Penicillamine

Class: Heavy Metal Antagonists
ATC Class: M01CC01
VA Class: AD300
CAS Number: 52-67-5
Brands: Cuprimine, Depen

• 
  

  Only clinicians familiar with the toxicity, special dosage considerations, and therapeutic benefits should prescribe penicillamine.^{a b} Do not use casually.^{a b}

  
  


• 
  

  Closely monitor patients.^{a b}

  
  


• 
  

  Inform patients to promptly report symptoms suggestive of toxicity to their clinician.^{a b}

  
  

Introduction

Heavy metal antagonist; a disease-modifying antirheumatic drug (DMARD).^c

Uses for Penicillamine

Wilson’s Disease

Promotes excretion of copper in the treatment of Wilson’s disease.^{a b c}

Used in conjunction with a low copper diet.^{a b c}

Improves neurologic, corneal, hepatic, and psychiatric manifestations in symptomatic patients.^{a b c}

Prevents signs and symptoms of the disease in asymptomatic patients.^{a b}

Cystinuria

Use in conjunction with conventional measures (urine dilution and alkalinization) to reduce excretion of cystine and prevent renal calculi in patients with cystinuria when conventional measures alone are not successful.^{a b c}

Rheumatoid Arthritis

Management of rheumatoid arthritis in adults whose symptoms progress despite an adequate regimen of NSAIAs.^{a b c 206 207}

Because penicillamine can cause severe adverse reactions, restrict use to patients with severe disease.^{a b}

Lead Poisoning

Has been used for the treatment of lead poisoning†.^{204 d}

AAP considers penicillamine a third-line agent for the treatment of lead poisoning.^{204 d}

Penicillamine Dosage and Administration

General

• 
  

  Individualize dosage according to the condition being treated and patient response.^{a b c}

  
  


• 
  

  When used for cystinuria, high fluid intake (e.g., 500 mL of water at bedtime and again during the night) needed.^{a b c} The greater the fluid intake, the lower the penicillamine dosage required.^{a b c}

  
  

Administration

Oral Administration

Administer orally on an empty stomach (i.e., at least 1 hour before or 2 hours after meals, and at least 1 hour apart from any other drug, food, or milk).^{a b c} Administer the last dose of the day ≥3 hours after the evening meal.^c Administration on an empty stomach ensures maximum absorption and reduces the potential for inactivation of penicillamine by metals in the GI tract.^{a b}

If used in individuals who cannot swallow capsules, contents may be administered in 15–30 mL of chilled pureed fruit or fruit juice.^c

When used for rheumatoid arthritis, administer dosages >500 mg daily in divided doses.^{a b c}

Dosage

Pediatric Patients

Wilson’s Disease

Oral

Optimal dosage determined by measuring urinary copper excretion and/or serum free copper concentrations.^{a b c}

20 mg/kg daily given in divided doses.^c

Cystinuria

Oral

Individualize dosage based on urinary cystine excretion.^{a b c}

30 mg/kg daily given in 4 equal doses.^{a b c} If 4 equal doses are not feasible, give larger dose at bedtime.^{a b c} If dosage reduced because of adverse effects, retain bedtime dose.^{a b c}

Lead Poisoning†

Oral

20–30 mg/kg daily has been recommended.^c

Adults

Wilson’s Disease

Oral

Optimal dosage determined by measuring urinary copper excretion and/or serum free copper concentrations.^{a b c}

Initially, 250 mg 4 times daily.^{a b c} For patients who do not tolerate an initial dosage of 1 g daily, initiate with 250 mg daily and gradually increase dosage.^{a b c}

If tolerated, a dosage of 0.75–1.5 g daily should be continued for 3 months; this dosage produces an initial 24-hour cupruresis of >2 mg.^{a b c} Subsequent dosage based on serum free copper concentrations.^{a b c}

Dosages >2 g daily are seldom necessary.^{a b c}

Cystinuria

Oral

Individualize dosage based on urinary cystine excretion.^{a b c}

Initiate with 250 mg daily and gradually increase dosage to provide close control and minimize adverse reactions.^{a b c}

Usual dosage is 2 g daily given in 4 equal doses; range is 1–4 g daily.^{a b c} If 4 equal doses are not feasible, give larger dose at bedtime.^{a b c} If dosage reduced because of adverse effects, retain bedtime dose.^{a b c}

Rheumatoid Arthritis

Initial Therapy

Oral

Initially, 125–250 mg daily; increase by 125–250 mg daily at 1–3 month intervals as patient response and tolerance allow.^{a b c} Many patients achieve remission with dosage of 500–750 mg daily.^c

If remission is achieved, continue dosage; if no improvement and no signs of serious toxicity noted with 500–750 mg daily, increase by 250 mg daily at 2–3 month intervals until remission occurs or toxicity develops.^{a b c}

Discontinue penicillamine if improvement not observed after 3–4 months of treatment with 1–1.5 g daily.^{a b c}

Maintenance Therapy

Oral

Usual dosage 500–750 mg daily; in patients who respond, but have incomplete suppression of disease after the first 6–9 months of therapy, increase daily dosage by 125–250 mg daily at 3 month intervals to a maximum of 1–1.5 g daily.^{a b c}

Optimum duration of therapy not established; attempt to reduce dosage by 125–250 mg daily at 3 month intervals in patients with remission of symptoms ≥6 months, ^{a b c}

Exacerbation Therapy

Oral

If exacerbation does not subside within 3 months, consider increasing penicillamine dosage.^{a b c}

Prescribing Limits

Adults

Wilson’s Disease

Oral

Maximum 2 g daily.^{a b c}

Rheumatoid Arthritis

Oral

Maximum 1 g daily; occasionally 1.5 g daily required.^{a b c}

Special Populations

Pregnancy

If penicillamine is used in pregnant women with Wilson's disease, the manufacturers recommend a maximum dosage of 0.75–1 g daily.^{a b} If cesarean section is planned, the recommended dosage is 250 mg daily during the last 6 weeks of pregnancy; this dosage is continued postoperatively until wound healing is complete.^{a b} (See Contraindications and Mucocutaneous Effects under Cautions.)

Surgical Candidates

Reduce dosage to 250 mg daily in patients considering surgery.^{a b} Do not reinitiate full dosage until wound healing is complete.^{a b} (See Contraindications and Mucocutaneous Effects under Cautions.)

Cautions for Penicillamine

Contraindications

• 
  

  Known or suspected pregnancy except when used for the treatment of Wilson’s disease or in certain individuals with cystinuria.^{a b} (See Fetal/Neonatal Morbidity and Mortality and Pregnancy under Cautions.)

  
  


• 
  

  Breast-feeding.^{a b} (See Lactation under Cautions.)

  
  


• 
  

  History of penicillamine-related aplastic anemia or agranulocytosis.^{a b c}

  
  


• 
  

  Rheumatoid arthritis patients with current or history of renal insufficiency.^{a b c}

  
  

Warnings/Precautions

Warnings

Hematologic Effects

Aplastic anemia, agranulocytosis, and thrombocytopenia (sometimes fatal) reported.^{a b c} Leukopenia and thrombocytopenia reported.^{a b c}

For the first 6 months, monitor WBC counts, hemoglobin, and platelet counts every 2 weeks; after 6 months, monitor monthly.^{a b} Discontinue penicillamine if WBC count decreases to <3500/mm³.^{a b} Temporarily interrupt therapy if platelet count decreases to <100,000/mm³.^{a b}

Temporarily interrupt therapy if platelet or WBC counts progressively decrease in 3 successive determinations, even if values are still within normal range.^{a b c}

Iron deficiency anemia reported, especially in children or premenopausal women.^{a b c} Iron therapy may be administered for short periods.^{a b c} (See Iron Supplements under Interactions.)

Renal Effects

Slight to moderate proteinuria (<2 g/24 hours) common; may improve spontaneously or following dosage reduction.^c

Hematuria or proteinuria may be warning signs of membranous glomerulopathy that can progress to nephrotic syndrome; essential to closely observe patients who develop hematuria or proteinuria.^{a b}

For the first 6 months, perform urinalysis every 2 weeks; after 6 months, perform monthly.^{a b}

Determine quantitative 24-hour urinary protein levels every 1–2 weeks in patients with rheumatoid arthritis who develop moderate proteinuria; do not increase penicillamine dosage in these patients.^{a b} Reduce dosage or discontinue penicillamine for proteinuria >1 g/24 hours or progressive increases in proteinuria.^{a b} Discontinue therapy if gross hematuria or persistent microscopic hematuria develops.^{a b}

Weigh risks versus benefits of continued therapy in patients with Wilson's disease or cystinuria who develop urinary abnormalities.^{a b c}

Discontinue immediately if abnormal urinary findings associated with hemoptysis and pulmonary infiltrates develop.^{a b c} (See Goodpasture's Syndrome under Cautions.)

Following discontinuance of penicillamine, ≥1 year may be required for urinary abnormalities to resolve.^{a b c}

Annual radiograph of the kidneys advised to check for renal stones in patients with cystinuria.^{a b}

Hepatotoxicity

Intrahepatic cholestasis and toxic hepatitis reported rarely.^{a b} Monitor liver function every 3–6 months.^{a b}

Pulmonary Effects

Obliterative bronchiolitis reported rarely.^{a b}

Goodpasture’s Syndrome

Goodpasture’s syndrome reported rarely.^{a b c} Discontinue immediately if abnormal urinary findings associated with hemoptysis and pulmonary infiltrates occur.^{a b c}

Myasthenia Gravis

Myasthenic syndrome, sometimes progressing to myasthenia gravis, reported.^{a b c} Symptoms typically resolve after discontinuation of penicillamine.^{a b c}

Fetal/Neonatal Morbidity and Mortality

May cause fetal harm; congenital cutis laxa and associated birth defects reported.^{a b c}

Decisions regarding use of penicillamine in pregnant women should be individualized based on the condition being treated.^{a b} (See Pregnancy under Cautions.)

Advise women who become pregnant while taking penicillamine that there is a potential hazard to the fetus.^{a b}

Sensitivity Reactions

Hypersensitivity Reactions

Drug fever, sometimes accompanied by macular cutaneous eruption, reported; usually occurs after 2–3 weeks of therapy.^{a b c} Temporarily interrupt therapy if drug fever develops in patients with Wilson’s disease or cystinuria; restart with low dosage and gradually increase to full dosage once fever subsides.^{a b c} Discontinue if drug fever occurs in patients with rheumatoid arthritis; initiate alternative therapy for rheumatoid arthritis.^{a b c}

If pruritus or rash accompanied by fever, arthralgia, lymphadenopathy, or other allergic manifestations develop, discontinue penicillamine.^{a b c}

Cross-sensitivity

Potential for cross-sensitivity between penicillamine and penicillin.^{a b c}

Dermatologic Reactions

Most forms of pemphigus reported; pemphigus vulgaris and pemphigus foliaceus reported most frequently.^{a b c} Discontinue if pemphigus suspected.^{a b c}

Rash may occur early in therapy or, less frequently, after many months of therapy.^{a b c} Observe skin and mucous membranes for allergic reactions.^{a b} Generalized pruritic, erythematous, maculopapular, or morbilliform rash occurs early; usually resolves following discontinuance of penicillamine and does not recur when drug is restarted at lower dosage.^{a b c} Late rash with intense pruritus reported after ≥6 months therapy.^{a b c} If late rash occurs, discontinue penicillamine.^{a b} Rash may recur if the drug is restarted.^{a b c}

Antinuclear Antibodies

Possible positive antinuclear antibody (ANA) titers; patients with increases in ANA titers may develop a syndrome resembling systemic lupus erythematosus.^{a b c} Monitor patients who develop an abnormal ANA test; not necessary to discontinue penicillamine.^{a b c}

General Precautions

Mucocutaneous Effects

Potential increased skin friability at pressure or trauma sites (i.e., shoulders, elbows, knees, toes, and buttocks);^{a b c} may progress to purpuric or vesicular ecchymoses.^c Occurs most frequently with dosages >2 g daily;^c does not require discontinuance.^{a b c}

May affect wound healing; dosage adjustment recommended in patients undergoing surgery.^{a b} (See Pregnancy and Surgical Candidates under Dosage and Administration.)

Oral ulcerations with the appearance of aphthous stomatitis reported; rarely, cheilosis, glossitis, gingivostomatitis, and ulceration of the vulva and vagina reported.^{a b c}

Pyridoxine

Penicillamine increases pyridoxine requirement; pyridoxine 25–50 mg daily recommended for patients with Wilson’s disease or cystinuria; also recommended for rheumatoid arthritis patients with impaired nutrition.^{a b c}

Effects on Taste

Hypogeusia reported; may last ≥2–3 months; may progress to full loss of taste; usually self-limiting.^{a b c}

Specific Populations

Pregnancy

Category D.^a (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Contraindicated in women with rheumatoid arthritis who are pregnant.^{a b c} (See Contraindication under Cautions.)

If administered to women with Wilson's disease during pregnancy, dosage adjustment needed.^{a b} (See Pregnancy under Dosage and Administration.)

Use in pregnant women with cystinuria not recommended.^{a b} If stone formation continues, consider benefits to the mother versus risk to the fetus.^{a b}

Use in women of childbearing potential only if potential benefits outweigh risks.^{a b}

Lactation

Discontinue nursing because of potential risk to nursing infants.^{a b c} (See Contraindications under Cautions.)

Pediatric Use

Efficacy not established for treatment of juvenile rheumatoid arthritis.^{a b c}

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.^a Select dosage with caution, starting at the low end of the dosing range, because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy.^a May be useful to monitor renal function.^a

Skin rash and taste disturbances reported more frequently in geriatric individuals than in younger adults.^a

Renal Impairment

Contraindicated for the treatment of rheumatoid arthritis in patients with current or a history of renal insufficiency.^{a b c}

Common Adverse Effects

Early and late rashes^{a b c} , taste disturbances, ^{a b c} proteinuria, ^{a b c} anorexia, ^{a b c} epigastric pain, ^{a b c} nausea, ^{a b c} vomiting, ^{a b c} diarrhea, ^{a b c} leukopenia, ^{a b c} thrombocytopenia. ^{a b c}

Interactions for Penicillamine

Specific Drugs

Drug	Interaction	Comments
Antacids	Possible decreased plasma penicillamine concentrationsa	Separate administration by ≥1 hoursa
Antimalarials	Potential additive hematologic and/or adverse renal effectsa b c	Concomitant use not recommendeda b c
Cytotoxic agents	Potential additive hematologic and/or adverse renal effectsa b c	Concomitant use not recommendeda b c
Gold therapy	Potential additive hematologic and/or adverse renal effectsa b c	Concomitant use not recommended a b c
Iron supplements	Possible decreased plasma penicillamine concentrationsa b	Separate administration by ≥2 hoursa b
Zinc supplements	Possible decreased plasma penicillamine concentrationsa	Separate administration by ≥1 hoursa

Penicillamine Pharmacokinetics

Absorption

Bioavailability

Absorption from the GI tract is variable; 40–70% of an oral dose (given as capsules) absorbed.^a Peak plasma concentrations usually attained within 1–3 hours.^{a c}

Food

Presence of food in the GI tract decreases extent of absorption.^{a b}

Distribution

Extent

Crosses the placenta.^c

Plasma Protein Binding

80% (mainly albumin and ceruloplasmin).^a

Elimination

Metabolism

Metabolized in the liver to inactive metabolites.^{a c}

Elimination Route

Excreted principally in urine as disulfides.^{a c}

Stability

Storage

Oral

Capsules and Tablets

15–30°C.^c

ActionsActions

• 
  

  Chelates copper, iron, mercury, and lead to form stable soluble complexes that are excreted by the kidney.^{a b c} Removes excess copper in patients with Wilson's disease.^{a b c}

  
  


• 
  

  Combines with cystine to form penicillamine-cysteine disulfide, a complex that is more soluble than cystine.^{a b c} Reduces concentration of cystine in urine of patients with cystinuria.^{a b c}

  
  


• 
  

  Mechanism of anti-inflammatory effects in rheumatoid arthritis not fully determined; inhibits collagen formation; reduces immunoglobulin M rheumatoid factor; depresses T-cell activity; depolymerizes some macroglobulins; does not reduce B-cell activity.^{a b c}

  
  


• 
  

  Inhibits pyridoxal-dependent enzymes.^c

  
  

Advice to Patients

• 
  

  Importance of advising patients to seek immediate medical attention if signs and symptoms of toxicity (e.g., fever, sore throat, chills, bruising, bleeding) develop.^{a b}

  
  


• 
  

  Importance of taking penicillamine on an empty stomach (at least 1 hour before or 2 hours after meals, and at least 1 hour apart from any other drug, food, or milk).^{a b c}

  
  


• 
  

  Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as concomitant illnesses.^{a b}

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed; apprise women of potential risks to fetus.^{a b} Importance of women of childbearing potential informing clinician of missed period(s).^{a b}

  
  


• 
  

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

  
  

Preparations

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

Penicillamine

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Capsules	125 mg	Cuprimine	Merck
		250 mg	Cuprimine	Merck
	Tablets	250 mg	Depen Titratable (with povidone; scored)	MedPoint

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 June 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

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

References

200. Merck. Cuprimine (penicillamine) capsules prescribing information (dated 1997 Feb). In: Physicians’ desk reference. 53rd ed. Montvale, NJ; Medical Economics Company Inc; 1999:1766-9.

201. Ramselaar ACP, Dekker AW, Huber-Bruning O et al. Acquired sideroblastic anaemia after aplastic anemia caused by D-penicillamine therapy for rheumatoid arthritis. Ann Rheum Dis. 1987; 46:156-8. [IDIS 226248] [PubMed 3827338]

202. Craig HR. Penicillamine induced mammary hyperplasia: report of a case and review of the literature. J Rheumatol. 1988; 15:1294-7. [PubMed 3184079]

203. Reid DM, Martynoga AG, Nuki G. Reversible gynecomastia associated with d-penicillamine in a man with rheumatoid arthritis. BMJ. 1982; 285:1083-4. [IDIS 159628] [PubMed 6812755]

204. Committee on Drugs, American Academy of Pediatrics. Treatment guidelines for lead exposure in children. Pediatrics. 1995; 96:155-60. [IDIS 349805] [PubMed 7596706]

205. Shannon M, Graef J, Lovejoy FH. Efficacy and toxicity of d-penicillamine in low-level lead poisoning. J Pediatr. 1988; 112:799-804. [IDIS 241344] [PubMed 3361395]

206. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002; 46:358-46.

207. Anon. Drugs for rheumatoid arthritis. Med Lett Drugs Ther. 2000; 42:57-64. [PubMed 10887424]

a. Merck. Cuprimine (penicillamine) capsules prescribing information. Whitehouse Station, NJ; Oct 2004.

b. MedPointe Healthcare Inc. Depen (penicillamine) tablets prescribing information. Somerset, NJ; 2003 Dec.

c. AHFS Drug Information 2007. McEvoy GK, ed. Penicillamine. Bethesda, MD: American Society of Health-System Pharmacists; 2007. From .

d. American Academy of Pediatrics, Committee on Environmental Health. Lead exposure in children: prevention, detection, and management. Pediatrics. 2005; 116:1036-46. [PubMed 16199720]

More Penicillamine resources

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

• Penicillamine Professional Patient Advice (Wolters Kluwer)


• Penicillamine MedFacts Consumer Leaflet (Wolters Kluwer)


• penicillamine Concise Consumer Information (Cerner Multum)


• penicillamine Advanced Consumer (Micromedex) - Includes Dosage Information


• Cuprimine Prescribing Information (FDA)


• Depen Prescribing Information (FDA)

Compare Penicillamine with other medications

• Cystinuria
• Rheumatoid Arthritis
• Wilson's Disease

Percodan

Generic Name: aspirin and oxycodone (AS pir in and ox i KOE done)

Brand Names: Endodan, Percodan, Roxiprin

What is aspirin and oxycodone?

Aspirin is in a group of drugs called salicylates (sa-LIS-il-ates). It works by reducing substances in the body that cause pain, fever, and inflammation.

Oxycodone is in a group of drugs called narcotic pain relievers.

The combination of aspirin and oxycodone is used to relieve moderate to severe pain.

Aspirin and oxycodone may also be used for purposes not listed in this medication guide.

What is the most important information I should know about aspirin and oxycodone?

Aspirin should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Aspirin can cause a serious and sometimes fatal condition called Reye's syndrome in children.

Stop using this medication and call your doctor at once if you have any symptoms of bleeding in your stomach or intestines. Symptoms include black, bloody, or tarry stools, and coughing up blood or vomit that looks like coffee grounds.

Oxycodone may be habit-forming and should be used only by the person it was prescribed for. Never share aspirin and oxycodone with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Avoid drinking alcohol. It may increase your risk of stomach bleeding while taking aspirin.

Tell your doctor if the medicine seems to stop working as well in relieving your pain.

What should I discuss with my healthcare provider before taking aspirin and oxycodone?

Aspirin should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Aspirin can cause a serious and sometimes fatal condition called Reye's syndrome in children. Do not use aspirin and oxycodone if you have a bleeding or blood clotting disorder such as hemophilia. Do not use this medication if you are allergic to aspirin or oxycodone or to a non-steroidal anti-inflammatory drug (NSAID) such as Advil, Aleve, Motrin, Naprosyn, Orudis, Cataflam, Celecoxib, Feldene, Indocin, Lodine, Mobic, Relafen, Toradol, Voltaren, and others.

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

• 
  

  asthma or other breathing disorders;

  
  


• liver or kidney disease;


• 
  

  a history of head injury or brain tumor;

  
  


• 
  

  epilepsy or other seizure disorder;

  
  


• 
  

  stomach or intestinal disorder, history of stomach ulcer or bleeding;

  
  


• 
  

  a pancreas disorder;

  
  


• 
  

  curvature of the spine; or

  
  


• 
  

  mental illness or a history of drug or alcohol addiction.

  
  

Oxycodone may be habit-forming and should be used only by the person it was prescribed for. Never share aspirin and oxycodone with another person, especially someone with a history of drug abuse or addiction. FDA pregnancy category D. This medication can cause harm to an unborn baby, and breathing problems or addiction/withdrawal symptoms in a newborn. Taking aspirin during late pregnancy may cause bleeding in the mother or the baby during delivery. Do not take aspirin and oxycodone during pregnancy unless your doctor has told you to. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Aspirin and oxycodone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more sensitive to the effects of this medicine.

How should I take aspirin and oxycodone?

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. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Drink 6 to 8 full glasses of water daily to help prevent constipation while you are taking aspirin and oxycodone. Ask your doctor about ways to increase the fiber in your diet. Do not use a stool softener (laxative) without first asking your doctor. You may have withdrawal symptoms when you stop using this medication after using it over a long period of time. Do not stop using the medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely. If you need surgery, tell the surgeon ahead of time that you are using aspirin and oxycodone. Store at room temperature away from moisture, heat, and light.

Keep track of the amount of medicine used from each new bottle. Oxycodone is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Always check your bottle to make sure you have received the correct pills (same brand and type) of medicine prescribed by your doctor. Ask the pharmacist if you have any questions about the medicine you receive at the pharmacy.

After you have stopped using this medication, flush any unused pills down the toilet.

See also: Percodan dosage (in more detail)

What happens if I miss a dose?

Since aspirin and oxycodone is taken as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of aspirin and oxycodone can be fatal.

Overdose symptoms may include extreme drowsiness, pinpoint pupils, nausea, vomiting, diarrhea, confusion, ringing in your ears, cold or clammy skin, muscle weakness, fainting, weak pulse, slow heart rate, coma, blue lips, shallow breathing, or no breathing.

What should I avoid while taking aspirin and oxycodone?

Aspirin and oxycodone may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Ask a doctor or pharmacist before using any other over-the-counter cold, allergy, or pain medicine. Aspirin is contained in many combination medicines. Taking certain products together can cause you to get too much aspirin. Check the label to see if a medicine contains aspirin. Avoid drinking alcohol. It may increase your risk of stomach bleeding while taking aspirin.

Aspirin and oxycodone 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:

• 
  

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

  
  


• 
  

  shallow breathing, slow heartbeat;

  
  


• 
  

  fast heart rate;

  
  


• 
  

  feeling light-headed, fainting;

  
  


• 
  

  confusion, hallucinations;

  
  


• 
  

  easy bruising or bleeding; or

  
  


• 
  

  problems with urination.

  
  

Less serious side effects may include:

• 
  

  headache, dizziness, drowsiness;

  
  


• 
  

  heartburn, nausea, vomiting, upset stomach, bloating, gas, constipation, diarrhea;

  
  


• 
  

  feeling dizzy or drowsy;

  
  


• 
  

  headache;

  
  


• 
  

  sweating;

  
  


• 
  

  ringing in your ears; or

  
  


• 
  

  dry mouth.

  
  

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 aspirin and oxycodone?

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

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

• 
  

  acetazolamide (Diamox);

  
  


• 
  

  a diuretic (water pill);

  
  


• 
  

  methotrexate (Rheumatrex, Trexall);

  
  


• 
  

  steroids (prednisone and others);

  
  


• 
  

  a blood thinner such as warfarin (Coumadin, Jantoven);

  
  


• 
  

  a bronchodilator (such as Atrovent, Spiriva);

  
  


• 
  

  atropine (Donnatal), dimenhydrinate (Dramamine), or scopolamine (Transderm-Scop);

  
  


• 
  

  insulin or diabetes medications that you take by mouth;

  
  


• 
  

  an ACE inhibitor such as benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace), and others;

  
  


• 
  

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

  
  


• 
  

  bowel or bladder medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin), tolterodine (Detrol) and others; or

  
  


• 
  

  an NSAID such as ibuprofen (Motrin, Advil), diclofenac (Cataflam, Celecoxib, Voltaren), etodolac (Lodine), indomethacin (Indocin), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.

  
  

This list is not complete and other drugs may interact with aspirin and oxycodone. 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 Percodan resources

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

• Percodan Prescribing Information (FDA)


• Percodan Consumer Overview


• Percodan Advanced Consumer (Micromedex) - Includes Dosage Information


• Percodan MedFacts Consumer Leaflet (Wolters Kluwer)


• Endodan Prescribing Information (FDA)

Compare Percodan with other medications

• Pain

Where can I get more information?

• Your pharmacist can provide more information about aspirin and oxycodone.

See also: Percodan side effects (in more detail)

PrameGel

Generic Name: pramoxine topical (pra MOX een TOP i kal)

Brand Names: Anest Hemor, Blistex Pro Relief, Calaclear, Caladryl Clear, Callergy Clear, Curasore, Fleet Pain Relief Pad, Gold Bond Anti-Itch, Itch-X, PrameGel, Pramox, Prax, Proctofoam, Proctozone-P, Sarna Sensitive, Sarna Sensitive Eczema Itch Relief, Sarna Ultra, Soothe-It Plus Hemmorhoidal Pad, Summers Eve Anti-Itch, Tronolane

What is PrameGel (pramoxine topical)?

Pramoxine is an anesthetic, or "numbing medicine." It works by interfering with pain signals sent from the nerves to the brain.

Pramoxine topical (for the skin) is used to treat pain or itching caused by insect bites, minor burns or scrapes, hemorrhoids, and minor skin rash, dryness, or itching. Pramoxine topical is also used to treat chapped lips, and pain or skin irritation caused by coming into contact with poison ivy, poison oak, or poison sumac.

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

What is the most important information I should know about PrameGel (pramoxine topical)?

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.

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

Less serious side effects are more likely, and you may have none at all.

What should I discuss with my health care provider before using PrameGel (pramoxine topical)?

You should not use this medication if you are allergic to pramoxine.

Ask a doctor or pharmacist if it is safe for you to take this medicine if you are allergic to any drugs or any other numbing medicines.

FDA pregnancy category C. It is not known whether pramoxine topical will harm an unborn baby. Do not use this medication without medical advice if you are pregnant. It is not known whether pramoxine topical passes into breast milk or if it could harm a nursing baby. Do not use this medication without medical advice if you are breast-feeding a baby.

How should I use PrameGel (pramoxine topical)?

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.

Pramoxine is usually applied to the affected area 3 to 5 times daily, depending on which form of this medication you use. Follow the label directions or your doctor's instructions about how much medication to use and how often.

Pramoxine hemorrhoid cream, lotion, foam, or medicated wipe may be used on the rectum after each bowel movement to treat hemorrhoid pain and itching.

Wash your hands before and after applying pramoxine topical. Wash the affected skin area with warm water and a mild soap. Rinse and dry the area thoroughly.

To use pramoxine on the skin, (spray, lotion, gel, or stick), apply just enough of the medication to cover the area to be treated.

To use the pramoxine medicated wipe to treat the hemorrhoid area, apply the medication by patting the wipe onto the rectal area. Avoid harsh rubbing. You may fold the wipe and leave it in place for up to 15 minutes. Each pramoxine medicated wipe is for one use only. Throw the wipe away after using.

Shake the pramoxine rectal foam before each use. Squirt only a small amount of the medicine onto a clean tissue and apply it to your rectum. Do not insert this medication or the medicated wipe into your rectum. Use pramoxine topical only on the outside of the area.

Stop using pramoxine and call your doctor if your symptoms do not improve after 7 days of treatment, or if your condition clears up and then comes back.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Since pramoxine topical is used on an as needed basis, you are not likely to miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using PrameGel (pramoxine topical)?

Avoid getting this medication in your eyes or nose. If this does happen, rinse with water. Do not use pramoxine topical on deep skin wounds, blistered skin, severe burns, or large skin areas. Seek medical attention for more severe skin irritation or injury.

Avoid using other medications on the areas you treat with pramoxine topical unless you doctor tells you to.

PrameGel (pramoxine topical) 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 pramoxine topical and call your doctor at once if you have a serious side effect such as:

• 
  

  any new redness or swelling where the medicine was applied; or

  
  


• 
  

  severe pain, burning, or stinging where the medicine is applied.

  
  

Less serious side effects are more likely, and you may have none at all.

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 PrameGel (pramoxine topical)?

It is not likely that other drugs you take orally or inject will have an effect on topically applied pramoxine. But many drugs can interact with each other. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

More PrameGel resources

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

• PrameGel Gel MedFacts Consumer Leaflet (Wolters Kluwer)


• Caladryl Clear MedFacts Consumer Leaflet (Wolters Kluwer)


• Itch-X Foam MedFacts Consumer Leaflet (Wolters Kluwer)


• Pramoxine Hydrochloride Monograph (AHFS DI)


• Prax Lotion MedFacts Consumer Leaflet (Wolters Kluwer)


• Proctofoam Foam MedFacts Consumer Leaflet (Wolters Kluwer)


• Sarna Sensitive Lotion MedFacts Consumer Leaflet (Wolters Kluwer)


• Tronolane Cream MedFacts Consumer Leaflet (Wolters Kluwer)

Compare PrameGel with other medications

• Anal Itching
• Pruritus

Where can I get more information?

• Your pharmacist can provide more information about pramoxine topical.

See also: PrameGel side effects (in more detail)

Hypnorex

Hypnorex may be available in the countries listed below.

Ingredient matches for Hypnorex

Lithium

Lithium carbonate (a derivative of Lithium) is reported as an ingredient of Hypnorex in the following countries:

• Germany

International Drug Name Search

Phenytek

Generic Name: phenytoin (oral) (FEN i toyn)

Brand Names: Dilantin, Dilantin Infatabs, Dilantin-125, Phenytek

What is phenytoin?

Phenytoin is an anti-epileptic drug, also called an anticonvulsant. It works by slowing down impulses in the brain that cause seizures.

Phenytoin is used to control seizures. Phenytoin is not made to treat all types of seizures, and your doctor will determine if it is the right medication for you.

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

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

You may have thoughts about suicide while taking this medication. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

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

You may have thoughts about suicide while taking this medication. Tell your doctor if you have new or worsening depression or suicidal thoughts during the first several months of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.

Patients of Asian ancestry may have a higher risk of developing a rare but serious skin reaction to phenytoin. Your doctor may recommend a blood test before you start the medication to determine your risk of this skin reaction.

How should I take phenytoin?

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.

Do not crush, chew, break, or open an extended-release capsule. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time. Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid 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.

To be sure this medication is helping your condition, your blood may need to be tested often. You may also need a blood test when switching from one form of phenytoin to another. Visit your doctor regularly.

If you are taking phenytoin to treat seizures, keep taking the medication even if you feel fine. You may have an increase in seizures if you stop taking phenytoin. Follow your doctor's instructions. Wear a medical alert tag or carry an ID card stating that you take phenytoin. Any medical care provider who treats you should know that you are taking a seizure medication. Store at room temperature away from moisture, light, and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of phenytoin can be fatal.

What should I avoid while taking phenytoin?

Drinking alcohol can increase some of the side effects of phenytoin, and can also increase your risk of seizure.

Avoid taking antacids at the same time you take phenytoin. Antacids can make it harder for your body to absorb the medication.

Phenytoin may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Phenytoin 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.

Less serious side effects may include:

• 
  

  headache, joint pain.

  
  

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

What other drugs will affect phenytoin?

Drugs that can increase phenytoin levels in your blood include:

• 
  

  stomach acid reducers such as cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), or nizatidine (Axid);

  
  


• 
  

  certain sedatives (such as Librium or Valium) or antidepressants (such as Prozac);

  
  


• 
  

  estrogen hormone replacement;

  
  

This list is not complete and there are many other medicines that can interact with phenytoin. 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. Keep a list of all your medicines and show it to any healthcare provider who treats you.

More Phenytek resources

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

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


• Phenytek Prescribing Information (FDA)


• Phenytek Advanced Consumer (Micromedex) - Includes Dosage Information


• Phenytoin Professional Patient Advice (Wolters Kluwer)


• Phenytoin Monograph (AHFS DI)


• Phenytoin MedFacts Consumer Leaflet (Wolters Kluwer)


• Dilantin Suspension MedFacts Consumer Leaflet (Wolters Kluwer)


• Dilantin Prescribing Information (FDA)


• Dilantin Consumer Overview


• Dilantin Infatabs Chewable Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Dilantin Infatabs Prescribing Information (FDA)


• Dilantin Kapseals Prescribing Information (FDA)


• Dilantin-125 Prescribing Information (FDA)

Compare Phenytek with other medications

• Anxiety
• Arrhythmia
• Epilepsy
• Neurosurgery
• Peripheral Neuropathy
• Seizures
• Status Epilepticus
• Trigeminal Neuralgia

Where can I get more information?

• Your pharmacist can provide more information about phenytoin.

See also: Phenytek side effects (in more detail)

Patanol

Generic Name: olopatadine (Ophthalmic route)

oh-loe-PA-ta-deen

Commonly used brand name(s)

In the U.S.

• Pataday


• Patanol

Available Dosage Forms:

• Solution

Therapeutic Class: Ophthalmologic Agent

Pharmacologic Class: Antihistamine

Uses For Patanol

Olopatadine ophthalmic (eye) solution is used to temporarily prevent itching of the eye caused by a condition known as allergic conjunctivitis. It works by acting on certain cells, called mast cells, to prevent them from releasing substances that cause the allergic reaction.

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

Before Using Patanol

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

Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of olopatadine in children up to 3 years of age with use in other age groups.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of olopatadine in the elderly with use in other age groups.

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. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

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.

Proper Use of olopatadine

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

This medicine should not be used for irritation caused by contact lenses.

If your eye is red, do not wear your contact lens.

If you wear contact lenses: Take out your contact lenses before using olopatadine eye drops. Wait at least 10 minutes after putting the eye drops in before you put your contact lenses back in only if your eye is not red.

To use the eye drops:

• First, wash your hands. Tilt your head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed for 1 or 2 minutes to allow the medicine to be absorbed by the eye.


• If you think you did not get the drop of medicine into your eye properly, use another drop.


• To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed.

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 ophthalmic dosage form (eye drops):
  
  • For treatment of allergic conjunctivitis:
    
    • Adults and children 3 years of age and older—Use one drop (0.1% solution) in each affected eye two times a day, with each dose being at least six to eight hours apart. Or, use one drop (0.2% solution) in each affected eye one time a day.
    
    
    • Children up to 3 years of age—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.

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.

Precautions While Using Patanol

If your symptoms do not improve or if your condition becomes worse, check with your doctor.

Patanol 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.

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

• Headache


• runny or stuffy nose


• sore throat

Less common

• Back pain


• burning, dryness, itching, or stinging of the eye


• change in taste


• chills


• diarrhea


• eye irritation or pain


• feeling of something in the eye


• general feeling of discomfort or illness


• increased cough


• loss of appetite


• muscle aches and pains


• nausea


• pain


• redness of eye or inside of eyelid


• shivering


• sweating


• swelling of eyelid


• trouble sleeping


• unusual tiredness or weakness


• vomiting

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: Patanol 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 Patanol resources

• Patanol Side Effects (in more detail)
• Patanol Use in Pregnancy & Breastfeeding
• Patanol Support Group
• 8 Reviews for Patanol - Add your own review/rating

• Patanol Prescribing Information (FDA)


• Patanol Consumer Overview


• Patanol Monograph (AHFS DI)


• Patanol Drops MedFacts Consumer Leaflet (Wolters Kluwer)


• Pataday Prescribing Information (FDA)

Compare Patanol with other medications

• Seasonal Allergic Conjunctivitis

Chlorofarm-S

Chlorofarm-S may be available in the countries listed below.

Ingredient matches for Chlorofarm-S

Buflomedil

Buflomedil hydrochloride (a derivative of Buflomedil) is reported as an ingredient of Chlorofarm-S in the following countries:

• Greece

International Drug Name Search

Pancrelipase Capsules

Pronunciation: PAN-kree-LYE-pase
Generic Name: Pancrelipase
Brand Name: Examples include Creon and Zenpep

Pancrelipase Capsules is used for:

Improving food digestion in patients who cannot digest food properly because they have a pancreas problem (exocrine pancreatic insufficiency) caused by cystic fibrosis or certain other conditions.

Pancrelipase Capsules is a digestive enzyme combination. It works by helping the body to digest protein, starch, and fat.

Do NOT use Pancrelipase Capsules if:

• you are allergic to any ingredient in Pancrelipase Capsules


• you have inflammation of the pancreas (pancreatitis) or a flare-up of long-term pancreas problems

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

Before using Pancrelipase Capsules:

Some medical conditions may interact with Pancrelipase 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 (including pork proteins)


• if you have gout, high uric acid levels, or a history of kidney problems


• if you have a history of pancreas problems or stomach or bowel problems (eg, blockage, scarring, short bowel syndrome, Crohn disease)


• if you have trouble swallowing capsules

Some MEDICINES MAY INTERACT with Pancrelipase Capsules. However, no specific interactions with Pancrelipase Capsules are known at this time.

Ask your health care provider if Pancrelipase 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 Pancrelipase Capsules:

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

• Pancrelipase Capsules comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Pancrelipase Capsules refilled.


• Take Pancrelipase Capsules by mouth with each meal or snack as directed by your doctor.


• Swallow Pancrelipase Capsules whole with enough liquid to swallow it completely. Do not break, crush, chew, or hold Pancrelipase Capsules in your mouth before swallowing. Doing so may increase the risk of mouth or tongue irritation from Pancrelipase Capsules. Follow with a glass of water or juice. Contact your doctor if you experience mouth or tongue irritation while taking Pancrelipase Capsules.


• If the patient is an infant (up to 12 months old), open the capsule and sprinkle the contents into the infant's mouth or over a small amount of applesauce at room temperature. Do NOT mix Pancrelipase Capsules directly in breast milk or formula. If sprinkled onto applesauce, give the mixture to the infant right away. After giving Pancrelipase Capsules, follow it with breast milk or formula. Be sure that none of the medicine is crushed, chewed, or left in the mouth.


• If the patient is an adult or child older than 12 months who cannot swallow the capsule whole, open it and sprinkle the contents over a small amount of acidic soft food (such as applesauce) at room temperature. Mix the medicine with the food and swallow the entire mixture right away, followed by a glass of water or juice. Be sure that none of the medicine is crushed, chewed, or left in the mouth. Check with your doctor if you are unsure which foods you may mix with Pancrelipase Capsules.


• If you miss a dose of Pancrelipase Capsules, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once or take a dose without a snack or a meal.

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

Important safety information:

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


• Do NOT take more than the recommended dose without checking with your doctor.


• Do not switch between Pancrelipase Capsules and another pancreatic enzyme medicine without first checking with your doctor.


• Pancrelipase Capsules may cause high or low blood sugar. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your heart beat faster; make your vision change; give you a headache, chills, or tremors; or make you hungrier. 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 you experience any of these symptoms, contact your doctor right away.


• Pancrelipase Capsules may increase the risk of developing a rare, serious condition called fibrosing colonopathy. When this occurs, it is usually with high doses over a long period of time. It has been most commonly reported in children with cystic fibrosis. Contact your doctor right away if you experience unusual or severe nausea, vomiting, or stomach pain, or severe or persistent loose stools, constipation, or diarrhea.


• Pancrelipase Capsules comes from pork (pig) pancreas tissue. There is an extremely rare risk of developing a viral disease from this product. No cases of viral disease from pork pancreas products have been identified.


• CHILDREN may be more likely to experience certain side effects (decreased appetite, irritability) while taking Pancrelipase Capsules. Discuss any questions with your doctor.


• PREGNANCY and BREAST-FEEDING: It is not known if Pancrelipase Capsules can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Pancrelipase Capsules while you are pregnant. It is not known if Pancrelipase Capsules is found in breast milk. If you are or will be breast-feeding while you use Pancrelipase Capsules, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Pancrelipase 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:

Decreased appetite; dizziness; frequent or abnormal bowel movements; gas; headache; irritability; sore throat or cough; stomach pain; vomiting.

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); painful, swollen joints; severe or persistent loose stools, diarrhea, or constipation; severe or unusual nausea, vomiting, or stomach pain; stomach bloating; symptoms of high blood sugar (eg, increased urination, thirst, or hunger; confusion; unusual drowsiness; fast breathing; flushing); symptoms of low blood sugar (eg, anxiety, dizziness, drowsiness, fast heartbeat, headache, lightheadedness, tremors, unusual sweating, weakness).

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: Pancrelipase 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.

Proper storage of Pancrelipase Capsules:

Store Pancrelipase Capsules at room temperature up to 77 degrees F (25 degrees C). Brief storage at temperatures between 77 and 104 degrees F (25 and 40 degrees C) is permitted for up to 30 days. Store in the original container away from heat, moisture, and light. Do not store in the bathroom. Keep Pancrelipase Capsules out of the reach of children and away from pets.

General information:

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


• Pancrelipase 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 Pancrelipase 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 Pancrelipase resources

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

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Thioctic Acid

In some countries, this medicine may only be approved for veterinary use.

Scheme

BAN

ATC (Anatomical Therapeutic Chemical Classification)

A16AX01

CAS registry number (Chemical Abstracts Service)

0000062-46-4

Chemical Formula

C8-H14-O2-S2

Molecular Weight

206

Therapeutic Category

Hepatoprotective agent

Chemical Name

1,2-Dithiolane-3-pentanoic acid

Foreign Names

• Acidum thiocticum (Latin)
• DL-alpha-Liponsäure (German)

Generic Names

• Thioctic Acid (OS: BAN, JAN)
• 6,8-Thioctsäure (IS)
• Lipoaminsäure (IS)
• α-Lipoic Acid (IS)
• Acidum thiocticum (PH: Ph. Eur. 6)
• Thioctic Acid (PH: BP 2010, Ph. Eur. 6)
• alpha-Liponsäure, Ethylenbis(azan)-Salz (IS)
• Ethylenediamine thioctate (IS)
• Thioctic acid diaminoethane (IS)
• Thioctic acid ethanediamine (IS)

Brand Names

• Alanox
  Darya-Varia, Indonesia



• Alpha-Lipogamma
  Wörwag Pharma, Germany



• Alpha-Lipon AL
  Aliud, Germany



• Alpha-Lipon Stada
  Stada, Germany



• Alpha-Lipon
  Stada, China



• alpha-Liponsäure Heumann
  Heumann, Germany



• alpha-Liponsäure Sandoz
  Sandoz, Germany



• Alpha-Liponsäure-CT
  CT Arzneimittel, Germany



• Alpha-RP
  MIP, Germany



• alpha-Vibolex
  CNP, Germany



• Berlithion
  Berlin-Chemie, Serbia; Berlin-Chemie, Russian Federation



• Berlition
  Berlin Chemie, Bosnia & Herzegowina



• Biletan
  Gador, Argentina



• Biomo-lipon
  Biomo, Germany



• espa-lipon
  Esparma, Germany; Esparma, Russian Federation; espharma, Lithuania



• Lipoicin
  Takeda, Hong Kong



• Liponsäure-ratiopharm
  Ratiopharm, Germany



• Lypoaran
  Kobayashi Kako, Japan



• Mecola Forte
  Lapi Laboratories, Indonesia



• Neurium
  Hexal, Germany



• Neurotioct
  TRB, Argentina



• Neutracol
  Beta, Argentina



• Retipon
  Mann, Germany



• Thioctacid
  Bayer, Mexico; Gen, Turkey; Meda, Austria; Meda, Germany; Meda, Lithuania; Meda, Romania; Meda Pharma, Slovakia; Pliva, Russian Federation; Viatris, Czech Republic; Viatris, Georgia; Viatris, Romania



• Thiogamma oral
  Wörwag Pharma, Czech Republic



• Thiogamma
  Artesan, Serbia; Solupharm, Bulgaria; Solupharm, Serbia; Worwag, Slovakia; Wörwag Pharma, Czech Republic; Wörwag Pharma, Germany; Wörwag Pharma, Georgia; Wörwag Pharma, Lithuania; Wörwag Pharma, Latvia; Wörwag Pharma, Poland; Wörwag Pharma, Romania; Wörwag Pharma, Russian Federation



• Thiotomin
  Nisshin Seiyaku - Yamagata, Japan



• Tioctan
  Farmindustria, Peru; Purissimus, Argentina; Roth, Austria



• Tioctan (veterinary use)
  Bayer Animal Health, South Africa



• Tromlipon
  Trommsdorff, Germany



• Alpha-Lipogamma
  Wörwag Pharma, Germany



• Biomo-lipon
  Biomo, Germany



• espa-lipon
  Esparma, Germany; espharma, Lithuania



• Liponsäure-ratiopharm
  Ratiopharm, Germany



• Neurium
  Hexal, Germany



• Vitatrans
  Medice, Germany



• Alpha-Lipogamma
  Wörwag Pharma, Germany



• Thiogamma
  Worwag, Slovakia



• Thiogamma Injekt
  Wörwag Pharma, Germany



• Thiogamma Turbo-Set
  Wörwag Pharma, Germany



• Thioctacid T
  Meda, Lithuania; Pliva, Russian Federation; Viatris, Czech Republic



• Thioctacid
  Meda, Austria; Meda, Germany; Meda, Estonia; Meda, Latvia; Meda Pharma, Slovakia



• Tromlipon
  Trommsdorff, Germany

International Drug Name Search

Glossary

BAN	British Approved Name
IS	Inofficial Synonym
JAN	Japanese Accepted Name
OS	Official Synonym
PH	Pharmacopoeia Name

Click for further information on drug naming conventions and International Nonproprietary Names.