Wednesday, 28 September 2016

Diamox



Generic Name: acetazolamide (a SEET a ZOLE a mide)

Brand Names: Diamox, Diamox Sequels


What is Diamox (acetazolamide)?

Acetazolamide is a carbonic anhydrase inhibitor. Carbonic anhydrase is a protein in your body. Acetazolamide reduces the activity of this protein.


Acetazolamide is used to treat glaucoma and to treat and to prevent acute mountain sickness (altitude sickness). It is also used as a part of some treatment plans for congestive heart failure and seizure disorders.


Acetazolamide may also be used for purposes other than those listed in this medication guide.


What is the most important information I should know about Diamox (acetazolamide)?


Call your doctor immediately if you experience a sore throat, fever, unusual bleeding or bruising, tingling or tremors in your hands or feet, pain in your side or groin, or a rash. These symptoms could be early signs of a serious side effect.


Use caution when driving, operating machinery, or performing other hazardous activities. Acetazolamide may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Avoid prolonged exposure to sunlight. Acetazolamide may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.

Who should not take Diamox (acetazolamide)?


Tell your doctor if you have ever had an allergic reaction to a sulfa-based drug such as sulfamethoxazole (e.g., Bactrim, Septra, Gantanol). Acetazolamide is also a sulfa-based drug, and you may have a similar reaction to it.


Before taking acetazolamide, tell your doctor if you



  • are on aspirin therapy,




  • have liver disease,




  • have kidney disease,




  • have heart disease,




  • have lung disease, or




  • have a hormonal disease.



You may not be able to take acetazolamide, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.


Acetazolamide is in the FDA pregnancy category C. This means that it is not known whether acetazolamide will harm an unborn baby. Do not take acetazolamide without first talking to your doctor if you are pregnant. Acetazolamide passes into breast milk. It is not known whether acetazolamide will affect a nursing infant. Do not take acetazolamide without first talking to your doctor if you are breast-feeding a baby.

How should I take Diamox (acetazolamide)?


Take acetazolamide exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.


Take each dose with a full glass of water. Take acetazolamide with food if it upsets your stomach. Store acetazolamide at room temperature away from moisture and heat.

What happens if I miss a dose?


Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.


What happens if I overdose?


Seek emergency medical attention.

Symptoms of an acetazolamide overdose are not well known, but the following symptoms might be expected: drowsiness, decreased appetite, nausea, vomiting, dizziness, numbness or tingling, shaking, and ringing in the ears.


What should I avoid while taking Diamox (acetazolamide)?


Use caution when driving, operating machinery, or performing other hazardous activities. Acetazolamide may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Avoid prolonged exposure to sunlight. Acetazolamide may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.

Diamox (acetazolamide) side effects


If you experience any of the following serious side effects, stop taking acetazolamide and seek emergency medical attention:

  • an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);




  • a sore throat or a fever;




  • unusual bleeding or bruising;




  • side or groin pain;




  • tingling or tremors in your hands or feet; or




  • a rash.



Other, less serious side effects may be more likely to occur. Continue to take acetazolamide and talk to your doctor if you experience



  • decreased appetite, nausea, vomiting, constipation, diarrhea, or changes in taste;




  • drowsiness, dizziness, fatigue, or weakness;




  • nervousness or mild tremor;




  • headache or confusion;




  • increased sensitivity of the skin to sunlight;




  • worsening gout;




  • loss of blood sugar control (if you are diabetic);




  • ringing in your ears or hearing problems; or




  • changes in your vision.



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 Diamox (acetazolamide)?


Before taking this medication, tell your doctor if you are taking any of the following medicines:



  • cyclosporine (Sandimmune). Cyclosporine may have more side effects if it is taken with acetazolamide.




  • primidone (Mysoline). Primidone may not be as effective if it is taken with acetazolamide, and seizure control may be reduced.




  • diflunisal (Dolobid). Diflunisal may increase both the activity and the side effects of acetazolamide.




  • aspirin, salsalate (Disalcid, Salflex, Salsitab, others), choline salicylate (Arthropan), magnesium salicylate (Doan's, Magan, Mobidin), and other aspirin-like products (salicylates). These medicines may also interact with acetazolamide, and special monitoring of your therapy may be necessary.




  • lithium (Lithobid, Eskalith, others). Acetazolamide may decrease the level of lithium in your blood. Special monitoring or a dosage adjustment may be necessary.



Drugs other than those listed here may also interact with acetazolamide. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.



More Diamox resources


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


  • Diamox Prescribing Information (FDA)

  • Diamox Monograph (AHFS DI)

  • Acetazolamide Prescribing Information (FDA)

  • Acetazolamide Professional Patient Advice (Wolters Kluwer)

  • Acetazolamide MedFacts Consumer Leaflet (Wolters Kluwer)

  • Diamox Sequels Sustained-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)



Compare Diamox with other medications


  • Edema
  • Epilepsy
  • Glaucoma
  • Hydrocephalus
  • Mountain Sickness / Altitude Sickness
  • Pseudotumor Cerebri
  • Seizure Prevention


Where can I get more information?


  • Your pharmacist can provide more information about acetazolamide.

See also: Diamox side effects (in more detail)


Lorabid


Generic Name: Loracarbef (lor-a-KAR-bef)
Brand Name: Lorabid


Lorabid is used for:

Treating mild to moderate infections caused by certain bacteria.


Lorabid is a carbacephem antibiotic. It kills sensitive bacteria by interfering with formation of the bacteria's cell wall while it is growing. This weakens the cell wall and it ruptures, resulting in the death of the bacteria.


Do NOT use Lorabid if:


  • you are allergic to any ingredient in Lorabid or to cephalosporins (eg, cephalexin)

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



Before using Lorabid:


Some medical conditions may interact with Lorabid. 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 had a severe allergic reaction (eg, severe rash, hives, difficulty breathing, dizziness) to a penicillin antibiotic (eg, amoxicillin) or other beta-lactam antibiotic (eg, imipenem)

  • if you have stomach or bowel problems (eg, inflammation), blood clotting problems, kidney or liver problems, or poor nutrition

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


  • Diuretics (eg, furosemide) because the risk of kidney side effects may be increased

  • Anticoagulants (eg, warfarin) or heparin because the risk of bleeding may be increased

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


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


  • Take Lorabid on an empty stomach at least 1 hour before or 2 hours after eating.

  • To clear up your infection completely, continue using Lorabid for the full course of treatment even if you feel better in a few days.

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

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



Important safety information:


  • Lorabid may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Lorabid. Using Lorabid alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.

  • Lorabid is effective only against bacteria. It is not effective for treating viral infections (eg, the common cold).

  • It is important to use Lorabid for the full course of treatment. Failure to do so may decrease the effectiveness of Lorabid and may increase the risk that the bacteria will no longer be sensitive to Lorabid and will not be able to be treated by this or certain other antibiotics in the future.

  • Long-term or repeated use of Lorabid may cause a second infection. Your doctor may want to change your medicine to treat the second infection. Contact your doctor if signs of a second infection occur.

  • If severe diarrhea, stomach pain/cramps, or bloody stools occur, contact your doctor immediately. This could be a symptom of a serious side effect requiring immediate medical attention. Do not treat diarrhea without consulting your doctor.

  • Diabetes patients - Lorabid may cause incorrect test results with some urine glucose tests. Check with your doctor before you adjust the dose of your diabetes medicine or change your diet.

  • Lorabid may affect certain LAB TEST results. Make sure your doctor and laboratory personnel know that you are using Lorabid.

  • Use Lorabid with caution in the ELDERLY because they may be more sensitive to its effects.

  • Use Lorabid with extreme caution in CHILDREN younger than 6 months of age. Safety and effectiveness in this age group have not been confirmed.

  • Use Lorabid with extreme caution in CHILDREN younger than 10 years of age who have diarrhea or a stomach or bowel infection.

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


Possible side effects of Lorabid:


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; dizziness; drowsiness; headache; loss of appetite; nausea; stomach pain; stuffy nose; 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); bloody stools; decreased urination; fever; hoarseness; red, swollen, or blistered skin; seizures; severe diarrhea; severe nausea or vomiting; severe stomach pain or cramps; unusual bruising or bleeding; unusual tiredness; vaginal irritation or discharge; yellowing of the eyes or skin.



This is not a complete list of all side effects that may occur. If you have questions or need medical advice about side effects, contact your doctor or health care provider. You may report side effects to the FDA at 1-800-FDA-1088 (1-800-332-1088) or at http://www.fda.gov/medwatch.


See also: Lorabid 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 (http://www.aapcc.org/DNN/), or emergency room immediately. Symptoms may include severe diarrhea, nausea, stomach upset, or vomiting.


Proper storage of Lorabid:

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


General information:


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

  • Lorabid 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.

This information is a summary only. It does not contain all information about Lorabid. 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 Lorabid resources


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


  • Lorabid Prescribing Information (FDA)

  • Lorabid Concise Consumer Information (Cerner Multum)

  • Lorabid Monograph (AHFS DI)

  • Lorabid Advanced Consumer (Micromedex) - Includes Dosage Information



Compare Lorabid with other medications


  • Bladder Infection
  • Bronchitis
  • Impetigo
  • Kidney Infections
  • Otitis Media
  • Pneumonia
  • Sinusitis
  • Skin Infection
  • Strep Throat
  • Tonsillitis/Pharyngitis
  • Upper Respiratory Tract Infection

Lortab Oral Solution




Generic Name: hydrocodone bitartrate and acetaminophen

Dosage Form: oral syrup
LORTAB® ELIXIR

Hydrocodone Bitartrate and

Acetaminophen Oral Solution

7.5 mg/500 mg per 15 mL


CIII


Rx only



WARNING

Hepatotoxicity


Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen-containing product (see WARNINGS).




Lortab Oral Solution Description


Hydrocodone bitartrate and acetaminophen is supplied in liquid form for oral administration.


WARNING: May be habit-forming (see PRECAUTIONS, Information For Patients/Caregivers, and DRUG ABUSE AND DEPENDENCE).


Hydrocodone bitartrate is an opioid analgesic and antitussive and occurs as fine, white crystals or as a crystalline powder. It is affected by light. The chemical name is 4,5α-epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate (2:5). It has the following structural formula:



   C18H21NO3 • C4H606 • 2 ½ H20                                      M.W. 494.490


Acetaminophen, 4'-hydroxyacetanilide, a slightly bitter, white, odorless, crystalline powder, is a non-opiate, non-salicylate analgesic and antipyretic. It has the following structural formula:


                              


C8H9NO2                                                                      M.W. 151.16














LORTAB Elixir contains:Per

5 mL
Per

15 mL
Hydrocodone Bitartrate2.5 mg7.5 mg
Acetaminophen167 mg500 mg
Alcohol7%7%

In addition, the liquid contains the following inactive ingredients: citric acid anhydrous, ethyl maltol, glycerin, methylparaben, propylene glycol, propylparaben, purified water, saccharin sodium, sorbitol solution, sucrose, with D&C Yellow #10 and FD&C Yellow #6 as coloring and natural and artificial flavoring.



Lortab Oral Solution - Clinical Pharmacology



Hydrocodone is a semisynthetic narcotic analgesic and antitussive with multiple actions qualitatively similar to those of codeine. Most of these involve the central nervous system and smooth muscle. The precise mechanism of action of hydrocodone and other opiates is not known, although it is believed to relate to the existence of opiate receptors in the central nervous system. In addition to analgesia, narcotics may produce drowsiness, changes in mood and mental clouding.


The analgesic action of acetaminophen involves peripheral influences, but the specific mechanism is as yet undetermined. Antipyretic activity is mediated through hypothalamic heat regulating centers. Acetaminophen inhibits prostaglandin synthetase. Therapeutic doses of acetaminophen have negligible effects on the cardiovascular or respiratory systems; however, toxic doses may cause circulatory failure and rapid, shallow breathing.



Pharmacokinetics


The behavior of the individual components is described below.


Hydrocodone

Following a 10 mg oral dose of hydrocodone administered to five adult male subjects, the mean peak concentration was 23.6 ± 5.2 ng/mL. Maximum serum levels were achieved at 1.3 ± 0.3 hours and the half-life was determined to be 3.8 ± 0.3 hours. Hydrocodone exhibits a complex pattern of metabolism including O-demethylation, N-demethylation and 6-keto reduction to the corresponding 6-α- and 6-β-hydroxymetabolites.


See OVERDOSAGE for toxicity information.


Acetaminophen

Acetaminophen is rapidly absorbed from the gastrointestinal tract and is distributed throughout most body tissues. The plasma half-life is 1.25 to 3 hours, but may be increased by liver damage and following overdosage. Elimination of acetaminophen is principally by liver metabolism (conjugation) and subsequent renal excretion of metabolites. Approximately 85% of an oral dose appears in the urine within 24 hours of administration, most as the glucuronide conjugate, with small amounts of other conjugates and unchanged drug.


See OVERDOSAGE for toxicity information.



Indications and Usage for Lortab Oral Solution


LORTAB Elixir (hydrocodone bitartrate and acetaminophen oral solution) is indicated for the relief of moderate to moderately severe pain.



Contraindications


This product should not be administered to patients who have previously exhibited hypersensitivity to hydrocodone, acetaminophen, or any other component of this product.


Patients known to be hypersensitive to other opioids may exhibit cross sensitivity to hydrocodone.



Warnings



Respiratory Depression


At high doses or in sensitive patients, hydrocodone may produce dose-related respiratory depression by acting directly on the brain stem respiratory center. Hydrocodone also affects the center that controls respiratory rhythm, and may produce irregular and periodic breathing.


Infants may have increased sensitivity to the respiratory depressant effects of opioids (see PRECAUTIONS, Pediatric Use). If use of LORTAB Elixir in such patients is contemplated, it should be administered cautiously, in substantially reduced initial doses, by personnel experienced in administering opioids to infants, and with intensive monitoring.



Head Injury And Increased Intracranial Pressure


The respiratory depressant effects of narcotics and their capacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions or a preexisting increase in intracranial pressure. Furthermore, narcotics produce adverse reactions, which may obscure the clinical course of patients with head injuries.



Acute Abdominal Conditions


The administration of narcotics may obscure the diagnosis or clinical course of patients with acute abdominal conditions.



Misuse, Abuse, And Diversion Of Opioids


LORTAB Elixir contains hydrocodone, an opioid agonist, and is a Schedule III controlled substance. Opioid agonists have the potential for being abused and are sought by abusers and people with addiction disorders, and are subject to diversion.


LORTAB Elixir can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing LORTAB Elixir in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse or diversion (see DRUG ABUSE AND DEPENDENCE).



Hepatotoxicity


Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen-containing product. The excessive intake of acetaminophen may be intentional to cause self-harm or unintentional as patients attempt to obtain more pain relief or unknowingly take other acetaminophen-containing products.


The risk of acute liver failure is higher in individuals with underlying liver disease and in individuals who ingest alcohol while taking acetaminophen.


Instruct patients to look for acetaminophen or APAP on package labels and not to use more than one product that contains acetaminophen. Instruct patients to seek medical attention immediately upon ingestion of more than 4000 milligrams of acetaminophen per day, even if they feel well.



Hypersensitivity/ Anaphylaxis


There have been post-marketing reports of hypersensitivity and anaphylaxis associated with use of acetaminophen. Clinical signs included swelling of face, mouth, and throat, respiratory distress, urticaria, rash, pruritus, and vomiting. There were infrequent reports of life-threatening anaphylaxis requiring emergency medical attention. Instruct patients to discontinue LORTAB Elixir immediately and seek medical care if they experience these symptoms. Do not prescribe LORTAB Elixir for patients with acetaminophen allergy.



Precautions



General


Special Risk Patients

As with any narcotic analgesic agent, LORTAB Elixir should be used with caution in elderly or debilitated patients, and those with severe impairment of hepatic or renal function, hypothyroidism, Addison's disease, prostatic hypertrophy or urethral stricture. The usual precautions should be observed and the possibility of respiratory depression should be kept in mind.


Cough Reflex

Hydrocodone suppresses the cough reflex; as with all narcotics, caution should be exercised when LORTAB Elixir are used postoperatively and in patients with pulmonary disease.



Information For Patients/Caregivers


Hydrocodone, like all narcotics, may impair mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. Such tasks should be avoided while taking this product. Alcohol and other CNS depressants may produce an additive CNS depression, when taken with this combination product, and should be avoided.


Hydrocodone may be habit-forming. Patients should take the drug only for as long as it is prescribed, in the amounts prescribed, and no more frequently than prescribed.


Physicians should instruct patients and caregivers to read the patient information leaflet, which appears as the last section of the labeling.


  • Do not take LORTAB Elixir if you are allergic to any of its ingredients.

  • If you develop signs of allergy such as a rash or difficulty breathing stop taking LORTAB Elixir and contact your healthcare provider immediately.

  • Do not take more than 4000 milligrams of acetaminophen per day. Call your doctor if you took more than the recommended dose.


Laboratory Tests


In patients with severe hepatic or renal disease, effects of therapy should be monitored with serial liver and/or renal function tests.



Drug Interactions


Patients receiving narcotics, antihistamines, antipsychotics, antianxiety agents, or other CNS depressants (including alcohol) concomitantly with hydrocodone bitartrate and acetaminophen oral solution may exhibit an additive CNS depression. When combined therapy is contemplated, the dose of one or both agents should be reduced.


The use of MAO inhibitors or tricyclic antidepressants with hydrocodone preparations may increase the effect of either the antidepressant or hydrocodone.



Drug/Laboratory Test Interactions


Acetaminophen may produce false-positive test results for urinary 5-hydroxyindoleacetic acid.



Carcinogenesis, Mutagenesis, Impairment Of Fertility


No adequate studies have been conducted in animals to determine whether hydrocodone has a potential for carcinogenesis, mutagenesis, or impairment of fertility.


Hydrocodone has not demonstrated mutagenic potential using the Ames Salmonella-Microsomal Activation test, the Basc test on Drosophila germ cells, and the Micronucleus test on mouse bone marrow.


No adequate studies have been conducted in animals to determine whether acetaminophen has a potential for carcinogenesis, mutagenesis, or impairment of fertility.


Acetaminophen has not demonstrated mutagenic potential using the Ames Salmonella-Microsomal Activation test, the Basc test on Drosophila germ cells, and the Micronucleus test on mouse bone marrow.



Pregnancy


Teratogenic Effects

Pregnancy Category C


There are no adequate and well-controlled studies in pregnant women. LORTAB Elixir should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.


Nonteratogenic Effects

Babies born to mothers who have been taking opioids regularly prior to delivery will be physically dependent. The withdrawal signs include irritability and excessive crying, tremors, hyperactive reflexes, increased respiratory rate, increased stools, sneezing, yawning, vomiting and fever. These signs usually appear during the first few days of life. The intensity of the syndrome does not always correlate with the duration of maternal opioid use or dose. There is no consensus on the best method of managing withdrawal.



Labor And Delivery


Narcotic analgesics cross the placental barrier. The closer to delivery and the larger the dose used, the greater the possibility of respiratory depression in the newborn. Narcotic analgesics should be avoided during labor if delivery of a premature infant is anticipated. If the mother has received narcotic analgesics during labor, newborn infants should be observed closely for signs of respiratory depression. Resuscitation may be required (see OVERDOSAGE). The effect of hydrocodone, if any, on the later growth, development, and functional maturation of the child is unknown.



Nursing Mothers


Acetaminophen is excreted in breast milk in small amounts, but the significance of its effects on nursing infants is not known. It is not known whether hydrocodone is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from hydrocodone and acetaminophen, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.



Pediatric Use


Safety and effectiveness in the pediatric population below the age of two years have not been established. Use of LORTAB Elixir in the pediatric population is supported by the evidence from adequate and well controlled studies of hydrocodone and acetaminophen combination products in adults with additional data which support the development of metabolic pathways in children two years of age and over (see DOSAGE AND ADMINISTRATION for pediatric dosage information).



Geriatric Use


Clinical studies of hydrocodone bitartrate and acetaminophen oral solution did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.


Hydrocodone and the major metabolites of acetaminophen are known to be substantially excreted by the kidney. Thus the risk of toxic reactions may be greater in patients with impaired renal function due to the accumulation of the parent compound and/or metabolites in the plasma. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.


Hydrocodone may cause confusion and over-sedation in the elderly; elderly patients generally should be started on low doses of hydrocodone bitartrate and acetaminophen oral solution and observed closely.



Adverse Reactions


Potential effects of high dosage are also listed in the OVERDOSAGE section.


Cardio-renal


Bradycardia, cardiac arrest, circulatory collapse, renal toxicity, renal tubular necrosis, hypotension.


Central Nervous System/Psychiatric


Anxiety, dizziness, drowsiness, dysphoria, euphoria, fear, general malaise, impairment of mental and physical performance, lethargy, light-headedness, mental clouding, mood changes, psychological dependence, sedation, somnolence progressing to stupor or coma.


Endocrine


Hypoglycemic coma.


Gastrointestinal System


Abdominal pain, constipation, gastric distress, heartburn, hepatic necrosis, hepatitis, occult blood loss, nausea, peptic ulcer, and vomiting.


Genitourinary System


Spasm of vesical sphincters, ureteral spasm, and urinary retention.


Hematologic


Agranulocytosis, hemolytic anemia, iron deficiency anemia, prolonged bleeding time, thrombocytopenia.


Hypersensitivity


Allergic reactions.


Musculoskeletal


Skeletal muscle flaccidity.


Respiratory Depression


Acute airway obstruction, apnea, dose-related respiratory depression (see OVERDOSAGE), shortness of breath.


Special Senses


Cases of hearing impairment or permanent loss have been reported predominantly in patients with chronic overdose.


Skin


Cold and clammy skin, diaphoresis, pruritus, rash.



Drug Abuse and Dependence



Misuse, Abuse, And Diversion Of Opioids


LORTAB Elixir contains hydrocodone, an opioid agonist, and is a Schedule III controlled substance. LORTAB Elixir, and other opioids, used in analgesia can be abused and are subject to criminal diversion.


Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Drug addiction is a treatable disease utilizing a multidisciplinary approach, but relapse is common.


"Drug seeking" behavior is very common in addicts and drug abusers. Drug-seeking tactics include emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing or referral, repeated "loss" of prescriptions, tampering with prescriptions and reluctance to provide prior medical records or contact information for other treating physician(s). "Doctor shopping" to obtain additional prescriptions is common among drug abusers and people suffering from untreated addiction.


Abuse and addiction are separate and distinct from physical dependence and tolerance. Physical dependence usually assumes clinically significant dimensions only after several weeks of continued opioid use, although a mild degree of physical dependence may develop after a few days of opioid therapy. Tolerance, in which increasingly large doses are required in order to produce the same degree of analgesia, is manifested initially by a shortened duration of analgesic effect, and subsequently by decreases in the intensity of analgesia. The rate of development of tolerance varies among patients. Physicians should be aware that abuse of opioids can occur in the absence of true addiction and is characterized by misuse for non-medical purposes, often in combination with other psychoactive substances. LORTAB Elixir, like other opioids, may be diverted for non-medical use. Record-keeping of prescribing information, including quantity, frequency, and renewal requests is strongly advised.


Proper assessment of the patient, proper prescribing practices, periodic re-evaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs.



Overdosage


Following an acute overdosage, toxicity may result from hydrocodone or acetaminophen.



Signs And Symptoms


Hydrocodone

Serious overdose with hydrocodone is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis) extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and sometimes bradycardia and hypotension. In severe overdosage, apnea, circulatory collapse, cardiac arrest and death may occur.


Acetaminophen

In acetaminophen overdosage: dose-dependent, potentially fatal hepatic necrosis is the most serious adverse effect. Renal tubular necrosis, hypoglycemic coma and coagulation defects may also occur. Early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis and general malaise. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours post-ingestion.



Treatment


A single or multiple drug overdose with hydrocodone and acetaminophen is a potentially lethal polydrug overdose, and consultation with a regional poison control center is recommended. Immediate treatment includes support of cardiorespiratory function and measures to reduce drug absorption. Oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated. Assisted or controlled ventilation should also be considered.


For hydrocodone overdose, primary attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and the institution of assisted or controlled ventilation. The narcotic antagonist naloxone hydrochloride is a specific antidote against respiratory depression which may result from overdosage or unusual sensitivity to narcotics, including hydrocodone. Since the duration of action of hydrocodone may exceed that of the antagonist, the patient should be kept under continued surveillance, and repeated doses of the antagonist should be administered as needed to maintain adequate respiration. A narcotic antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression.


Gastric decontamination with activated charcoal should be administered just prior to N-acetylcysteine (NAC) to decrease systemic absorption if acetaminophen ingestion is known or suspected to have occurred within a few hours of presentation. Serum acetaminophen levels should be obtained immediately if the patient presents 4 hours or more after ingestion to assess potential risk of hepatotoxicity; acetaminophen levels drawn less than 4 hours post-ingestion may be misleading. To obtain the best possible outcome, NAC should be administered as soon as possible where impending or evolving liver injury is suspected. Intravenous NAC may be administered when circumstances preclude oral administration.


Vigorous supportive therapy is required in severe intoxication. Procedures to limit the continuing absorption of the drug must be readily performed since the hepatic injury is dose dependent and occurs early in the course of intoxication.



Lortab Oral Solution Dosage and Administration


Dosage should be adjusted according to severity of pain and response of the patient. However, it should be kept in mind that tolerance to hydrocodone can develop with continued use and that the incidence of untoward effects is dose related.


The usual adult dosage is one tablespoonful every 4 to 6 hours as needed for pain. The total daily dosage for adults should not exceed 6 tablespoonfuls. The usual dosages for children are given by the table below, and are to be given every 4 to 6 hours as needed for pain. These dosages correspond to an average individual dose of 0.27 mL/kg of LORTAB Elixir (providing 0.135 mg/kg of hydrocodone bitartrate and 9 mg/kg of acetaminophen). Dosing should be based on weight whenever possible.


























BODY WEIGHTAPPROXIMATE AGEDOSE

Every 4 to 6 hours
MAXIMUM TOTAL DAILY DOSE

(6 doses per day)
12 to 15 kg

27 to 34 lbs.
2 to 3 years¾ teaspoonful = 3.75 mL4 ½ teaspoonfuls = 22.5 mL
16 to 22 kg

35 to 50 lbs.
4 to 6 years1 teaspoonful = 5 mL6 teaspoonfuls = 30 mL
23 to 31 kg

51 to 69 lbs.
7 to 9 years1 ½ teaspoonfuls = 7.5 mL9 teaspoonfuls = 45 mL
32 to 45 kg

70 to 100 lbs.
10 to 13 years2 teaspoonfuls = 10 mL12 teaspoonfuls = 60mL
46 kg and up

101 lbs. and up
14 years to adult1 Tablespoonful = 15 mL6 Tablespoonfuls = 90 mL

The total daily dosage for children should not exceed 6 doses per day. It is of utmost importance that the dose of LORTAB Elixir be administered accurately. A household teaspoon or tablespoon is not an adequate measuring device, especially when one-half or three-fourths of a teaspoonful is to be measured. Given the inexactitude of the household spoon measure and the possibility of using a tablespoon instead of a teaspoon, which could lead to overdosage, it is strongly recommended that care givers obtain and use a calibrated measuring device. Health care providers should recommend a dropper that can measure and deliver the prescribed dose accurately, and instruct care givers to use extreme caution in measuring the dosage.



How is Lortab Oral Solution Supplied


LORTAB Elixir (hydrocodone bitartrate and acetaminophen oral solution) is a yellow-colored tropical fruit punch flavored liquid containing hydrocodone bitartrate 7.5 mg and acetaminophen 500 mg per 15 mL, with 7% alcohol. It is supplied in containers of 1 pint (473 mL) NDC 50474-909-16.



Storage


Store at 20 to 25°C (68 to 77°F). [see USP Controlled Room Temperature]


Dispense in a tight, light-resistant container with a child-resistant closure.



For Medical Information


Contact: Medical Affairs Department

Phone: (866) 822-0068

Fax: (770) 970-8859


A Schedule CIII Narcotic


Manufactured for

UCB, Inc.

Smyrna, GA 30080


Rev. 8E 05/2011



Patient Information Leaflet


LORTAB® ELIXIR (Hydrocodone Bitartrate

and Acetaminophen Oral Solution)

7.5 mg/500 mg per 15 mL


CIII


Summary


LORTAB (pronounced LOR-tab) is used to relieve moderate to moderately severe pain. You should not take LORTAB Elixir if you are allergic to hydrocodone or acetaminophen. The most common side effects of LORTAB Elixir are abdominal pain, dizziness, drowsiness, light-headedness, nausea, shortness of breath, unusual tiredness, and vomiting. Take this medicine as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.


Uses


LORTAB Elixir is an analgesic used to relieve moderate to moderately severe pain. Lortab Elixir is a combination product containing hydrocodone (hye-droe-KO-done) bitartrate and acetaminophen (a-seat-a-MIN-oh-fen). Hydrocodone is a narcotic pain reliever and a cough suppressant. Acetaminophen is a non-narcotic pain reliever and fever reducer. A narcotic analgesic and acetaminophen used together may provide better pain relief than either product used alone. If you have any questions, please call your doctor or pharmacist.


General Cautions


  • Do not take this drug if you have allergies or unusual reactions to narcotic pain relievers or acetaminophen because it is likely that you may also be allergic to LORTAB Elixir.

  • This product may inhibit your mental and physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. Such tasks should be avoided while you are taking this product.

  • This medicine may not be right for you. Check with your doctor or pharmacist, if you:
    • are pregnant.

    • are nursing.

    • are taking other medications; narcotic pain relievers; allergy medicines; anti-depressant medicines; acetaminophen-containing medicines or other medicines that cause central nervous system depression, including alcohol.

    • have other medical problems: a history of drug or alcohol abuse; recent head injury; emphysema, asthma, or other chronic lung disease; liver disease, kidney disease; underactive thyroid, Addison's disease, enlarged prostate or difficulty urinating.


Proper Use


Take this medicine as directed by your doctor. Do not share it with anyone else. This medicine can cause drug dependence and has the potential for abuse. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If you think that this medicine is not working properly after taking it for some time, do not increase the dose. Check with your doctor or pharmacist.


Dosing


The dose of this medication will be different for different patients. Follow the directions provided by your doctor. The following information includes only the average doses of this medication. If your dose is different, do not change doses unless your doctor tells you to do so.


























BODY WEIGHTAPPROXIMATE AGEDOSE

Every 4 to 6 hours
MAXIMUM TOTAL DAILY DOSE

(6 doses per day)
12 to 15 kg

27 to 34 lbs.
2 to 3 years¾ teaspoonful = 3.75 mL4 ½ teaspoonfuls = 22.5 mL
16 to 22 kg

35 to 50 lbs.
4 to 6 years1 teaspoonful = 5 mL6 teaspoonfuls = 30 mL
23 to 31 kg

51 to 69 lbs.
7 to 9 years1 ½ teaspoonfuls = 7.5 mL9 teaspoonfuls = 45 mL
32 to 45 kg

70 to 100 lbs.
10 to 13 years2 teaspoonfuls = 10 mL12 teaspoonfuls = 60mL
46 kg and up

101 lbs. and up
14 years to adult1 Tablespoonful = 15 mL6 Tablespoonfuls = 90 mL

It is very important that LORTAB Elixir be dosed accurately. A household teaspoon or tablespoon is not an accurate measuring device, especially when one-half or three-fourths of a teaspoonful is to be measured.


Since a household teaspoon is not accurate and can be mixed-up with a tablespoon (which can cause overdosage), it is strongly recommended that you obtain and use a proper measuring device. Ask your doctor or pharmacist for help to find a dropper that can measure the needed dose properly and ask for help if you do not understand how to use the dropper.


Missed Dose


  • To avoid a possible overdose, it is important that you do not take more than a single dosage at one time, or that you don't take doses at intervals less than 4 hours apart.

  • If you miss taking a dose of LORTAB Elixir, take it as soon as you remember. However, make sure to wait at least 4 hours before taking your next dose.

  • If you missed taking a dose, and it is almost time for your next dose, skip the missed dose and take your medicine as scheduled.

  • Do not double the prescribed dose.

Possible Side Effects


Side effects you may experience include abdominal pain, constipation, difficulty urinating, dizziness, drowsiness, fear, fuzzy thinking, general feeling of discomfort or illness, light-headedness, mood changes, nausea, nervousness, rash, shortness of breath, slower reactions, unusual tiredness, and vomiting.


Call your doctor if these effects continue or are bothersome.


Side effects not listed above may sometimes occur. If you notice any other effects, check with your doctor.


Storage


  • Keep out of the reach of children.

  • Store at room temperature (protect from heat, do not refrigerate).

  • Keep in original labeled bottle.

  • Discard medicines that are old or no longer needed.

  • Even a single overdose of this medicine may be a life-threatening situation. If you suspect that you or someone else may have taken more than the prescribed dose of this medicine, contact your local poison control center or emergency room immediately. This medicine was prescribed for your particular condition. Do not use if for another condition or give the drug to others.

  • This leaflet provides a summary of information about LORTAB Elixir. If you have any questions or concerns, or want more information about LORTAB Elixir, contact your doctor or pharmacist. Your pharmacist also has a longer leaflet about LORTAB Elixir that is written for health professionals that you can ask to read.


Prepared by UCB, Inc.

Rev. 8E 05/2011



PRINCIPAL DISPLAY PANEL - 473 mL Bottle Carton


ucb


NDC 50474-909-16

1 Pint (473 mL)


LORTAB® ELIXIR


HYDROCODONE BITARTRATE

AND ACETAMINOPHEN

ORAL SOLUTION

7.5 mg/500 mg per 15 mL














Contains:Per

5 mL
Per

15 mL
Hydrocodone

Bitartrate
2.5 mg7.5 mg
Acetaminophen167 mg500 mg
Alcohol7%7%

CIII


Important Patient

Information Leaflet

Enclosed


Rx only










LORTAB 
hydrocodone bitartrate and acetaminophen  syrup










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)50474-909
Route of AdministrationORALDEA ScheduleCIII    











Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
hydrocodone bitartrate (hydrocodone)hydrocodone bitartrate7.5 mg  in 15 mL
acetaminophen (acetaminophen)acetaminophen500 mg  in 15 mL




























Inactive Ingredients
Ingredient NameStrength
anhydrous citric acid 
ethyl maltol 
glycerin 
methylparaben 
propylene glycol 
propylparaben 
water 
saccharin sodium 
sorbitol 
sucrose 
D&C Yellow NO. 10 
FD&C Yellow NO. 6 


















Product Characteristics
ColorYELLOWScore    
ShapeSize
FlavorTROPICAL FRUIT PUNCHImprint Code
Contains      










Packaging
#NDCPackage DescriptionMultilevel Packaging
150474-909-16473 mL In 1 BOTTLENone










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
ANDAANDA08105103/08/1993


Labeler - UCB, Inc. (028526403)
Revised: 07/2011UCB, Inc.

More Lortab Oral Solution resources


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


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Videx


See also: Generic Videx EC


Videx is a brand name of didanosine, approved by the FDA in the following formulation(s):


VIDEX (didanosine - for solution; oral)



  • Manufacturer: BRISTOL MYERS SQUIBB

    Approval date: October 9, 1991

    Strength(s): 10MG/ML [RLD][AA]

Has a generic version of Videx been approved?


A generic version of Videx has been approved by the FDA. However, this does not mean that the product will necessarily be commercially available - possibly because of drug patents and/or drug exclusivity. The following products are equivalent to Videx and have been approved by the FDA:


didanosine for solution; oral



  • Manufacturer: AUROBINDO PHARMA

    Approval date: March 8, 2007

    Strength(s): 10MG/ML [AA]

Note: Fraudulent online pharmacies may attempt to sell an illegal generic version of Videx. These medications may be counterfeit and potentially unsafe. If you purchase medications online, be sure you are buying from a reputable and valid online pharmacy. Ask your health care provider for advice if you are unsure about the online purchase of any medication.

See also: About generic drugs.




Related Patents


Patents are granted by the U.S. Patent and Trademark Office at any time during a drug's development and may include a wide range of claims.




  • Oral dosing formulations of dideoxy purine nucleosides
    Patent 5,880,106
    Issued: March 9, 1999
    Inventor(s): Ullah; Ismat & Agharkar; Shreeram Narahari & Wiley; Gary James
    Assignee(s): Bristol-Myers Squibb Company
    Improved oral dosage formulations for acid-labile dideoxy purine nucleoside derivatives such as ddA, ddI, and ddG, have been developed by incorporating selected water-insoluble buffering systems in the formulation. These novel formulations provide reduced mass dosage units in the form of convenient, palatable chewable/dispersible tablets or a dry powder sachet. The reduced mass requirement, necessary to allow tablets of reasonable size, was achieved in part by an unexpected 20 to 25% increase in drug bioavailability resulting from use of the selected buffering systems comprised of an insoluble magnesium antacid agent and either dihydroxyaluminum sodium carbonate or calcium carbonate.
    Patent expiration dates:

    • July 22, 2011


    • January 22, 2012
      ✓ 
      Pediatric exclusivity



See also...

  • Videx Chewable/Dispersible Buffered Tablets Consumer Information (Wolters Kluwer)
  • Videx Powder Pack Consumer Information (Wolters Kluwer)
  • Videx Solution Consumer Information (Wolters Kluwer)
  • Videx Consumer Information (Cerner Multum)
  • Videx Advanced Consumer Information (Micromedex)
  • Videx AHFS DI Monographs (ASHP)
  • Didanosine Chewable/Dispersible Buffered Tablets Consumer Information (Wolters Kluwer)
  • Didanosine Delayed-Release Enteric-Coated Capsules Consumer Information (Wolters Kluwer)
  • Didanosine Powder Pack Consumer Information (Wolters Kluwer)
  • Didanosine Solution Consumer Information (Wolters Kluwer)
  • Didanosine Consumer Information (Cerner Multum)
  • Videx Pediatric Advanced Consumer Information (Micromedex)
  • Didanosine Advanced Consumer Information (Micromedex)
  • Didanosine AHFS DI Monographs (ASHP)

Tuesday, 27 September 2016

Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets


Pronunciation: lor-AT-a-DEEN/SOO-doe-e-FED-rin
Generic Name: Loratadine/Pseudoephedrine
Brand Name: Examples include AllerClear D-24 Hour and Claritin-D 24 Hour


Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets are used for:

Temporarily relieving symptoms of hay fever or respiratory allergies such as stuffy or runny nose, sneezing, itchy or watery eyes, itchy nose or throat, or sinus congestion or pressure. It may also be used for other conditions as determined by your doctor.


Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets are an antihistamine and decongestant combination. The antihistamine works by blocking the action of histamine, which helps reduce symptoms such as watery eyes and sneezing. The decongestant promotes sinus and nasal drainage, relieving congestion and pressure.


Do NOT use Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets if:


  • you are allergic to any ingredient in Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets

  • you have narrow-angle glaucoma, severe high blood pressure, severe heart/blood vessel disease (coronary artery disease), or severe difficulty urinating

  • you are taking droxidopa or have taken furazolidone or a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the last 14 days

  • you have experienced serious side effects such as irregular heart rhythms with decongestants (eg, pseudoephedrine, phenylephrine)

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



Before using Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets:


Some medical conditions may interact with Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets. 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 high blood pressure, heart or blood vessel disease (eg, ischemic heart disease), diabetes, kidney or liver problems, thyroid problems, glaucoma, difficulty urinating due to an enlarged prostate, or trouble sleeping

Some MEDICINES MAY INTERACT with Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets. Tell your health care provider if you are taking any other medicines, especially any of the following:


  • Furazolidone or MAOIs (eg, phenelzine) because side effects, such as headache, fever, and high blood pressure, may occur

  • Droxidopa because irregular heartbeat or heart attack may occur

  • Guanadrel or guanethidine because their effectiveness may be decreased by Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets

  • Bromocriptine because the risk of its side effects or toxic effects may be increased by Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets

  • Urinary alkalinizers (eg, sodium bicarbonate) because they may increase the risk of Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets's side effects

This may not be a complete list of all interactions that may occur. Ask your health care provider if Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets 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 Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets:


Use Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.


  • Take Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets by mouth with or without food.

  • Swallow Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets whole. Do not break, crush, or chew before swallowing.

  • If you miss a dose of Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets and are using it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets.



Important safety information:


  • Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets may cause dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets 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.

  • If your symptoms do not get better within 7 days or if they get worse, or if you develop a fever, check with your doctor.

  • Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets has pseudoephedrine in it. Before you start any new medicine, check the label to see if it has pseudoephedrine in it too. If it does or if you are not sure, check with your doctor or pharmacist.

  • Before you begin taking any new medicines, either prescription or nonprescription, check with your doctor or pharmacist. This includes any medicines that contain appetite suppressants, antihistamines, or decongestants.

  • Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets may interfere with skin allergy tests. If you are scheduled for a skin test, talk to your doctor. You may need to stop taking Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets for a few days before the tests.

  • Use Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets with caution in the ELDERLY; they may be more sensitive to its effects.

  • Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets should not be used in CHILDREN younger than 12 years old without first checking with the child's doctor; safety and effectiveness in these children have not been confirmed.

  • PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets while you are pregnant. Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets are found in breast milk. If you are or will be breast-feeding while you use Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets, check with your doctor. Discuss any possible risks to your baby.


Possible side effects of Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets:


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:



Coughing; dizziness; drowsiness; dry mouth; excitability; fatigue; headache; loss of appetite; mild stomach upset; nausea; nervousness; sleeplessness; sore throat; thirst.



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); chest pain; difficulty urinating; fast or irregular heartbeat; mental or mood changes; seizures; severe dizziness; uncontrolled shaking or tremor.



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: Loratadine/Pseudoephedrine side effects (in more detail)


If OVERDOSE is suspected:


Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include hallucinations; high fever; irregular or unusually slow or fast heartbeat; loss of consciousness; mental or mood changes; seizures; severe drowsiness or dizziness; unusual nervousness or excitement.


Proper storage of Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets:

Store Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets at room temperature, between 68 and 77 degrees F (20 and 25 degrees C), in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets out of the reach of children and away from pets.


General information:


  • If you have any questions about Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets, please talk with your doctor, pharmacist, or other health care provider.

  • Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets are 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 Loratadine/Pseudoephedrine 24-Hour Sustained-Release Tablets. 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 Loratadine/Pseudoephedrine resources


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


Compare Loratadine/Pseudoephedrine with other medications


  • Hay Fever
  • Nasal Congestion

Loracarbef Suspension


Generic Name: Loracarbef (lor-a-KAR-bef)
Brand Name: Lorabid


Loracarbef Suspension is used for:

Treating mild to moderate infections caused by certain bacteria.


Loracarbef Suspension is a carbacephem antibiotic. It kills sensitive bacteria by interfering with formation of the bacteria's cell wall while it is growing. This weakens the cell wall and it ruptures, resulting in the death of the bacteria.


Do NOT use Loracarbef Suspension if:


  • you are allergic to any ingredient in Loracarbef Suspension or to cephalosporins (eg, cephalexin)

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



Before using Loracarbef Suspension:


Some medical conditions may interact with Loracarbef Suspension. 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 had a severe allergic reaction (eg, severe rash, hives, difficulty breathing, dizziness) to a penicillin antibiotic (eg, amoxicillin) or other beta-lactam antibiotic (eg, imipenem)

  • if you have stomach or bowel problems (eg, inflammation), blood clotting problems, kidney or liver problems, or poor nutrition

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


  • Diuretics (eg, furosemide) because the risk of kidney side effects may be increased

  • Anticoagulants (eg, warfarin) or heparin because the risk of bleeding may be increased

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


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


  • Take Loracarbef Suspension on an empty stomach at least 1 hour before or 2 hours after eating.

  • Shake well before each use.

  • Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.

  • To clear up your infection completely, continue using Loracarbef Suspension for the full course of treatment even if you feel better in a few days.

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

Ask your health care provider any questions you may have about how to use Loracarbef Suspension.



Important safety information:


  • Loracarbef Suspension may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Loracarbef Suspension. Using Loracarbef Suspension alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.

  • Loracarbef Suspension is effective only against bacteria. It is not effective for treating viral infections (eg, the common cold).

  • It is important to use Loracarbef Suspension for the full course of treatment. Failure to do so may decrease the effectiveness of Loracarbef Suspension and may increase the risk that the bacteria will no longer be sensitive to Loracarbef Suspension and will not be able to be treated by this or certain other antibiotics in the future.

  • Long-term or repeated use of Loracarbef Suspension may cause a second infection. Your doctor may want to change your medicine to treat the second infection. Contact your doctor if signs of a second infection occur.

  • If severe diarrhea, stomach pain/cramps, or bloody stools occur, contact your doctor immediately. This could be a symptom of a serious side effect requiring immediate medical attention. Do not treat diarrhea without consulting your doctor.

  • Diabetes patients - Loracarbef Suspension may cause incorrect test results with some urine glucose tests. Check with your doctor before you adjust the dose of your diabetes medicine or change your diet.

  • Loracarbef Suspension may affect certain LAB TEST results. Make sure your doctor and laboratory personnel know that you are using Loracarbef Suspension.

  • Use Loracarbef Suspension with caution in the ELDERLY because they may be more sensitive to its effects.

  • Use Loracarbef Suspension with extreme caution in CHILDREN younger than 6 months of age. Safety and effectiveness in this age group have not been confirmed.

  • Use Loracarbef Suspension with extreme caution in CHILDREN younger than 10 years of age who have diarrhea or a stomach or bowel infection.

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


Possible side effects of Loracarbef Suspension:


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; dizziness; drowsiness; headache; loss of appetite; nausea; stomach pain; stuffy nose; 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); bloody stools; decreased urination; fever; hoarseness; red, swollen, or blistered skin; seizures; severe diarrhea; severe nausea or vomiting; severe stomach pain or cramps; unusual bruising or bleeding; unusual tiredness; vaginal irritation or discharge; yellowing of the eyes or skin.



This is not a complete list of all side effects that may occur. If you have questions or need medical advice about side effects, contact your doctor or health care provider. You may report side effects to the FDA at 1-800-FDA-1088 (1-800-332-1088) or at http://www.fda.gov/medwatch.


See also: Loracarbef 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 (http://www.aapcc.org/DNN/), or emergency room immediately. Symptoms may include severe diarrhea, nausea, stomach upset, or vomiting.


Proper storage of Loracarbef Suspension:

Store Loracarbef Suspension at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Throw away any unused medicine after 14 days. Do not store in the bathroom. Keep Loracarbef Suspension out of the reach of children and away from pets.


General information:


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

  • Loracarbef Suspension 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.

This information is a summary only. It does not contain all information about Loracarbef Suspension. 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 Loracarbef resources


  • Loracarbef Side Effects (in more detail)
  • Loracarbef Use in Pregnancy & Breastfeeding
  • Loracarbef Drug Interactions
  • Loracarbef Support Group
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Monday, 26 September 2016

Toplep




Toplep may be available in the countries listed below.


Ingredient matches for Toplep



Topiramate

Topiramate is reported as an ingredient of Toplep in the following countries:


  • South Africa

International Drug Name Search

Lorazepam Concentrate




Lorazepam Oral Concentrate, USP CIV

Rx Only



Lorazepam Concentrate Description


Each mL of Lorazepam for oral administration contains:


Lorazepam........................................................................................ 2 mg



Inactive Ingredients


Lorazepam contains polyethylene glycol and propylene glycol.


Lorazepam, an antianxiety agent, has the chemical formula, 2H-1,4-benzodiazepin-2-one, 7-chloro-5-(2-chlorophenyl)-1,3-dihydro-3-hydroxy-, (±)-:



Lorazepam is a nearly white powder almost insoluble in water.



Lorazepam Concentrate - Clinical Pharmacology


Studies in healthy volunteers show that in single high doses lorazepam has a tranquilizing action on the central nervous system with no appreciable effect on the respiratory or cardiovascular systems.


Lorazepam is readily absorbed with an absolute bioavailability of 90 percent. Peak concentrations in plasma occur approximately two hours following administration. The peak plasma level of lorazepam from a 2 mg dose is approximately 20 ng/mL.


The mean half-life of unconjugated lorazepam in human plasma is about 12 hours and for its major metabolite, lorazepam glucuronide, about 18 hours. At clinically relevant concentrations, lorazepam is approximately 85% bound to plasma proteins. Lorazepam is rapidly conjugated at its 3-hydroxy group into lorazepam glucuronide which is then excreted in the urine. Lorazepam glucuronide has no demonstrable CNS activity in animals.


The plasma levels of lorazepam are proportional to the dose given. There is no evidence of accumulation of lorazepam on administration up to six months.


Studies comparing young and elderly subjects have shown that advancing age does not have a significant effect on the pharmacokinetics of lorazepam. However, in one study involving single intravenous doses of 1.5 mg to 3 mg of lorazepam injection, mean total body clearance of lorazepam decreased by 20% in 15 elderly subjects of 60 to 84 years of age compared to that in 15 younger subjects of 19 to 38 years of age.



Indications and Usage for Lorazepam Concentrate


Lorazepam is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.


The effectiveness of lorazepam in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies. The physician should periodically reassess the usefulness of the drug for the individual patient.



Contraindications


Lorazepam is contraindicated in patients with


  • hypersensitivity to the benzodiazepines or to any components of the formulation.

  • acute narrow-angle glaucoma.


Warnings


Pre-existing depression may emerge or worsen during use of benzodiazepines including lorazepam. Lorazepam is not recommended for use in patients with a primary depressive disorder or psychosis.


Use of benzodiazepines, including lorazepam, both used alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression (see PRECAUTIONS: Clinically Significant Drug Interactions).


Use of benzodiazepines, including lorazepam, may lead to physical and psychological dependence.


As with all patients on CNS-depressant drugs, patients receiving lorazepam should be warned not to operate dangerous machinery or motor vehicles and that their tolerance for alcohol and other CNS depressants will be diminished.



Physical And Psychological Dependence


The use of benzodiazepines, including lorazepam, may lead to physical and psychological dependence. The risk of dependence increases with higher doses and longer term use and is further increased in patients with a history of alcoholism or drug abuse or in patients with significant personality disorders. The dependence potential is reduced when lorazepam is used at the appropriate dose for short-term treatment. Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving lorazepam or other psychotropic agents.


In general, benzodiazepines should be prescribed for short periods only (e.g. 2 to 4 weeks). Extension of the treatment period should not take place without reevaluation of the need for continued therapy. Continuous long-term use of product is not recommended. Withdrawal symptoms (e.g. rebound insomnia) can appear following cessation of recommended doses after as little as one week of therapy. Abrupt discontinuation of product should be avoided and a gradual dosage-tapering schedule followed after extended therapy.


Abrupt termination of treatment may be accompanied by withdrawal symptoms. Symptoms reported following discontinuation of benzodiazepines include headache, anxiety, tension, depression, insomnia, restlessness, confusion, irritability, sweating, rebound phenomena, dysphoria, dizziness, derealization, depersonalization, hyperacusis, numbness/tingling of extremities, hypersensitivity to light, noise, and physical contact/perceptual changes, involuntary movements, nausea, vomiting, diarrhea, loss of appetite, hallucinations/delirium, convulsions/seizures, tremor, abdominal cramps, myalgia, agitation, palpitations, tachycardia, panic attacks, vertigo, hyperreflexia, short-term memory loss, and hyperthermia. Convulsions/seizures may be more common in patients with pre-existing seizure disorders or who are taking other drugs that lower the convulsive threshold such as antidepressants.


There is evidence that tolerance develops to the sedative effects of benzodiazepines.


Lorazepam may have abuse potential, especially in patients with a history of drug and/or alcohol abuse.



Precautions


In patients with depression, a possibility for suicide should be borne in mind; benzodiazepines should not be used in such patients without adequate antidepressant therapy.


Lorazepam should be used with caution in patients with compromised respiratory function (e.g. COPD, sleep apnea syndrome).


Elderly or debilitated patients may be more susceptible to the sedative effects of lorazepam. Therefore, these patients should be monitored frequently and have their dosage adjusted carefully according to patient response; the initial dosage should not exceed 2 mg.


Paradoxical reactions have been occasionally reported during benzodiazepine use. Such reactions may be more likely to occur in children and the elderly. Should these occur, use of the drug should be discontinued.


The usual precautions for treating patients with impaired renal and hepatic function should be observed. As with all benzodiazepines, the use of lorazepam may worsen hepatic encephalopathy; therefore, lorazepam should be used with caution in patients with severe hepatic insufficiency and/or encephalopathy. Dosage for patients with severe hepatic insufficiency should be adjusted carefully according to patient response; lower doses may be sufficient in such patients.


In patients where gastrointestinal or cardiovascular disorders coexist with anxiety, it should be noted that lorazepam has not been shown to be of significant benefit in treating the gastrointestinal or cardiovascular component.


Esophageal dilation occurred in rats treated with lorazepam for more than one year at 6 mg/kg/day. The no-effect dose was 1.25 mg/kg/day (approximately 6 times the maximum human therapeutic dose of 10 mg per day). The effect was reversible only when the treatment was withdrawn within two months of first observation of the phenomenon. The clinical significance of this is unknown. However, use of lorazepam for prolonged periods and in geriatric patients requires caution, and there should be frequent monitoring for symptoms of upper G.I. disease.


Safety and effectiveness of lorazepam in children of less than 12 years have not been established.



Information for patients


To assure the safe and effective use of lorazepam, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is advisable that they consult with their physician before either increasing the dose or abruptly discontinuing this drug.



Essential Laboratory Tests


Some patients on lorazepam have developed leukopenia, and some have had elevations of LDH. As with other benzodiazepines, periodic blood counts and liver-function tests are recommended for patients on long-term therapy.



Clinically Significant Drug Interactions


The benzodiazepines, including lorazepam, produce increased CNS-depressant effects when administered with other CNS depressants such as alcohol, barbiturates, antipsychotics, sedative/hypnotics, anxiolytics, antidepressants, narcotic analgesics, sedative antihistamines, anticonvulsants, and anesthetics.


Concomitant use of clozapine and lorazepam may produce marked sedation, excessive salivation, hypotension, ataxia, delirium, and respiratory arrest.


Concurrent administration of lorazepam with valproate results in increased plasma concentrations and reduced clearance of lorazepam. Lorazepam dosage should be reduced to approximately 50% when co-administered with valproate.


Concurrent administration of lorazepam with probenecid may result in a more rapid onset or prolonged effect of lorazepam due to increased half-life and decreased total clearance. Lorazepam dosage needs to be reduced by approximately 50% when co-administered with probenecid.


The effects of probenecid and valproate on lorazepam may be due to inhibition of glucuronidation.


Administration of theophylline or aminophylline may reduce the sedative effects of benzodiazepines, including lorazepam.



Carcinogenesis and Mutagenesis


No evidence of carcinogenic potential emerged in rats during an 18-month study with lorazepam. No studies regarding mutagenesis have been performed.



Pregnancy


Reproductive studies in animals were performed in mice, rats, and two strains of rabbits. Occasional anomalies (reduction of tarsals, tibia, metatarsals, malrotated limbs, gastroschisis, malformed skull and microphthalmia) were seen in drug-treated rabbits without relationship to dosage. Although all of these anomalies were not present in the concurrent control group, they have been reported to occur randomly in historical controls. At doses of 40 mg/kg and higher, there was evidence of fetal resorption and increased fetal loss in rabbits which was not seen at lower doses.


The clinical significance of the above findings is not known. However, an increased risk of congenital malformations associated with the use of minor tranquilizers (chlordiazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has been suggested in several studies. Because the use of these drugs is rarely a matter of urgency, the use of lorazepam during this period should be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant, they should communicate with their physician about the desirability of discontinuing the drug.


In humans, blood levels obtained from umbilical cord blood indicate placental transfer of lorazepam and lorazepam glucuronide. Infants of mothers who ingested benzodiazepines for several weeks or more preceding delivery have been reported to have withdrawal symptoms during the postnatal period. Symptoms such as hypoactivity, hypotonia, hypothermia, respiratory depression, apnea, feeding problems, and impaired metabolic response to cold stress have been reported in neonates born of mothers who have received benzodiazepines during the late phase of pregnancy or at delivery.



Nursing mothers


Lorazepam has been detected in human breast milk; therefore, it should not be administered to breast-feeding women, unless the expected benefit to the woman outweighs the potential risk to the infant.


Sedation and inability to suckle have occurred in neonates of lactating mothers taking benzodiazepines. Infants of lactating mothers should be observed for pharmacological effects (including sedation and irritability).



Geriatric use


Clinical studies of lorazepam generally were not adequate to determine whether subjects aged 65 and over respond differently than younger subjects; however, the incidence of sedation and unsteadiness was observed to increase with age (see ADVERSE REACTIONS).


Age does not appear to have a significant effect on lorazepam kinetics (see CLINICAL PHARMACOLOGY).


Clinical circumstances, some of which may be more common in the elderly, such as hepatic or renal impairment, should be considered. Greater sensitivity (e.g., sedation) of some older individuals cannot be ruled out. In general, dose selection for an elderly patient should be cautious, and lower doses may be sufficient in these patients (see DOSAGE AND ADMINISTRATION).



Adverse Reactions


Most adverse reactions to benzodiazepines, including CNS effects and respiratory depression, are dose dependent, with more severe effects occurring with high doses.


In a sample of about 3500 patients treated for anxiety, the most frequent adverse reaction to lorazepam was sedation (15.9%), followed by dizziness (6.9%), weakness (4.2%), and unsteadiness (3.4%). The incidence of sedation and unsteadiness increased with age.


Other adverse reactions to benzodiazepines, including lorazepam are fatigue, drowsiness, amnesia, memory impairment, confusion, disorientation, depression, unmasking of depression, disinhibition, euphoria, suicidal ideation/attempt, ataxia, asthenia, extrapyramidal symptoms, convulsions/seizures tremor, vertigo, eye-function/visual disturbance (including diplopia and blurred vision), dysarthria/slurred speech, change in libido, impotence, decreased orgasm; headache, coma; respiratory depression, apnea, worsening of sleep apnea, worsening of obstructive pulmonary disease; gastrointestinal symptoms including nausea, change in appetite, constipation, jaundice, increase in bilirubin, increase in liver transaminases, increase in alkaline phosphatase; hypersensitivity reactions, anaphylactic/oid reactions; dermatological symptoms, allergic skin reactions, alopecia; SIADH, hyponatremia; thrombocytopenia, agranulocytosis, pancytopenia; hypothermia; and autonomic manifestations.


Paradoxical reactions, including anxiety, excitation, agitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, and hallucinations may occur. Small decreases in blood pressure and hypotension may occur but are usually not clinically significant, probably being related to the relief of anxiety produced by lorazepam.


To report SUSPECTED ADVERSE REACTIONS, contact Hi-Tech Pharmacal Co., Inc. at 1-800-262-9010 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.



OVERDOSAGE


In postmarketing experience, overdose with lorazepam has occurred predominantly in combination with alcohol and/or other drugs. Therefore, in the management of overdosage, it should be borne in mind that multiple agents may have been taken.



Symptoms


Overdosage of benzodiazepines is usually manifested by varying degrees of central nervous system depression ranging from drowsiness to coma. In mild cases, symptoms include drowsiness, mental confusion, paradoxical reactions, dysarthria and lethargy. In more serious cases, and especially when other drugs or alcohol were ingested, symptoms may include ataxia, hypotonia, hypotension, cardiovascular depression, respiratory depression, hypnotic state, coma, and death.



Management


General supportive and symptomatic measures are recommended; vital signs must be monitored and the patient closely observed. When there is a risk of aspiration, induction of emesis is not recommended. Gastric lavage may be indicated if performed soon after ingestion or in symptomatic patients. Administration of activated charcoal may also limit drug absorption. Hypotension, though unlikely, usually may be controlled with norepinephrine bitartrate injection. Lorazepam is poorly dialyzable. Lorazepam glucuronide, the inactive metabolite, may be highly dialyzable.


The benzodiazepine antagonist flumazenil may be used in hospitalized patients as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. The complete flumazenil package insert including CONTRAINDICATIONS, WARNINGS, and PRECAUTIONSshould be consulted prior to use.



Lorazepam Concentrate Dosage and Administration



Proper Use of Lorazepam


Lorazepam oral concentrate is a concentrated oral solution as compared to standard oral liquid medications. It is recommended that Lorazepam be mixed with liquid or semi-solid food such as water, juices, soda or soda-like beverages, applesauce and puddings.


Use only the calibrated dropper provided with this product. Draw into the dropper the amount prescribed for a single dose. Then squeeze the dropper contents into a liquid or semi-solid food. Stir the liquid or food gently for a few seconds. The lorazepam formulation blends quickly and completely. The entire amount of the mixture, of drug and liquid or drug and food, should be consumed immediately. Do not store for future use.


Lorazepam is administered orally. For optimal results, dose, frequency of administration, and duration of therapy should be individualized according to patient response.


The usual range is 2 mg/day to 6 mg/day given in divided doses, the largest dose being taken before bedtime, but the daily dosage may vary from 1 mg/day to 10 mg/day.


For anxiety, most patients require an initial dose of 2 mg/day to 3 mg/day given b.i.d. or t.i.d.


For insomnia due to anxiety or transient situational stress, a single daily dose of 2 mg to 4 mg may be given, usually at bedtime.


For elderly or debilitated patients, an initial dosage of 1 mg/day to 2 mg/day in divided doses is recommended, to be adjusted as needed and tolerated.


The dosage of lorazepam should be increased gradually when needed to help avoid adverse effects. When higher dosage is indicated, the evening dose should be increased before the daytime doses.



How is Lorazepam Concentrate Supplied


2 mg per mL Lorazepam Oral Concentrate USP


NDC 50383-705-30: Bottles of 30 mL with calibrated dropper (graduations of 0.25 mL [0.5 mg], 0.50 mL [1 mg], 0.75 mL [1.5 mg] and 1.0 mL [2 mg] on the dropper).


PROTECT FROM LIGHT


Store at Cold Temperature–Refrigerate 2°-8°C (36°-46°F)


Dispense only in the bottle and only with the calibrated dropper provided.


Discard opened bottle after 90 days.




Manufactured by:


Hi-Tech Pharmacal Co., Inc.


Amityville, NY 11701




Rev. 705:00 2/10 MG #27179



PRINCIPAL DISPLAY PANEL



NDC 50383-705-30


Lorazepam Oral Concentrate, USP


2 mg per mL


Each mL contains: Lorazepam 2 mg


See Package Insert for Complete Prescribing Information.


Pharmacist: Please see side panel for dispensing information.




Store at Cold Temperature -


Refrigerate 2°-8°C (36°-46°F)




Rx only


30 mL Bottle and Dropper









LORAZEPAM 
lorazepam  concentrate










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)50383-705
Route of AdministrationORALDEA ScheduleCIV    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
LORAZEPAM (LORAZEPAM)LORAZEPAM2 mg  in 1 mL








Inactive Ingredients
Ingredient NameStrength
POLYETHYLENE GLYCOL 
PROPYLENE GLYCOL 


















Product Characteristics
Color    Score    
ShapeSize
FlavorImprint Code
Contains      














Packaging
#NDCPackage DescriptionMultilevel Packaging
150383-705-301  In 1 CARTONcontains a BOTTLE
130 mL In 1 BOTTLEThis package is contained within the CARTON (50383-705-30)










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
ANDAANDA20016901/30/2012


Labeler - Hi-Tech Pharmacal Co., Inc. (101196749)









Establishment
NameAddressID/FEIOperations
Hi-Tech Pharmacal Co., Inc.101196749MANUFACTURE
Revised: 01/2012Hi-Tech Pharmacal Co., Inc.