); enlargement of the breasts; impotence (usually seen in patients on high doses for prolonged periods); decreased white blood cell counts. Other side effects include irregular heartbeat, impotence, rash, visual changes, allergic reactions, and hepatitis.
DRUG CLASS AND MECHANISM: Viral illnesses differ from bacterial infections in that viruses are not living organisms, but rather take over living cells and reproduce themselves, often at the expense of the host cell. Acyclovir is an antiviral drug which acts against the Herpes viruses, including herpes simplex 1 and 2 (cold sores and genital herpes), varicella-zoster (shingles and chicken pox), and the Epstein-Barr virus (mononucleosis). Acyclovir inhibits the replication of viral DNA needed to reproduce itself. Virally infected cells absorb more acyclovir than normal cells and convert more of it to an active form which prolongs its antiviral activity where it is most needed.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: Capsules (200 mg); Tablets (400mg, 800mg); Ointment 5% (15gm).
STORAGE: Acyclovir should be stored at room temperature in a tight container.
PRESCRIBED FOR: Oral acyclovir is used to treat initial genital herpes infections and to treat patients with recurrent (6 episodes per year) severe genital herpes. Acyclovir reduces the pain and the number of lesions in the initial case, and decreases the frequency and severity in those with recurrent infections. In the treatment of shingles, acyclovir reduces pain, shortens the healing time, and limits the spread of virus and the formation of new lesions. Acyclovir can be used to treat chicken pox and acts to reduce healing time, limit the number of lesions, and reduce fever if used within the first 24 hours after the onset of the disease. Acyclovir ointment is used topically to treat initial genital herpes where it has been shown to decrease pain, reduce healing time, and limit the spread of the infection.
DOSING: Acyclovir may be taken with or without food. Acyclovir is excreted mainly by the kidney and dosages need to be reduced in patients with kidney dysfunction.
DRUG INTERACTIONS: Genital herpes is a sexually transmitted disease and patients should avoid intercourse when they have visible lesions. Resistance to acyclovir can develop, especially with overuse. Therefore, acyclovir should be used only for severe cases and only as long as needed. Long-term suppression for recurrent genital herpes should include periodic re-evaluations and trials without the drug or intermittent short-term treatments.
SIDE EFFECTS: Rare side effects in patients treated short-term with acyclovir are nausea, vomiting, and headache. Long-term treatment has the additional potential for rash and diarrhea.
DRUG CLASS AND MECHANISM: Lamivudine is an oral medication that is used for the treatment of infections with the human immunodeficiency (HIV) and hepatitis B viruses. It is in a class of drugs called reverse transcriptase inhibitors which also includes zalcitabine (Hivid), zidovudine (Retrovir), didanosine (Videx), and stavudine (Zerit). During infection with HIV, the HIV virus multiplies within the body's cells. The viruses then are released from the cells and spread throughout the body where they infect other cells. In this manner, HIV infection spreads to new, uninfected cells that the body is continually producing, and HIV infection is perpetuated. When producing new viruses, the HIV virus must manufacture new DNA for each virus. Reverse transcriptase is the virus' enzyme that forms this new DNA. Lamivudine first is converted within the body to its active form, lamivudine triphosphate. This active form is similar to a chemical, deoxycytidine triphosphate, that is used by reverse transcriptase to make new DNA. The reverse transcriptase uses lamivudine triphosphate instead of deoxycytidine triphosphate, and the lamivudine triphosphate interferes with the reverse transcriptase. Lamivudine does not kill existing HIV virus, and it is not a cure for HIV. Lamivudine was approved by the FDA in 1995.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Tablets: 150 mg; oral solution 10 mg/ml
STORAGE: Store tablets and solution at room temperature, 15-30°C (59-86°F).
PRESCRIBED FOR: Lamivudine is used for the treatment of HIV infection, prevention of HIV in those accidentally exposed to HIV, and the treatment of the hepatitis B infection.
DOSING: For the treatment of HIV infection the recommended dose for adults is 150 mg twice daily for those weighing 50 kg or more and 2 mg/kg twice daily if less than 50 kg.
Children (12 to 16 years old) weighing 50 kg or more should receive 150 mg twice daily.
Children ( 3 months to 12 years old) should be treated with 4 mg/kg twice daily up to a maximum dose of 300 mg daily.
For postexposure prevention of HIV infection, 150 mg twice daily of lamivudine is administered in conjunction with 600 mg daily of zidovudine (Retrovir) for 28 days.
Hepatitis B is treated with 100 mg twice daily.
Lamivudine may be administered without regard to meals.
DRUG INTERACTIONS: Trimethoprim/sulfamethoxazole (Bactrim) increases the concentration of lamivudine in the body.
SIDE EFFECTS: The most severe side effects are pancreatitis, liver failure and metabolic disturbance (lactic acidosis). Lamivudine also causes a decrease in blood cells, muscle pain and weakness, and nerve damage in the extremities (peripheral neuropathy). Symptoms of peripheral neuropathy are tingling, numbness and pain in the feet or hands. Other side effects are fever, abdominal pain, weight loss, nausea, vomiting, diarrhea, hair loss and difficulty sleeping.
DRUG CLASS AND MECHANISM: Zidovudine is an oral and injectable medication that is used for the treatment of infections with the human immunodeficiency virus (HIV). It is in a class of drugs called reverse transcriptase inhibitors which also includes zalcitabine (Hivid), stavudine (Zerit), didanosine (Videx), and lamivudine (Epivir). During infection with HIV, the HIV virus multiplies within the body's cells. The newly-formed viruses then are released from the cells and spread throughout the body where they infect other cells. In this manner, the infection continually spreads to new, uninfected cells that the body is continually producing, and HIV infection is perpetuated. When producing new viruses, the HIV virus must manufacture new DNA for each virus. Reverse transcriptase is the enzyme that the virus uses to make this new DNA. Zidovudine inhibits the activity of reverse transcriptase and blocks the production of DNA and new viruses. Specifically, zidovudine is converted within the body to its active form (zidovudine triphosphate). This active form is similar to the compound thymidine triphosphate, a chemical that is required by the HIV virus to make new DNA. The reverse transcriptase uses zidovudine triphosphate instead of thymidine triphosphate for making DNA, and it is the zidovudine triphosphate that interferes with the reverse transcriptase. Zidovudine does not kill existing HIV virus, and it is not a cure for HIV. Retrovir was approved by the FDA in 1987.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Capsules: 100 mg; syrup 50 mg/5 ml; injections 10mg/ml
STORAGE: Store at room temperature, 15-30°C (59-86°F). Keep capsules and syrup away from light.
PRESCRIBED FOR: Zidovudine is used for the treatment of HIV and the prevention of HIV transmission from an infected mother to her fetus.
DOSING: For the treatment of HIV infection the recommended oral dose for adults is 100 mg every 4 hours. The intravenous dose is 1 to 2 mg/kg every 4 hours.
For children 3 months to 12 years old, the oral starting dose is 180 mg/m2 every 6 hours not to exceed 200 mg every 6 hours.
Infants should be given 2 mg/kg orally every 6 hours within 12 hours of birth and for 6 weeks or 1.5 mg/kg intravenously every 6 hours.
To prevent HIV transmission from mother to fetus, the dose is 100 mg five times daily or 200 mg three times daily. Treatment should be initiated between the14th and 34th weeks of pregnancy and continued until the time of labor. During labor and delivery, 2mg/kg should be administered intravenously over 1 hr followed by 1 mg/kg/hr until the umbilical cord is clamped.
DRUG INTERACTIONS: Fluconazole (Diflucan), probenecid and trimethoprim (Trimpex) reduce the elimination of zidovudine and therefore increase the blood concentration of zidovudine. This can lead to increased side effects from zidovudine.
SIDE EFFECTS: The most severe side effects are a decrease in blood cells, muscle pain (myopathy) enlarged liver (hepatomegaly) and metabolic disturbance (lactic acidosis). Other side effects are chills, rash, confusion, dizziness, headache, diarrhea, nausea and weight loss.
DRUG CLASS AND MECHANISM: Stavudine is an oral medication that is used for the treatment of infections with the human immunodeficiency virus (HIV). It is in a class of drugs called reverse transcriptase inhibitors which also includes zalcitabine (Hivid), zidovudine (Retrovir), didanosine (Videx), and lamivudine (Epivir). During infection with HIV, the HIV virus multiplies within the body's cells. The newly-formed viruses then are released from the cells and spread throughout the body where they infect other cells. In this manner, the infection continually spreads to new, uninfected cells that the body is continually producing, and HIV infection is perpetuated. When producing new viruses, the HIV virus must manufacture new DNA for each virus. Reverse transcriptase is the enzyme that the virus uses to form this new DNA. Specifically, stavudine is converted within the body to its active form (stavudine triphosphate). This active form is similar to thymidine triphosphate, a chemical that is required by the HIV virus to make new DNA. The reverse transcriptase uses stavudine triphosphate instead of thymidine triphosphate for making DNA, and it is the stavudine triphosphate that interferes with the reverse transcriptase. Stavudine does not kill existing HIV virus and it is not a cure for HIV. Stavudine was approved by the FDA in June, 1994.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Capsules: 15, 20, 30 and 40mg. Powder for oral solution, 1 mg/ml.
STORAGE: Store capsules at room temperature, 15-30°C (59-86°F). The dry powder for oral solution should be kept at room temperature and away form moisture. Solutions should be refrigerated.
PRESCRIBED FOR: Stavudine is used for the treatment of HIV infection.
DOSING: The recommended dose for adults is 40 mg twice daily for those weighing 60 kg or more and 30 mg twice daily if less than 60 kg.
Children weighing less than 30 kg should receive 1 mg/kg. Children weighing 30 kg or more should be treated like adults.
Stavudine may be administered without regard to meals.
DRUG INTERACTIONS: Zidovudine prevents the conversion of stavudine to its active form (stavudine triphosphate) and this reduces the action of stavudine against the HIV virus. Therefore stavudine should not be combined with zidovudine.
SIDE EFFECTS: The most severe side effects are a decrease in blood cells, muscle pain (myopathy), pancreatitis, liver failure and metabolic disturbance (lactic acidosis). Stavudine damages nerves and can cause a severe peripheral neuropathy, a condition in which sensation in the legs and/or arms is altered or lost. Symptoms of peripheral neuropathy are tingling, numbness and pain in the feet or hands. Other side effects include chills, rash, abdominal pain, weight loss and insomnia.
DRUG CLASS AND MECHANISM: Aceclofenac has been shown to have potent analgesic and anti-inflammatory activities, similar to indomethacin and diclofenac and due to its preferential cox-2 blockade it has better safety than conventional NSAIDs with respect to adverse effects on gastrointestinal and cardiovascular system.
GENERIC AVAILABLE: Yes
PRESCRIPTION: Yes
PREPARATIONS: Tablets: 100 mg and 200mg.
STORAGE: Store at room temperature, 15-30°C (59-86°F). Keep away from moisture.
PRESCRIBED FOR: Aceclofenac is a phenylaceticacid derivative and it is a inhibitor of prostoglandin synthesis and used in rheumatoid arthiritis
DOSING: The usual dose of aceclofenac is 100 mg given twice daily by mouth, one tablet in the morning and one in the evening. There is no evidence that the dosage of aceclofenac needs to be modified in patients with mild renal impairment, but as with other NSAIDS caution should be exercised.
DRUG INTERACTIONS: Aceclofenac may increase plasma concentrations of lithium, digoxin and methotrexate, increase the activity of anticoagulant, inhibits the activity of diuretics, enhance cyclosporin nephrotoxicity and precipitate convulsions when co-administered with quinolone antibiotics. Furthermore, hypo or hyperglycaemia may result from the concomitant administration of aceclofenac and antidiabetic drugs, although this is rare. The co administration of aceclofenac with other NSAIDS of corticosteroids may results in increased frequency of adverse event.
SIDE EFFECTS: Aceclofenac may increase the blood levels of lithium, digoxin and methotrexate. There may be an increased risk of bleeding from the gut if aceclofenac is taken with blood thinning or anti-clotting medicines such as warfarin. The effect of diuretics such as frusemide (furosemide) may be reduced by aceclofenac. The use of aceclofenac with diuretics, ciclosporin or ACE inhibitors may increase the risk of kidney problems and alterations to the potassium balance in the body. There may be an increased risk of side effects such as stomach irritation if aceclofenac is taken with corticosteroids such as prednisolone. Aceclofenac should not be taken with any other NSAID, due to an increased risk of side effects. Convulsions may occur when aceclofenac is given together with quinolone antibiotics. This may occur in patients with or without previous history of epilepsy or convulsions.
DRUG CLASS AND MECHANISM: Tramadol is a man-made (synthetic) analgesic (pain reliever). Its exact mechanism of action is unknown but similar morphine. Like morphine, tramadol binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain from throughout the body to. Tramadol, like other narcotics used for the treatment of pain, may be abused. Tramadol is not a nonsteroidal antiinflammatory drug (NSAID) and does not have the increased risk of stomach ulceration and internal bleeding that can occur with NSAIDs.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets (immediate release): 50 mg. Tablets (extended release): 100, 200, and 300 mg.
STORAGE: Store at room temperature, 15-30°C (59-86°F). Store in a sealed container.
PRESCRIBED FOR: Tramadol is used in the management of moderate to moderately severe pain. Extended release tablets are used for moderate to moderately severe chronic pain in adults who require continuous treatment for an extended period.
DOSING: The recommended dose of tramadol is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain. The maximum dose is 400 mg/day. To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25 mg every 3 days to reach 100 mg/day (25 mg 4 times daily). Thereafter, doses can be increased by 50 mg every 3 days to reach 200 mg day (50 mg 4 times daily). Tramadol may be taken with or without food.
Recommended dose for extended release tablets is 100 mg daily which may be increased by 100 mg every 5 days but not to exceed 300 mg /day. Extended release tablets should be swallowed whole and not crushed or chewed.
DRUG INTERACTIONS: Carbamazepine reduces the effect of tramadol by increasing its inactivation in the body. Quinidine (Quinaglute, Quinidex) reduces the inactivation of tramadol, thereby increasing the concentration of tramadol by 50%-60%. Combining tramadol with monoamine oxidase inhibitors (for example, Parnate) or selective serotonin inhibitors [(SSRIs, for example, fluoxetine (Prozac)] may result in severe side effects such as seizures or a condition called serotonin syndrome.
Tramadol may increase central nervous system and respiratory depression when combined with alcohol, anesthetics, narcotics, tranquilizers or sedative hypnotics.
SIDE EFFECTS: Tramadol is generally well tolerated, and side effects are usually transient. Commonly reported side effects include nausea, constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Some patients who received tramadol have reported seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations.
DRUG CLASS AND MECHANISM: Alendronate is in a class of medications used to strengthen bone. Bone is in a constant state of remodeling, whereby old bone is removed by cells called osteoclasts, and new bone is laid down by cells called osteoblasts. Alendronate inhibits bone removal by the osteoclasts.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: tablet: 10mg (daily); 70mg (weekly)
STORAGE: Store at room temperature, sealed container, avoid moisture.
PRESCRIBED FOR: Alendronate is used to treat osteoporosis (thinning of bone) in women after menopause. After menopause, there is an increased rate of bone loss (resorption). In these patients, alendronate has been shown to increase bone density while strengthening bone, and decrease the rate of bone fractures. Alendronate is also helpful in the treatment of Paget's disease of the bone. Paget's disease is characterized by a disorderly and accelerated remodeling of the bone, leading to bone weakness and pain.
DOSING: Since food, other medications, and vitamins can interfere with the absorption of alendronate, it should be taken at least 30 minutes before food, beverage, vitamins or medicines. In order to avoid chemical irritation of the esophagus (the tube that connects the mouth with the stomach), alendronate should be taken with a full glass of plain water first thing in the morning and never chewed or sucked. It should be avoided by patients with abnormalities of the esophagus which delay esophageal emptying, such as scarring (stricture) or poor motility (achalasia). Patients should also not lie down for 30 minutes after swallowing the tablets. Those patients who are unable to remain upright for at least 30 minutes after taking medication should avoid alendronate.
DRUG INTERACTIONS: The safety of alendronate in patients with significant kidney disease is not known. Therefore, it is not recommended for patients with significant kidney conditions. Since alendronate can lower blood calcium, low blood calcium levels are corrected prior to use. Calcium supplements, antacids and medications can interfere with the absorption of alendronate.
SIDE EFFECTS: Alendronate is generally well tolerated. Side effects are infrequent and mild. Side effects include stomach pain or upset, constipation, diarrhea, muscle ache, and headache. Alendronate can irritate the esophagus to cause heartburn in patients who lie down flat after swallowing, thereby delaying passage of the medication to the stomach.
DRUG CLASS AND MECHANISM: Estrogen is a hormone which among other actions, regulates the turnover (formation and destruction) of bone. Decreases in estrogen levels that are seen after menopause or after removal of the ovaries, lead to a loss of bone density and weakened bones, a condition called osteoporosis. Raloxifene decreases bone turnover and increases bone density although not to the same extent as estrogen itself. This makes bones stronger and prevents fractures in women with osteoporosis. Raloxifene is called a "selective estrogen receptor modulator" since it has effects like estrogen on some tissues but inhibits the effects of estrogen on other tissues. Raloxifene decreases low density lipoprotein (LDL or "bad") cholesterol in the blood; however, unlike estrogen, raloxifene does not increase high density lipoprotein (HDL or "good") cholesterol.
PRESCRIPTION: yes
GENERIC AVAILABLE: no
PREPARATIONS: Tablets, 60mg.
STORAGE: Tablets should be stored between 15° (59°F) and 30°C (86°F).
PRESCRIBED FOR: Raloxifene is prescribed for the prevention and treatment of osteoporosis in post-menopausal women.
DOSING: Raloxifene generally is prescribed once daily. It can be taken with or without meals. Persons with cirrhosis may need lower doses.
DRUG INTERACTIONS: Cholestyramine (Questran) reduces the absorption of raloxifene. Therefore, these two medications should be taken several hours apart. Raloxifene may slightly reduce the ability of blood to clot and thus increase the effects of medications that reduce clotting (blood thinners). Therefore, if raloxifene is given with blood thinners such as warfarin (Coumadin), the ability of blood to clot may need to be monitored more closely with frequent measurements of the prothrombin time of blood.
SIDE EFFECTS: The most common side effects with raloxifene are hot flashes (seen in 1 of every four persons), sinusitis (1 in 10), weight gain (1 in 11), muscle pain (1 in 12), leg cramps (1 in 20), and ankle swelling (1 in 30).
Raloxifene increases the risk of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (blood clots in the lung). The greatest increase in risk occurs during the first 4 months of use. Patients taking raloxifene should avoid prolonged periods of restricted movement during travel when blood clots are more prone to occur.
DRUG CLASS AND MECHANISM: It has been estimated that impotence affects 140 million men worldwide. Over half of all men with impotence are thought to have some physical (medical) cause. The remainder are believed to have psychogenic causes of impotence. Medical causes of impotence include diabetes and circulatory, neurological or urological conditions.
Penile erection is caused by the engorgement of the penis with blood. This engorgement occurs when the blood vessels delivering blood to the penis increase the delivery of blood and the blood vessels carrying blood away from the penis decrease the removal of blood. Under normal conditions, sexual stimulation leads to the production and release of nitric oxide in the penis. Nitric oxide then activates the enzyme, guanylate cyclase, which causes the production of cyclic guanosine monophosphate (cGMP). It is the cGMP that is primarily responsible for the erection by affecting the amount of blood that the blood vessels deliver and remove from the penis.
Sildenafil also reduces the pressure in the pulmonary artery in a serious condition called pulmonary arterial hypertension.
Sildenafil inhibits an enzyme called phosphodiesterase-5 (PDE5) which destroys the cGMP. Thus, sildenafil prevents the destruction of cGMP and allows cGMP to accumulate and persist longer. The longer cGMP persists, the more prolonged the engorgement of the penis.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Viagra is a blue, film-coated, rounded, diamond-shaped tablets that comes in 25, 50, and 100 mg tablets for treating impotence. Revatio comes in a 20 mg tablet and is used for treating pulmonary arterial hypertension..
STORAGE: Tablets should be kept at room temperature, 15- 30°C (59-86°F).
PRESCRIBED FOR: Sildenafil is used for the treatment of erectile dysfunction of either organic (medical condition) or psychogenic (psychological) cause and for pulmonary arterial hypertension.
DOSING: Sildenafil is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. When sildenafil is taken with a high fat meal, the rate of absorption is reduced, with an average delay in the time to maximal concentration of 1 hour.
DRUG INTERACTIONS: Sildenafil increases the effects of the blood pressure lowering medications. It also increases the blood pressure lowering effects of nitrates, e.g. isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating angina. Patients taking nitrates should not receive sildenafil.
Cimetidine (Tagamet), erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox) and mibefradil (Posicor) can cause marked increases in the amount of sildenafil in the body. Patients taking these medications should be observed carefully if sildenafil is used.
It is expected that rifampin will decrease blood levels of sildenafil and probably reduce its effectiveness.
SIDE EFFECTS: Approximately 15% of persons taking sildenafil experience side effects. The most common side effects are facial flushing (1 in 10), headaches (1 in 6), stomach pain, nasal congestion, nausea, diarrhea, and an inability to differentiate between the colors green and blue.
USES: Sildenafil is used to treat male sexual function problems (impotence or erectile dysfunction) by blocking a certain enzyme (phosphodiesterase-PDE5) in the body. In combination with sexual stimulation, sildenafil works by helping the blood flow into the penis to achieve and maintain an erection. This drug is not indicated for use in women. Use of this drug does not protect against sexually transmitted diseases (e.g., HIV, hepatitis B, gonorrhea, syphilis). Practice "safe sex" such as using latex condoms. Consult your doctor or pharmacist for more details.
HOW TO USE: This drug is taken by mouth as needed, at least 30 minutes, but no more than 4 hours, before sexual activity (1 hour before is the most effective). Do not take more often than once daily, and take as directed. A high fat meal may delay the time of onset of this drug. Avoid eating grapefruit or drinking grapefruit juice while you are being treated with this medication unless your doctor instructs you otherwise. The dosage is based on your medical condition, response to therapy, and other medications you may be taking (see also Drug Interactions section). Consult your doctor or pharmacist for more details.
SIDE EFFECTS: Headache, flushing, stomach upset, heartburn, nasal stuffiness, diarrhea, dizziness, or lightheadedness may occur. Vision changes such as increased sensitivity to light, blurred vision, or impaired blue/green color discrimination may also occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Sexual activity may put extra strain on your heart, especially if you have heart problems. If you have heart problems and experience any of these serious side effects while having sex, stop and tell your doctor immediately of: severe dizziness, fainting, chest pain, nausea. In the unlikely event you have a painful or prolonged erection (lasting more than 4 hours), stop using this drug and seek immediate medical attention or permanent problems could occur. A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching, unusual swelling, severe dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
DRUG CLASS AND MECHANISM: Tadalafil is an oral drug that is used for treating impotence (the inability to attain or maintain a penile erection). It is in a class of drugs called phosphodiesterase inhibitors that also includes sildenafil (Viagra) and vardenafil (Levitra).
Erection of the penis is caused by the filling of the penis with blood. Filling occurs because the blood vessels that bring blood to the penis increase in size and deliver more blood to the penis, and, at the same time, the blood vessels that take blood away from the penis decrease in size and remove less blood from the penis.
Sexual stimulation that leads to an erection causes the production and release of nitric oxide in the penis. The nitric oxide causes an enzyme, guanylate cyclase, to produce cyclic guanosine monophosphate (cGMP). It is the cGMP that is primarily responsible for increasing and decreasing the size of the blood vessels carrying blood to and from the penis, respectively, and causing the erection. When the cGMP is destroyed by another enzyme, phosphodiesterase-5, the blood vessels return to their normal size, blood leaves the penis, and the erection ends. Tadalafil prevents phosphodiesterase-5 from destroying cGMP so that cGMP stays around longer. The persistence of cGMP leads to a more prolonged engorgement of the penis with blood.
Tadalafil was approved by the FDA in November, 2003.
PRESCRIPTION: Yes.
GENERIC AVAILABLE: No.
PREPARATIONS: Tablets: 5, 10, and 20 mg.
STORAGE: Store at room temperature between 15-30°C (59-86°F).
PRESCRIBED FOR: Tadalafil is used for the treatment of impotence.
DOSING: For most individuals, the recommended starting dose of tadalafil is 10 mg per day taken before sexual activity. Depending on the adequacy of the response or side effects, the dose may be increased to 20 mg or decreased to 5 mg a day. The effect of tadalafil may last up to 36 hours. Individuals who are taking medications that increase the blood levels of tadalafil should not exceed a total dose of 10 mg in 72 hours (See drug interactions). Tadalafil may be taken with or without food since food does not affect its absorption from the intestine.
DRUG INTERACTIONS: The breakdown and elimination of tadalafil from the body may be decreased by erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Therefore, these drugs may increase the levels of tadalafil in the blood. If these drugs are being used at the same time as tadalafil, the dose of tadalafil should be reduced in order to avoid side effects from high levels of tadalafil.
Tadalafil exaggerates the increases in heart rate and lowering of blood pressure caused by nitrates, e.g. nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating heart pain (angina). In patients who take nitrates for angina, tadalafil could cause heart pain or possibly even a heart attack by exaggerating the increase in heart rate and the lowering of blood pressure. Therefore, tadalafil should not be used with nitrates. Tadalafil also exaggerates the blood pressure lowering effects of some alpha-blocking drugs e.g., terazosin (Hytrin) that primarily are used for treating high blood pressure or enlargement of the prostate. Individuals who take these alpha-blockers should be on a stable dose of the alpha-blocker before tadalafil is started. In such situations, tadalafil should be started at the lowest dose. If the patient is already taking tadalafil, the alpha-blocker should be started at the lowest dose. Tadalafil and alcohol both lower blood pressure. Therefore, combining tadalafil with alcohol may cause excessive drops in blood pressure and cause dizziness, headaches and increased heart rate.
SIDE EFFECTS: The most common side effects of tadalafil are facial flushing (reddening), headaches, stomach upset, diarrhea, flu-like symptoms and nausea. Tadalafil also may cause low blood pressure, blurred vision and changes in color vision, and abnormal ejaculation. Tadalafil has been associated with prolonged erections or priapism (painful erections lasting more than 6 hours). Patients should seek immediate medical help if they experience an erection lasting more than 4 hours. Use of tadalafil, most often in patients with pre-existing heart disease, has been associated with chest pain, heart attacks, death, strokes, palpitations and increased heart rate; however, it is not clear whether these side effects are due to tadalafil, concurrent use of nitrates, or the sexual activity itself.
DRUG CLASS AND MECHANISM: Vardenafil is an oral drug that is used to treat impotence (the inability to attain or maintain a penile erection.). It is a phosphodiesterase inhibitor that is similar to sildenafil (Viagra).
Penile erection is caused by the engorgement of the penis with blood. This engorgement occurs when the blood vessels delivering blood to the penis increase in size and increase the delivery of blood to the penis. At the same time, the blood vessels carrying blood away from the penis decrease in size and decrease the removal of blood from the penis. Sexual stimulation that leads to the engorgement and erection causes the production and release of nitric oxide in the penis. Nitric oxide then activates the enzyme, guanylate cyclase to produce cyclic guanosine monophosphate (cGMP). The cGMP is primarily responsible for increasing and decreasing the size of the blood vessels carrying blood to and from the penis, respectively. Vardenafil prevents an enzyme called phosphodiesterase-5 from destroying cGMP so that cGMP persists longer. The longer cGMP persists, the more prolonged the engorgement of the penis. Vardenafil was approved by the FDA in August, 2003.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 2.5, 5, 10 and 20 mg
STORAGE: Vardenafil should be stored at room temperature between 15-30°C (59-86°F).
PRESCRIBED FOR: Vardenafil is used for the treatment of impotence.
DOSING: For most individuals, the recommended dose of vardenafil is 10 mg per day taken 60 minutes before intercourse. If there is no response or side effects, the dose may be increased to 20 mg or, if there are side effects, it may be reduced to 5 mg. Individuals 65 years of age or older should begin therapy with 5 mg. Individuals who are taking medications that increase the blood levels of vardenafil should start treatment with 2.5 to 5 mg of vardenafil. (See drug interactions.)
DRUG INTERACTIONS: The breakdown and elimination of vardenafil from the body is inhibited by erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Therefore, these drugs increase the concentration of vardenafil in the blood. If these drugs are being used at the same time as vardenafil, the dose of vardenafil should be reduced in order to avoid side effects from vardenafil.
Vardenafil reduces the concentration of ritonavir and indinavir and may reduce the effect these drugs.
Vardenafil increases the heart rate and also exaggerates the blood pressure lowering effects of nitrates (e.g. nitroglycerine). In patients who take nitrates for chest pain (angina), vardenafil could cause chest pain by increasing heart rate and lowering blood pressure. Therefore, patients with angina should not use vardenafil. Vardenafil also exaggerates the blood pressure lowering effects of alpha-blocking drugs, e.g. terazosin (Hytrin), and should not be used by individuals who also use alpha-blockers.
SIDE EFFECTS: The most common side effects of vardenafil are facial flushing (reddening), headaches, stomach upset, diarrhea, flu like symptoms and nausea. Vardenafil also may cause chest pain, low blood pressure, blurred vision and changes in color vision, abnormal ejaculation and priapism (painful erection).
WARNING: Smoking cigarettes while using this medication increases your chance of having heart problems. Do not smoke. The risk of heart problems increases with age (especially in women greater than 35 years of age) and with frequent smoking (15 cigarettes per day or greater).
USES: This medication is used to prevent pregnancy. This medication is a combination of two types of hormones (levonorgestrel, a progestin and ethinyl estradiol, an estrogen). Besides preventing pregnancy, similar birth control pills have been shown to decrease anemia, painful periods (dysmenorrhea), ovarian cysts, the number of episodes of pelvic inflammatory disease, and decrease the occurrence of certain cancers (uterine, ovarian). Using this medication does not protect you or your partner against sexually transmitted diseases (e.g., HIV, gonorrhea).
HOW TO USE: Begin taking this medication on the first Sunday following the beginning of your period (menstruation). If your period begins on a Sunday, begin taking this medication on that day. Take one "active" pill (pills that contain the hormones) once daily for 84 days in a row. Following these active pills, you will then take an "inactive" pill (pills that do not contain the hormones) once daily for 7 days in a row. After the last inactive pill, you will repeat the same cycle the very next day, starting again with an active pill. For this medication to be effective you must try to take this medication at the same time each day, not more than 24 hours apart. Pick a time that will be easy for you to remember. Use an additional form of birth control (e.g., condom or spermicide) during the first week of taking this medication since it will take a while to be effective. A Patient Information Leaflet about this drug should be dispensed with each prescription. Read the information carefully. Ask your doctor or pharmacist any questions you may have regarding this medication.
USES: Clomiphene is used to treat infertility.
OTHER USES: This medication may also be used to diagnose certain conditions.
HOW TO USE: It is important that this medication be taken as directed. Follow your dosing schedule carefully. Be sure to ask your doctor if you have any questions. You may be asked to record your body temperature and to properly time sexual intercourse for best results.
DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription drugs you may use, especially of: other fertility treatments.
STORAGE: Store at room temperature between 59 and 86 degrees F (between 15 and 30 degrees C) away from moisture and sunlight. Do not store in the bathroom.
DRUG CLASS AND MECHANISM: The prostate gland is located around the tube which empties urine from the bladder (urethra). As the prostate gland enlarges, usually after 50 years of age, it can obstruct or partially block the urine flow. This leads to symptoms which include dribbling of urine, narrow stream, problems starting urine flow, interruption while urinating, and a feeling of incomplete emptying. Other symptoms include wetting and staining of clothes, urinary burning, and urgency.
Prostate gland enlargement (Benign Prostatic Hyperplasia or BPH), is directly dependent on DHT (a hormone converted from the male hormone testosterone). Finasteride inhibits the enzyme necessary for the conversion of testosterone to DHT in the prostate. Therefore, administration of finasteride lowers blood and tissue DHT levels and helps reduce the size of the prostate gland.
Although reductions in the size of the prostate gland can occur in virtually all the patients who take finasteride, only 50% will experience improvement in the symptoms of BPH. Patients generally respond to finasteride in several weeks, but it often takes 6 months for the patient to receive the full effect of the drug.
PRESCRIPTION: yes
GENERIC AVAILABLE: no
PREPARATIONS: Tablet (5mg).
STORAGE: Finasteride should be stored at room temperature in a tight light resistant container.
PRESCRIBED FOR: Finasteride is used to treat symptoms of BPH. Finasteride is approved for use with the alpha-blocker, doxazosin, to reduce the progression of symptoms of BPH.
DOSING: Finasteride is metabolized mainly by the liver, and caution should be used in patients with liver dysfunction. Finasteride may be taken with or without food.
DRUG INTERACTIONS: Drug interactions are generally not a problem.
SIDE EFFECTS: Side effects are rare but can include impotence and decreased sex drive. Finasteride should not be used by women, children, or male partners of women trying to become pregnant. Finasteride should not be used until a thorough prostate examination has been done to exclude cancer, stricture, or infection in the gland.
DRUG CLASS AND MECHANISM: Tamsulosin is a drug for the treatment of men who are having difficulty urinating because of benign prostatic hyperplasia (BPH). In men, the tube which carries urine from the bladder to the penis (called the urethra) travels through the prostate gland. As men get older, the prostate gland enlarges, and the muscle cells within the prostate gland and the neck of the bladder (which control the flow of urine) tighten. The combination of enlargement and tightening of muscles compresses the urethra and obstructs the flow of urine. This results in difficulty urinating and retention of urine within the bladder. The tightening or contraction of the muscle cells is controlled by nerves. One type of nerve, the alpha adrenergic nerves, cause the muscle cells to tighten by releasing a chemical related to epinephrine (adrenalin). Tamsulosin blocks the effects of this chemical on the muscle cells and causes the muscles to relax. This results in a decrease in obstruction to the flow of urine. There are other drugs which block alpha adrenergic nerves throughout the body and which are used in treating diseases of the heart, blood vessels, and prostate for example, prazosin (Minipress), terazosin (Hytrin), doxazosin (Cardura), and alfuzosin (Uroxatral). Tamsulosin is more active against the alpha adrenergic nerves of the prostate and bladder neck than these other drugs and has a lesser effect on alpha adrenergic nerves elsewhere in the body. For this reason, tamsulosin causes fewer side effects, especially low blood pressure, than other alpha adrenergic blocking drugs. Moreover, tamsulosin therapy can be started at the optimum dose whereas other alpha adrenergic blocking drugs need to be started at low doses with the doses slowly increased over time in order to minimize the side effects. Tamsulosin was approved by the FDA in 1997.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Capsules: 0.4mg.
STORAGE: Capsules should be stored at room temperature, 15-30 °C (59-86 °F).
PRESCRIBED FOR: Tamsulosin is used to treat men who are having problems urinating because of BPH.
DOSING: Tamsulosin should be taken once daily after a meal. When taken on an empty stomach, more of the medication is absorbed. This could cause a greater effect and potentially a drop in blood pressure.
DRUG INTERACTIONS: There have been no drug interactions described with tamsulosin. No important interactions were noted when tamsulosin was used with atenolol (Tenormin), enalapril (Vasotec), and nifedipine (Adalat; Procardia).
SIDE EFFECTS: Tamsulosin is generally well tolerated. Occasionally, tamsulosin can cause a drop in blood pressure, rarely resulting in dizziness or fainting. Other reported side effects include headache, dizziness, nasal congestion, and palpitations.
USES: This medication is used to improve the appearance of the skin by reducing fine lines and wrinkles, reducing roughness and improving coloration.
OTHER USES: This medication can also be used to treat acne.
HOW TO USE: This medication is for use on the face as directed, usually once a day at bedtime. Clean and dry your face. Apply a pea-size amount of cream using just enough to cover your entire face lightly. Be careful to avoid your eyes, nostrils and mouth. Wash your hands after use. Do not use this more often than prescribed or in large amounts. It will not give you faster or better results but will increase the risk of side effects. Do not use on sunburn or eczema or other serious skin conditions. Effects of this medication will be gradual with most improvement seen in the first 6 months of continued therapy. If used for acne the condition may worsen at first, then improve.
SIDE EFFECTS: You may experience mild redness or stinging, itching, burning, skin scaling, peeling and dry skin the first several weeks as your body adjusts to the medication. If any of these effects continue or become severe, discontinue use and notify your doctor. Report any of the following serious effects: blisters/crusting or swelling of skin, darkening or lightening of skin color. If you notice other effects not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Before taking this medication tell your doctor if you have any pre-existing skin disorders or if you have any allergies. This medication increases your sensitivity to the sun. Limit sun exposure and avoid sun lamps. Use a sunscreen and wear protective clothing when outdoors. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is unknown if this drug is excreted into breast milk. Consult with your doctor before breast-feeding.