Neurontin

Generic Name: gabapentin (Oral route)

gab-a-PEN-tin

Commonly used brand name(s)

In the U.S.

• FusePaq Fanatrex


• Gabarone


• Gralise


• Neurontin

Available Dosage Forms:

• Capsule


• Suspension


• Tablet


• Solution

Therapeutic Class: Anticonvulsant

Chemical Class: Gamma Aminobutyric Acid (class)

Uses For Neurontin

Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.

Gabapentin is also used in adults to manage a condition called postherpetic neuralgia, which is pain that occurs after “shingles.”

Gabapentin extended-release tablets is used to treat a condition called Restless Legs Syndrome (RLS). RLS is a neurologic disorder that affects sensation and movement in the legs to feel uncomfortable. This results in an irresistible feeling of wanting to move your legs to make them comfortable.

Gabapentin is an anticonvulsant. It increases the amount of a chemical called gamma-aminobutyric acid (GABA) in the brain. It is felt that some epileptic seizures occur when there are low levels of GABA in the brain. By increasing the amount of GABA, gabapentin reduces the number of seizures.

Gabapentin also works to relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis.

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

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, gabapentin is used in certain patients with the following medical condition:

• Diabetic peripheral neuropathy.

Before Using Neurontin

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

Allergies

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

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of gabapentin for treating partial seizures in children. However, safety and efficacy have not been established in children younger than 3 years of age.

Appropriate studies have not been performed on the relationship of age to the effects of gabapentin for treating postherpetic neuralgia and Restless Legs Syndrome in children. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of gabapentin in the elderly. However, elderly patients are more likely to have unwanted effects (e.g., problems with balance or walking, swelling in the feet or legs) and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving gabapentin.

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 taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is 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.

• Ketorolac


• Naproxen

Using this medicine 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.

• Aluminum Carbonate, Basic


• Aluminum Hydroxide


• Aluminum Phosphate


• Dihydroxyaluminum Aminoacetate


• Dihydroxyaluminum Sodium Carbonate


• Ginkgo


• Magaldrate


• Magnesium Carbonate


• Magnesium Hydroxide


• Magnesium Oxide


• Magnesium Trisilicate


• Morphine


• Morphine Sulfate Liposome

Interactions with Food/Tobacco/Alcohol

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

Other Medical Problems

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

• Cancer or tumors, history of or


• Depression, history of or


• Mental illness, history of—Use with caution. May make these conditions worse.

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

• Kidney impairment, severe or


• Undergoing kidney dialysis—Should not be used in patients with these conditions.

Proper Use of gabapentin

This section provides information on the proper use of a number of products that contain gabapentin. It may not be specific to Neurontin. Please read with care.

Take this medicine only as directed by your doctor, to help your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

This medicine comes with a Medication Guide. It is very important that you read and understand this information. Be sure to ask your doctor about anything you do not understand.

Gabapentin may be taken with or without food. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed.

Do not use the Horizant® extended-release tablets if you are required to sleep during daytime and remain awake at night.

For patients with epilepsy who take gabapentin three times per day, do not allow more than 12 hours to pass between any 2 doses. The medicine works best if a constant amount is in the blood.

If you or your child have trouble swallowing capsules, talk to your doctor about using the tablet or solution form. This medicine may also be given as a combination with any of the forms, such as tablets with solution.

You may break the scored Neurontin® tablets into two pieces, but make sure you or your child use the second half of the tablet as the next dose. Ask your doctor or pharmacist if you have any questions.

Swallow the Gralise® tablets or the Horizant® extended-release tablets whole. Do not break, crush, or chew them. The Gralise® tablets should be taken with the evening meal. The Horizant® extended-release tablets should be taken with food at about 5 PM.

Measure the oral liquid using a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

Gabapentin may be used together with other seizure medicines. Keep using all of your medicines unless your doctor tells you to stop.

If you take an antacid (such as Di-Gel®, Gaviscon®, Gelusil®, Maalox® or Mylanta®), wait at least 2 hours before taking gabapentin.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way. Take the Horizant® extended-release tablets only for Restless Legs Syndrome. The safety and effectiveness of the extended-release tablet for epilepsy have not been established.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage forms (capsules, solution, and tablets):
  
  • For epilepsy:
    
    • Adults and teenagers 12 years of age and older—At first, 300 milligrams (mg) three times per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1800 mg per day.
    
    
    • Children 3 to 12 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is 10 to 15 milligrams (mg) per kilogram (kg) of body weight per day, divided into three doses. Your doctor may adjust your dose as needed. The usual dose for children 5 years of age and older is 25 to 35 mg per kg of body weight per day, divided into three doses. The usual dose for children 3 and 4 years of age is 40 mg per kg of body weight per day, divided into three doses.
    
    
    • Children younger than 3 years of age—Use and dose must be determined by your doctor.
    
    
  
  
  • For postherpetic neuralgia:
    
    • Adults— At first, 300 milligrams (mg) taken as a single dose on day 1. On day 2, 300 mg two times per day. On day 3, 300 mg three times per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1800 mg per day.
    
    
    • Children—Use and dose must be determined by your doctor.
    
    
  
  


• For oral dosage form (extended-release tablet):
  
  • For Restless Legs Syndrome:
    
    • Adults—600 milligrams (mg) once a day to be taken with food at about 5 PM. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1200 mg per day.
    
    
    • Children—Use and dose must be determined by your doctor.
    
    
  
  

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you missed taking the dose of Horizant® extended-release tablets at the recommended time, take the next dose at about 5 PM the following day.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

You should store the oral liquid in the refrigerator. Do not freeze.

Precautions While Using Neurontin

It is very important that your doctor check the progress of you or your child at regular visits, especially for the first few months you take gabapentin. This is necessary to allow dose adjustments and to check for any unwanted effects. Blood tests may also be needed to check for unwanted effects.

It is important to tell your doctor if you become pregnant. Your doctor may want you to join the North American Antiepileptic Drug Pregnancy Registry. The registry is used by pregnant patients who are taking this medicine.

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors, such as feeling sad or hopeless, getting upset easily, or feeling nervous, restless, or hostile. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor right away.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; other medicines for seizures (e.g., barbiturates); muscle relaxants; or anesthetics, including some dental anesthetics. Check with your medical doctor or dentist before taking any of the above while you or your child are using gabapentin.

Gabapentin may cause blurred vision, double vision, clumsiness, unsteadiness, dizziness, drowsiness, sleepiness, or trouble with thinking. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, or able to think or see well. If these side effects are especially bothersome, check with your doctor.

Stop using this medicine and check with your doctor right away if you or your child develop a fever; rash; swollen, painful, or tender lymph glands in the neck, armpit, or groin; unusual bleeding or bruising; or yellow eyes or skin. These may be symptoms of a serious and life-threatening condition called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).

Before you have any medical tests, tell the doctor in charge that you or your child are taking gabapentin. The results of certain medical tests may be affected by this medicine.

Do not stop using gabapentin without first checking with your doctor. Stopping the medicine suddenly may cause your seizures to return or to occur more often. Your doctor may want you or your child to gradually reduce the amount you are taking before stopping it completely.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Neurontin Side Effects

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

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

More common

• Clumsiness or unsteadiness


• continuous, uncontrolled, back-and-forth, or rolling eye movements

More common in children

• Aggressive behavior or other behavior problems


• anxiety


• concentration problems and change in school performance


• crying


• depression


• false sense of well-being


• hyperactivity or increase in body movements


• rapidly changing moods


• reacting too quickly, too emotionally, or overreacting


• restlessness


• suspiciousness or distrust

Less common

• Black, tarry stools


• chest pain


• chills


• cough


• depression, irritability, or other mood or mental changes


• fever


• loss of memory


• pain or swelling in the arms or legs


• painful or difficult urination


• shortness of breath


• sore throat


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


• swollen glands


• unusual bleeding or bruising


• unusual tiredness or weakness

Incidence not known

• Abdominal or stomach pain


• blistering, peeling, or loosening of the skin


• clay-colored stools


• coma


• confusion


• convulsions


• dark urine


• decreased urine output


• diarrhea


• dizziness


• fast or irregular heartbeat


• headache


• increased thirst


• itching


• joint pain


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


• loss of appetite


• muscle ache or pain


• nausea


• red skin lesions, often with a purple center


• red, irritated eyes


• skin rash


• unpleasant breath odor


• vomiting of blood


• yellow eyes or skin

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

Symptoms of overdose

• Double vision


• drowsiness


• sluggishness


• slurred speech


• unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

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

More common

• Blurred vision


• cold or flu-like symptoms


• delusions


• dementia


• hoarseness


• lack or loss of strength


• lower back or side pain


• swelling of the hands, feet, or lower legs


• trembling or shaking

Less common or rare

• Accidental injury


• appetite increased


• back pain


• bloated or full feeling


• body aches or pain


• burning, dry, or itching eyes


• change in vision


• change in walking and balance


• clumsiness or unsteadiness


• congestion


• constipation


• cough producing mucus


• decrease in sexual desire or ability


• dementia


• difficulty with breathing


• dryness of the mouth or throat


• earache


• excess air or gas in the stomach or intestines


• excessive tearing


• eye discharge


• feeling faint, dizzy, or lightheadedness


• feeling of warmth or heat


• flushed, dry skin


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


• frequent urination


• fruit-like breath odor


• impaired vision


• incoordination


• increased hunger


• increased sensitivity to pain


• increased sensitivity to touch


• increased thirst


• indigestion


• low blood pressure


• nervousness


• noise in the ears


• pain, redness, rash, swelling, or bleeding where the skin is rubbed off


• passing gas


• redness or swelling in the ear


• redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid


• runny nose


• sneezing


• sweating


• tender, swollen glands in the neck


• tightness in the chest


• tingling in the hands and feet


• troubled breathing


• trouble with sleeping


• trouble with swallowing


• trouble with thinking


• twitching


• unexplained weight loss


• voice changes


• vomiting


• weakness or loss of strength


• weight gain


• wheezing

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: Neurontin side effects (in more detail)

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More Neurontin resources

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

• Neurontin Prescribing Information (FDA)


• Neurontin Monograph (AHFS DI)


• Neurontin MedFacts Consumer Leaflet (Wolters Kluwer)


• Neurontin Consumer Overview


• Gabapentin Prescribing Information (FDA)


• Gabapentin MedFacts Consumer Leaflet (Wolters Kluwer)


• Gabapentin Professional Patient Advice (Wolters Kluwer)


• Gralise Prescribing Information (FDA)


• Gralise Consumer Overview


• Gralise MedFacts Consumer Leaflet (Wolters Kluwer)


• Horizant Consumer Overview


• Horizant Extended-Release Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Horizant Prescribing Information (FDA)

Compare Neurontin with other medications

• Alcohol Withdrawal
• Anxiety
• Benign Essential Tremor
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• Burning Mouth Syndrome
• Diabetic Nerve Damage
• Epilepsy
• Fibromyalgia
• Hiccups
• Hot Flashes
• Hyperhidrosis
• Insomnia
• Migraine
• Nausea/Vomiting, Chemotherapy Induced
• Pain
• Periodic Limb Movement Disorder
• Peripheral Neuropathy
• Persisting Pain, Shingles
• Postmenopausal Symptoms
• Pruritus
• Reflex Sympathetic Dystrophy Syndrome
• Restless Legs Syndrome
• Trigeminal Neuralgia
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Ziprasidone Capsules

Pronunciation: zi-PRAS-i-done
Generic Name: Ziprasidone
Brand Name: Geodon

Ziprasidone Capsules is an antipsychotic. It may increase the risk of death when used to treat mental problems caused by dementia in elderly patients. Most of the deaths were linked to heart problems or infection. Ziprasidone Capsules is not approved to treat mental problems caused by dementia. Discuss any questions or concerns with your doctor.

Ziprasidone Capsules is used for:

Treating schizophrenia. It is also used alone or with other medicines (eg, lithium, valproate) to treat bipolar disorder (manic-depression). It may also be used for other conditions as determined by your doctor.

Ziprasidone Capsules an antipsychotic. It may work by altering the balance of certain chemicals that occur naturally in the brain, which are responsible for thinking and behavior.

Do NOT use Ziprasidone Capsules if:

• you are allergic to any ingredient in Ziprasidone Capsules


• you have recently had a heart attack, have severe heart failure, or have a history of certain types of irregular heartbeat (eg, long QT syndrome)


• you are taking astemizole, cisapride, dofetilide, droperidol, halofantrine, levomethadyl, a macrolide immunosuppressive (eg, tacrolimus), mefloquine, methadone, nilotinib, pentamidine, certain phenothiazines (eg, thioridazine), pimozide, probucol, procainamide, quinidine, certain quinolone antibiotics (eg, moxifloxacin), a serotonin receptor antagonist antiemetic (eg, dolasetron), sotalol, sparfloxacin, terfenadine, or tetrabenazine.

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

Before using Ziprasidone Capsules:

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

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


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


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


• if you have considered or attempted suicide


• if you have had any problem with fainting or dizziness


• if you have a history of heart problems (eg, heart failure, slow or irregular heartbeat), low blood potassium or magnesium levels, low blood volume, low white blood cell counts, a drug-induced movement disorder, diabetes, kidney or liver problems, stroke, heart attack, low blood pressure, seizures, difficulty swallowing, neuroleptic malignant syndrome (NMS), Alzheimer disease, or dementia


• if you have diabetes or a family history of diabetes or if you are very overweight


• if you have had high blood prolactin levels or a history of certain types of cancer (eg, breast, pancreas, pituitary), or if you are at risk for breast cancer


• if you are dehydrated, drink alcohol, or will be exposed to high temperatures

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

• Arsenic, astemizole, bepridil, chloroquine, cisapride, class III antiarrhythmics (eg, amiodarone, sotalol), dofetilide, domperidone, droperidol, halofantrine, haloperidol, IA and IC antiarrhythmics (eg, flecainide, procainamide, propafenone, quinidine), kinase inhibitors (eg, lapatinib, nilotinib), levomethadyl, macrolide immunosuppressives (eg, tacrolimus), macrolides and ketolides (eg, azithromycin, erythromycin), maprotiline, mefloquine, methadone, pentamidine, phenothiazines (eg, thioridazine), pimozide, probucol, quinolones (eg, ciprofloxacin, moxifloxacin), serotonin receptor antagonist antiemetics (eg, dolasetron), sparfloxacin, streptogramins (eg, mitomycin, pristinamycin), terfenadine, or tetrabenazine because the risk of side effects, such as abnormal heart rhythms, may be increased


• Tramadol because the risk of seizures may be increased


• Ketoconazole because it may increase the risk of Ziprasidone Capsules's side effects


• Carbamazepine because it may decrease Ziprasidone Capsules's effectiveness

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

How to use Ziprasidone Capsules:

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

• An extra patient leaflet is available with Ziprasidone Capsules. Talk to your pharmacist if you have questions about this information.


• Take Ziprasidone Capsules by mouth with food.


• Swallow Ziprasidone Capsules whole. Do not break, crush, or chew before swallowing.


• Taking Ziprasidone Capsules at the same time each day will help you remember to take it.


• Take Ziprasidone Capsules on a regular schedule to get the most benefit from it.


• It may take a few weeks for you to notice the benefits of Ziprasidone Capsules. Continue to take Ziprasidone Capsules even if you feel well. Do not miss any doses.


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

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

Important safety information:

• Ziprasidone Capsules may cause drowsiness, dizziness, or lightheadedness. These effects may be worse if you take it with alcohol or certain medicines. Use Ziprasidone Capsules with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


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


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


• Do not become overheated in hot weather or while you are being active; heatstroke may occur.


• Ziprasidone Capsules may rarely cause a prolonged, painful erection. This could happen even when you are not having sex. If this is not treated right away, it could lead to permanent sexual problems such as impotence. Contact your doctor right away if this happens.


• Ziprasidone Capsules may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.


• Ziprasidone Capsules may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away.


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


• Serotonin syndrome is a possibly fatal syndrome that can be caused by Ziprasidone Capsules. Your risk may be greater if you take Ziprasidone Capsules with certain other medicines (eg, "triptans," monoamine oxidase inhibitors [MAOIs]). Symptoms may include agitation; confusion; hallucinations; coma; fever; fast or irregular heartbeat; tremor; excessive sweating; and nausea, vomiting, or diarrhea. Contact your doctor at once if you have any of these symptoms.


• Neuroleptic malignant syndrome (NMS) is a possibly fatal syndrome that can be caused by Ziprasidone Capsules. Symptoms may include fever; stiff muscles; confusion; abnormal thinking; fast or irregular heartbeat; and sweating. Contact your doctor at once if you have any of these symptoms.


• Ziprasidone Capsules may increase the amount of a certain hormone (prolactin) in your blood. Symptoms may include enlarged breasts, missed menstrual period, decreased sexual ability, or nipple discharge. Contact your doctor right away if you experience any of these symptoms.


• Some patients who take Ziprasidone Capsules may develop muscle movements that they cannot control. This is more likely to happen in elderly patients, especially women. The chance that this will happen or that it will become permanent is greater in those who take Ziprasidone Capsules in higher doses or for a long time. Muscle problems may also occur after short-term treatment with low doses. Tell your doctor at once if you have muscle problems with your arms; legs; or your tongue, face, mouth, or jaw (eg, tongue sticking out, puffing of cheeks, mouth puckering, chewing movements) while taking Ziprasidone Capsules.


• Lab tests, including electrolyte levels, complete blood cell counts, or fasting blood sugar levels, may be performed while you use Ziprasidone Capsules. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.


• Use Ziprasidone Capsules with caution in the ELDERLY; they may be more sensitive to its effects, especially dizziness and lightheadedness upon sitting or standing up and uncontrolled muscle movements.


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


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Ziprasidone Capsules while you are pregnant. Using Ziprasidone Capsules during the third trimester may result in uncontrolled muscle movements or withdrawal symptoms in the newborn. Discuss any questions or concerns with your doctor. It is not known if Ziprasidone Capsules is found in breast milk. Do not breast-feed while taking Ziprasidone Capsules.

Possible side effects of Ziprasidone Capsules:

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

Anxiety; constipation; diarrhea; dizziness; drowsiness; dry mouth; feeling unusually tired or sleepy; headache; increased cough or runny nose; loss of appetite; nausea; restlessness; upset stomach; vomiting; weakness; weight gain.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); abnormal thoughts; change in amount of urine produced; confusion; decreased sexual ability; difficulty speaking or swallowing; enlarged breasts; fainting; fast, slow, or irregular heartbeat; fever, chills or persistent sore throat; inability to move; missed menstrual period; muscle rigidity; muscle spasms or twitching; nipple discharge; pounding in the chest; prolonged or painful erection; seizures; shortness of breath; suicidal thoughts or attempts; sweating; symptoms of high blood sugar (increased thirst, increased urination, confusion, flushing, rapid breathing, or fruity breath odor); tremor; uncontrolled movements (eg, arm or leg movements, twitching of the face or tongue, jerking or twisting); unusual mood or mental changes; vision changes.

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

See also: Ziprasidone side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include fainting; irregular heartbeat; seizure; slurring of speech; uncontrolled movement of the head and neck.

Proper storage of Ziprasidone Capsules:

Store Ziprasidone Capsules at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Ziprasidone Capsules out of the reach of children and away from pets.

General information:

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


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


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


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

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

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Ziprasidone resources

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

Compare Ziprasidone with other medications

• Autism
• Bipolar Disorder
• Body Dysmorphic Disorder
• Paranoid Disorder
• Schizoaffective Disorder
• Schizophrenia
• Tourette's Syndrome

nadolol

Generic Name: nadolol (na DOE lol)

Brand Names: Corgard

What is nadolol?

Nadolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).

Nadolol is used to treat angina (chest pain) or hypertension (high blood pressure).

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

What is the most important information I should know about nadolol?

Do not stop taking nadolol without first talking to your doctor. Stopping suddenly may make your condition worse. If you need surgery, tell the surgeon ahead of time that you are using nadolol. You may need to stop using the medicine for a short time. Nadolol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Nadolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

What should I discuss with my healthcare provider before taking nadolol?

You should not take nadolol if you are allergic to it, or if you have:

• 
  

  asthma or chronic obstructive pulmonary disease (COPD;

  
  


• 
  

  certain serious heart conditions such as"AV block" or slow heart rhythm; or

  
  


• 
  

  conditions that cause very low blood pressure.

  
  

If you have any of these other conditions, you may need a nadolol dose adjustment or special tests:

• 
  

  bronchitis, emphysema, sleep apnea, or other breathing problem;

  
  


• 
  

  congestive heart failure;

  
  


• 
  

  liver or kidney disease;

  
  


• 
  

  diabetes;

  
  


• 
  

  a thyroid disorder; or

  
  


• 
  

  pheochromocytoma (tumor of the adrenal gland).

  
  

FDA pregnancy category C. It is not known whether nadolol will harm an unborn baby. Nadolol may cause heart or lung problems in a newborn if the mother takes the medication during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Nadolol can pass into breast milk and may harm a nursing baby. You should not breast-feed while taking nadolol.

How should I take nadolol?

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.

Your doctor may occasionally change your dose to make sure you get the best results.

Your blood pressure will need to be checked often, and you may need other blood tests at your doctor's office. Visit your doctor regularly.

Do not skip doses or stop taking nadolol without first talking to your doctor. Stopping suddenly may make your condition worse. If you need surgery, tell the surgeon ahead of time that you are using nadolol. You may need to stop using the medicine for a short time.

Taking nadolol can make it harder for you to tell when your blood sugar is low. If you have diabetes, check your blood sugar regularly.

This medication can cause false results with certain lab tests of the urine. Tell any doctor who treats you that you are using nadolol.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Nadolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

Store at room temperature away from moisture, heat, and light.

See also: Nadolol 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 your next dose is less than 8 hours away. 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 slow heart rate, extreme dizziness, or fainting.

What should I avoid while taking nadolol?

Nadolol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Drinking alcohol can further lower your blood pressure and may increase certain side effects of nadolol.

Nadolol 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. Call your doctor at once if you have a serious side effect such as:

• 
  

  slow or uneven heartbeats;

  
  


• 
  

  numbness or cold feeling;

  
  


• 
  

  feeling like you might pass out;

  
  


• 
  

  feeling short of breath, even with mild exertion;

  
  


• 
  

  swelling or rapid weight gain;

  
  


• 
  

  bronchospasm (wheezing, chest tightness, trouble breathing);

  
  


• 
  

  hallucinations, behavior changes; 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:

• 
  

  dizziness, spinning sensation;

  
  


• 
  

  tired feeling;

  
  


• 
  

  mild nausea, diarrhea, constipation, upset stomach, bloating, gas; or

  
  


• 
  

  tingly feeling.

  
  

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

Nadolol Dosing Information

Usual Adult Dose for Angina Pectoris:

Initial dose: 40 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.
Doses up to 160-240 mg may be needed.

Usual Adult Dose for Hypertension:

Initial dose: 40 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.
Doses up to 240-320 mg may be needed.

Usual Adult Dose for Parkinsonian Tremor:

Initial dose: 40-60 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.

Usual Adult Dose for Anxiety:

Initial dose: 40 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.
Doses up to 320 mg may be needed.

Usual Adult Dose for Benign Essential Tremor:

Initial dose: 40 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.
Doses up to 320 mg may be needed.

Usual Adult Dose for Esophageal Variceal Hemorrhage Prophylaxis:

Initial dose: 40 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.
Doses up to 320 mg may be needed.

Usual Adult Dose for Glaucoma:

Initial dose: 40 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.
Doses up to 320 mg may be needed.

Usual Adult Dose for Lithium Tremor:

Initial dose: 40 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.
Doses up to 320 mg may be needed.

Usual Adult Dose for Migraine Prophylaxis:

Initial dose: 40 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.
Doses up to 320 mg may be needed.

Usual Adult Dose for Supraventricular Tachycardia:

Initial dose: 40 mg orally once a day.
Maintenance dose: 40-80 mg orally once a day.
Doses up to 320 mg may be needed.

What other drugs will affect nadolol?

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

• 
  

  digoxin (digitalis, Lanoxin);

  
  


• 
  

  a diuretic (water pill);

  
  


• 
  

  insulin or oral diabetes medication; or

  
  


• 
  

  reserpine.

  
  

This list is not complete and other drugs may interact with nadolol. 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 nadolol resources

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

• nadolol Advanced Consumer (Micromedex) - Includes Dosage Information


• Nadolol Prescribing Information (FDA)


• Nadolol Professional Patient Advice (Wolters Kluwer)


• Nadolol Monograph (AHFS DI)


• Nadolol MedFacts Consumer Leaflet (Wolters Kluwer)


• Corgard Prescribing Information (FDA)

Compare nadolol with other medications

• Angina
• Anxiety
• Benign Essential Tremor
• Esophageal Variceal Hemorrhage Prophylaxis
• Glaucoma
• High Blood Pressure
• Lithium Tremor
• Migraine Prevention
• Mitral Valve Prolapse
• Parkinsonian Tremor
• Supraventricular Tachycardia

Where can I get more information?

• Your pharmacist can provide more information about nadolol.

See also: nadolol side effects (in more detail)

Night Time Pain

Generic Name: acetaminophen and diphenhydramine (a SEET a MIN oh fen and DYE fen HYE dra meen)

Brand Names: Anacin P.M. Aspirin Free, Coricidin Night Time Cold Relief, Excedrin PM, Excedrin PM Caplet, Excedrin PM Express Gels, Headache Relief PM, Legatrin PM, Mapap PM, Midol PM, Night Time Pain, Percogesic Extra Strength, Percogesic Original Strength, Tylenol Cold Relief Caplet, Tylenol Cold Relief Nighttime, Tylenol Cold Relief Nighttime Caplet, Tylenol Extra Strength PM, Tylenol Extra Strength PM Rapid Release Gelcaps, Tylenol Extra Strength PM Vanilla Caplet, Tylenol PM, Tylenol Sore Throat Nighttime, Unisom with Pain Relief

What is Night Time Pain (acetaminophen and diphenhydramine)?

Acetaminophen is a pain reliever and fever reducer.

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

The combination of acetaminophen and diphenhydramine is used to treat headache, fever, body aches, runny or stuffy nose, sneezing, itching, watery eyes, and sinus congestion caused by allergies, the common cold, or the flu.

Acetaminophen and diphenhydramine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Night Time Pain (acetaminophen and diphenhydramine)?

Do not take more of this medication than is recommended. An overdose of acetaminophen can damage your liver or cause death. Do not take this medication without a doctor's advice if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You should not use this medicine if you have severe constipation, a blockage in your stomach or intestines, or if you are unable to urinate. Do not use this medicine if you have untreated or uncontrolled diseases such as glaucoma, asthma or COPD, heart disease, or overactive thyroid. Avoid drinking alcohol. It may increase your risk of liver damage while taking acetaminophen and can increase certain side effects of diphenhydramine. Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose.

What should I discuss with my healthcare provider before taking Night Time Pain (acetaminophen and diphenhydramine)?

You should not use this medicine if you have severe constipation, a blockage in your stomach or intestines, or if you are unable to urinate. Do not take this medication without a doctor's advice if you have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic beverages per day. You may not be able to take medicine that contains acetaminophen. Do not use this medicine if you have untreated or uncontrolled diseases such as glaucoma, asthma or COPD, high blood pressure, heart disease, coronary artery disease, or overactive thyroid.

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

• 
  

  liver disease, cirrhosis, or a history of alcoholism;

  
  


• 
  

  a blockage in your digestive tract (stomach or intestines);

  
  


• 
  

  kidney disease;

  
  


• 
  

  cough with mucus, or cough caused by smoking, emphysema, or chronic bronchitis;

  
  


• 
  

  enlarged prostate or urination problems;

  
  


• 
  

  low blood pressure; or

  
  


• 
  

  if you take potassium (Cytra, Epiklor, K-Lyte, K-Phos, Kaon, Klor-Con, Polycitra, Urocit-K).

  
  

It is not known whether acetaminophen and diphenhydramine will harm an unborn baby. Do not use this medicine without your doctor's advice if you are pregnant. This medication may pass into breast milk and may harm a nursing baby. Antihistamines and decongestants may also slow breast milk production. Do not use this medicine without your doctor's advice if you are breast-feeding a baby.

How should I take Night Time Pain (acetaminophen and diphenhydramine)?

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

Do not take more of this medication than is recommended. An overdose of acetaminophen can damage your liver or cause death.

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.

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 take for longer than 7 days in a row. Stop taking the medicine and call your doctor if you still have a fever after 3 days of use, you still have pain after 7 days (or 5 days if treating a child), if your symptoms get worse, or if you have a skin rash, ongoing headache, or any redness or swelling.

If you need surgery or medical tests, tell the surgeon or doctor ahead of time if you have taken this medicine within the past few days. Store at room temperature away from moisture and heat. Do not allow liquid medicine to freeze.

What happens if I miss a dose?

Since this medicine is taken when 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. An overdose of acetaminophen can be fatal.

The first signs of an acetaminophen overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in your upper stomach, dark urine, and yellowing of your skin or the whites of your eyes.

Overdose symptoms may also include severe forms of some of the side effects listed in this medication guide.

What should I avoid while taking Night Time Pain (acetaminophen and diphenhydramine)?

Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP. Avoid drinking alcohol. It may increase your risk of liver damage while taking acetaminophen, and can increase certain side effects of diphenhydramine. This medicine may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Night Time Pain (acetaminophen and diphenhydramine) 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:

• 
  

  chest pain, rapid pulse, fast or uneven heart rate;

  
  


• 
  

  confusion, hallucinations, severe nervousness;

  
  


• 
  

  tremor, seizure (convulsions);

  
  


• 
  

  easy bruising or bleeding, unusual weakness;

  
  


• 
  

  urinating less than usual or not at all; or

  
  


• 
  

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

  
  

Less serious side effects may include:

• 
  

  dizziness, drowsiness;

  
  


• 
  

  mild headache;

  
  


• 
  

  dry mouth, nose, or throat;

  
  


• 
  

  constipation;

  
  


• 
  

  blurred vision;

  
  


• 
  

  feeling nervous; or

  
  


• 
  

  sleep problems (insomnia);

  
  

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

What other drugs will affect Night Time Pain (acetaminophen and diphenhydramine)?

Ask a doctor or pharmacist before using this medicine if you regularly use other medicines that make you sleepy (such as narcotic pain medication, sedatives, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by diphenhydramine.

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

• 
  

  leflunomide (Arava);

  
  


• 
  

  topiramate (Topamax);

  
  


• 
  

  zonisamide (Zonegran);

  
  


• 
  

  diphenhydramine (Benadryl) applied to the skin;

  
  


• 
  

  an antibiotic, antifungal medicine, sulfa drug, or tuberculosis medicine;

  
  


• 
  

  an antidepressant;

  
  


• 
  

  birth control pills or hormone replacement therapy;

  
  


• 
  

  bladder or urinary medications;

  
  


• 
  

  blood pressure medication;

  
  


• 
  

  a bronchodilator;

  
  


• 
  

  cancer medicine;

  
  


• 
  

  cholesterol-lowering medications such as Lipitor, Niaspan, Zocor, Vytorin, and others;

  
  


• 
  

  gout or arthritis medications (including gold injections);

  
  


• 
  

  HIV/AIDS medication;

  
  


• 
  

  medication for nausea and vomiting, stomach ulcers, or irritable bowel syndrome;

  
  


• 
  

  medicines to treat psychiatric disorders;

  
  


• 
  

  an NSAID such as Advil, Aleve, Arthrotec, Cataflam, Celebrex, Indocin, Motrin, Naprosyn, Treximet, Voltaren, others; or

  
  


• 
  

  seizure medication.

  
  

This list is not complete and other drugs may interact with acetaminophen and diphenhydramine. 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 Night Time Pain resources

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

Compare Night Time Pain with other medications

• Headache
• Insomnia
• Pain

Where can I get more information?

• Your pharmacist can provide more information about acetaminophen and diphenhydramine.

See also: Night Time Pain side effects (in more detail)

Povidone/Iodine Cream

Pronunciation: POE-vi-done/EYE-oh-dine
Generic Name: Povidone/Iodine
Brand Name: Examples include Betadine and Pharmadine

Povidone/Iodine Cream is used for:

Treating minor wounds and infections, as well as killing bacteria.

Povidone/Iodine Cream is an antiseptic combination. It works by killing sensitive bacteria.

Do NOT use Povidone/Iodine Cream if:

• you are allergic to any ingredient in Povidone/Iodine Cream

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

Before using Povidone/Iodine Cream:

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

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


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


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


• if you have serious burns or deep puncture wounds

Some MEDICINES MAY INTERACT with Povidone/Iodine Cream. However, no specific interactions are known at this time.

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

How to use Povidone/Iodine Cream:

Use Povidone/Iodine Cream as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Clean the affected area. Apply a small amount of Povidone/Iodine Cream to the affected area. The area may be left uncovered, or you may cover it with a sterile bandage.


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

Ask your health care provider any questions you may have about how to use Povidone/Iodine Cream.

Important safety information:

• If you have had a severe allergic reaction to Povidone/Iodine Cream or a medicine that contains iodine, contact your doctor or pharmacist immediately. A severe allergic reaction includes a severe rash, hives, difficulty breathing, or dizziness. If you have questions about whether you are allergic to Povidone/Iodine Cream or if a certain medicine contains iodine, contact your doctor or pharmacist.


• If you experience a skin rash, hives, or itching, or any other unusual reaction after using this product, discontinue use and contact your doctor as soon as possible.


• Povidone/Iodine Cream is for external use only. Do not get Povidone/Iodine Cream in your eyes.


• Do not use Povidone/Iodine Cream over large areas of the body or for more than 1 week unless advised to do so by your doctor.


• Contact your doctor before using Povidone/Iodine Cream on serious burns, deep wounds, or puncture wounds.


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

Possible side effects of Povidone/Iodine Cream:

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

Skin irritation.

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

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

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

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of Povidone/Iodine Cream:

Store Povidone/Iodine Cream at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Povidone/Iodine Cream out of the reach of children and away from pets.

General information:

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


• Povidone/Iodine Cream is to be used only by the patient for whom it is prescribed. Do not share it with other people.


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


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

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

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Povidone/Iodine resources

• Povidone/Iodine Use in Pregnancy & Breastfeeding
• Povidone/Iodine Support Group
• 0 Reviews · Be the first to review/rate this drug

nicardipine

nye-kar-di-peen

Commonly used brand name(s)

In the U.S.

• Cardene


• Cardene SR

Available Dosage Forms:

• Capsule, Extended Release


• Capsule

Therapeutic Class: Cardiovascular Agent

Pharmacologic Class: Calcium Channel Blocker

Chemical Class: Dihydropyridine

Uses For nicardipine

Nicardipine is used alone or together with other medicines to treat severe chest pain (angina) or high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled .

Nicardipine is a calcium channel blocker. It works by affecting the movement of calcium into the cells of the heart and blood vessels. As a result, nicardipine relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload .

nicardipine is available only with your doctor's prescription .

Before Using nicardipine

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 nicardipine, the following should be considered:

Allergies

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

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of nicardipine in the pediatric population. Safety and efficacy have not been established .

Geriatric

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

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 taking nicardipine, 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 nicardipine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Levomethadyl

Using nicardipine 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.

• Amiodarone


• Atazanavir


• Dantrolene


• Droperidol


• Everolimus


• Fentanyl


• Vecuronium

Using nicardipine 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.

• Acebutolol


• Alprenolol


• Atenolol


• Betaxolol


• Bevantolol


• Bisoprolol


• Bucindolol


• Carteolol


• Carvedilol


• Celiprolol


• Cyclosporine


• Dalfopristin


• Dilevalol


• Esmolol


• Fluconazole


• Indinavir


• Itraconazole


• Ketoconazole


• Labetalol


• Levobunolol


• Magnesium


• Mepindolol


• Metipranolol


• Metoprolol


• Nadolol


• Nebivolol


• Oxprenolol


• Penbutolol


• Pindolol


• Propranolol


• Quinupristin


• Rifapentine


• Sotalol


• St John's Wort


• Talinolol


• Tertatolol


• Timolol

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. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

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

• Aortic stenosis (narrowing of a valve in your heart), severe—Should not be used in patients with this condition .

• Congestive heart failure—Use with caution. May make this condition worse .

• Kidney disease or


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

• Stroke, recent—Blood pressure–lowering effects of nicardipine may be increased .

Proper Use of nicardipine

In addition to the use of nicardipine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet .

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well .

Remember that nicardipine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease .

Dosing

The dose of nicardipine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of nicardipine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For chest pain:
  
  • For oral dosage form (capsules):
    
    • Adults—At first, 20 milligrams (mg) three times a day. Your doctor may increase your dose if needed.
    
    
    • Children—Use must be determined by your doctor .
    
    
  
  


• For high blood pressure:
  
  • For oral dosage form (capsules):
    
    • Adults—At first, 20 milligrams (mg) three times a day. Your doctor may increase your dose if needed.
    
    
    • Children—Use must be determined by your doctor .
    
    
  
  
  • For oral dosage form (extended-release capsules):
    
    • Adults—At first, 30 milligrams (mg) two times a day. Your doctor may increase your dose if needed.
    
    
    • Children—Use must be determined by your doctor .
    
    
  
  

Missed Dose

If you miss a dose of nicardipine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using nicardipine

It is very important that your doctor check your progress at regular visits to make sure nicardipine is working properly and to check for unwanted effects .

nicardipine Side Effects

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

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

More common

• Arm, back, or jaw pain


• chest pain or discomfort


• chest tightness or heaviness


• fast or irregular heartbeat


• nausea


• palpitations


• shortness of breath


• sweating


• swelling of the legs

Less common

• Shakiness


• swelling

Rare

• Blurred vision


• cold hands and feet


• cold sweats


• confusion


• cough or hoarseness


• difficulty swallowing


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


• extra heartbeat


• fever or chills


• hives


• increase in frequency of urination


• itching


• lower back or side pain


• painful or difficult urination


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


• skin rash


• unusual tiredness or weakness


• wheezing

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

Symptoms of overdose

• Sleepiness


• slurred speech

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

More common

• Feeling of warmth


• headache


• lack or loss of strength


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

Less common

• Acid or sour stomach


• belching


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


• difficulty in moving


• dry mouth


• heartburn


• indigestion


• joint pain


• muscle aching or cramping


• muscle pains or stiffness


• rash


• stomach discomfort, upset, or pain


• swollen joints

Rare

• Changes in vision


• constipation


• continuing ringing or buzzing or other unexplained noise in ears


• decreased interest in sexual intercourse


• difficult or labored breathing


• discouragement


• fear or nervousness


• feeling of constant movement of self or surroundings


• feeling sad or empty


• hearing loss


• inability to have or keep an erection


• increase in body movements


• irritability


• lack of appetite


• loss of interest or pleasure


• loss in sexual ability, desire, drive, or performance


• nervousness


• pain or tenderness around eyes and cheekbones


• runny nose


• sensation of spinning


• sneezing


• sore throat


• stuffy nose


• trouble concentrating


• trouble sleeping

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: nicardipine 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 nicardipine resources

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

• nicardipine Concise Consumer Information (Cerner Multum)


• Cardene Prescribing Information (FDA)


• Cardene MedFacts Consumer Leaflet (Wolters Kluwer)


• Cardene SR Prescribing Information (FDA)


• Cardene SR Sustained-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)


• Nicardipine Prescribing Information (FDA)


• Nicardipine Monograph (AHFS DI)


• Nicardipine MedFacts Consumer Leaflet (Wolters Kluwer)

Compare nicardipine with other medications

• Angina Pectoris Prophylaxis
• Heart Failure
• High Blood Pressure

Zemuron

Generic Name: Rocuronium Bromide
Class: Neuromuscular Blocking Agents
VA Class: MS200
Chemical Name: 1-[(2β,3α,5α,16β,17β)-17-(acetyloxy)-3-hydroxy-2-(4-morpholinyl) androstan-16-yl]-1-(2-propenyl)-pyrrolidinium bromide
Molecular Formula: C₃₂H₅₃N₂O₄•Br
CAS Number: 119302-91-9

• 
  

  Should be administered only under supervision of qualified clinicians experienced in the administration of neuromuscular blocking agent therapy.¹

  
  

Introduction

Nondepolarizing neuromuscular blocking agent.^{1 9}

Uses for Zemuron

Skeletal Muscle Relaxation

Production of skeletal muscle relaxation during surgery after general anesthesia has been induced.¹

Facilitation of endotracheal intubation.^{1 2 3 6 7}

Treatment to increase pulmonary compliance during assisted or controlled respiration.¹

Zemuron Dosage and Administration

General

• 
  

  Adjust dosage carefully according to individual requirements and response.¹

  
  


• 
  

  Assess neuromuscular blockade and recovery in patients undergoing anesthesia; a peripheral nerve stimulator is recommended to accurately monitor the degree of muscle relaxation and to minimize the possibility of overdosage.¹

  
  


• 
  

  To avoid patient distress, administer only after unconsciousness has been induced.¹

  
  

Facilitation of Endotracheal Intubation

• 
  

  Endotracheal intubation for nonemergency surgical procedures generally can be performed in about 1 minute following administration of 0.6-mg/kg dose.¹ (See Onset and also Duration under Pharmacokinetics.)

  
  


• 
  

  Good to excellent conditions for rapid sequence intubation result in <2 minutes following dose of 0.6–1.2 mg/kg in appropriately premedicated and adequately anesthetized patients.¹

  
  

Maintenance of Neuromuscular Blockade

• 
  

  Repeated administration of maintenance doses does not have a clinically important, cumulative effect on neuromuscular blockade.¹

  
  


• 
  

  Rate of spontaneous recovery from neuromuscular blockade following discontinuance of maintenance infusion usually is comparable to that following administration of intermittent IV injections.¹

  
  

Reversal of Neuromuscular Blockade

• 
  

  To reverse neuromuscular blockade, administer a cholinesterase inhibitor (e.g., neostigmine, pyridostigmine, edrophonium), usually in conjunction with an antimuscarinic (e.g., atropine, glycopyrrolate) to block adverse muscarinic effects of the cholinesterase inhibitor.^a

  
  

Administration

IV Administration

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

Administer IV only.¹ Administer initial (intubating) dose by rapid IV injection; administer maintenance dosage by intermittent IV injection or continuous IV infusion.¹

Consult specialized references for specific procedures and techniques of administration.^a

Do not mix in the same syringe or administer through the same needle as an alkaline solution.¹

Dilution

For continuous IV infusion, dilute rocuronium bromide injection to the desired concentration (usually 0.5 or 1 mg/mL) in a compatible IV infusion solution (see Solution Compatibility under Stability).¹ Use within 24 hours.¹

Dosage

Available as rocuronium bromide; dosage expressed in terms of the salt.¹

Pediatric Patients

Skeletal Muscle Relaxation

Initial (Intubating) Dosage

IV

Children 3 months to 14 years of age: 0.6 mg/kg when used concomitantly with halothane anesthesia.¹ (See Onset and also Duration under Pharmacokinetics.)

Maintenance Dosage

Intermittent IV Injection

Children 3 months to 14 years of age: 0.075–0.125 mg/kg provides clinically sufficient neuromuscular blockade for about 7–10 minutes.¹ Initiate intermittent maintenance doses once neuromuscular blockade has returned to 25% of control.¹ (See Onset and also Duration under Pharmacokinetics.)

Children 1–12 years of age may require more frequent doses than adults.¹

Continuous IV Infusion

Children 3 months to 14 years of age: 12 mcg/kg per minute; initiate continuous IV infusion once neuromuscular blockade has returned to 10% of control.¹

Adults

Skeletal Muscle Relaxation

Initial (Intubating) Dosage

IV

0.6 mg/kg.¹ May use smaller initial dose (i.e., 0.45 mg/kg).¹ If a larger initial dose is considered necessary, 0.9 or 1.2 mg/kg.¹ (See Onset and also Duration under Pharmacokinetics.)

0.6–1.2 mg/kg for rapid sequence intubation in appropriately premedicated and adequately anesthetized patients.¹

Maintenance Dosage

Intermittent IV Injection

0.1, 0.15, or 0.2 mg/kg when used concomitantly with balanced anesthesia.¹ (See Onset and also Duration under Pharmacokinetics.)

Initiate intermittent maintenance doses once neuromuscular blockade has returned to 25% of control.¹

Continuous IV Infusion

Initially, 10–12 mcg/kg per minute.¹ Individualize dosage when desired level of neuromuscular block is attained; 4–16 mcg/kg per minute usually is required.¹

Initiate continuous IV infusion once neuromuscular blockade has returned to 10% of control.¹

May need to reduce infusion rate by about 30–50% approximately 45–60 minutes following the initial IV dose if steady-state anesthesia has been induced with enflurane or isoflurane.¹

Special Populations

Hepatic Impairment

Increased initial dosage may be required during rapid sequence induction to achieve effective neuromuscular blockade (however, doses >0.6 mg/kg have not been evaluated); once blockade is established, duration may be prolonged.¹ (See Hepatic Impairment under Cautions.)

Renal Impairment

Dosage adjustments not required.¹ (See Renal Impairment under Cautions.)

Geriatric Patients

Dosage adjustments not required.¹ (See Geriatric Use under Cautions.)

Burn Patients

Substantially increased doses may be required due to development of resistance.^a (See Burn Patients under Cautions.)

Obese Patients

Base dosage on actual body weight.¹

Patients with Neuromuscular Disease

Administer small test dose; monitor degree of neuromuscular blockade with a peripheral nerve stimulator to determine dosage requirements.¹ (See Neuromuscular Disease under Cautions.)

Other Populations

Patients in whom potentiation of neuromuscular blockade or difficulties with reversal of blockade may occur (e.g., patients with carcinomatosis, cachectic or debilitated patients): Consider reduced initial dosage.¹

Cautions for Zemuron

Contraindications

• 
  

  Known hypersensitivity to rocuronium bromide or any ingredient in the formulation.¹

  
  

Warnings/Precautions

Warnings

Respiratory Effects

Potential for severely compromised respiratory function and respiratory paralysis.^a

Should be used only by individuals experienced in the use of neuromuscular blocking agents and in the maintenance of an adequate airway and respiratory support.¹ Facilities and personnel necessary for intubation, administration of oxygen, and assisted or controlled respiration should be immediately available.¹

IV cholinesterase inhibitor (e.g., neostigmine, pyridostigmine, edrophonium) should be readily available.¹ (See Reversal of Neuromuscular Blockade under Dosage and Administration.)

Use with caution in patients with pulmonary impairment or respiratory depression.^a

Neuromuscular Disease

Possible profound neuromuscular blockade in patients with neuromuscular disease (e.g., myasthenia gravis, Eaton-Lambert syndrome).¹

Administer small test dose; monitor degree of neuromuscular blockade with a peripheral nerve stimulator.¹

Sensitivity Reactions

Hypersensitivity Reactions

Serious and occasionally fatal hypersensitivity reactions, including anaphylaxis, reported.¹

Caution in patients with a history of anaphylactic reaction to other neuromuscular blocking agents; potential for cross-sensitivity.¹

General Precautions

Burn Patients

Resistance to therapy with neuromuscular blocking agents can develop in burn patients,¹ particularly those with burns over 25–30% or more of body surface area.^a

Resistance generally becomes apparent ≥1 week after the burn,^a peaks ≥2 weeks after the burn,^a persists for several months or longer,^a and decreases gradually with healing.^a

Consider possible need for substantially increased doses.^a

Histamine Release

Histamine release or adverse effects associated with histamine release (e.g., bronchospasm, urticaria, flushing) reported rarely.¹

Cardiovascular Effects

Possible increased pulmonary vascular resistance; use with caution in patients with pulmonary hypertension or valvular heart disease.¹

Intensive Care Setting

Possible development of tolerance to neuromuscular blocking agent therapy.¹ Possible prolonged paralysis and/or muscle weakness and atrophy.¹

Continuous monitoring of neuromuscular transmission recommended during neuromuscular blocking agent therapy in intensive care setting.¹ Do not administer additional doses before there is a definite response to nerve stimulation tests.¹

Impaired Circulation

Possible delayed onset of action in patients with impaired circulation (e.g., cardiovascular disease).¹ Larger-than-usual initial doses generally are not recommended; when feasible, allow additional time for onset of clinically sufficient neuromuscular blockade.¹

Electrolyte Disturbances

Possible increased or decreased neuromuscular blockade in patients with electrolyte disturbances (e.g., diarrhea, adrenocortical insufficiency) or acid/base imbalances.^{1 a}

Malignant Hyperthermia

Malignant hyperthermia is rarely associated with use of neuromuscular blocking agents and/or potent inhalation anesthetics.^a Be vigilant for its possible development and prepared for its management in any patient undergoing general anesthesia.¹

Rocuronium has not been evaluated in patients susceptible to malignant hyperthermia.¹

Local Effects

Possible local irritation; discontinue injection and restart in another vein if extravasation occurs.¹

Specific Populations

Pregnancy

Category C.¹

Possible poor or inadequate intubating conditions following rapid sequence induction in cesarean section patients; use not recommended for rapid sequence induction in such patients.¹

Lactation

Not known whether rocuronium is distributed into milk.¹

Pediatric Use

Safety and efficacy not established in children <3 months of age or >14 years of age.¹

Geriatric Use

Slightly slower onset and slightly increased duration of neuromuscular blockade; however, recovery time in patients ≥65 years of age does not appear to differ from that in younger adults.¹

Hepatic Impairment

Possible incomplete neuromuscular blockade; increased initial dosage may be required.¹ See Hepatic Impairment under Dosage and Administration.

Use with caution.¹ Possible increase in half-life, duration of neuromuscular blockade, and recovery time.¹ (See Special Populations under Absorption and also under Elimination, in Pharmacokinetics.)

Renal Impairment

No substantial differences in pharmacokinetic profile relative to patients without renal impairment.¹ (See Absorption: Special Populations, under Pharmacokinetics.)

Common Adverse Effects

Skeletal muscle weakness.^a

Interactions for Zemuron

Specific Drugs

Drug	Interaction	Comments
Anesthetics, general (enflurane, isoflurane)	Increased potency and prolonged duration of neuromuscular blockadea	Reduced rocuronium infusion rate may be required1 (See Dosage under Dosage and Administration)
Anesthetics, local	Possible increased neuromuscular blockade1	Reduced initial rocuronium dosage may be required1
Anticonvulsants (carbamazepine, phenytoin)	Possible decreased duration and degree of neuromuscular blockade1	Higher rocuronium infusion rates may be required1
Anti-infectives (e.g., aminoglycosides, bacitracin, polymyxins, tetracyclines, vancomycin)	Possible prolonged duration of neuromuscular blockade1	Reduced initial rocuronium dosage may be required1
Lithium	Possible increased neuromuscular blockade1	Reduced initial rocuronium dosage may be required1
Magnesium salts	Increased neuromuscular blockade1	Use with caution; reduce rocuronium dosage if necessary a
Procainamide	Possible increased neuromuscular blockade1	Reduced initial rocuronium dosage may be required1
Propofol	Change in duration of, or recovery from, neuromuscular blockade unlikely1
Quinidine	Possible increased neuromuscular blockade; possible recurrence of paralysis1	Reduced initial rocuronium dosage may be required1
Succinylcholine		Administer rocuronium only after patient has recovered form succinylcholine-induced neuromuscular blockade1

Zemuron Pharmacokinetics

Absorption

Bioavailability

Poorly absorbed from the GI tract.^a

Onset

Onset of action is slower than that of succinylcholine but more rapid than that of most other currently available nondepolarizing agents.^{2 3 4 5 6 7 8}

Onset of neuromuscular blockade is more rapid in pediatric patients than adults.¹

Following IV administration of 0.45 or 0.6 mg/kg in adults, neuromuscular blockade is clinically sufficient in about 1.3 (range 0.8–6.2) or 1 (range: 0.4–6) minute, respectively, and is maximal in <4 or <3 minutes, respectively.¹

Maximum neuromuscular blockade generally occurs within 1 minute in children 3 months to 12 years of age.¹

Duration

Following initial dose of 0.45 or 0.6 mg/kg under balanced anesthesia in adults, clinically sufficient neuromuscular blockade persists for about 22 (range: 12–31) or 31 (range: 15–85) minutes, respectively.¹ Following initial adult dose of 0.9 or 1.2 mg/kg, clinically sufficient neuromuscular blockade persists for about 58 (range: 27–111) or 67 (range: 38–160) minutes, respectively.¹

Following initial dose of 0.6 mg/kg under halothane anesthesia in children 3–12 months of age or >1–12 years of age, clinically sufficient neuromuscular blockade generally persists for about 41 (range: 24–68) or 26 (range: 17–39) minutes, respectively.¹

Following maintenance doses of 0.1, 0.15, or 0.2 mg/kg in adults receiving balanced anesthesia, clinically sufficient neuromuscular blockade persists for about 12 (range: 2–31), 17 (range: 6–50), or 24 (range: 7–69) minutes, respectively.¹

Following maintenance doses of 0.075–0.125 mg/kg in children, clinically sufficient neuromuscular blockade persists for 7–10 minutes.¹

The time necessary for 25–75% recovery from neuromuscular blockade in adults is about 13 minutes.¹

Spontaneous recovery from neuromuscular blockade in children 3–12 months of age generally proceeds at a rate comparable to that in adults; recovery is more rapid in children 1–12 years of age.¹

Special Populations

In patients with hepatic impairment, prolonged duration of neuromuscular blockade.¹

In patients with renal failure, no substantial change in onset or duration of neuromuscular blockade; however, interindividual variation in duration may be greater.¹

In geriatric patients, slightly slower onset and slightly prolonged duration of neuromuscular blockade.¹

Distribution

Plasma Protein Binding

About 30%.¹

Special Populations

In patients with hepatic impairment, increased volume of distribution.¹

Elimination

Metabolism

Metabolized to a less active metabolite, 17-desacetyl-rocuronium.¹

Elimination Route

Eliminated primarily by the liver.¹

Half-life

Triphasic; terminal half-life is 1.4 or 2.4 hours during balanced anesthesia or isoflurane anesthesia, respectively.¹

Special Populations

In patients with hepatic impairment, terminal half-life is 4.3 hours during isoflurane anesthesia.¹

Stability

Storage

Parenteral

Injection

2–8°C; do not freeze.¹

Compatibility

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

Parenteral

Solution Compatibility¹

Compatible
Dextrose 5% in water
Sodium chloride 0.9%
Dextrose 5% in sodium chloride 0.9%
Ringer's injection, lactated

Drug Compatibility

Y-Site CompatibilityHID

Compatible
Dexmedetomidine HCl
Fenoldopam mesylate
Hetastarch in lactated electrolyte injection (Hextend)
Milrinone lactate

ActionsActions

• 
  

  Produces skeletal muscle relaxation by causing a decreased response to acetylcholine (ACh) at the myoneural (neuromuscular) junction of skeletal muscle.^a

  
  


• 
  

  Exhibits high affinity for ACh receptor sites and competitively blocks access of ACh to motor end-plate of myoneural junction; may affect ACh release.^{1 a}

  
  


• 
  

  Blocks the effects of both the small quantities of ACh that maintain muscle tone and the large quantities of ACh that produce voluntary skeletal muscle contraction; does not alter the resting electrical potential of the motor end-plate or cause muscular contractions.^a

  
  


• 
  

  Appears to have little, if any, histamine-releasing activity.^{1 a}

  
  

Advice to Patients

• 
  

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

  
  


• 
  

  Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., cardiovascular disease, neuromuscular disease).¹

  
  


• 
  

  Importance of informing patients of other important precautionary information.¹ (See Cautions.)

  
  

Preparations

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

Rocuronium Bromide

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	Injection, for IV use only	10 mg/mL	Zemuron	Organon

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 July 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. Organon. Zemuron (rocuronium bromide) injection prescribing information. West Orange, NJ: 2002 Jun.

2. Puhringer FK, Khuenl-Brady KS, Koller J et al. Evaluation of the endotracheal intubating conditions of rocuronium (ORG 9426) and succinylcholine in outpatient surgery. Anesth Analg. 1993; 76:904-5.

3. Huizinga AC, Vandenbrom RH, Wierda JM et al. Intubating conditions and onset of neuromuscular block of rocuronium (Org 9426); a comparison with suxamethonium. Acta Anaesthesiol Scand. 1992; 36:463-8. [PubMed 1321542]

4. Magorian T, Flannery KB, Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology. 1993; 79:913-8. [IDIS 322375] [PubMed 7902034]

5. Bartkowski RR, Witkowski TA, Azad S et al. Rocuronium onset of action: a comparison with atracurium and vecuronium. Anesth Analg. 1993; 77:574-8. [IDIS 319830] [PubMed 8103649]

6. Cooper R, Mirakhur RK, Clarke RS et al. Comparison of intubating conditions after administration of Org 9246 (rocuronium) and suxamethonium. Br J Anaesth. 1992; 69:269-73. [IDIS 302324] [PubMed 1389845]

7. Mirakhur RK. Newer neuromuscular blocking drugs: an overview of their clinical pharmacology and therapeutic use. Drugs. 1992; 44:182-99. [PubMed 1382013]

8. Agoston S, Vandenbrom RHG, Wierda JMKH. Clinical pharmacokinetics of neuromuscular blocking drugs. Clin Pharmacokinet. 1992; 22:94-115. [PubMed 1551294]

9. Organon, West Orange, NJ: Personal communication.

a. AHFS Drug Information 2004. McEvoy GK, ed. Neuromuscular Blocking Agents General Statement. Bethesda, MD: American Society of Health-System Pharmacists; 2004:1303-6.

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1463-4.

More Zemuron resources

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

• Zemuron Prescribing Information (FDA)


• Zemuron Concise Consumer Information (Cerner Multum)


• Zemuron MedFacts Consumer Leaflet (Wolters Kluwer)


• Rocuronium Prescribing Information (FDA)

Compare Zemuron with other medications

• Anesthesia