Thursday, September 29, 2016

Talofen




Talofen may be available in the countries listed below.


Ingredient matches for Talofen



Promazine

Promazine hydrochloride (a derivative of Promazine) is reported as an ingredient of Talofen in the following countries:


  • Italy

International Drug Name Search

Terbinafine Teva




Terbinafine-Teva may be available in the countries listed below.


Ingredient matches for Terbinafine-Teva



Terbinafine

Terbinafine hydrochloride (a derivative of Terbinafine) is reported as an ingredient of Terbinafine-Teva in the following countries:


  • Belgium

  • France

  • Israel

International Drug Name Search

ALLERcalm Allergy Relief Tablets





1. Name Of The Medicinal Product



1. CHLORPHENAMINE TABLETS BP 4mg



2. Alpharma Chlorphenamine Hayfever & Allergy Relief Tablets



3. Vantage Chlorphenamine Hayfever & Allergy Relief Tablets



4. ALLERcalm Allergy Relief Tablets


2. Qualitative And Quantitative Composition



Each tablet contains 4mg Chlorphenamine Maleate.



3. Pharmaceutical Form



Yellow uncoated tablets.



4. Clinical Particulars



4.1 Therapeutic Indications



1) For the symptomatic control of all allergic conditions which are responsive to antihistamines, including hay fever, urticaria, vasomotor rhinitis, angioneurotic oedema, food allergy, drug and serum reactions, insect bites.



4.2 Posology And Method Of Administration



Posology



Adults: 1 tablet every four or six hours to a maximum daily dose of 24mg.



Not recommended for children under 12 years of age unless otherwise directed by a practitioner.



Elderly: As in adults, but the elderly are prone to confusional psychosis and other neurological anticholinergic effects.



Method of Administration



For oral administration.



4.3 Contraindications



Hypersensitivity to antihistamines; patients who have received therapy with MAOI's within the previous fourteen days.



4.4 Special Warnings And Precautions For Use



In common with other drugs having anticholinergic effects, Chlorphenamine should be used with caution in epilepsy, prostatic hypertrophy, glaucoma, hepatic disease, bronchitis, bronchiectasis, thyrotoxicosis, raised intra-ocular pressure, severe hypertension or cardiovascular disease and bronchial asthma.



4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction



Chlorphenamine may have an additive effect when used concurrently with hypnotics and anxiolytics causing potentiation of drowsiness. A similar additive effect will result from concurrent usage of alcohol with Chlorphenamine. MAOI therapy intensifies the anticholinergic effects of Chlorphenamine. Chlorphenamine inhibits phenytoin metabolism and can lead to phenytoin toxicity.



4.6 Pregnancy And Lactation



The safety of Chlorphenamine in pregnancy has not been established. Chlorphenamine should therefore only be used when clearly required and when potential benefits outweigh the potential unknown risks to the foetus. Use during the third trimester may result in reactions in the newborn or premature neonates.



Small amounts of antihistamines are excreted in breast milk. Use by nursing mothers is not recommended because of the risks of adverse effects in the infant.



Antihistamines may inhibit lactation.



4.7 Effects On Ability To Drive And Use Machines



The anticholinergic properties of Chlorphenamine may cause drowsiness, dizziness, blurred vision and psychomotor impairment, which can seriously hamper the patient's ability to drive and use machinery.



4.8 Undesirable Effects



Sedation varying from slight drowsiness to deep sleep. Inability to concentrate, lassitude, blurred vision, GI disturbances such as nausea, vomiting and diarrhoea may occasionally occur. Urinary retention, headaches, dryness of the mouth. Dizziness, palpitation, tachycardia, arrhythmias, hypotension, tightness of the chest, abdominal pain, dyspepsia, anorexia, hepatic including jaundice, thickening of the bronchial secretions, haemolytic anaemia and other blood dyscrasias infrequently occur.



Allergic reactions including exfoliative dermatitis, photosensitivity and skin reactions. Urticaria, twitching, muscular weakness and in co-ordination. Tinnitus, depression, irritability and nightmares infrequently occur.



Paradoxical excitation in children and confusional psychosis in the elderly can occur.



The effects of alcohol may be increased. Children and the elderly are more likely to experience the neurological anticholinergic effects.



4.9 Overdose



The estimated lethal dose of Chlorphenamine is 25-50mg/kg body weight.



Symptoms and signs include sedation, paradoxical stimulation of the CNS, toxic psychosis, seizures, apnoea, convulsions, anticholinergic effects, dystonic reactions and cardiovascular collapse including arrhythmias.



Treatment includes gastric lavage or emesis using ipecacuanha syrup. Following these measures activated charcoal and cathartics may be administered to minimise absorption. Other symptomatic and supportive measures should be provided with special attention to cardiac, respiratory, renal and hepatic functions and fluid and electrolyte balance.



Treat hypotension and arrhythmias vigorously. CNS convulsions may be treated with IV diazepam or phenytoin. Haemoperfusion may be used in severe cases.



5. Pharmacological Properties



5.1 Pharmacodynamic Properties



Chlorphenamine Maleate is an antihistamine.



5.2 Pharmacokinetic Properties



Chlorphenamine Maleate is an alkylamine derivative with a plasma half-life of up to 42 hours which is extensively metabolised in the liver and excreted almost exclusively in the urine.



5.3 Preclinical Safety Data



There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.



6. Pharmaceutical Particulars



6.1 List Of Excipients



Also contains: calcium sulphate, magnesium stearate, maize starch, E172, E460.



6.2 Incompatibilities



None known.



6.3 Shelf Life



Shelf-life



Three years from the date of manufacture.



Shelf-life after dilution/reconstitution



Not applicable.



Shelf-life after first opening



Not applicable.



6.4 Special Precautions For Storage



Store below 25°C in a dry place.



6.5 Nature And Contents Of Container



The product containers are rigid injection moulded polypropylene or injection blow-moulded polyethylene tablet containers with polyfoam wad or polyethylene ullage filler and snap-on polyethylene lids; in case any supply difficulties should arise the alternative is amber glass bottles with screw caps and polyfoam wad or cotton wool.



The product may also be supplied in blister packs in cartons:



a) Carton: Printed carton manufactured from white folding box board.



b) Blister pack: (i) 250µm white rigid PVC. (ii) Surface printed 20µm hard temper aluminium foil with 5-7g/M² PVC and PVdC compatible heat seal lacquer on the reverse side.



Pack sizes: 7, 28, 30, 50, 56, 60, 84, 90, 100, 112, 120, 168, 180, 250, 500, 1000.



Product may also be supplied in bulk packs, for reassembly purposes only, in polybags contained in tins, skillets or polybuckets filled with suitable cushioning material. Bulk packs are included for temporary storage of the finished product before final packaging into the proposed marketing containers.



Maximum size of bulk packs: 50,000.



6.6 Special Precautions For Disposal And Other Handling



Not applicable.



Administrative Data


7. Marketing Authorisation Holder



Name or style and permanent address of registered place of business of the holder of the Marketing Authorisation:



Actavis UK Limited



(Trading style: Actavis)



Whiddon Valley



BARNSTAPLE



N Devon EX32 8NS



8. Marketing Authorisation Number(S)



PL 0142/0209



9. Date Of First Authorisation/Renewal Of The Authorisation



9.5.86



Renewed: 20.10.02



10. Date Of Revision Of The Text



June 2007




Terbinafina Ratiopharm




Terbinafina Ratiopharm may be available in the countries listed below.


Ingredient matches for Terbinafina Ratiopharm



Terbinafine

Terbinafine is reported as an ingredient of Terbinafina Ratiopharm in the following countries:


  • Portugal

International Drug Name Search

Wednesday, September 28, 2016

Vecural




Vecural may be available in the countries listed below.


Ingredient matches for Vecural



Vecuronium

Vecuronium Bromide is reported as an ingredient of Vecural in the following countries:


  • Argentina

  • Peru

International Drug Name Search

Teobid




Teobid may be available in the countries listed below.


Ingredient matches for Teobid



Theophylline

Theophylline is reported as an ingredient of Teobid in the following countries:


  • Venezuela

International Drug Name Search

Tamizam




Tamizam may be available in the countries listed below.


Ingredient matches for Tamizam



Tamoxifen

Tamoxifen citrate (a derivative of Tamoxifen) is reported as an ingredient of Tamizam in the following countries:


  • Belgium

  • Luxembourg

International Drug Name Search

Pymeroxomil




Pymeroxomil may be available in the countries listed below.


Ingredient matches for Pymeroxomil



Bromazepam

Bromazepam is reported as an ingredient of Pymeroxomil in the following countries:


  • Vietnam

International Drug Name Search

Alendromet




Alendromet may be available in the countries listed below.


Ingredient matches for Alendromet



Alendronic Acid

Alendronic Acid sodium trihydrate (a derivative of Alendronic Acid) is reported as an ingredient of Alendromet in the following countries:


  • Germany

International Drug Name Search

Flavosten




Flavosten may be available in the countries listed below.


Ingredient matches for Flavosten



Ipriflavone

Ipriflavone is reported as an ingredient of Flavosten in the following countries:


  • Japan

International Drug Name Search

Tax-O-Bid




Tax-O-Bid may be available in the countries listed below.


Ingredient matches for Tax-O-Bid



Cefotaxime

Cefotaxime is reported as an ingredient of Tax-O-Bid in the following countries:


  • Ethiopia

International Drug Name Search

Heparin Sodium ADD-Vantage




Ingredient matches for Heparin Sodium ADD-Vantage



Heparin

Heparin sodium salt (a derivative of Heparin) is reported as an ingredient of Heparin Sodium ADD-Vantage in the following countries:


  • United States

International Drug Name Search

Tinatrim




Tinatrim may be available in the countries listed below.


Ingredient matches for Tinatrim



Clotrimazole

Clotrimazole is reported as an ingredient of Tinatrim in the following countries:


  • Bangladesh

International Drug Name Search

Terbinafina Genfar




Terbinafina Genfar may be available in the countries listed below.


Ingredient matches for Terbinafina Genfar



Terbinafine

Terbinafine is reported as an ingredient of Terbinafina Genfar in the following countries:


  • Colombia

International Drug Name Search

Humex allergie cétirizine




Humex allergie cétirizine may be available in the countries listed below.


Ingredient matches for Humex allergie cétirizine



Cetirizine

Cetirizine dihydrochloride (a derivative of Cetirizine) is reported as an ingredient of Humex allergie cétirizine in the following countries:


  • France

International Drug Name Search

Lanreotide




In the US, Lanreotide (lanreotide systemic) is a member of the drug class somatostatin and somatostatin analogs and is used to treat Acromegaly.

US matches:

  • Lanreotide

  • Lanreotide Subcutaneous

  • Lanreotide Acetate

Scheme

Rec.INN

ATC (Anatomical Therapeutic Chemical Classification)

H01CB03

CAS registry number (Chemical Abstracts Service)

0108736-35-2

Chemical Formula

C54-H69-N11-O10-S2

Molecular Weight

1096

Therapeutic Categories

Antineoplastic agent

Growth hormone release inhibiting hormone analogue (analogue of somatostatin)

Chemical Names

3-(2-Naphthyl)-D-alanyl-L-cysteinyl-L-tyrosyl-D-tryptophyl-L-lysyl-L-valyl-L-cysteinyl-L-threoninamid, cycl.(2-7)-disulfid (IUPAC)

3-(2-Naphthyl)-D-alanyl-L-cysteinyl-L-tyrosyl-D-tryptophyl-L-lysyl-L-valyl-L-cysteinyl-L-threoninamide, cyclic (2->7)-disulfide (WHO)

L-Threoninamide, 3-(2-naphthalenyl)-D-alanyl-L-cysteinyl-L-tyrosyl-D-tryptophyl-L-lysyl-L-valyl-L-cysteinyl-, cyclic (2->7)-disulfide

Foreign Names

  • Lanreotidum (Latin)
  • Lanreotid (German)
  • Lanréotide (French)
  • Lanreotida (Spanish)

Generic Names

  • Lanreotide (OS: BAN)
  • Lanréotide (OS: DCF)
  • BIM 23014 (IS)
  • BN 52030 (IS)
  • Lanreotide Acetate (OS: USAN)
  • BIM 23014C (IS: Ipsen)

Brand Names

  • Ipstyl Lyfjaver
    Lyfjaver, Iceland


  • Ipstyl
    Ipsen, Italy


  • Somatulina LP
    Ipsen, Portugal


  • Somatuline
    Gen, Turkey; Ipsen, Slovakia


  • Somatuline PR
    Beaufour Ipsen, Taiwan


  • Ipstyl
    Ipsen, Denmark; Ipsen, Iceland; Ipsen, Italy; Ipsen, Norway


  • Somatulina Autogel
    Ipsen, Spain; Ipsen, Portugal


  • Somatulina
    Ipsen, Spain; Ipsen, Portugal


  • Somatuline retard
    Ipsen, Austria


  • Somatuline
    Beaufour Ipsen, Hungary; Beaufour Ipsen, Poland; Beaufour Ipsen, Romania; Delphi, Netherlands; Dr. Fisher, Netherlands; EU-Pharma, Netherlands; Ipsen, Australia; Ipsen, Belgium; Ipsen, Czech Republic; Ipsen, Estonia; Ipsen, Finland; Ipsen, France; Ipsen, United Kingdom; Ipsen, Greece; Ipsen, Ireland; Ipsen, Israel; Ipsen, Latvia; Ipsen, Netherlands; Ipsen, Serbia; Ipsen, Russian Federation; Ipsen, Slovakia; Ipsen, United States; Medcor, Netherlands; Stephar, Netherlands; Synthesis, Colombia


  • Somatuline Autogel
    Beaufour Ipsen, Romania; Globopharm, Switzerland; Ipsen, Austria; Ipsen, Australia; Ipsen, Germany; Ipsen, Ireland; Ipsen, Israel; Ipsen, Lithuania; Ipsen, Luxembourg; Ipsen, Serbia; Ipsen, Sweden; PharmaSwiss, Slovenia; Sidus, Argentina


  • Somatuline PR
    Ipsen, Czech Republic; Ipsen, Finland; Ipsen, Hong Kong; Ipsen, Lithuania; Ipsen, Luxembourg; Ipsen, Netherlands; Ipsen, Poland


  • Somatuline
    PRIpsen, Sweden


  • Somatuline PR
    PharmaSwiss, Slovenia

International Drug Name Search

Glossary

BANBritish Approved Name
DCFDénomination Commune Française
IUPACInternational Union of Pure and Applied Chemistry
ISInofficial Synonym
OSOfficial Synonym
Rec.INNRecommended International Nonproprietary Name (World Health Organization)
USANUnited States Adopted Name
WHOWorld Health Organization

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

Tuesday, September 27, 2016

Terfenadine




In the US, Terfenadine (terfenadine systemic) is a member of the drug class antihistamines and is used to treat Allergies, Conjunctivitis - Allergic, Eye Redness/Itching, Hay Fever and Urticaria.

US matches:

  • Terfenadine

Scheme

Rec.INN

ATC (Anatomical Therapeutic Chemical Classification)

R06AX12

CAS registry number (Chemical Abstracts Service)

0050679-08-8

Chemical Formula

C32-H41-N-O2

Molecular Weight

471

Therapeutic Categories

Antiallergic agent

Histamine, H₁-receptor antagonist

Chemical Name

1-Piperidinebutanol, α-[4-(1,1-dimethylethyl)phenyl]-4-(hydroxydiphenylmethyl)-

Foreign Names

  • Terfenadinum (Latin)
  • Terfenadin (German)
  • Terfénadine (French)
  • Terfenadina (Spanish)

Generic Names

  • Terfenadina (OS: DCIT)
  • Terfenadine (OS: BAN, JAN, USAN)
  • Terfénadine (OS: DCF)
  • RMI 9918 (IS: MarionMerrell)
  • Terfenadin (PH: Ph. Eur. 6)
  • Terfenadine (PH: BP 2010, USP 23, Ph. Eur. 6)
  • Terfénadine (PH: Ph. Eur. 6)
  • Terfenadinum (PH: Ph. Eur. 6)

Brand Names

  • Bronal
    Galenika, Bosnia & Herzegowina; Galenika, Serbia


  • Effie
    Codal Synto, Sri Lanka


  • Histalergan
    Sanitas, Chile


  • Rhinofed (Terfenadine and Pseudoephedrine)
    Dexa Medica, Indonesia


  • Servinin
    Novartis, Bangladesh


  • Tamagon
    Medochemie, Bahrain; Medochemie, Cyprus; Medochemie, Iraq; Medochemie, Jordan; Medochemie, Sri Lanka; Medochemie, Sudan; Medochemie, Yemen


  • Tefen
    Srbolek, Serbia


  • Teldane
    Aventis, Peru


  • Terfenadin AL
    Aliud, Germany


  • Terfenadine FLX
    Accord Healthcare, Netherlands


  • Terfin
    Interbat, Indonesia


  • Ternadin
    Dunar, Spain


  • Triludan
    Aventis, Luxembourg

International Drug Name Search

Glossary

BANBritish Approved Name
DCFDénomination Commune Française
DCITDenominazione Comune Italiana
ISInofficial Synonym
JANJapanese Accepted Name
OSOfficial Synonym
PHPharmacopoeia Name
Rec.INNRecommended International Nonproprietary Name (World Health Organization)
USANUnited States Adopted Name

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

Tensobon




Tensobon may be available in the countries listed below.


Ingredient matches for Tensobon



Captopril

Captopril is reported as an ingredient of Tensobon in the following countries:


  • Germany

  • Indonesia

International Drug Name Search

Rythmodan 150mg Capsules.





1. Name Of The Medicinal Product



Rythmodan 150mg Capsules.


2. Qualitative And Quantitative Composition



Capsule containing Disopyramide 150mg.



For excipients, see 6.1.



3. Pharmaceutical Form



Capsule.



4. Clinical Particulars



4.1 Therapeutic Indications



Rythmodan is used in the treatment of cardiac arrhythmias as follows:-



1. The prevention and treatment of arrhythmias occurring after myocardial infarction.



2. Maintenance of normal rhythm following electroconversion eg atrial fibrillation, atrial flutter.



3. Persistent ventricular extrasystoles.



4. Control of arrhythmias following the use of digitalis or similar glycosides.



5. Suppression of arrhythmias during surgical procedures eg cardiac catheterisation.



6. The prevention of paraxysmal supraventricular tachycardia.



7. Other types of arrhythmias e.g. atrial extrasystoles, Wolff-Parkinson-White Syndrome.



4.2 Posology And Method Of Administration



Route of administration



Oral



300 mg to 800mg daily in divided doses.



Children :



Not recommended as insufficient data available.



Elderly



A dose reduction due to reduced renal and hepatic function in the elderly (especially elderly non-smokers) should be considered (see section 4.4)



4.3 Contraindications



Disopyramide is contra–indicated in un–paced second or third degree atrioventricular block; bundle–branch block associated with first–degree atrioventricular block ; unpaced bifasicular block; pre-existing long QT syndromes; severe sinus node dysfunction ; severe heart failure, unless of secondary to cardiac arrhythmia ; hypersensitivity to disopyramide. It is also contra–indicated in concomitant administration with other anti–arrhythmics or other drugs liable to provoke ventricular arrythmias, especially Torsade de Pointes (see section 4.5). The sustained release formulation is contra–indicated in patients with renal or hepatic impairment.



4.4 Special Warnings And Precautions For Use



Antiarrhythmic drugs belonging to the class 1c (Vaughan Williams Classification) were included in the Cardiac Arrhythmia Suppression Trial (CAST), a long term multicentre randomised, double blind study in patients with asymptomatic non life–threatening ventricular arrhythmia who have had a myocardial infarction more than six days but less than two years previously. A significant increase in mortality and non–fatal cardiac arrest rate was seen in patients treated with class 1c antiarrhythmic drugs when compared with a matched placebo group. The applicability of the CAST results to other antiarrhythmics and other populations (eg. those without recent infarction) is uncertain. At present, it is best to assume that the risk extends to other antiarrhythmic agents for patients with structural heart disease.



There is no evidence that prolonged suppression of ventricular premature contractions with antiarrhythmic drugs prevents sudden death. For this reason, antiarrhythmic drugs should not be prescribed for the treatment of patients with asymptomatic ventricular premature contractions.



All antiarrhythmic drugs can produce unwanted effects when they are used to treat symptomatic but not life threatening arrhythmia; the expected benefits should be balanced against their risks.



In patients with structural heart disease, proarrhythmia and cardiac decompensation are special risks associated with antiarrhythmic drugs. Special caution should be exercised when prescribing in this context.



Disopyramide should not be used in patients with uncompensated congestive heart failure, unless this heart failure is secondary to cardiac arrhythmia. If disopyramide is to be given under these circumstances, special care and monitoring are essential.



Life-threatening and haemodynamically significant arrhythmias are difficult to treat and affected patients have a high mortality risk. Treatment of these arrhythmias, by whatever modality, must be initiated in hospital.



Owing to its negative inotropic effect, disopyramide should be used with caution in patients suffering from significant cardiac failure.This group may be specially sensitive to the negative inotropic properties of disopyramide. Such patients should be fully digitalised or controlled with other therapy before treatment with disopyramide is commenced.



Aggravation of existing arrhythmia, or emergence of a new type of arrhythmia, demands urgent review of disopyramide treatment.



Similarly, if an atrioventricular block or a bifascicular block occurs during treatment, the use of disopyramide should be reviewed.



There have been reports of ventricular tachycardia, ventricular fibrillation and Torsade de Pointes in patients receiving disopyramide. These have usually, but not always, been associated with significant widening of the QRS complex or prolonged QT interval. The QT interval and QRS duration must be monitored and disopyramide should be stopped if these are increased by more than 25%. If these changes or arrhythmias develop the drug should be discontinued. Disopyramide should be used only with caution in patients with atrial flutter or atrial tachycardia with block as conversion of a partial AV block to a 1:1 response may occur, leading to a potentially more serious tachyarrhythmia.



The occurrence of hypotension following disopyramide administration requires prompt discontinuation of the drug. This has been observed especially in patients with cardiomyopathy or uncompensated congestive heart failure. Any resumption of therapy should be at a lower dose with close patient monitoring. Disopyramide should be used with caution in the treatment of digitalis intoxication.



Potassium imbalance: Antiarrhythmic drugs may be hazardous in patients with potassium imbalance, as potassium abnormalities can induce arrhythmias.



During treatment with disopyramide, potassium levels should be checked regularly. Patients treated with diuretics or stimulant laxatives are at particular risk of hypokalaemia.



Renal insufficiency: In renal insufficiency, the dosage of disopyramide should be reduced by adjusting the interval between administrations.



Hepatic insufficiency: Hepatic impairment causes an increase in the plasma half–life of Rythmodan and a reduced dosage may be required.



Hypoglycaemia:  Hypoglycaemia has been reported in association with disopyramide administration. The risk of hypoglycaemia, sometimes severe, occurs particularly in elderly or malnourished subjects, treated diabetics and patients with renal insufficiency or cardiac failure. Blood sugar levels should be monitored in all patients. Strict adherence to the dosing recommendations is advised. If hypoglycaemia occurs then treatment with disopyramide should be stopped.



Hypoglycaemia may be associated with interactions with drugs metabolised by hepatic CYP3A (see Section 4.5 Interactions with other medicinal products and other forms of interaction).



Atropine–like effects: There is a risk of :



– ocular hypertension in patients with narrow–angle glaucoma



– acute urinary retention in patients with prostatic enlargement



– aggravation of myasthenia gravis



– cognitive disorders, especially in elderly patients (see also section 4.8).



4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction



Combination with other antiarrhythmic drugs: Combinations of antiarrhythmic drugs are not well researched and their effect may be unpredictable. Thus, antiarrhythmic combination should be avoided except under certain circumstances, eg. beta–blockers for angina pectoris ; digoxin with beta–blocker and verapamil for the control of atrial fibrillation, when defined as effective for an individual.



Interaction with drugs associated with risk of Torsade de Pointes, such as



– tricyclic and tetracyclic antidepressants



– All macrolide antibiotics (e.g. erythromycin, clarithromycin, azithromycin etc)



– astemizole ; cisapride ; pentamidine ; pimozide ; sparfloxacin ; terfenadine and thioridazone.



Phosphodiesterase Type 5 Inhibitors:



There is evidence that phosphodiesterase Type 5 inhibitors may be potentially associated with a risk of QT prolongation. Concomitant administration of disopyramide with such drugs may potentially enhance this QT prolongation effect and is not recommended.



The concomitant use of these medications whilst undergoing treatment with disopyramide increases the chance of cardiac arrhythmia.



There is some evidence that disopyramide is metabolised by hepatic CYP3A. Concomitant administration of significant inhibitors of this isozyme (e.g. certain macrolide or azole antifungal antibiotics) may therefore increase the serum levels of disopyramide. On the other hand, inducers of CYP3A (e.g. rifampicin and certain anticonvulsants such as phenytoin, primidone and phenobarbital) may reduce disopyramide and increase MN–disopyramide serum levels. Since the magnitude of such potential effects is not foreseeable, such drug combinations are not recommended.



When prescribing a drug metabolised by CYP3A [such as theophylline, HIV protease inhibitors (e.g. ritonavir, indinavir, saquinavir), ciclosporin A, warfarin] it should be kept in mind that disopyramide is probably also a substrate of this isozyme and thus competitive inhibition of metabolism might occur, possibly increasing serum levels of these drugs.



Interactions with hypokalaemia inducing drugs: Concomitant use with drugs can induce hypokalaemia such as : diuretics, amphotericin B, tetracosactide (corticotropin analogue), gluco and mineralo–corticoids may reduce the action of the drug, or potentiate proarrhythmic effects. Stimulant laxatives are not recommended to be given concomitantly, due to their potassium lowering potential.



Other drug interactions:



Atropine and other anticholinergic drugs, including phenothiazines, may potentiate the atropine–like effects of disopyramide.



4.6 Pregnancy And Lactation



Pregnancy: Although Rythmodan has undergone animal tests for teratogenicity without evidence of any effect on the developing foetus, its safety in human pregnancy has not been established. Rythmodan has been reported to stimulate contractions of the pregnant uterus. The drug should only be used during pregnancy if benefits clearly outweigh the possible risks to the mother and foetus.



Lactation: Studies have shown that oral Rythmodan is secreted in breast milk, although no adverse effects to the infant have been noted. However, clinical experience is limited and Rythmodan should only be used in lactation if, in the clinician's judgement, it is essential for the welfare of the patient. The infant should be closely supervised, particularly for anticholinergic effects and drug levels determined if necessary. Ideally, if the drug is considered essential, an alternative method of feeding should be used.



4.7 Effects On Ability To Drive And Use Machines



Some adverse reactions may impair the patients ability to concentrate and react, and hence the ability to drive or operate machinery. (See section 4.8).



4.8 Undesirable Effects



Cardiac: It is accepted that the arrhythmogenic potential of disopyramide is weak. However, as with all antiarrhythmic drugs, disopyramide may worsen or provoke arrhythmias. This proarrhythmic effect is more likely to occur in the presence of hypokalemia with the associated use of antiarrhythmic drugs, in patients with severe structural heart disease with prolongation of the QT interval.



Intra–cardiac conduction abnormalities may occur: QT interval prolongation, widening of the QRS complex, atrioventricular block and bundle–branch block.



Other types of arrhythmia have been reported: Bradycardia, sinus block, ventricular fibrillation, ventricular tachycardia and torsades de pointes.



Episodes of severe heart failure or even cardiogenic shock have also been described particularly in patients with severe structural heart disease. The resulting low cardiac output can cause hypotension, renal insufficiency and/or acute hepatic ischemia.



Other adverse reactions include:



Atropine-like effects (see also section 4.4):



urinary: dysuria; acute urinary retention, especially in prostatism



ocular: disorders of accommodation; diplopia



gastrointestinal: dry mouth; abdominal pain; nausea, vomiting, anorexia, diarrhoea; constipation



impotence



cognitive disorders



Psychiatric disorders.



Skin reactions: very rarely, rashes.



Rarely: hypoglycaemia, sometimes severe (see Section 4.4 Special warnings and precautions for use). In some cases, severe hypoglycaemia resulted in coma.



Very rarely: cholestatic jaundice, headache, dizzy sensation, neutropenia.



Rapid infusion may cause profuse sweating.



4.9 Overdose



There is no specific antidote for disopyramide. Prostigmine derivatives can be used to treat anticholinergic effects. Symptomatic supportive measures may include : early gastric lavage ; administration of a cathartic followed by activated charcoal by mouth or stomach tube ; IV administration of isoprenaline, other vasopressors and/or positive inotropic agents ; if needed - infusion of lactate and/or magnesium, electro–systolic assistance, cardioversion, insertion of an intra–aortic balloon for counterpulsion and mechanically assisted ventilation. Haemodialysis, haemofiltration or haemoperfusion with activated charcoal has been employed to lower the serum concentrations of the drug.



5. Pharmacological Properties



5.1 Pharmacodynamic Properties



Class 1 anti-arrhythmic agent.



It decreases membrane responsiveness, prolongs the effective refractory period (ERP) and slows automaticity in cells with augmented automaticity. Effective refractory period of the atrium is lengthened, ERP of the A-V node is shortened and conduction in accessory pathways is prolonged.



Disopyramide is a myocardial depressant and has anti-cholinergic effects.



5.2 Pharmacokinetic Properties



Elimination phase of plasma t1/2: 5-8 hours. Increased in hepatic impairment, cardiac and hepatic disease.



Protein binding: 50 - 60%. Saturable and concentration dependent.



Volume of distribution: Variable according to method of determination.



Metabolism: Approximately 25% of a dose metabolised to a mono-N-dealkylated derivative. Additional 10% as other metabolites.



Excretion: 75% unchanged drug via urine, remainder in faeces mono-N-dealkylated metabolite 25% in urine, 64% via faeces.



5.3 Preclinical Safety Data



Not applicable.



6. Pharmaceutical Particulars



6.1 List Of Excipients



Maize starch,



Magnesium stearate,



STA-RX 1500 (pregelatinised starch)



Talc.



Capsule shell:



Gelatin



Indigo carmine



Iron oxide



Titanium dioxide (E171)



6.2 Incompatibilities



Not known.



6.3 Shelf Life



PVC Blister :                    36 months



6.4 Special Precautions For Storage



Do not store above 25°C



6.5 Nature And Contents Of Container



PVC/PVdC blister strips in cardboard cartons containing 84 capsules.



6.6 Special Precautions For Disposal And Other Handling



None.



7. Marketing Authorisation Holder



Sanofi-aventis



One Onslow Street



Guildford



Surrey GU1 4YS



UK



8. Marketing Authorisation Number(S)



PL 04425/0608



9. Date Of First Authorisation/Renewal Of The Authorisation



12 February 2009



10. Date Of Revision Of The Text



24 February 2010



LEGAL STATUS


POM




Blow




Blow may be available in the countries listed below.


Ingredient matches for Blow



Montelukast

Montelukast sodium salt (a derivative of Montelukast) is reported as an ingredient of Blow in the following countries:


  • Colombia

International Drug Name Search

Teofurmate




Teofurmate may be available in the countries listed below.


Ingredient matches for Teofurmate



Theophylline

Theophylline is reported as an ingredient of Teofurmate in the following countries:


  • Japan

International Drug Name Search

Teofilina Biocrom




Teofilina Biocrom may be available in the countries listed below.


Ingredient matches for Teofilina Biocrom



Theophylline

Theophylline is reported as an ingredient of Teofilina Biocrom in the following countries:


  • Argentina

International Drug Name Search

Monday, September 26, 2016

Tramacur




Tramacur may be available in the countries listed below.


Ingredient matches for Tramacur



Tramadol

Tramadol is reported as an ingredient of Tramacur in the following countries:


  • Croatia (Hrvatska)

  • Slovenia

International Drug Name Search

Scheriproct Ointment





INTENDIS




Scheriproct
Ointment


(1.9 mg prednisolone hexanoate / 5.0 mg cinchocaine hydrochloride per 1 g)



Scheriproct
Suppositories


(1.3 mg prednisolone hexanoate / 1.0 mg cinchocaine hydrochloride per suppository)



Read all of this leaflet carefully before you start using this medicine.


  • Keep this leaflet. You may need to read it again.

  • If you have any further questions, ask your doctor or pharmacist.

  • This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.

  • If you experience any side effect and this becomes serious, tell your doctor or pharmacist.



In this leaflet:



  • 1. What Scheriproct is and what it is used for


  • 2. Before you use Scheriproct


  • 3. How to use Scheriproct


  • 4. Possible side effects


  • 5. How to store Scheriproct


  • 6. Further information




What Scheriproct is and what it is used for


Scheriproct contains a substance which reduces inflammation (predinisolone) and a local anaesthetic (cinchocaine) which relieves pain.


This medicine is used for the relief of the inflammation, swelling, itching and soreness of piles (haemorrhoids) and to relieve itching of the anus (back passage). It is used short-term usually for 5 to 7 days.




Before you use Scheriproct



Do not use Scheriproct if you:


  • are allergic (hypersensitive) to prednisolone hexanoate, cinchocaine hydrochloride, other local anaesthetics or any of the other ingredients of Scheriproct.

  • have a viral infection (e.g. herpes, shingles, chicken-pox)

  • have any bacterial or fungal infections of the skin or elsewhere for which you are not receiving treatment.



Take special care with Scheriproct


  • Long-term continuous treatment should be avoided because it increases the possibility of side effects. This is particularly important for infants and small children because continuous treatment with Scheriproct for long periods
    may reduce the activity of the adrenal glands and so lower resistance to disease. Also, long-term treatment can cause the skin to thin and deteriorate in the affected area (see section 4, “Possible Side Effects”) and some of the medicine may be absorbed into the blood stream.

  • If the area treated with Scheriproct is also infected your doctor should prescribe another medicine, to use with Scheriproct, to treat the infection.

  • Do not use a waterproof dressing to cover areas where you have applied the cream.



Taking other medicines


Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.




Pregnancy and breast-feeding


Contact your doctor for advice before using this medicine if you are pregnant or intending to become pregnant or are breast-feeding. There may be a very small risk to the development of a baby in pregnant women treated with Scheriproct. As with most medicines, this risk is likely to be greatest during the first 3 months of pregnancy.




Driving and using machines


Scheriproct has no influence on the ability to drive and use machines.





How to use Scheriproct


Always use Scheriproct exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure. Do not use Scheriproct for more than 7 days.


Always wash your hands before and after applying Scheriproct.



How to use Scheriproct Ointment:


  • 1. Before you use the ointment, gently but thoroughly wash and dry the anus (back passage) and the skin around it.

  • 2. If the ointment is to be used for the area around the anus:

  • Squeeze a small quantity (about the size of a pea) on to the top of your finger.

  • Spread it gently over the skin and just inside the anus.

  • Do not rub it in.

  • 3. If the ointment is to be used inside the anus:

  • Put the separate nozzle (applicator) onto the tube.

  • Squeeze the tube until the nozzle is full of ointment. The amount of ointment in the nozzle is one dose.

  • Insert the nozzle very carefully into the anus until the whole length of the nozzle is inside.

  • Then, while squeezing the tube gently, withdraw the nozzle.

  • Wash the nozzle carefully in hot soapy water and rinse thoroughly.

Generally, the ointment should be applied twice a day, but it may be applied three or four times on the first day, to obtain quick relief.




How to use Scheriproct Suppositories:


  • 1. Before you insert a suppository find the small tear in the foil packet and remove the covering foil, by tearing it in half.

  • 2. If the suppositories have become softened, owing to warm temperature, they can be hardened by putting them into cold water before you remove the covering foil.

  • 3. Insert the whole suppository into the anus.

  • 4. To make insertion easier, either stand with one foot raised on a chair or squat down.

The usual treatment is one suppository a day, to be inserted preferably after a bowel movement. However, if your discomfort is severe, you should insert one suppository two or three times a day at the start of treatment.




If you use more Scheriproct than you should or if you accidentally swallow some Scheriproct


If you use too much Scheriproct or accidentally swallow Scheriproct it is unlikely to be dangerous but contact your doctor or pharmacist if you are worried.




If you forget to use Scheriproct


Do not use a double dose to make up for a forgotten dose. When you remember, use the next prescribed dose and continue with the treatment. See your doctor or pharmacist, if you are worried.



If you have any further questions on the use of this product, ask your doctor or pharmacist.




Scheriproct Ointment Side Effects


Like all medicines, Scheriproct can cause side effects, although not everybody gets them.


Some thinning of the skin may occur if too much Scheriproct is applied for long periods of time (much longer than 5 to 7 days).


Allergic skin reactions may occur in rare cases. Castor oil, one of the ingredients of Scheriproct Ointment may cause a skin reaction.


If you experience any of these side effects and this becomes serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.




How to store Scheriproct



  • Store Scheriproct out of the reach and sight of children.

  • There are no special storage precautions for Scheriproct Ointment.

  • Do not store Scheriproct Suppositories above 25ºC.

  • Do not use Scheriproct after the expiry date which is stated on the pack.

  • Medicines must not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.



Further information



What Scheriproct Ointment contains


  • The active substances are prednisolone hexanoate and cinchocaine hydrochloride. 1 g of Scheriproct Ointment contains 1.9 mg prednisolone hexanoate and 5.0 mg cinchocaine hydrochloride

  • The other ingredients are polyethylene glycol 400 monoricinoleate, hydrogenated castor oil, castor oil, 2 octyldodecanol, chypre perfume oil.



What Scheriproct Suppositories contain


  • The active substances are prednisolone hexanoate and cinchocaine hydrochloride. Each suppository contains 1.3 mg prednisolone hexanoate and 1.0 mg cinchocaine hydrochloride

  • The other ingredient is hard fat.



What Scheriproct looks like and contents of the pack



  • Scheriproct Ointment is a colourless to slightly yellowish ointment supplied in tubes of 30g.


  • Scheriproct Suppositories are yellowish-white and are supplied in packs of 12 suppositories.



Marketing Authorisation Holder



Intendis GmbH

Max-Dohrn-Strasse 10

D-10589

Berlin

Germany




Manufacturer


The ointment is manufactured by:



Intendis Manufacturing, S.p.A

Milan

Italy


The suppositories are manufactured by:



Istituto de Angeli S.r.l.

Reggello

Italy


or



Intendis Manufacturing, S.p.A

Milan

Italy




Distributor in the UK



Meda Pharmaceuticals Ltd

Skyway House

Parsonage Road

Takeley

Bishop Stortford

CM22 6PU

UK




This leaflet was last approved in July 2009



Scheriproct is a registered trademark of Intendis GmbH.



81920967





Tensolisin




Tensolisin may be available in the countries listed below.


Ingredient matches for Tensolisin



Lisinopril

Lisinopril is reported as an ingredient of Tensolisin in the following countries:


  • Dominican Republic

  • Honduras

International Drug Name Search

Terbinafina Richet




Terbinafina Richet may be available in the countries listed below.


Ingredient matches for Terbinafina Richet



Terbinafine

Terbinafine hydrochloride (a derivative of Terbinafine) is reported as an ingredient of Terbinafina Richet in the following countries:


  • Argentina

International Drug Name Search

Typhim Vi


Pronunciation: TIE-foyd PAHL-ee-SACK-ah-ride
Generic Name: Typhoid Vi Polysaccharide Vaccine
Brand Name: Typhim Vi


Typhim Vi is used for:

Preventing typhoid fever in persons 2 years of age and older who are at increased risk because they are traveling to an area where this infection is more common, have been in contact with infected individuals, or work in an environment that increases their risk (eg, lab work).


Typhim Vi is a vaccine. It works by stimulating the immune system of the person who receives the vaccine to make their own protective antibodies against this disease.


Do NOT use Typhim Vi if:


  • you are allergic to any ingredient in Typhim Vi

  • you are already infected or are a carrier of typhoid

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



Before using Typhim Vi:


Some medical conditions may interact with Typhim Vi. 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 a weakened immune system or are unable to make antibodies due to HIV infection, cancer, or cancer therapy (eg, chemo or radiation) or you are taking medicines that suppress the immune system (eg, certain cancer medicines, corticosteroids such as methylprednisolone, cyclosporine)

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


  • Immunosuppressives (eg, certain cancer medicines, corticosteroids such as methylprednisolone, cyclosporine) because the effectiveness of Typhim Vi may be decreased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Typhim Vi 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 Typhim Vi:


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


  • Typhim Vi is administered as an injection at your doctor's office, hospital, or clinic.

  • This vaccine should be given at least 2 weeks before being exposed to typhoid fever.

  • If Typhim Vi contains particles or is discolored, or if the vial is cracked or damaged in any way, do not use it.

  • Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for proper disposal.

  • If you miss a dose of Typhim Vi, contact your doctor immediately.

Ask your health care provider any questions you may have about how to use Typhim Vi.



Important safety information:


  • Typhim Vi should be given 2 weeks prior to expected exposure.

  • Side effects usually occur within 48 hours after receiving this vaccine. Contact your health care provider if any of the following symptoms persist for more than 2 days: tenderness, redness, pain, or hardening at the injection site; general body discomfort; headache; muscle pain; nausea; diarrhea; fever.

  • Travelers should continue to take other precautions to avoid contact with possibly infected food or water.

  • It is recommended that you receive another single dose of Typhim Vi every 2 years if you continue to be exposed to typhoid fever.

  • Typhim Vi is not recommended for use in CHILDREN younger than 2 years of age. Safety and effectiveness in this age group have not been confirmed.

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


Possible side effects of Typhim Vi:


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:



Diarrhea; fever; general body discomfort; headache; muscle pain; nausea; tenderness, pain, redness, swelling, and hardening at the injection site.



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); difficulty swallowing; giant hives; hoarseness; shock.



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: Typhim Vi 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 Typhim Vi:

Typhim Vi is usually handled and stored by a health care provider. If you are using Typhim Vi at home, store Typhim Vi as directed by your pharmacist or health care provider.


General information:


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

  • Typhim Vi 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 Typhim Vi. 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 Typhim Vi resources


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


  • Typhim Vi Advanced Consumer (Micromedex) - Includes Dosage Information

  • typhoid vaccine, inactivated Subcutaneous, Injection Advanced Consumer (Micromedex) - Includes Dosage Information

  • Typhim VI Concise Consumer Information (Cerner Multum)

  • Typhoid Vaccine Monograph (AHFS DI)



Compare Typhim Vi with other medications


  • Typhoid Prophylaxis

Terbonile




Terbonile may be available in the countries listed below.


Ingredient matches for Terbonile



Terbinafine

Terbinafine hydrochloride (a derivative of Terbinafine) is reported as an ingredient of Terbonile in the following countries:


  • Turkey

International Drug Name Search

Six Plus Parapaed Paracetamol Suspension 250mg / 5ml





1. Name Of The Medicinal Product



Six Plus Parapaed Paracetamol Suspension 250mg/5ml



Paracetamol Suspension 250mg/5ml



Six Plus Paracetamol Suspension 250mg/5ml



Asda 6+ Paracetamol Oral Suspension 250mg/5ml



Enterprise Six Plus Paracetamol Suspension 250mg/5ml



Lexon 6+ Paracetamol Oral Suspension 250mg/5ml



Paracetamol 250mg/5ml Oral Suspension


2. Qualitative And Quantitative Composition



Each 5ml spoonful contains Paracetamol BP 250mg



3. Pharmaceutical Form



Oral Suspension.



Orange to orange/brown suspension with orange odour and taste.



4. Clinical Particulars



4.1 Therapeutic Indications



For the treatment of mild to moderate pain and as an anti-pyretic. Used for the relief of pain and feverishness associated with teething, toothache, headache, colds and flu.



4.2 Posology And Method Of Administration



















Child's Age




How Much




How often



(in 24 hours)




6 – 8 years




One 5 ml spoonful (large end)




4 times




8 – 10 years




One 5.0 ml spoonful (large end) and one 2.5 ml spoonful (small end)




4 times




10 – 12 years




Two 5 ml spoonfuls (large end)




4 times




• Do not give more than 4 doses in any 24 hour period



• Leave at least 4 hours between doses



• Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist



• Do not give to children under the age of 6 years


  


Children aged 12 - 16 years: Two – three 5 ml spoonfuls (large end) up to 4 times a day.



Adults and children over 16 years: Two – four 5 ml spoonfuls (large end) up to 4 times a day.



It is important to shake the bottle for at least 10 seconds before use.



4.3 Contraindications



Hypersensitivity to Paracetamol or any of the other constituents.



4.4 Special Warnings And Precautions For Use



Care is advised in the administration of Paracetamol to patients with severe renal or severe hepatic impairment. The hazards of overdose are greater in those with (non-cirrhotic) alcoholic liver disease.



The label should contain the following statements:



• Contains paracetamol.



• Do not give this medicine with any other paracetamol-containing product.



• For oral use only.



• Never give more medicine than shown in the table.



• Do not overfill the spoon.



• Always use the spoon supplied with the pack.



• Do not give more than 4 doses in any 24 hour period.



• Leave at least 4 hours between doses.



• Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist.



• As with all medicines, if your child is currently taking any medicine consult your doctor or pharmacist before taking this product.



• Do not store above 25°C. Store in the original package.



• Keep all medicines out of the reach and sight of children.



• Immediate medical advice should be sought in the event of an overdose, even if the child seems well (label).



• Immediate medical advice should be sought in the event of an overdose, even if the child seems well, because of the risk of delayed, serious liver damage (leaflet).



4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction



The speed of absorption of Paracetamol may be increased by metoclopramide or domperidone and absorption reduced by colestyramine. The anti-coagulant effect of warfarin and other coumarins may be enhanced by prolonged regular use of Paracetamol with increased risk of bleeding; occasional doses have no significant effect.



Drugs which induce hepatic microsomal enzymes such as alcohol. Concomitant barbiturates and tricyclic antidepressants may increase the hepatoxicity of Paracetamol particularly after overdose. Anti-convulsant or oral steroid contraceptives have the ability to reduce serum levels of Paracetamol by liver enzyme induction.



4.6 Pregnancy And Lactation



Epidemiological studies in human pregnancy have shown no ill effects due to Paracetamol used in the recommended dosage, but patients should follow the advice of their doctor regarding its use.



Paracetamol is excreted in breast milk but not in a clinically significant amount. Available published data does not contraindicate breast-feeding.



4.7 Effects On Ability To Drive And Use Machines



None



4.8 Undesirable Effects



Adverse effects of Paracetamol are rare but hypersensitivity including skin rash may occur. There have been reports of blood dyscrasias including thrombocytopenia and agranulocytosis, but these were not necessarily causally related to Paracetamol. With prolonged use or overdosage, hepatic necrosis, acute pancreatitis and nephrotoxicity have been reported.



4.9 Overdose



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



Risk Factors



If the patient:



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



or



b, Regularly consumes ethanol in excess of recommended amounts.



or



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



Symptoms



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



Management



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



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



5. Pharmacological Properties



5.1 Pharmacodynamic Properties



Paracetamol is an antipyretic analgesic. The mechanism of action is probably similar to that of aspirin and dependent on the inhibition of prostaglandin synthesis. This inhibition appears, however to be on a selective basis.



5.2 Pharmacokinetic Properties



Paracetamol is rapidly and almost completely absorbed from the gastro-intestinal tract. The concentration in plasma reaches a peak in 30 to 60 minutes and the half life in plasma is 1 to 4 hours after therapeutic doses. Paracetamol is relatively uniformly distributed throughout most body fluids. Binding of the drug to plasma proteins is variable; 20 to 50% may be bound at the concentrations encountered during acute intoxication. Following therapeutic doses 90 to 100% of the drug may be recovered in the urine within the first day. However, practically no Paracetamol is excreted unchanged, and the bulk is excreted after hepatic conjugation.



5.3 Preclinical Safety Data



There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.



6. Pharmaceutical Particulars



6.1 List Of Excipients



Ethanol (96%)



Sorbitan Monooleate



Glycerol (E422)



Magnesium Aluminium Silicate



Hydrogenated Glucose Syrup (E965)



Saccharin Sodium (E954)



Xanthan Gum



Sunset Yellow (E110)



Orange Flavour 6902



Sodium Benzoate (E211)



Citric Acid (monohydrate)



Polysorbate 80



Purified water



6.2 Incompatibilities



None known.



6.3 Shelf Life



Amber glass bottles – 3 years



High density polyethylene – 3 years.



6.4 Special Precautions For Storage



Do not store above 25°C. Store in the original container.



6.5 Nature And Contents Of Container



Pharmaceutical grade III amber glass bottles with pilfer proof screw caps.



Pack sizes: 70ml, 100ml, 150ml, 200ml, 500ml, 1 Litre and 2 Litre.



High density polyethylene bottles with tamper evident plastic cap.



Pack sizes: 500ml, 1 Litre and 2 Litre.



6.6 Special Precautions For Disposal And Other Handling



As for all medicines – no special requirements.



7. Marketing Authorisation Holder



Pinewood Laboratories Limited



Ballymacarbry



Clonmel



Co. Tipperary



Ireland



8. Marketing Authorisation Number(S)



PL 04917/0010



9. Date Of First Authorisation/Renewal Of The Authorisation



23/03/2007



10. Date Of Revision Of The Text



07/10/2011




Nucynta ER


Generic Name: tapentadol (ta PEN ta dol)

Brand Names: Nucynta, Nucynta ER


What is Nucynta ER (tapentadol)?

Tapentadol is in a group of drugs called narcotic pain relievers. It is similar to morphine.


Tapentadol is used to treat moderate to severe chronic pain.


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


What is the most important information I should know about Nucynta ER (tapentadol)?


You should not use this medication if you are allergic to tapentadol, or if you have severe liver or kidney disease, if you are having an asthma attack, or if you have a bowel obstruction called paralytic ileus. Do not use tapentadol if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects. Tapentadol may be habit-forming and should be used only by the person it was prescribed for. Keep the medication in a secure place where others cannot get to it. Do not drink alcohol while you are taking tapentadol. Dangerous side effects or death can occur when alcohol is combined with a narcotic pain medicine. Check your food and medicine labels to be sure these products do not contain alcohol.

Never take tapentadol in larger amounts, or for longer than recommended by your doctor. Tell your doctor if the medicine seems to stop working as well in relieving your pain.


This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Do not stop using tapentadol suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using tapentadol.

What should I discuss with my healthcare provider before taking Nucynta ER (tapentadol)?


You should not use this medication if you are allergic to tapentadol, or if you have severe liver or kidney disease, if you are having an asthma attack, or if you have a bowel obstruction called paralytic ileus. Do not use tapentadol if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

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



  • asthma, COPD, sleep apnea, or other breathing disorders;



  • liver or kidney disease;


  • curvature of the spine;




  • a history of head injury or brain tumor;




  • epilepsy or other seizure disorder;




  • gallbladder disease or pancreas problems;




  • mental illness; or




  • a history of drug or alcohol addiction.




FDA pregnancy category C. It is not known whether this medication is harmful to an unborn baby. Tapentadol may cause breathing problems and addiction or withdrawal symptoms in a newborn if the mother takes the medication during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Tapentadol can pass into breast milk and may harm a nursing baby. Do not breast-feed while taking this medication.

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


Tapentadol may be habit forming and should be used only by the person it was prescribed for. Never share tapentadol 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. Do not give tapentadol to a child.

How should I take Nucynta ER (tapentadol)?


Take exactly as prescribed. Never take tapentadol in larger amounts, or for longer than recommended by your doctor. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain.


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


Take this medicine with a full glass of water.

You may take tapentadol with or without food.


Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

Tapentadol can cause constipation. Talk to your doctor before using a laxative or stool softener to treat or prevent this side effect.


Do not stop using tapentadol suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using tapentadol. Store at room temperature away from moisture and heat.

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


Ask a pharmacist about how to dispose of any unused pills after you have stopped taking tapentadol.


Never crush a tablet or other pill to mix into a liquid for snorting tapentadol or injecting the drug into your vein. This practice has resulted in death with the misuse of narcotic pain medicines and similar prescription drugs.


What happens if I miss a dose?


Since tapentadol 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 tapentadol can be fatal.

Overdose symptoms may include extreme drowsiness, blurred vision, confusion, vomiting, cold and clammy skin, weak pulse, shallow breathing, fainting, or breathing that stops.


What should I avoid while taking Nucynta ER (tapentadol)?


This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Do not drink alcohol while you are using tapentadol. Dangerous side effects or death can occur when alcohol is combined with tapentadol. Check your food and medicine labels to be sure these products do not contain alcohol.

Nucynta ER (tapentadol) side effects


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

  • weak or shallow breathing, weak pulse, slow heartbeat;




  • seizure (convulsions);




  • severe drowsiness or dizziness;




  • confusion, problems with speech or balance; or




  • agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting.



Less serious side effects may include:



  • mild nausea or vomiting;




  • constipation;




  • mild dizziness, drowsiness;




  • dry mouth;




  • itching; or




  • increased sweating.



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 Nucynta ER (tapentadol)?


Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by tapentadol. Tell your doctor if you regularly use any of these medicines, or any other narcotic pain medicines.

There may be other drugs that can interact with tapentadol. 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 Nucynta ER resources


  • Nucynta ER Side Effects (in more detail)
  • Nucynta ER Use in Pregnancy & Breastfeeding
  • Nucynta ER Drug Interactions
  • 3 Reviews for Nucynta ER - Add your own review/rating


  • Nucynta ER Prescribing Information (FDA)

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

  • Nucynta ER Advanced Consumer (Micromedex) - Includes Dosage Information

  • Tapentadol Professional Patient Advice (Wolters Kluwer)

  • Nucynta MedFacts Consumer Leaflet (Wolters Kluwer)

  • Nucynta Prescribing Information (FDA)

  • Nucynta Consumer Overview

  • Nucynta Monograph (AHFS DI)



Compare Nucynta ER with other medications


  • Pain


Where can I get more information?


  • Your pharmacist can provide more information about tapentadol.

See also: Nucynta ER side effects (in more detail)